How Important is the Sleep Study? Self-treat user looking for opinions

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Stom
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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Stom » Mon Aug 06, 2018 1:50 pm

palerider wrote:
Mon Aug 06, 2018 1:40 pm

:Sigh: once again, you're arguing about things you don't understand, based on poorly worded documents.
You are proving my earlier stated point that you like shooting people down, often posting just a negation without providing any helpful information.

I posted three separate citations from three legitimate, verifiable sources, all showing that hypopneas are scored by flow. You have cited...nothing.

I could be wrong. This is not my field. But I did my due diligence and research before posting anything, providing not one but three separate sources. You need to provide some citations that show a different measure of scoring hypopneas if you wish to actually show I've made an error. So far, you have not.
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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by palerider » Mon Aug 06, 2018 1:54 pm

Stom wrote:
Mon Aug 06, 2018 1:50 pm
palerider wrote:
Mon Aug 06, 2018 1:40 pm

:Sigh: once again, you're arguing about things you don't understand, based on poorly worded documents.
You are proving my earlier stated point that you like shooting people down, often posting just a negation without providing any helpful information.

I posted three separate citations from three legitimate, verifiable sources, all showing that hypopneas are scored by flow. You have cited...nothing.

I could be wrong. This is not my field. But you need to provide some citations that show a different measure of scoring hypopneas if you wish to actually show I've made an error. So far, you have not.
Your "opinion" is important, and precious... Just not to me.

If you don't like my simple, easy to understand explanation, the feel free to come up with your own explanation of the difference between flow limitations and hypopneas.

So far, all you've done, is what you like doing, arguing.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Stom » Mon Aug 06, 2018 2:02 pm

palerider wrote:
Mon Aug 06, 2018 1:54 pm
Your "opinion" is important, and precious... Just not to me.

If you don't like my simple, easy to understand explanation, the feel free to come up with your own explanation of the difference between flow limitations and hypopneas.

So far, all you've done, is what you like doing, arguing.
Not really an opinion when it is demonstrated as fact.

I cited three legitimate, reliable, verifiable sources all agreeing that hypopneas are scored as a reduction in flow. You have cited *nothing* to contradict those sources, yet you are still trying to call me out because reasons.

You once harped on me for not looking up specific intentional leak rate graphs before commenting on the issue of the difference of intentional leaks rates between mask types. And I should have. This time it's on you. You should cite something to back up your explanation that contradicts the AASM scoring criteria for hypopneas and the ResMed machine scoring critera for hyponeas.

Simple, easy to understand explanations are only useful if they are true.
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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by palerider » Mon Aug 06, 2018 3:29 pm

a wrote:
Mon Aug 06, 2018 2:02 pm
palerider wrote:
Mon Aug 06, 2018 1:54 pm
Your "opinion" is important, and precious... Just not to me.

If you don't like my simple, easy to understand explanation, the feel free to come up with your own explanation of the difference between flow limitations and hypopneas.

So far, all you've done, is what you like doing, arguing.
Blah blah argue argue...
as usual, no actual knowledge, just argument.

I'm sure you think the "pump" produces "pressure", since that's what poorly worded sources often say.
a wrote: I could be wrong. This is not my field.
Another know it all newbie. :Sigh:

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Stom » Mon Aug 06, 2018 3:58 pm

palerider wrote:
Mon Aug 06, 2018 3:29 pm
Stom wrote:
Mon Aug 06, 2018 2:02 pm
palerider wrote:
Mon Aug 06, 2018 1:54 pm
Your "opinion" is important, and precious... Just not to me.

If you don't like my simple, easy to understand explanation, the feel free to come up with your own explanation of the difference between flow limitations and hypopneas.

So far, all you've done, is what you like doing, arguing.
Blah blah argue argue...
as usual, no actual knowledge, just argument.

I'm sure you think the "pump" produces "pressure", since that's what poorly worded sources often say.

I'll let you have the last word, since you're unable not to argue, as has been already demonstrated, and I'll let other people make up their own minds.
Stom wrote: I could be wrong. This is not my field.
Another know it all newbie. :Sigh:
My three citations continue to stand unopposed.

Once again you are all negation and personal attack. You fail to provide any citations that prove your claim. And ironically you try to label me as the argumentative one.

I freely admit that I'm ignorant about respiratory therapy, which is why I checked three separate reliable sources before commenting. You've claimed over and over that I'm wrong, yet in your multiple responses to me you have failed in every single one of them to provide a even *single* valid citation proving your claim.

I want accurate understanding and my mind is open to science and sound evidence. To keep my understanding based on reliable evidence I have to give the three verifiable sources I cited more credibility than some pseudonymous dude on the internet I don't know who refuses to cite any evidence whatsoever to prove his/her claim.
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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Fetou » Mon Aug 06, 2018 7:13 pm

My understanding from that awesome video (also by ResMed) is that there isn't necessarily any reduction in the amount of oxygen going through the airway during flow limitations, but rather that there is more strain/difficulty in the process of keeping the air flowing through than there would be without a limitation.

Apneas of either variety only occur when the airway actually closes and the oxygen doesn't get through to supply the body. The degree to which the impeded airway is preventing the oxygen from traveling through the airway is what will designate the hypopnea vs. the obstructive apnea, with what appears to be 80% reduction in the amount of air that can make it into the body being the border line for the Hypopnea vs. OA.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by palerider » Mon Aug 06, 2018 7:23 pm

Fetou wrote:
Mon Aug 06, 2018 7:13 pm
My understanding from that awesome video (also by ResMed) is that there isn't necessarily any reduction in the amount of oxygen going through the airway during flow limitations, but rather that there is more strain/difficulty in the process of keeping the air flowing through than there would be without a limitation.
Yes, you get it, though it's just 'air' and not specifically oxygen.
Fetou wrote:
Mon Aug 06, 2018 7:13 pm
Apneas of either variety only occur when the airway actually closes and the oxygen doesn't get through to supply the body. The degree to which the impeded airway is preventing the oxygen from traveling through the airway is what will designate the hypopnea vs. the obstructive apnea, with what appears to be 80% reduction in the amount of air that can make it into the body being the border line for the Hypopnea vs. OA.
Well, central apneas don't have any closure of the airway, you just don't even try to breathe... that's why respironics calls them 'clear airway' apneas, because your airway is clear of obstruction (everybody else calls them centrals). But, essentially, yes.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by palerider » Mon Aug 06, 2018 7:36 pm

a wrote:
Mon Aug 06, 2018 3:58 pm
My three citations continue to stand unopposed.
Your 'three citations' do nothing but prove you don't know what you're reading, and the fact that you decided to stick your nose into this conversation that had nothing to do with you proves that you're just here to argue, about things you don't understand.
Respiratory flow: "This flow rate is defined as the mask minute ventilation." -- https://academic.oup.com/annweh/article/51/3/327/139423
Flow, in the 'citations' you found refers to *respiratory flow*, which is a measure of *volume*.
Flow Limitation – the partial closure of the upper airway impeding the flow of air into the lungs.
Hypopnea - shallow breathing in which the air flow in and out of the airway is less than half of normal--usually associated with oxygen desaturation. -- viewtopic/t17521/Flow-limitation-as-com ... opnea.html"
Also, consistent with what I said.
Inspiratory flow limitation during sleep is defined by a decreasing intrathoracic pressure without a corresponding increase in airway flow rate. This alinearity in the pressure:flow relationship during inspiration is commonly caused by narrowing of a hypotonic upper airway in response to the negative intrathoracic pressure developed during inspiration (1). There are several potential consequences of inspiratory airflow limitation during sleep (see also Discussion). If the increased airway resistance achieved is sufficiently high, the tidal volume will fall (2, 3). In turn, if the high upper airway resistance and reduced tidal volume persist, then sleep-disordered breathing events will occur in the form of hypopneas (over a few breaths) or even prolonged alveolar hypoventilation might ensue with associated CO2 retention and arterial hypoxemia and disrupted sleep state. -- https://www.atsjournals.org/doi/full/10 ... .3.9708056
ALSO consistent with what I said.

Inspiratory flow limitation during sleep is defined by a decreasing intrathoracic pressure without a corresponding increase in airway flow rate. That's pretty simple, a flow limitation.

In turn, if the high upper airway resistance and reduced tidal volume persist, then sleep-disordered breathing events will occur in the form of hypopneas If *volume* is reduced, you get hypopneas.

The *simple fact* is that you're reading things, without understanding the usage of the terms, and then you're *arguing about it*.
a wrote:
Mon Aug 06, 2018 3:58 pm
And ironically you try to label me as the argumentative one.
Only, once again, *you started the argument*. This topic does not concern you, this topic is not about you, this topic has nothing to do with you, and yet, here you are, trying to 'win points'.
a wrote:
Mon Aug 06, 2018 3:58 pm
I freely admit that I'm ignorant about respiratory therapy, which is why I checked three separate reliable sources before commenting.
You read words, but you *don't understand what they mean*. You lack context.

I have dialysis in the afternoons, I have better things to do than try do do elementary education and refute a jackass that just wants to argue with everything I say, while using my *PHONE* to post.
a wrote:
Mon Aug 06, 2018 3:58 pm
I want accurate understanding and my mind is open to science and sound evidence. To keep my understanding based on reliable evidence I have to give the three verifiable sources I cited more credibility than some pseudonymous dude on the internet I don't know who refuses to cite any evidence whatsoever to prove his/her claim.
No, you clearly want to argue, you want to try and prove you're smarter than I am, by sticking your face in somewhere that you weren't involved, just so you can try and "get one up on me".

But, ya know what? you're not worth the time, all you're worth is being ignored.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Stom » Tue Aug 07, 2018 12:05 am

Hypopneas are scored based on a reduction in the rate of flow that lasts at least 10 seconds, they are not scored based on volume.

Inspiratory Flow Limitations are obstructive, limiting inpspiratory flow. So are *obstructive* hypopneas. They are actually kind of similar.

Central hypopneas are also scored based on the same reduction in flow rate as obstructive hypopneas but are different in that they lack respiratory effort.

None of your citations refute those facts. Nor do your repeated personal attacks on me. And, in fact, your own citation refutes your own claims. You wrote:
palerider wrote:
Sun Aug 05, 2018 2:58 pm
Because flow limitations are a completely different thing from hypopneas.

Flow Limitations are exactly what the name says... a limit to the rate of flow, whereas hyponeas are a reduction on volume.

You can have hypopneas without flow limitations, and you can have flow limitations without even a hint of a hypopnea, or indeed any reduction in tidal volume (which is the amount of air inhaled and exhaled in a breath.
But your own citation says:
There are several potential consequences of inspiratory airflow limitation during sleep (see also Discussion). If the increased airway resistance achieved is sufficiently high, the tidal volume will fall (2, 3). In turn, if the high upper airway resistance and reduced tidal volume persist, then sleep-disordered breathing events will occur in the form of hypopneas (over a few breaths)
[emphasis added]

In other words, obstructive hypopneas are an extension of inspiratory flow limitations, not some "completely different thing".

Similarly, your claim that flow rate is a measure of volume relies on a misreading of a single sentence in the paper you cite ("This flow rate is defined as the mask minute ventilation."), a paper that actually measures and lists minute volume and flow rates separately, because they are two different things:
Oxygen uptake, minute ventilation and air flow rates were measured with Metamax 1 (Cortex, Germany)...In the three tests with respirators, minute ventilation and flow rates were measured during the inhalation cycle...For each minute (4 and 5) the second part (30 s) was evaluated. For each breath during 30 s a highest inhalation flow rate was measured and the average, defined as mean peak inspiratory flow rate (PIFR), was calculated. The highest value for all the breaths during the period was defined as the maximal PIFR. This single value was on the average 10% higher than the mean PIFR during the minute. All minute volumes and flow rates are given in BTPS
[emphasis added]

They are calculating the minute volumes. The paper has *separate* figures for the minute vent rates (figure 3) and the flow rates (figures 4 and 5) - which they wouldn't and couldn't do if air flow rate == minute vent rate. Note they also list separate Minute Vent data ("VE (l/min) BTPS") and average flow rates ("Mean insp. flow raste (l/min) BTPS" ), which, again, they wouldn't and couldn't do if flow rate == Minute Vent

Flow rate isn't volume. It's flow rate.
volumetric flow rate (also known as volume flow rate, rate of fluid flow or volume velocity) is the volume of fluid which passes per unit time;
https://en.wikipedia.org/wiki/Volumetric_flow_rate

Saying flow rate is a measure of volume is just like saying miles per hour is a measure of distance. Volumetric flow units don't tell you how much volume of gas there is, but rather the rate of units of volume over time.
"Minute ventilation is defined as the volume of air inhaled (inhaled minute volume) or exhaled (expired minute volume) within any 60-s period."
Robert C. Basner • Sairam Parthasarathy, Eds, Nocturnal Non-Invasive Ventilation: Theory, Evidence, and Clinical Practice, Springer, 2015

To confirm that flow rate and minute vent are two different things, look no further than your Sleepyhead charts:
Attachments
Screen Shot 2018-08-06 at 10.53.54 PM.png
Screen Shot 2018-08-06 at 10.53.54 PM.png (129.45 KiB) Viewed 12051 times
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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Fetou » Tue Aug 07, 2018 5:07 am

Well unfortunately it appears that the snores are not meant to be stopped. It maxed out the pressure to 25cm trying to deal with them and still failed! :x
Sleepyhead Capture Aug06.JPG
Sleepyhead Capture Aug06.JPG (609.73 KiB) Viewed 12036 times
There does seem to be slightly less frequent arousals, and the flow limitations have all but disappeared. AHI is still being inflated by awake events. I intend to start posting more zoomed in parts of the data going forward to practice interpreting what is going on. Some of the patterns my breathing takes are pretty wonky looking.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by bombayone » Tue Aug 07, 2018 5:31 am

Stom: Welcome to cpaptalk.com. The forum is really a good place with many well informed, well intentioned, helpful members. A few forum members, like Pale Rider, are mean spirited bullies who tend to deny any knowledge or reality but their own. They view this as a a personal web space where their opinions, right or wrong, are not to be be challenged, particularly by new forum members.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Pugsy » Tue Aug 07, 2018 7:12 am

bombayone wrote:
Tue Aug 07, 2018 5:31 am
They view this as a a personal web space where their opinions, right or wrong, are not to be be challenged, particularly by new forum members.
Not true. Anyone can challenge anyone. Just don't expect to not be challenged in return.

To everyone....Please knock off the personal attacks and vendettas. All they do is create a toxic environment here and that can cross over into where someone is violating the terms of agreement...and also note the term "at our sole discretion"...that means the powers that be (guess who that is :lol: ) get to decide the lines in the sand. If you don't like it...well...there is always that other forum where the ship is more tightly reined...but beware...you piss the moderators off over there the axed falls swiftly and often without warning.
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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Fetou » Tue Aug 07, 2018 7:18 am

Pugsy wrote:
Tue Aug 07, 2018 7:12 am
bombayone wrote:
Tue Aug 07, 2018 5:31 am
They view this as a a personal web space where their opinions, right or wrong, are not to be be challenged, particularly by new forum members.
Not true. Anyone can challenge anyone. Just don't expect to not be challenged in return.

To everyone....Please knock off the personal attacks and vendettas. All they do is create a toxic environment here and that can cross over into where someone is violating the terms of agreement...and also note the term "at our sole discretion"...that means the powers that be (guess who that is :lol: ) get to decide the lines in the sand. If you don't like it...well...there is always that other forum where the ship is more tightly reined...but beware...you piss the moderators off over there the axed falls swiftly and often without warning.
While using CPAPtalk.com, you will not:

post any material, or links to any material that is (at our sole discretion) knowingly false and/or defamatory, inaccurate, abusive, vulgar, hateful, harassing, obscene, profane, sexually oriented, threatening, invasive of a person's privacy, or otherwise violates any law;
Perhaps just make a sticky for complaints about PaleRider. He isn't for everyone clearly. Perhaps a support group could be formed for those who have very negative experiences with his style.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Pugsy » Tue Aug 07, 2018 7:37 am

Fetou wrote:
Tue Aug 07, 2018 7:18 am
Perhaps just make a sticky for complaints about PaleRider. He isn't for everyone clearly. Perhaps a support group could be formed for those who have very negative experiences with his style.
:lol: :lol: As you can imagine there will be no such sticky.

Perhaps people who don't like his style should just put him on the Foe list and don't read what he writes. Unfortunately then they would be cutting their nose off to spite their face if they really need help because he knows this stuff backwards and forwards.
He speaks the truth...his delivery method sometimes suck but he speaks the truth.
He is not the only forum member whose delivery method sometimes sucks though...we would be missing a lot of long time members here if their delivery method got them banned.
Hell..sometimes my delivery method sucks too. :lol:

The vendettas though...they gotta stop. We all see them for what they are and I am getting tired of it.

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Re: How Important is the Sleep Study? Self-treat user looking for opinions

Post by Fetou » Wed Aug 08, 2018 5:41 am

Just got the best and perhaps longest sleep session since starting on this. Everything is beginning to feel routine, starting to get proficient at how to lay on the pillows with the mask on, how to prevent leaks, etc. I really do want to express a deep and profound love for this VAuto. It makes the whole experience feel so natural. It even pretends to just be a regular old alarm clock radio with it's form factor!
Sleepyhead Capture Aug07.JPG
Sleepyhead Capture Aug07.JPG (673.55 KiB) Viewed 11984 times
The pressure graph is pretty flat as desired. I think the machine has ample time to react to whatever is happening with the higher minimum, and it honestly just isn't bothering me as much as when it used to spike from a low level to a higher level during the night. Pressure support does not seem to be causing any CA issues for me. I've had one flagged central in my entire time with the VAuto with 5cm or higher P/S.



Now for some of the more zoomed in graphs:
Sleepyhead Capture Aug07 SWJ.JPG
Sleepyhead Capture Aug07 SWJ.JPG (162.95 KiB) Viewed 11984 times
^ This is within the first ten minutes of getting to bed. Is this just transitional SWJ?



Sleepyhead Capture Aug07 apnea.JPG
Sleepyhead Capture Aug07 apnea.JPG (357.92 KiB) Viewed 11984 times
^ This one looks like a real apnea to me. It also has that similar preceding pattern that Pugsy described as a "cardio echo" on the last OA zoom that I shared.

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