OSCAR chart to grade please? Newguy

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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palerider
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Re: OSCAR chart to grade please? Newguy

Post by palerider » Wed Nov 16, 2022 8:53 pm

Pugsy wrote:
Wed Nov 16, 2022 7:53 pm
palerider wrote:
Wed Nov 16, 2022 7:33 pm
Pugsy wrote:
Wed Nov 16, 2022 10:14 am
Oh...there is definitely a fix available and it's fairly simple....ASV machine.
It's the getting the medical care team to prescribe it that is going to be the not so simple task.
Huh, and I happen to have two of those for sale. :ponder:
You still have those 2???? I would have thought they were long ago gone and spoken for.
Yeah, after selling the first one, I just mostly forgot about the other two, out of sight, out of mind, you know how it is... the third one got perma-loaned to a friend, who ended up loaning it to another friend... but that's OK, it's the one that had the 26k hours on it, and the ever-present nag screen about the blower having exceeded it's lifetime... though it was still going strong :D

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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Thu Nov 17, 2022 5:40 am

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Re: OSCAR chart to grade please? Newguy

Post by Wondering1 » Thu Nov 17, 2022 10:40 am

Rubicon wrote:
Thu Nov 17, 2022 5:40 am
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Rubicon, What are we supposed to be learning from these charts? Was there something there that you wanted to demonstrate and/or perhaps missed adding your comments?

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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Thu Nov 17, 2022 4:25 pm

Wondering1 wrote:
Thu Nov 17, 2022 10:40 am
Rubicon, What are we supposed to be learning from these charts?
Contradictions.
Was there something there that you wanted to demonstrate
Yes.

Contradictions.
perhaps missed adding your comments?
Nope.

BTW what's your story anyway? What brings you to the Bates Motel?
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Re: OSCAR chart to grade please? Newguy

Post by ozij » Thu Nov 17, 2022 9:49 pm

Lets see if I get it.

Sleep study:
Severe OSA, AHI (respiratory effort index was 58.6 consisted primarily of obstructive events events per hour (including many of the "unclassifed" apneas).
When supine, the desaturation (in the red square) are - to use Rubicon's adjective - "wicked bad".
I don't know enough about Airview and the way the study was run, to understand why the report identifies the "unknowns" as obstructives - I'm assuming this is the result of a valid human analysis on top of an automated one. Assumption: Gene does indeed have severe sleep apnea and needs a machine to clear those obstructions.

And then you look at the OSCAR overview and see:
  1. Too many obstructive events in the first period on auto mode
  2. The appearance of far more central apneas when pressure is raised in attempt to control the obstructives
  3. Things looking a bit better on the switch to fixed mode, but not good.
The OSCAR detailed charts show us
  1. How bad an obstructive aperea can be at a certain pressure
  2. How central apneas appear after the pressure is raised
  3. And obstructives and unstable breathing are still very much there.
Once again, something I don't understand: what looks like an exaggerated level of forced oscillations on that OA in the green background.

Images that should convince the sleep doctor that this is indeed COMPSAS - a situation in which the pressure necessary to get rid of obstructive events results in lowering the breathing effort. Hence, Gene needs a machine that will
  1. Take care of his obstructive evens with adequate pressure
  2. No less important: adaptively puff some air into his lungs when whenever his breathing control isn't functioning properly because of the lower CO2
An APAP does nothing in response to a central apnea. An ASV gets to work when that happens by - thus assuring that Gene has adequate oxygenation.

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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Fri Nov 18, 2022 3:12 am

ozij wrote:
Thu Nov 17, 2022 9:49 pm
Lets see if I get it.
IMO there is the most important contradiction.

OP asks for advice, then doesn't take it.

Indeed, makes a big point complaining about participation on AB when, in fact, clownbell told him twice that he needs an ASV.

You, me, Pugsy, RS1 and PR all suggesting/offering ASV here, and then complete reluctance to follow up-- "Gee, well, 3 thousand dollars, oh my..."

Hey! You're this BF success, remember? What's 3K that you won't have to pay anyway cause insurance will cover it?

So while all this techno mumbo-jumbo has been going on, in the back of my mind since the thread on AB I've been going

"What's really this guy's gig?"

While there are several possibilities, I believe the working theory should be a subset of the Physician-God Complex-- namely:

"My physician is God, so how can He possibly be wrong?"


Which brings us to the contradiction:

"If your Physician is God, why have you lowered yourself to talking (posting) to scum like us?"
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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Fri Nov 18, 2022 3:21 am

Another giveaway:
GeneMpls wrote:
Mon Oct 31, 2022 12:55 pm
... a lady, I always have better luck with them.
Not luck.

Less intimidated.
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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Fri Nov 18, 2022 3:40 am

ozij wrote:
Thu Nov 17, 2022 9:49 pm
I don't know enough about Airview and the way the study was run, to understand why the report identifies the "unknowns" as obstructives - I'm assuming this is the result of a valid human analysis on top of an automated one. Assumption: Gene does indeed have severe sleep apnea and needs a machine to clear those obstructions.
IMO the ApneaLink study was completely FUed (search LSOS to see my previous comments). I'd get a hold of the raw data and rescore it (well, not me per se as I no longer have the software here and it would take me considerable time and effort to reload it) with the thought that the whole mess was central to begin with!! Consequently, this really isn't CompSAS (although that's somewhat academic in that an ASV is still the treatment).

Keeping one finger on the checker tho, perhaps not the whole mess. In the red box, the desaturations appear to have a longer cycle time, and the HRV, if valid, is different.

The FOTs were presented to review if they're accurately reflecting what's happening, i.e., are those really OAs. I mean, besides the FOT they all look alike to me.
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Re: OSCAR chart to grade please? Newguy

Post by GeneMpls » Fri Nov 18, 2022 10:42 am

Sir Rubicon- I have been dealing with and analyzing and learning from multitudes of people since before I started my first business in 1979. I have learned that if you listen and watch they will show you what you need to know, which is not necessarily what they are telling you. I have been listening to many people on this forum and forming opinions about who should be listened to and who to take with a bit of seasoning. That is my responsibility to myself, and I take it seriously.

I really don't consider anyone scum, altho there are people who I choose to not be associated with. And if there is a god, he has better things to do than mess with the likes of us. I am not sure if my sleep doc really understands what my problem is, as it is obviously complicated, or if he does not have the time or inclination to get involved- that is a problem for both of us unfortunately. I am responsible to me and he to himself.

I am and have been trained as a technician [electronics] and have educated myself to try to fill in the gaps in my training ever since. I am serious about that too. I am considered [in some limited areas] a BF deal by some people. They have made this determination by knowing me, not by my telling them this.

I consider CPAP therapy as well suited to the technical approach, the machine is complicated but easy enough to understand and experiment with. I don't believe there are any dire results with changing air pressures gradually or turning on and off various features. I am looking for a tech who has knowledge and ability to guide me and if I have to cut the Dr. out of the picture because someone can do it better, let's go.

ASV therapy is something else as I understand it, it takes a lot more thought and knowledge. As to if I am taking any of the info on this forum for gospel... that remains to be determined.

I feel that the good people on this forum mean well and I am gratified that they have invested in me, that said, I am not prepared to use this as a serious argument with
the people who need to be convinced [sleep doc] and tell them they do not know their business. Thanks and sorry for stirring up any trouble. Gene

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Re: OSCAR chart to grade please? Newguy

Post by robysue1 » Fri Nov 18, 2022 11:12 am

GeneMpls wrote:
Fri Nov 18, 2022 10:42 am
I consider CPAP therapy as well suited to the technical approach, the machine is complicated but easy enough to understand and experiment with. I don't believe there are any dire results with changing air pressures gradually or turning on and off various features. I am looking for a tech who has knowledge and ability to guide me and if I have to cut the Dr. out of the picture because someone can do it better, let's go.

ASV therapy is something else as I understand it, it takes a lot more thought and knowledge. As to if I am taking any of the info on this forum for gospel... that remains to be determined.
The problem is that CPAP will not treat central sleep apnea problems. And the data that you have posted points to the need to have your medical team thoroughly investigate whether you have complex sleep apnea (CompSA) instead of garden variety OSA.

The only current machines that will actually treat central sleep apnea and complex sleep apnea are ASV machines.

I understand your reluctance to go into a doctor's office and say, "I think I need an ASV".

But on the other hand, I think you do need to go into the doctor's office and say, "Is it possible that all of the CAs my current machine is flagging every night, along with the long stretches of periodic breathing being flagged as CSR needs to be looked at carefully in order to determine whether I have central sleep apnea or complex sleep apnea?" Would another titration study with xPAP/ASV titration be useful for figuring out why I still have so many events every night and why I am still feeling so bad during the daytime?"
I feel that the good people on this forum mean well and I am gratified that they have invested in me, that said, I am not prepared to use this as a serious argument with
the people who need to be convinced [sleep doc] and tell them they do not know their business. Thanks and sorry for stirring up any trouble. Gene
You have described your sleep doctor as unresponse to your requests for appointments to talk about how CPAP therapy is currently failing to make you better.

You don't have to argue with the sleep doc. But you do need to ask him (or her, if you've been moved to the female doc) questions about why CPAP is not working for you. That means asking the doc to take the time to explain to you why he ordered your pressure reduced from 15 to 12. And how long he/she thinks you should wait for the CAs to resolve themselves. Most people who have a bit of a problem with CAs at the start of xPAP see the CAs disappear after a few weeks. In your case, it's been at least 3 months, and the CAs are not resolving. Further investigation needs to be done by your medical team. Asking them to do their job is not telling them they don't know their business. But it is telling them, you need them to not ignore the herd of zebras that are trampling all through your data just because they want to think those zebras are horses.

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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Fri Nov 18, 2022 12:01 pm

GeneMpls wrote:
Fri Nov 18, 2022 10:42 am
Sir Rubicon-
No really, I am scum. I have no problem accepting that I am scum. Frankly, I am quite happy being scum. It's a helluva lot easier being me for what I am than trying to be something I'm not.
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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Fri Nov 18, 2022 12:08 pm

GeneMpls wrote:
Fri Nov 18, 2022 10:42 am
I don't believe there are any dire results with changing air pressures gradually or turning on and off various features.
I wouldn't say dire, but you are lucky enough to be in the 1.5% of patients where DWing isn't the best approach-- AAMOF, usually counter-productive.

Are you going to die?

Yes.

Everybody dies.

Did you just waste 1000 hours on sub-optimal therapy?

Yup.

Do I really give a FF?

Nope.
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Re: OSCAR chart to grade please? Newguy

Post by palerider » Fri Nov 18, 2022 6:37 pm

GeneMpls wrote:
Fri Nov 18, 2022 10:42 am
ASV therapy is something else as I understand it, it takes a lot more thought and knowledge.
Not sure where you got *THAT* mis-information, but the Resmed ASVs (they invented them) are so much smarter machines that they have fewer settings than a standard auto bilevel machine, many people get excellent results with them just set at factory defaults.
GeneMpls wrote:
Fri Nov 18, 2022 10:42 am
a serious argument with the people who need to be convinced [sleep doc]
Why do "they" need to be convinced?
GeneMpls wrote:
Fri Nov 18, 2022 10:42 am
and tell them they do not know their business.
The sad fact of the matter is that many of 'them' really do NOT know their business.

If they DID, and they provided excellent service to their patients, you wouldn't be reading this, because you wouldn't BE HERE complaining of problems. Indeed, this forum wouldn't even exist, because nobody would need help with their ineffective treatment.

Think on it.

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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Sat Nov 19, 2022 5:42 am

Rubicon wrote:
Fri Nov 18, 2022 12:08 pm
Do I really give a FF?
OK I lied.

It bothers me how some physicians provide crap service and the patients are afraid to say anything for fear that they'll make worse things worser.

To an extent, they're right.

Unless they're ready to do a Jim Malone.
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Re: OSCAR chart to grade please? Newguy

Post by Rubicon » Sat Nov 19, 2022 5:48 am

"Quiet quitters."

Couldn't think of the new trendy expression...
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