Callen's questions...

Rubicon wrote: ↑

Tue Apr 25, 2023 3:59 am

kteague wrote: ↑

Tue Apr 25, 2023 2:59 am

Seems it often gets suggested when a separate thread would be better for either/both posters to get targeted responses. The way I see it, unless someone appears to be intentionally problematic, let things sort themselves out. I hate to think of you taking your time to move things around etc. We'll figure things out. You give enough time to this group as it is.

Agree.

If people post "My heart stops for about 30 seconds 6 times a night. Do you think that's a problem?" and put it in "Granny's Joke of the Day", ain't our problem if they wake up dead one morning.

Mr. (edit by moderator to remove personal information), I tried to send you a link to my OneDrive file, but it stated the email did not exist. I can't PM you on here either because my account is new. I'm too desperate to care right now, so I'll post the link to my OneDrive here. https://1drv.ms/f/s!Anq_rJGQiqX1gYF0IAV ... w?e=8Ix1Iq

Callen wrote: ↑

Tue Apr 25, 2023 9:35 pm

I can't PM you on here either because my account is new.

That's OK I usually don't respond to PMs anyway.

So you're hijacking the thread about hijacking.

There's no REM on the MSLT. Overall there are massive scoring errors. Technical quality of studies is poor. Whoever did it had NFI what they were doing. Chin EMG is missing which pretty much invalidates the MSLT (everything, really).

Studies should be repeated at a reputable center.

So you're hijacking the thread about hijacking.

While I figured you’d appreciate the irony, I didn’t think my situation was something that the forum would provide input on.

There's no REM on the MSLT. Overall there are massive scoring errors. Technical quality of studies is poor. Whoever did it had NFI what they were doing. Chin EMG is missing which pretty much invalidates the MSLT (everything, really).

FFS. I thought I things looked off - I chalked it all up to the reader software being stripped of all functionality and my lack of understanding.

I understand the technical quality is poor, but what is your intuition about the study? Does it appear that I have SDB or anything to explain my poor sleep and excessive daytime sleepiness?

I’m going to be livid if it turns that my neurologist incorrectly diagnosed me with NARCOLEPSY because of the negligence and/or incompetence of the RPSGT that performed and scored my studies. This is the one and ONLY scorer for the Sleep Center.

Studies should be repeated at a reputable center

What is the best way to find a reputable center? I’ve already made an appointment next month with a different sleep medicine specialist. I am dumbfounded by this whole situation.

Callen wrote: ↑

Wed Apr 26, 2023 7:30 am

I understand the technical quality is poor, but what is your intuition about the study? Does it appear that I have SDB or anything to explain my poor sleep and excessive daytime sleepiness?

Hey I ain't Rumpelstiltskin.

I’m going to be livid if it turns that my neurologist incorrectly diagnosed me with NARCOLEPSY because of the negligence and/or incompetence of the RPSGT that performed and scored my studies. This is the one and ONLY scorer for the Sleep Center.

Wasn't the +MSLT the ONLY basis for the dx. of N.?

Don't blame the RPSGT. According to Da Rules, the physician must review everything and sign an attestation that he did that.

What is the best way to find a reputable center?

You're a HCP. Start networking. More than a few people there should have some sound recommendations.

Hey I ain't Rumpelstiltskin.

That’s still out for debate.

Wasn't the +MSLT the ONLY basis for the dx. of N.?

The +MSLT and PSG. MD stated my fragmented sleep - frequent arousals and awakenings - on my PSG were supportive of the diagnosis.

Don't blame the RPSGT. According to Da Rules, the physician must review everything and sign an attestation that he did that.

Rules without enforcement are merely suggestions.

Epoch 292 in the MSLT has some room for discussion.



It starts out with 2 REMs and REM EEG. However, it reverts back to N1 based on SEMs and EEG change, and if we had EMG IMO the switch would be clearly defined.

Regardless, with only 12 seconds of REM activity, stage assigned must go to greatest portion, so this has to be N1.

So sleep is kinda like a fingerprint, Everybody is a little different, so it's of immense value to see what unambiguous REM looks like in PSG to help get a handle on what you're looking for in MSLT. Towards that end, Epoch 438 has some good tonic REM:

So I doubt the scorer was just arbitrarily throwing out 1s, 2s, and REMs and had some semblance of rationale in scoring. If you go to the other REM nap period (#4), there are some eye movements but they look more like SEMs to me:



Plus if you're having K-complexes (red circle) you can't be in REM, and there's quite a few.

But again, most importantly, EMG changes are critical here and without a signal, MSLT is Unacceptable For Analysis (UFA).

But again, most importantly, EMG changes are critical here and without a signal, MSLT is Unacceptable For Analysis (UFA).

I’m not sure why EMG data isn’t shown - I will link a picture to when I had all the electrodes on.

https://imgur.com/a/zfL1433

Tbh IDFK what to do. I’m inundated by perpetual sleepiness and I feel like I’m being gaslit by my providers. They all say my AHI of 8.5 (REM AHI 18.5) isn’t the cause of my sleepiness. My nasal flow on my PSG looks awful (to my untrained eyes.) It looks like there were so many RERA’s missed and/or scored as LM’s. I also don’t get how TF I can have limb movements I’m REM.

Callen wrote: ↑

Wed Apr 26, 2023 1:13 pm

I’m not sure why EMG data isn’t shown - I will link a picture to when I had all the electrodes on.

The reason there is no EMG signal from the chin leads is because...

...take a wild guess...

lazarus wrote: ↑

Sun Apr 23, 2023 11:33 am

Pugsy wrote: ↑

Sat Apr 22, 2023 7:29 am

How much of a set in stone rule do you all want when someone hijacks someone else's thread?

I can move things around but then the posts get squirrelly sometimes....so that's annoying as well.

It's also a lot more work for me.

Surely there are further opinions by others on the subject matter of the thread.

So, bump.

And this time a normal bump, not a nonsense bump, for a change.

I think that our glorious janitor (long may she reign) should split off thread hijacks,

Callen wrote: ↑

Wed Apr 26, 2023 7:30 am

So you're hijacking the thread about hijacking.

While I figured you’d appreciate the irony, I didn’t think my situation was something that the forum would provide input on.

Oh, we'll provide input on anything. Sometimes it's even useful input, and on occasion, it might even be helpful input, but that requires cooperation of the initial asker.

Callen wrote: ↑

Wed Apr 26, 2023 1:13 pm

to do. I’m inundated by perpetual sleepiness and I feel like I’m being gaslit by my providers. They all say my AHI of 8.5 (REM AHI 18.5) isn’t the cause of my sleepiness

I'd say they're FOS.

palerider wrote: ↑

Wed Apr 26, 2023 1:58 pm

I think that our glorious janitor (long may she reign) should split off thread hijacks,

I wish I could split this one off easily but with the way the forum software places posts in threads it wouldn't be clean and it would involve more work for me than just ignoring this obvious hijacking. It's not an easy clean job to move crap around here. I have tried it several times and each time it made a bigger mess and more work for me and right now I just don't have the time or mental energy to do it.

I didn't think this hijacking would be so continuous and on going. My mistake...I thought that maybe the hijackers would take the discussion to another thread created by the person who derailed the thread. A brand new topic should have been created.

Maybe since I have my answer to the original question I should just remove all my stuff (and others response to my question) and let the hijacker have this thread. It would be much easier for me to do that.

The reason there is no EMG signal from the chin leads is because...

...take a wild guess...

Oh god…. Please, no.

I just contact the office manager - she was ecstatic to hear my voice - and she said she would ask the sleep tech to look into it. They said they couldn’t add the video to the CD-ROM, but I specified chin EMG.

I’m hoping she put the chin leads on when I laid down (when she put the thermistor on.) Would the study be considered valid without chin EMG?