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[Guest]

What kind of trained professional is Muffy?

I am new to this forum but I have been following thi thread.

[NotMuffy]

Muffy: I'm going to ask a probably-stupid question because even after reading everything written here, I'm still pretty confused on one point. What is it that you would advise Paper_Nanny to be doing with her pressure and backup rate settings, both "now" to provide a consistent and not-dial-winged data set for her doctor...

Putting myself in her shoes and looking at her data, I don't know what those defaults would or should be...

Muffy does not participate in "dial wingin'" for a host of reasons, including, but not limited to, if she is, in fact, a "trained professional" (something that I don't see her ever having admitted to being), then she cannot do "E&M"; and frequently, if not the majority of the time, important information that would have a significant effect on treatment management is missing.

This is a perfect example:

MSD and my neurologist both concluded that drug effect was not an issue.

However, in response to your question, she should be on what the physician wants her on. At The Peak of the Madness, should she have given that DL to the physician, he would have had no choice but to say "See, ITYS, now do what I say for another month and then we'll see what happens."

That said, 3 treatment approaches have been suggested.

she seems to have had both qualitatively and quantitatively poor sleep (even relative to her diagnostic PSG) with the latest assortment of constant pressure and constant bilevel pressure winging.

Actually, other than the awakenings, her diagnostic PSG looks quite good, with the exception of Sleep Efficiency (although Split_City would call it normal, but his lab is in his garage).

However, maintaining a healthy dose of skepticism, that could fall under the "missing or inaccurate information" as well:

• The absence of SWS (the sleep, not the person) in a relatively young person is odd, especially when
• The continuity of NREM2 is incredible, if not incredulous; and
• The lack of commentary of Sleep Quality analysis does not necessarily mean that other abnormalities are not present (for example, I would expect a high liklihood of the presence of "alpha intrusion" in this scenario).

I wrote a paragraph summarizing her data, with a little thesis too, but I'm axing that for now.

Actually, I'd love to hear what you have to say.

OK, off to the beach!

Don't want to turn this day into "idle time"!

Edited to add "edited".

[Paper_Nanny]

Also try those things in your idle time (like in a doctor's waiting room) putting in the names:

NotMuffy
StillAnotherGuest

I am nowhere near that portable with my searching! And now, I find I made much of this evening "idle time" by searching for posts by or about NotMuffy/ StillAnotherGuest.

OK, off to the beach!

Don't want to turn this day into "idle time"!

I hope you understood that I was redefining "idle time" as "time spent searching for NotMuffy and StillanotherGuest on Google and cpaptalk". I wasn't implying that time spent on those searches was "time spent doing nothing useful." Quite the contrary. I find the information in those posts to be informative, useful, and helpful, to the extent that I can understand the information being discussed.

I think this community as a whole benefits immensely from the information and assistance you provide and aside from benefits to the abstract "community as a whole", I personally have benefitted and am thankful for your willingness to help me. Despite my lack of focus and despite my difficulty understanding and remembering information.

Deborah

[Paper_Nanny]

What kind of trained professional is Muffy?

I am new to this forum but I have been following thi thread.

S/he is a professional "baked goods". I don't know if that was by training or by inheritance, though. Could be the latter, considering the cousin in Great Britain.

[rested gal]

"See, ITYS, now do what I say for another month and then we'll see what happens."

Adding "I told you so" to the growing list of acronyms I hadn't seen before. At least that one was easier to figure out than, "SB'sC." (which I really LIKE... once it was explained! )

That said, 3 treatment approaches have been suggested.

Flipping back through the pages...like going on a scavenger hunt to find all three. In my idle time, of course. There's a SB'sC I'll find all three.

Have fun at the beach.

[Paper_Nanny]

Upload of waveform data from 07-21-2011:

http://db.tt/zOD9bXA

I don't know what the follow cuts from that data show. Can anyone help me out on that?

From page 14-- 6:50...
What's with that break in the breath there? That happened at least one other time that night.




This is from page 9-- 4:09... What are those things that look like the letter "r" being written in cursive?



Thanks.
Deborah

[Paper_Nanny]

That said, 3 treatment approaches have been suggested.

Flipping back through the pages...like going on a scavenger hunt to find all three. In my idle time, of course. There's a SB'sC I'll find all three. [/quote]

During my "idle time" today, I found one approach, suggested twice.

On Fri Jul 01, 2011 3:53 am, NotMuffy suggested "try some low level CPAP."

On Mon Jul 11, 2011 4:53 am, NotMuffy wrote, "The logical progression would then be to try some low level CPAP, which should have been done in the first place."

I don't think I will be having a whole lot of "idle time" this weekend, but maybe enough to find the other two treatment approaches.

Deborah

[rested gal]

What's with that break in the breath there?

Artifact.

What are those things that look like the letter "r" being written in cursive?

rrrrrrrrrrrrtifacts.

I'm sorry...just joking about both things. Couldn't resist!!!

[rested gal]

I think this might count as a second "suggestion", Deborah -- also mentioned twice:

viewtopic.php?p=616233#p616233

For instance, sitting down with a sharp pharmacist and looking at drug hygiene may be helpful (if that hasn't already been done). Stuff like looking at nighttime duloxetine dose and seeing if that's the best way to meet goal (does the lowering of arousal threshold create more issues than amelioration of other symptoms). Or if anything can be done with the methylphenidate - modafinil thing.

viewtopic.php?p=614108#p614108

Anyway, in relation to the SDB issues, with clonazepam, baclofen, carisoprodol, cyclobenzaprine, trazodone and tramadol all having sedative properties, the first thing I would look for is if you've moved out of "sedation" into "chronic respiratory depression". The elevated CO2 (while it could have been metabolic) now appears to be respiratory, and an ABG may be in order (what you really needed to do was monitor ETCO2 during the NPSG, but that ship has sailed). If your PFT is normal, then the respiratory depression (if present) is central.

Got headaches?

OTOH, you got methylphenidate and modafinil that may counteract some of the sedative properties. OK that's cool, except they may also create sleep disruption, and your DLs are not reflecting respiratory events but rather sleep disruption. The timeline I was referring to was in relation to the sleep studies (were you taking all that stuff during NPSG, or were one or more added since then). The NPSGs don't appear to have a lot of sleep fragmentation, however (aside from maybe a few too many awakenings).

BTW, I'd also check with the pharmacist about the modafinil-tizanidine and trazodone-methylphenidate combos. There may be some metabolism things you might not want there.

[NotMuffy]

If time is infinite before us, and time is infinite after us, the liklihood of being alive at a point along the continuum such that you would be aware of your existence is absolutely impossible.

..if there is infinite time before and forever, the probability that you would be aware of your existence (overall) is 100%.

However, the liklihood that you are dead is 99.99999999....

Or, from a practical perspective, realization along the continuum that you're alive (or think you're alive, depending if you're in or out of the Matrix)-- impossible.

[NotMuffy]

What are those things that look like the letter "r" being written in cursive?

Flow limitations.

Consequently, taking a little bit of artistic license, the first event is a RERA, and the second an obstructive hypopnea.

[NotMuffy]

I think this might count as a second "suggestion"...

That would be more like "treatment optimization", and it may be that nothing will be able to be done there.

[NotMuffy]

OK, time for a quiz:

The Epworth Sleepiness Scale

[NotMuffy]

What kind of trained professional is Muffy?

S/he is a professional "baked goods". I don't know if that was by training or by inheritance, though. Could be the latter, considering the cousin in Great Britain.

Oh right, Thomas.

He's an English Muffin.

[ameriken]

OK, time for a quiz:

The Epworth Sleepiness Scale

I dozed off while I was taking it.