Sleep Doc Liked My Data

Slartybartfast wrote:Went to see my pulmonologist this afternoon for my 6-month checkup.

Took hard copies of ResScan data reports to which I had appended oximetry reports from my CMS 50E, showing several nights where I alternated between my prescribed 11 cm fixed pressure and 9 cm minimum pressure in Automatic mode.

The doc shook my hand and asked how everything had been going, so I filled him in on my history. I didn't expect him to remember me after 3 months. So I reminded him that I had come to him with a chronic non-productive cough, having had bronchitis six times in the prior 9 months, feeling horrible, not knowing what was wrong, until the sleep study he ordered showed I had severe OSA. I got on CPAP, and all my symptoms went away immediately. While I was talking he was leafing through my file, nodding his head and making a few notes here and there.

Then I opened my briefcase and took out the ResScan reports. He suddenly paused, and stiffened a little. "You have software for your CPAP? Where did you get it?"

"The internet is your friend." (Evil grin)

"Okay. Hmmm," as he started leafing through the reports. Then I showed him that I had several nights of back to back data with the prescribed 11 cm fixed and my preferred 9 cm APAP settings, both with oximetry data to show that they are equally effective.

"We gave you an automatic machine?"

"No, I wanted an automatic machine, so bought my S9 Autoset online out-of-pocket."

"OK. Where did the oximetry data come from?"

Then I took out my CMS 50E and handed it to him. "I bought a pulse oximeter to verify that my therapy was just as effective in my own bed as it was here in your lab. I figured one night's data might not be predictive of what happens with me at home in my own bed. Remember, I'm a researcher, and I like data."

"You're an engineer, then?"

"No. Chemist. Pharmaceuticals." He nodded his head, remembering we had talked before. He scribbled that down, along with the name of the company I work for.

He looked through his file and found the titration report. "Here it is. CPAP 10.5 to 11 cm. And your machine's data shows . . . 10.8 cm 95th percentile. That's not bad for a machine to agree so closely to what we came up with." He was grinning broadly by this time. I knew I had turned the corner with him.

Then I turned the oximeter on and clipped it to my finger. The Doc's eyes grew wide when he saw all the information on the colorful display. He looked for all the world like a kid who had seen seen a new toy that he had to have. "It's even got a pulse wave. I've never seen one of these except on a monitor in the hospital. That's great. Where did you get this?"

"Just Google ‘Contec CMS 50E’ and several vendors will come up. It's only about $130." Doc wrote down the information. I gave it to him and he clipped it on his finger.

I showed him the menu and the settings and he asked, "So how did you get the printout?"

"It comes with software. You just plug it into a computer with the USB cable and download the data.”

"No Way! Software included? For $130? That's amazing."

"And if you want to collect the data in real-time, it even has Bluetooth."

“Bluetooth, too? I can't believe this. We don't have anything like this here. Everything we have is hard wired. Do you know what we would have to pay for something like this?

"Several hundred dollars?"

"Try several THOUSAND dollars! Wow, I can't believe it." He was grinning and exploring the menu features. (I expect some online vendor will get an order shortly)

Several minutes later, fully understanding what I had been doing since he saw me last, Doc looked over all my data and pointed out the few spikes that dipped below 88% SPO2. "Those are nothing. I wouldn't worry about those. Your oxygen saturation is always around 95%. That's excellent. Night after night. Very consistent. It shows your therapy is working. And here, you see your pulse went up a little here, and later down there? I bet that's when you rolled over on your side. You probably went to sleep on your back, here, and then when you rolled onto your side your pulse dropped. They ought to make a position sensor for this, too."

We talked back and forth for a while. I was his last appointment of the day so he had plenty of time. We talked about the data reports, about how he doesn't like the the idea of the software identifying "centrals," since central apneas can't be diagnosed without EEG data, and the "centrals" likely being an artifact of the CPAP therapy, anyway, so why should they count toward the AHI, and if you hook a rabbit up to a ventilator it will stop breathing on its own because the CO2 level remains too low to initiate breathing which mimics a central apnea, myoclonic jerks now being termed "sleep starts. . ." We went back and forth, each finishing each other's sentences for a while. I gathered that he was comfortable with my level of understanding of the therapy.

The take home messages from all this were:

Doc complimented me on taking the time to quickly learn what the therapy is all about, then getting a pulse oximeter to verify that it was working. He said that outside of a sleep lab you really can't know whether your CPAP therapy is effective without oximetry data. And having the reports with oximetry data brought in to him like this makes his job a lot easier, and his patients would also do better if more of them showed such motivation.

Slartybartfast wrote:Here you go.

You can see the areas of erratic breathing.
From that you can get the start and end times, and the go into your xPAP software and note what was happening with your breathing during those times.
It takes some digging, but the data is there.

Usually any events I have are associated within those intervals. Doc says that pattern is consistent with what he sees in the lab during patients' REM sleep.

Slartybartfast wrote:Here you go.

You can see the areas of erratic breathing.
From that you can get the start and end times, and the go into your xPAP software and note what was happening with your breathing during those times.
It takes some digging, but the data is there.

Usually any events I have are associated within those intervals. Doc says that pattern is consistent with what he sees in the lab during patients' REM sleep.