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Mr Capers wrote:Your comments on my reports would be most welcome

Were there any measures of sleep during your portable study?

Do you have the actual reports?

If so, can you scan and post them?

Did you ever notice that dsm's posts look like a bunch of CPAP "buzzwords" thrown aimlessly together?

Muffy

Muffy wrote:Did you ever notice that dsm's posts look like a bunch of CPAP "buzzwords" thrown aimlessly together?

Yes, I've noticed dsm doing that more times than I can count. Muddying the water.

Of course, I've done that myself a number of times, too!

Mr Capers, as I think you already know, I believe you're in good hands with -SWS and Muffy helping you work on your treatment issues.

Hi Muffy,

My at home sleep study reported nada on sleep. Breathing, positions, SpO2, snoring, but no sleep data. (It also missed that our waterbed sprang a leak that night and I awakened quite wet!) The report is from "Somnologica," perhaps you are familiar with these. I've not tried to scan it yet, but I did reproduce a lot of the numerical data in an earlier post. Here it is again:

Maybe this will help you some.

I would like to know more about sleep data, but don't know that I can finagle a real sleep lab sleep study out of Kaiser.

Thanks for looking and Happy Naps,
Mr Capers

Mr Capers wrote:I would like to know more about sleep data, but don't know that I can finagle a real sleep lab sleep study out of Kaiser.

Let's find out from your next visit if that's really true, Mr Capers. I don't think that's the case. I sure hope that's not the case. My understanding is that Kaiser is supposed to rely on PSG sleep studies as a tertiary method in difficult cases like yours.

Here's a document I just rendered with a Google search that describes some of Kaiser's rationale behind using home testing for the easier-to-manage OSA cases: http://www.foocus.com/pdfs/Articles/JanFeb08/Vernon.pdf

It's simple. You are NOT an easy-to-diagnose OSA case. Nor are you apparently an easy to "home titrate" case of mixed-apnea or CSA for your Kaiser health professionals. You genuinely NEED a PSG.... Period. Kaiser is supposed to give you a PSG since the portable home testing you received is not even CLOSE to suiting your challenging diagnostic and titration needs.

Kaiser loves to save money like any HMO. But if they deny you the PSG that you need, then presumably thousands of other Kaiser sleep patients may have a similar serious healthcare problem on their hands. So let's give Kaiser the benefit of the doubt and see if they agree to arrange a crucial PSG for one patient with a rather complicated breathing disorder.

If they don't, then it's time to start investigating the exact scope of this problem. One patient? A few patients? All or most patients legitimately needing that "tertiary" PSG are routinely denied by Kaiser. We can place dedicated fact-finding Kaiser polls on ALL the apnea message boards if necessary...

But let's give Kaiser the benefit of the doubt. They might gladly comply with a necessary PSG now that your treatment attempts have reached this point.

Mr Capers wrote:The report is from "Somnologica," perhaps you are familiar with these.

I believe I am actually a family member now, perhaps a second-cousin-once-removed. Somnologica married Rembrandt and begat RemLogic. Sandman was betrothed to RemLogic, and is currently being dragged up the aisle in Holy Matrimony via "Shotgun Wedding". It remains to be seen if a shotgun can hold up against a Dillon.

Mr Capers wrote:I've not tried to scan it yet, but I did reproduce a lot of the numerical data in an earlier post.

Right, saw that. Did you get a page entitled "Summary Graphs"?

Mr Capers wrote:I would like to know more about sleep data

Me too. Bad sleep is the easiest way to screw up an ASV algorithm.

-SWS wrote:You genuinely NEED a PSG.... Period.

At this point, we could use at least 4 of them:

An original diagnostic
A multi-mode titration (BTW, do you have the CPAP D/L)?
One on stable ASV
One with ASV dyssynchrony (don't bother to Google that, I just made it up)

Portable testing. So easy a caveman can do it.

Muffy

Hi Muffy and SWS,

What I really needed was to lose the internet That happened over the last few days. I've spent an ridiculous amount of time backing up, and doing a fresh install of the Mac operating system, and praying I wouldn't lose my windows stuff (on the same mac).

I'm not happy, but I'm at least back online but am having ASV dyssynchrony

"I didn't think that happened in this dimension," said Dr. Spock.

I gotta pay bills, get food to keep us lifes and limbs together, hit the ATM - get $, and download and install 48GB of updates for both systems. So, will get back with you in a day or two. In the meantime, please keep the food fights down to easily digestible stuff like mashed/pureed, creamed, etc. and leave off the tough hockey pucks and cow pies.

Happy Naps,
Mr Capers

Muffy wrote:

One on stable ASV
One with ASV dyssynchrony (don't bother to Google that, I just made it up)

Ok, I'll bite. (Nothing pureed here, just tough old meat) What do you mean by 'ASV dyssynchrony'?

timbolionguy wrote:Ok, I'll bite. (Nothing pureed here, just tough old meat)

Probably ASV's version of BiLevel asynchrony. At least that last one was just as Googleable as the word Googleable itself. But I think the concept Muffy is driving at is that in the case of a disordered respiratory controller related to CSDB, unstable sleep itself tends to cause unstable breathing---and vice-versa, as the two can become a vicious cycle.

Anyway the SV algorithms can sometimes have a tough time getting an efficient "lock' on chaotic CSDB/CompSAS breathing patterns, which are commonly exacerbated by unstable sleep itself. Those incessant sleep/wake transitions are inherently unfriendly to a disordered CO2-related homeostasis mechanism. The resulting chaotic breathing patterns can make it exceedingly difficult for the SV algorithms to normalize AHI in some CSDB/CompSAS patients.

Mr Capers wrote:In the meantime, please keep the food fights down to...

Food fights... I can't think of a better way to get stuck with "double secret probation" in just about any language: