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[EMTunit31]

I'm not sure what time I fell asleep but I know it wasn't right away.

[Pugsy]

Do you have any sort of follow up schedule with the doctor or a doctor.....Either the doctor ordering the sleep study or the doctor reading the sleep study?
They aren't always the same doc.
If you don't then I think maybe you should make an appointment.
Whatever is going on here needs to be sorted out accurately and arm chair stuff via the internet is not the ideal way to go about sorting it out in this situation. IMHO
We can toss out ideas but we are just tossing and I am pretty much out of them because I feel that there's more than plain jane vanilla OSA going on here and the problem is compounded because we don't know for sure what that other stuff is and playing around with plain jane vanilla OSA is one thing but playing around with central sleep apnea is another and even worse is playing around when we don't know for sure what we are playing around with.

[cathyf]

There are still a number of unanswered questions, so somebody (or thing) is REALLY wrong (the ResMed CA detection says obstructive, the HST detection (I'm guessing it was on Autoscore) says central, the ReSmart algorithm implies obstructive... while 2 out of 3 ain't bad, the "Gold Standard" (abdomino-thoracic belts in HST) said central.

Isn't the Gold Standard here the abdomino-thoracic belts PLUS eeg? If the belt says EMTunit31 is not trying to breathe, it makes a huge difference whether or not she is actually asleep. If she is awake, then all bets are off.

It looks to me like the answer is that the only conclusion that can be drawn from her in-home study and her S9 data is that she's got to have an in-lab sleep study -- with the EEG hooked up to distinguish asleep from awake -- to see what's really happening. This is a battle that has to be fought with the help of the doctor, getting the insurance company to be convinced that it is quite simply medically necessary.

[EMTunit31]

I am going to get an appointment with my primary doctor and my aunt jmw will be taking me so she can show and explain whats going on and why I need the in lab titration and a referral to a real sleep doctor. This is going to get easier, right?

[EMTunit31]

Also I am taking Allegra non drowsy (yeah, right) because the ragweed is killing me. Sinus headaches, watery eyes, post nasal drip and a lot of sneezing. I don't know if that changes anything or not.

[kaiasgram]

I am going to get an appointment with my primary doctor and my aunt jmw will be taking me so she can show and explain whats going on and why I need the in lab titration and a referral to a real sleep doctor. This is going to get easier, right?

Yes, if you don't give up, which you show no sign of doing. You just have a complicated case that calls for more than a home sleep test so is taking more time than it otherwise would. That plus the nincompoop doctor who signed off on your home sleep test and set you on a wayward path. You and your auntie are troopers.

[EMTunit31]

This is the story of my life. Everything comes the hard way. I prepare to make it smooth but it just won't happen that way

[Sludge]

When did you fall asleep last night?

Good point, that initial event-free period is noted'.

Do you believe the S9 is correct in terms of the event category determination?
A simple yes or no would real nice please.

I imagine it would.

There are still a number of unanswered questions, so somebody (or thing) is REALLY wrong (the ResMed CA detection says obstructive, the HST detection (I'm guessing it was on Autoscore) says central, the ReSmart algorithm implies obstructive... while 2 out of 3 ain't bad, the "Gold Standard" (abdomino-thoracic belts in HST) said central.

Isn't the Gold Standard here the abdomino-thoracic belts PLUS eeg? If the belt says EMTunit31 is not trying to breathe, it makes a huge difference whether or not she is actually asleep. If she is awake, then all bets are off.

No. If the physician was looking for OSA without the presence of significant co-morbidity, then HST would be fine. Since the OP reported husband observations of significant gasping/choking, then considerations of HST would not be wrong, especially if their insurance pushed them there. 99.99999% of the time, if you're having an obstructive apnea, you're asleep. Although if you're not asleep, then that is classified as "obstructed airway", mentioned earlier, and frankly still not off the table given the OP's rehab history.

However, in HST one needs detailed clinical history, and that stroke would certainly offer consideration as significant co-morbidity.

Specifically:

2.3. Ideally the sensor for identification of respiratory effort is either calibrated or uncalibrated inductance plethysmography.

However2, we need to be clear that the practice parameter is

Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients

[Sludge]

Anyway, this does not change our current plan one iota:

So what is your suggestion?

I think the ball will start rolling if you call you guy and say "I had 387 central central central central apneas on my sleep study but you gave me a diagnosis of obstructive apnea. What's up with that? And I read on the internet (they always love to hear that) that the WORST thing you can do with somebody who has central apnea is put them on a wide open APAP (that does not have central apnea identification technology). Now the thing skyrockets to 20 every night for no good reason. Why'd you do that to me?'"

How we makin' out with that?

[Sludge]

Meanwhile, a breath-by-breath analysis of the S9 data might be helpful, so if you want to upload that data to a Dropbox file we could do that.

[Sludge]

Did you call yet?

If the physician was looking for OSA without the presence of significant co-morbidity, then HST would be fine. Since the OP reported husband observations of significant gasping/choking, then considerations of HST would not be wrong, especially if their insurance pushed them there.

Circadian is an accredited OCST center, see testing criteria:

http://www.sleepeducation.com/disease-m ... g/overview

So call TODAY, and if we do not get an appropriate ACTION PLAN today (not an "ANSWER", an "ACTION PLAN") tell Esky we are calling Ohio SMB and AASM (numbers loaded into speed dial) and unleash hell.

Strength and honor.

[EMTunit31]

I did call Sludge and of course I got an answering machine. I left my questions for him and waiting for a reply. I do however have an appointment tomorrow at 4 with my primary doctor to go over study and get suggestions. My aunt is going with me to explain things that I can't. Maybe we will get something going from that. I would be happy to get you the breath by breath if you tell me what exactly it is you need. I will also post last nights results which is very little because I only slept for about 2 hours.

[EMTunit31]

I probably lay awake for an hour or maybe a bit longer before falling asleep.

[Pugsy]

Thank you Sludge for the straight forward answer. I needed that. I thought I was crazy.
I am going to leave things in your hands. This is over my head and if you weren't here I would try but since you are here I will defer to you but will be watching and learning.

To EMTunit31
How to get those files off that SD card so Sludge can see them.
I just have people make a copy of the entire SD card (so that all the files are available in all the folders nicely) and then upload that copy of the SD to some place on the web...I use Dropbox online storage. Then provide a link to that SD card copy for him to go download the files.
You may or may not need to compress/zip the SD card copy. It shouldn't be horribly huge at this point right now.

Any number of online storage places that are free. Dropbox is free up to a certain amount of storage. There is a pay for product but you don't have to pay.. It isn't needed to do what you want to do.

[EMTunit31]

Thanks Pugsy. I will put them on the web now.