OSCAR chart to grade please? Newguy

Yeah well my balls are up in the air too so if you want to take advantage of my offer you got till Tuesday.

Sorry- I did not see your offer but I would love to take you up on it, Please PM me your email and I will send via the Hightail service asap. Thank you Gene

Negative on the email. PM the dropbox link to me here with the understanding that any and all information can/will be shared and/or discussed on/with the forum.

dataq1 wrote: ↑

Sun Nov 13, 2022 10:42 pm

ozij wrote: ↑

Sun Nov 13, 2022 9:27 pm

The epitome of defensive medicine, making sure you will never have grounds for a malpractice suit.

Yes, I agree that it is defensive medicine. They seem to be saying that they will not rely on data obtained from a source that may evaluate the raw data differently, or may not even have the capability to provide the similar raw data .

So get yourself ResScan, the official Resmed software for displaying the data recorded by your machine. Compare the way the data as displayed in ResScan to the way the data is displayed in Oscar. Even a cursory comparison will show that Oscar accurately displays the data written to the SD card---provided you accept the idea that the Resmed engineers who wrote ResScan knew what they were doing when they wrote that program.

Also show the ResScan reports to your doctor and have him bad mouth the software developed by the experts who designed and built the machine he is asking you to use each and every night. And have him explain to you why the basic trending data as shown in ResScan cannot be relied on to tell you the following things about your therapy:

• Whether you are leaking at a rate that is (or is not) detrimental to the efficacy of your therapy.
• Whether your OSA is or is not controlled in the sense that most of your apneas and hypopneas are being prevented by the pressure the machine provides.

dataq1 wrote: ↑

Sun Nov 13, 2022 10:42 pm

That actually makes sense to me, as the data on indices from a home machine may not match the data obtained from a sleep study due to differences in interpretation. (lab sleep studies apply a different standard to identify hypopneas as contrasted with a Resmed / Respironics algorithms as an example).

This is precisely the justification that was used back in 2010 by my first sleep doc who waved my sleep study under my nose, who refused to give me a copy the first time I asked for it, who wanted to steer me to a DME that he was part owner, and whose DME insisted that all I needed was a Resmed S9 Escape---i.e. a brick that did not even record leak data. When you're using a CPAP brick that only records usage data, you can't even properly troubleshoot leaks. And leaks do affect both the user's comfort and the efficacy of the therapy.

But I guess since neither you nor your doc really wants to trust the data recorded by the machine and displayed in ResScan, you both also think that the one-night titration study not only determines the correct pressure needed to treat a patient's apnea, but it also determines whether or not that patient has a problem with leaks that needs to be addressed.

Here's some real data for you to think about: I had a grand total of 3 different titration studies done in-lab as full PSGs in the months following my OSA diagnoses. They all resulted in finding (correctly) that my OSA events could be substantially eliminated through the use of xPAP. But how much pressure was needed depended on the study:

• First titration study (August 2010): Recommended pressure CPAP at 9cm based on 33.0 minutes of sleep at the end of the night. To put that 33 minutes of sleep into perspective: I got a total of 253.6 minutes of sleep during the night for a sleep efficiency of 73.7%
• Second titration study (November 2010): Recommended pressure BiLevel with IPAP = 8cm, EPAP = 6cm based on 17.5 minutes of sleep on a night where I got a whopping 111.5 minutes of sleep for the whole night. (Sleep efficiency was 28.8% and this documented just how much my insomnia had deteriorated since starting CPAP @9cm in September 2010.)
• Third titration study (February 2011): Recommended pressure BiLevel 7/4 based on 68.4 minutes of sleep. (This study showed the First War on Insomnia was beginning to work---as in I got a total of 249 minutes of sleep with a sleep efficiency of 66.6%)

So which is my "correct" pressure according to your doc who won't trust any data from my xPAP machines that deal with treating and monitoring my treated OSA night after night after night?

The fact is that we do not sleep the same every single night. And as my three titration studies indicate, the final script for the pressure settings can be based on remarkably little sleep. And if that titration is done on a "good" night for the apnea, it's quite possible to wind up with a prescribed pressure setting that is not enough to treat your OSA effectively every night. On the other hand, if that titration study is done on an exceptionally "bad" night for the apnea, you can wind up with a script that is higher than you need and the excess pressure can lead to problems like aerophagia or pressure-induced centrals.

dataq1 wrote: ↑

Sun Nov 13, 2022 10:42 pm

ozij wrote: ↑

Sun Nov 13, 2022 9:27 pm

For most of the people coming to this forum, "how my OSA has changed over time (gotten better or worse)" is not the issue. It's "how well I'm sleeping with this mask on my face and how well I'm feeling when I get up".

That well may be true, that "people coming to this forum" are content to self-evaluate subjectively their sleep, but it also appears that many people are equally concerned with their objective/quantitative data ( AHI and each of the individual indices as an example)

I only related my experience with this team of doctors to relay the notion that they may have a different perspective on the quality of data, when the data comes from a source that they are not confident with.

Again, ask those doctors to look at your data in ResScan---the official Resmed software. And then have them tell you why the data as presented in ResScan is of no use in determining whether your machine is doing a good or bad job of treating your OSA.

And keep this in mind: The machine data is critically important for the doctors to look when a patient does not respond as expected.

Again, here's my data point: In the first two weeks after starting CPAP @9cm, I went from being fully functional in the daytime, albeit in pain and somewhat fatigued, to having excessive daytime sleepiness, as in falling asleep (for 15-30 seconds at a time) while standing at the board and lecturing in my classes and being frightened to drive for fear of falling asleep at the wheel. I also went from looking like a normal human being to one who was clearly sleep deprived with significant bags under my eyes and a gaunt appearance---folks at work were expressing concern for my health because I looked so bad.

Looking at the all the data in ResScan was what finally convince the PA in the sleep doc's office that something was seriously wrong. At first she figured (correctly) that maybe I didn't need 9cm of pressure all night long every single night since the AHI's were so close to 0.0 every night and she knew my deterioration in sleep quality was not caused by leaks because my excess leak line was pretty much right at 0.0 night after night, all night long. So there was a switch to APAP in a range of 4-8cm. Yes, the AHI went up (marginally), but more importantly the horrible aerophagia and the resulting insomnia didn't get better. ResScan data, including AHI and leak data combined with my on-going obvious problems with daytime sleepiness and nighttime insomnia , was used to justify both of the bilevel titration studies as well as convincing my insurance company to pay for a bilevel machine.

Rubicon wrote: ↑

Mon Nov 14, 2022 9:10 am

Negative on the email. PM the dropbox link to me here with the understanding that any and all information can/will be shared and/or discussed on/with the forum.

and

GeneMpls wrote: ↑

Mon Nov 14, 2022 9:02 am

Yeah well my balls are up in the air too so if you want to take advantage of my offer you got till Tuesday.

Sorry- I did not see your offer but I would love to take you up on it, Please PM me your email and I will send via the Hightail service asap. Thank you Gene

Gene,

Rubicon has real reasons for preferring the data be put in something like a shared folder on DropBox. If you don't know how to do that, pm me and I'm happy to give you step by step instructions.

Alternately, if you want me to put your SD card data on my dropbox and give Rubicon access to it, I'll be happy to do that and I'll give you my email in a PM.

Just let me know what you want to do.

Robysue1 -I have been screwing with Dropbox for half an hour- so yes please help me out. Gene

I am feeling like crap- going home. will try later, Gene

RS said:
Of course, ResScan is not as easy to install or use as Oscar is, but still: If your doc won't trust Oscar because it's a piece of 3rd party software that he's never heard of, handing him a ResScan printout of daily data (including the flow rate) should put a stop to a doctor's reluctance to look at data presented in Oscar with the claim that the data "can't be trusted."

————

Even better give printouts of Resscan AND Oscar.

GeneMpls wrote: ↑

Mon Nov 14, 2022 12:40 pm

Robysue1 -I have been screwing with Dropbox for half an hour- so yes please help me out. Gene

I am feeling like crap- going home. will try later, Gene

Gene,

I will PM you with some step by step instructions as well as some questions. We'll get your data accessible to Rubicon one way or another.

RobySue

lynninnj wrote: ↑

Mon Nov 14, 2022 1:33 pm

RS said:
Of course, ResScan is not as easy to install or use as Oscar is, but still: If your doc won't trust Oscar because it's a piece of 3rd party software that he's never heard of, handing him a ResScan printout of daily data (including the flow rate) should put a stop to a doctor's reluctance to look at data presented in Oscar with the claim that the data "can't be trusted."

————

Even better give printouts of Resscan AND Oscar.

Exactly. Anyone with one eyeball connected to half a brain should be able to compare a ResScan report and an Oscar report and realize that Oscar is reporting the same data with the same degree of accuracy if those reports are looked at side by side.

lynninnj wrote: ↑

Mon Nov 14, 2022 1:33 pm

If your doc won't trust Oscar because it's a piece of 3rd party software that he's never heard of....

I don't know that it the software that the staff has issue with. (ResScan reports exactly the same events etc as OSCAR, 'cuz ResScan only reports what the Cpap's firmware analysis, as does OSCAR).
I suspect that it's the analysis done by the cpap machine that is cause for their precaution.

SleepHQ had a recent video that questioned the on-board analysis of ResMed machines. (h/t to Thumper1947)
https://www.youtube.com/watch?v=Q3jCsglrF38&t=22s

dataq1 wrote: ↑

Mon Nov 14, 2022 2:13 pm

lynninnj wrote: ↑

Mon Nov 14, 2022 1:33 pm

If your doc won't trust Oscar because it's a piece of 3rd party software that he's never heard of....

I don't know that it the software that the staff has issue with. (ResScan reports exactly the same events etc as OSCAR, 'cuz ResScan only reports what the Cpap's firmware analysis, as does OSCAR).
I suspect that it's the analysis done by the cpap machine that is cause for their precaution.

SleepHQ had a recent video that questioned the on-board analysis of ResMed machines. (h/t to Thumper1947)
https://www.youtube.com/watch?v=Q3jCsglrF38&t=22s

The guy sounds like a dope. Why use the machine at all if you can’t trust the data or anything at all.

And fyi that wasn’t my quote. Above the line I said: RS said yadda yadda. Robysue

lynninnj wrote: ↑

Mon Nov 14, 2022 2:18 pm

The guy sounds like a dope.

If he listened to Niko @ SleepHQ (link above), questioning Resmed's analysis of events etc, he (and their clinic) might have reason to be cautious.

lynninnj wrote: ↑

Mon Nov 14, 2022 2:18 pm

Why use the machine at all if you can’t trust the data or anything at all.

He didn't say they didn't trust the therapy (pressurized air) that was being administered, he was referring to the machine's capability to do patient diagnostics. You know, telling the patient how many apneas, how many hypopneas, etc)

In any event, I only told that anecdote to suggest that doctors and their staff, just may have a different perspective on the reliability of home-acquired diagnostic data then us common folks who do not have a license to defend or an oath to uphold.

Just a difference in perspective, that's all.

GeneMpls wrote: ↑

Mon Nov 14, 2022 12:40 pm

Robysue1 -I have been screwing with Dropbox for half an hour- so yes please help me out. Gene

I am feeling like crap- going home. will try later, Gene

Zip up the entire SD card and upload it to https://www.dropbox.com/request/0LalWvEsijRIgX8sdM7H

All you have to do is click on that link and upload the zip file. I'll get it to Rubicon.

dataq1 wrote: ↑

Mon Nov 14, 2022 3:19 pm

lynninnj wrote: ↑

Mon Nov 14, 2022 2:18 pm

The guy sounds like a dope.

If he listened to Niko @ SleepHQ (link above), questioning Resmed's analysis of events etc, he (and their clinic) might have reason to be cautious.

lynninnj wrote: ↑

Mon Nov 14, 2022 2:18 pm

Why use the machine at all if you can’t trust the data or anything at all.

He didn't say they didn't trust the therapy (pressurized air) that was being administered, he was referring to the machine's capability to do patient diagnostics. You know, telling the patient how many apneas, how many hypopneas, etc)

But how does "he" (whoever "he" is) know whether the amount of pressurized air that a patient is using night after night after night is actually the right amount of pressurized air to use if he's not willing to use the machine's AHI data?

This is, in fact, the problem that real patients run into when they're set up with fixed pressure machines that record only usage data. The pressure is set based on one small snippet of what happened on one night in the artificial setting of a sleep lab. The patient may not have slept at all on their backs during that titration study. Or they not have reached a REM period while sleeping supine. But we don't sleep the same every night. And if your in-lab PSG titration study was done on a night where your apnea was not as bad as usual, you'll wind up with a recommended pressure level that is too low to prevent the real apneas and hypopnneas (however you choose to score them on a PSG) from actually happening in the patient's bedroom on most nights. Or a patient might not have significant problems with pressure induced central apneas on the titration test because the time at the prescribed pressure was under an hour; but sleeping at the prescribed pressure for 6-8 hours every night triggers CAs and a lower pressure really ought to be tried.

And if the doc just ignores the machine's AHI data because he thinks it's worth shit OR if the DME set the patient up with a brick that records only compliance data, there's no way at all to intelligently make a guess as to whether the pressure setting is wrong and needs to be adjusted when the patient comes back saying that they're having a whole lot of problems and they're not feeling well or (even worse) they're feeling worse than before they started therapy.

What then? Still do you still ignore the machine data because it doesn't score apneas and hypopneas in the way they're scored on a PSG? Or do you look at it and make an informed decision about whether the pressure might be too low (or too high) and order a pressure adjustment?

robysue1 wrote: ↑

Mon Nov 14, 2022 4:07 pm

dataq1 wrote: ↑

Mon Nov 14, 2022 3:19 pm

lynninnj wrote: ↑

Mon Nov 14, 2022 2:18 pm

The guy sounds like a dope.

If he listened to Niko @ SleepHQ (link above), questioning Resmed's analysis of events etc, he (and their clinic) might have reason to be cautious.

lynninnj wrote: ↑

Mon Nov 14, 2022 2:18 pm

Why use the machine at all if you can’t trust the data or anything at all.

He didn't say they didn't trust the therapy (pressurized air) that was being administered, he was referring to the machine's capability to do patient diagnostics. You know, telling the patient how many apneas, how many hypopneas, etc)

But how does "he" (whoever "he" is) know whether the amount of pressurized air that a patient is using night after night after night is actually the right amount of pressurized air to use if he's not willing to use the machine's AHI data?

This is, in fact, the problem that real patients run into when they're set up with fixed pressure machines that record only usage data. The pressure is set based on one small snippet of what happened on one night in the artificial setting of a sleep lab. The patient may not have slept at all on their backs during that titration study. Or they not have reached a REM period while sleeping supine. But we don't sleep the same every night. And if your in-lab PSG titration study was done on a night where your apnea was not as bad as usual, you'll wind up with a recommended pressure level that is too low to prevent the real apneas and hypopnneas (however you choose to score them on a PSG) from actually happening in the patient's bedroom on most nights. Or a patient might not have significant problems with pressure induced central apneas on the titration test because the time at the prescribed pressure was under an hour; but sleeping at the prescribed pressure for 6-8 hours every night triggers CAs and a lower pressure really ought to be tried.

And if the doc just ignores the machine's AHI data because he thinks it's worth shit OR if the DME set the patient up with a brick that records only compliance data, there's no way at all to intelligently make a guess as to whether the pressure setting is wrong and needs to be adjusted when the patient comes back saying that they're having a whole lot of problems and they're not feeling well or (even worse) they're feeling worse than before they started therapy.

What then? Still do you still ignore the machine data because it doesn't score apneas and hypopneas in the way they're scored on a PSG? Or do you look at it and make an informed decision about whether the pressure might be too low (or too high) and order a pressure adjustment?

Agreed.

I stand by my dope remark and appreciate the explanation offered by dataq

dataq1 wrote: ↑

Mon Nov 14, 2022 2:13 pm

SleepHQ had a recent video that questioned the on-board analysis of ResMed machines. (h/t to Thumper1947)
https://www.youtube.com/watch?v=Q3jCsglrF38&t=22s

Did you watch that video? Do you realize that in that video Nicko of SleepHQ relies on the data the machine records? We knew even without watching that video that ResMed's definition of a hypopnea is a 50% reduction in flow, as opposed to a 30% reduction used by sleep labs.
Which mean that by definition they would report less hyponeas. CPAP's were not meant to be diagnostic tools. They are meant to supply a therapeutic device and hopefully one that lets therapy be monitored. They have a reliable measure of breathing disturbances, based on reasonable operational definition, and the devices have been validated during PSG's.

Forget the presumed inability to analyze - there is raw data on the SD.
As RobySue so aptly said:

robysue1 wrote: ↑

Mon Nov 14, 2022 2:05 pm

Anyone with one eyeball connected to half a brain should be able to compare a ResScan report and an Oscar report and realize that Oscar is reporting the same data with the same degree of accuracy if those reports are looked at side by side.

The CPAP's are recording data in edf file format's.
https://www.edfplus.info/ [all emphasis mine]

The European Data Format (EDF) is a simple and flexible format for exchange and storage of multichannel biological and physical signals. It was developed by a few European 'medical' engineers who first met at the 1987 international Sleep Congress in Copenhagen.[...] EDF was published in 1992 in Electroencephalography and Clinical Neurophysiology 82, pages 391-393. Since then, EDF became the de-facto standard for EEG and PSG recordings in commercial equipment and multicenter research projects.

https://www.fieldtriptoolbox.org/getting_started/edf/

With the support of the late professor Annelise Rosenfalck from Aalborg university, the engineers initiated the project “Methodology for the Analysis of the Sleep-Wakefulness Continuum” (1989-1992) that was funded by the European Community through its “Comité d’Action Concertée” (COMAC committee) on Biomedical Engineering. They wanted to apply their sleep analysis algorithms to each others data and compare the analysis results. So, on a morning in Leiden in March 1990, they agreed upon a very simple file format to exchange their sleep recordings. This format became known as the European Data Format. In August 1990, all participating labs had contributed an EDF sleep recording to the project.

A list of EDF(+) comatible companies

How many times on this forum have people been asked to upload their OSCAR data because AHI is not enough?
How many time have people been asked about their feeling, their sleep quality???

And that is why Gene is now being asked to upload his whole SD card - and being offered help in doing that by kind, caring, intelligent people who know how important that is. Who know how their own therapeutic experience has been immeasurably improved when the reliable raw data recorded by their machines was analyzed by human beings.