2 questions

[pandatx]

Good morning everyone!

I have 2 questions:

1. Leak rate. I'm not mathy at all and don't understand this. Do I want most of my bar graph showing median, 95th percentile, or maximum?

2. When I go back for my follow up with my Dr at the sleep center he is going to notice that I changed my settings from 5.0 to 6.0-6.4 (ish). Should I expect a reprimand? I'm sure he's going to ask about me going into the clinician's menu.....

[49er]

Good morning everyone!

I have 2 questions:

1. Leak rate. I'm not mathy at all and don't understand this. Do I want most of my bar graph showing median, 95th percentile, or maximum?

2. When I go back for my follow up with my Dr at the sleep center he is going to notice that I changed my settings from 5.0 to 6.0-6.4 (ish). Should I expect a reprimand? I'm sure he's going to ask about me going into the clinician's menu.....

Hi Pandatx,

I am not sure about percentiles and leaks but here is an excellent thread in which Pugsy explains everything. It is also the one in which she threatens to come after Sheriff for his zero leak policy

viewtopic.php?f=1&t=88265&p=808615&hili ... te#p808615

Regarding your sleep doctor, is this the first one whose office has made your life so miserable?
If he reprimands you, say something like, based on your analysis of your data, you felt it was warranted going in to adjust the pressure. If you know you're looking for another doctor, I wouldn't sweat it too much.

I know what I would like to advise you to say to this doctor.

49er

[Pugsy]

Are you talking about the overview leak graph?

[caffeinatedcfo]

1. Leak rate: I believe you want most to show the lowest number. Not sure what that should be below, but when I have relatively leak-free nights, mine hovers just above zero.

2. Doctor: I would simply explain why you made the change and what effect it had on your treatment. If it improved treatment and he is upset I would be shocked (and concerned about his intentions).

[carbonman]

Good morning everyone!


2. When I go back for my follow up with my Dr at the sleep center he is going to notice that I changed my settings from 5.0 to 6.0-6.4 (ish). Should I expect a reprimand? I'm sure he's going to ask about me going into the clinician's menu.....

[pandatx]

you guys are hilarious, lol.

Pugsy, in the ResScan software: Summary graph-Leak. There's a bar graph with 3 colors of green but I don't understand how they should look optimally. For last night it shows all medium green (95th percentile). I don't know if that is good or bad.

[Pugsy]

Ahh...that graph.
Main thing is minimal time with anything above 24 L/min and the summary graph doesn't always tell you much of a good story because the 95% leak number sometimes makes things look worse than it is.

If everything is below 24 L/min...no need to worry about any of the other numbers. There really isn't an optimal pattern of which number (average, 95 % or max) that is going to really tell us much.

If some of the graph is showing above the 24 L/min line...well you really have to evaluate how much time by looking at the detailed report.

Remember the 95% number just means leak is at that number OR below that number for 95 % of the night and that covers a lot of territory sometimes. The OR BELOW part of the definition is often over look.
Sometimes it looks worse than it is.
I have a little post explaining how that can happen here in this thread.
For this reason I mainly evaluate leaks by watching the leak graph and don't get all excited about the numbers and for sure don't get excited about the summary leak graphs.
viewtopic.php?f=1&t=86705&st=0&sk=t&sd=a&start=45

[pandatx]

That graph really is confusing. If I understand you correctly, it doesn't look good if the entire thing shows 95th percentile, but when I look at the detailed graph (and in Sleepyhead) the leak data looks good. Only a couple of blip and not higher than 15 L/min.

Will definitely read the post you linked.

Thank you! As always xo

[Pugsy]

Yeah, that summary leak graph can be confusing because the underlying data can be confusing.
Unless you never have a 95% number above 24 L/min..it's going to look worse than it really is.

If I was going to look at the summary leak graph...I would eyeball the 95% number and hope it was below the red line.
If it's below the red line than things are good.
But even then the 95% number can mislead. A person can have a nice flat 0.0 leak for the bulk of the night only to have the 95% number look ugly maybe for 15 minutes and it totally implies a bad leaky night when in reality only maybe 15 minutes was bad.

If I sleep for 8 hours and have 15 minutes with a leak and the rest of the time the leak is flat at 0.0...I am doing the happy dance for sure.

[pandatx]

Okay Pugsy, I looked over your other post about it and it helped a lot. Thanks so much! xo

[Sir NoddinOff]

Regarding sleep doctors, there's just no way to tell until the rubber hits the road. I had one doctor that was shocked and chastised me, telling me I was ruining my therapy. On the other hand, I had another who looked at my laptop with Sleepyhead running and said "What program is that?, it looks cool". I showed him all my little tricks to zoom in on events, calculate the hours I was asleep, view my summaries, insert notes etc and he paid attention for the whole ten minute dog and pony show. Like I said, very hard to tell beforehand.

[BlackSpinner]

Regarding the doctor - keep repeating in your head "I pay your salary, you work for me, just like the plumber who fixes my tap and the guy who shovels my driveway (or cuts the lawn)"

[hyperlexis]

Good morning everyone!

I have 2 questions:

1. Leak rate. I'm not mathy at all and don't understand this. Do I want most of my bar graph showing median, 95th percentile, or maximum?

2. When I go back for my follow up with my Dr at the sleep center he is going to notice that I changed my settings from 5.0 to 6.0-6.4 (ish). Should I expect a reprimand? I'm sure he's going to ask about me going into the clinician's menu.....

Well rather than get into an adversarial relationship with your physician and having him accuse you of playing doctor, why don't you just say, hey I thought this may help, but what is your recommendation? Do my pressures need adjusting or should I continue at X pressure until my next appointment and see how it goes?

[StuUnderPressure]

When I go back for my follow up with my Dr at the sleep center he is going to notice that I changed my settings from 5.0 to 6.0-6.4 (ish). Should I expect a reprimand? I'm sure he's going to ask about me going into the clinician's menu.....

"Guess the DME just set it wrong!"
"But, 1 to 1.5 more is minimal, isn't it?"

[kaiasgram]

Regarding sleep doctors, there's just no way to tell until the rubber hits the road. I had one doctor that was shocked and chastised me, telling me I was ruining my therapy. On the other hand, I had another who looked at my laptop with Sleepyhead running and said "What program is that?, it looks cool". I showed him all my little tricks to zoom in on events, calculate the hours I was asleep, view my summaries, insert notes etc and he paid attention for the whole ten minute dog and pony show. Like I said, very hard to tell beforehand.

My new sleep doc did not give me a hard time about changing my pressure during my at-home titration week. And when he emailed me to tell me he was prescribing a bilevel machine he told me the pressure settings he was prescribing and then added "You can adjust the pressures later..."

I agree with SNO, it's not always possible to predict. But I think it is always a good idea to bring along your reports that demonstrate why you raised or lowered your pressure and what the outcome was. If there's a rhyme and reason for the changes you're making, it's pretty hard for the doc to argue that you're messing things up even if s/he is not happy that you're managing this yourself.