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.