Quote:

When I asked her how it went she said she'd just gotten there and didn't know.

Say, that's a great routine, I'll have to try that.

Is this the same lab?  Or really. is the same software being used?

In re: the other stuff, was the pulse oximeter probe on your finger or your ear during those sleep studies?
sleepydave

Dont forget to practice the "I'm too busy jerking tape off your face to make eye contact" routine that goes along with the "I just got here so I know nuh-ting!" line.  

This is a different lab but I asked if they use Sandman and they do. I also asked for copies of the files on a cd and got the healthcare worker guarded "I don't know anything about that" answer. I feel a battle coming.

The pulse ox probe was on my index finger for all of the studies, including last night.

SnoozeHunter

SleeplessJ wrote:

As a person with lots of hypopneas (and a surprising, though not serious, number of Centrals) I hope that's not what I have.  It sounds much harder to treat  

SleeplessJ,

I hope too that you don't have it. It sounds like a can of worms and I'd hate to have to throw you into the moat.  

Here are a couple of things I remembered from the sleep study the other night. I was talking to the night tech about the numbers from my last two titrations which she had reviewed. I said that I was not able to tolerate 19/15 but that I'm aware some people are on even higher pressures. I think someone here in the forum mentioned being on 25 or higher. The tech said that legally they can only take it up to 21. Is that true? Some machines can be set higher so why would it be illegal to do so?

I asked about scoring and the tech said she'd do some during the night while she monitored, but the scoring of the study would be done by the software. She said they no longer manually score the studies because the software has improved. When I asked how accurate the scoring software is, she replied that no method is 100% accurate. I completely agree with that statement, but I'm a little concerned that my diagnosis will be based soley on software algorithms, especially since they don't seem very keen on giving me a copy of the files.

Forgot to tell them that I awoke with some chest pain at least once during the night. It will be interesting to see if that causes any irregularities.

And, I think I might have snored. I rarely, if ever, snore so I'm not sure why I would have that night. But I awoke once to noise that seemed to be coming from my throat and it wasn't the usual exhalation noise.

SnoozeHunter

Hi snooze:

Quote:

The tech said that legally they can only take it up to 21.

And then what?  The CPAP Police come bustin' in?

The only regulation I know of is from the 1995 FDA Draft Guidelines for Ventilators which under

Quote:

6.0 SPECIAL REOUIREMENTS & TESTING FOR VENTILATORS WITH NON-ACTIVE EXALATION VALVE CONTROL

says you can build a machine that goes to 30 cmH2O, but that's about it.

Now, clinically, if you're up to 21 cmH2O of CPAP you really have to ask yourself if that's where you wanna be, but that's something different.  So perhaps there was a lab-specific policy that relates to that.

Ahh, computer-assisted scoring.  They can push that button all they want, but the AASM Standard for Laboratories 14.b. says

Quote:

If used, computer-assisted scoring must be reviewed on an epoch-by-epoch basis for accuracy.

which means they have to go back over the whole thing by eyeball.  At least if they want to adhere to the standard.
sleepydave

sleepydave wrote:

Ahh, computer-assisted scoring.  They can push that button all they want, but the AASM Standard for Laboratories 14.b. says

Quote:

If used, computer-assisted scoring must be reviewed on an epoch-by-epoch basis for accuracy.

which means they have to go back over the whole thing by eyeball.  At least if they want to adhere to the standard.
sleepydave

Sounds like there might be a whole new career field opening up for speed readers!  Hire someone who can flip through pages reallllly fast.  Sign something that says, "Yep, I reviewed (translation: glanced at) every epoch with my own eyeballs and agree with the computer's results."

"Well, I might have missed a few pages when I blinked, but hey...who's counting?"     

rested gal wrote:

Sounds like there might be a whole new career field opening up for speed readers!  Hire someone who can flip through pages reallllly fast.  Sign something that says, "Yep, I reviewed (translation: glanced at) every epoch with my own eyeballs and agree with the computer's results."

"Well, I might have missed a few pages when I blinked, but hey...who's counting?"     

hee hee

Sounds like a good job.  

The thing is, it would be really great if the tests could be reliably scored by a software program. It would standardize the scoring of events instead of leaving it open to tech and physician interpretation which can vary. Maybe this software can do that, but in my experience, medical interpretation by software programs is only good as a second reader, not as a replacement for a human with experience. Generally, the two together, experienced human + software, can increase accuracy of diagnosis over either one alone.

I've already mentioned to the nurse that I want copies of the sandman files. My follow-up appointment with the doc is July 26th and I'm going to take a blank cd with me and ask him to get them for me. I hope he doesn't give me a hard time about it.

Snooze

Sorry 'bout the formatting. The good news is that I'm in the low moderate range now instead of severe. My sleep architecture is still not good, but during the short times I was in stage 3, things straightened out pretty well. My O2 level was a little lower during that time but still within good range.

The doc says no more pap therapy as that only multiplied the centrals and didn't help me feel better. He wants to try meds now to make me sleep.

Total Sleep Time:      291.5
Sleep Latency:          18.0
REM Latency:            128.5
Sleep Efficiency:        67.0
REM Periods:             3
Stage Shifts:             137
Awakenings:             50

Stage 1:    7.9%
Stage 2:    79.9%
Stage 3:    2.6%
Stage 4:    0.0%
REM:         9.6%
MVT:         0.0%

NREM:
Central Apneas:    21    Index:    4.8
Obstructive Apneas:    1    Index:    0.2
Mixed Apneas:    0    Index:    0.0
Hypopneas:    42    Index:    9.6

REM:
Central Apneas:    0    Index:    0.0
Obstructive Apneas:    0    Index:    0.0
Mixed Apneas:    0    Index:    0.0
Hypopneas:    13    Index:    27.9

AHI:    15.9

SaO2:    
Mean:94.8
Min 88.0

Total Arousals:
    NREM:    97    Index: 22.1
    REM:    16    Index: 34.3
    Total:    113    Index: 23.3

PLM’s:
    NREM:    7    Index: 1.1
    REM:    0    Index: 0.0
    Total:    7    Index: 1.4

PLM Arousals:  All 0

Respiratory Arousals:
    NREM:    64    Index: 14.6
    REM:    13    Index: 27.9
    Total:    77    Index: 15.9

Spontaneous Arousals:

    NREM:    33    Index: 7.5
    REM:    3    Index: 6.4
    Total:    36    Index: 7.4

SnoozeHunter, have you thought about trying a dental device, like the TAP II, or TAP titanium (whatever it's called)?

Might be difficult to sleep with, and isn't going to address centrals; but maybe would take care of the hypopneas.  Maybe?

snoozehunter wrote:

Sorry 'bout the formatting.

There are over 12,000 violent crimes per year committed as a direct result of phpbb formatting.

I don't see any 45 meg data files.

rested gal wrote:

SnoozeHunter, have you thought about trying a dental device, like the TAP II, or TAP titanium (whatever it's called)?

Might be difficult to sleep with, and isn't going to address centrals; but maybe would take care of the hypopneas. Maybe?

Not a bad thought, RG.  Still like to look at the raw data first, tho.  I have yet to see a real obstructive event yet on the snooze during ambient pressure, only a pile of sleep-onset periodic breathing.

And that architecture...

...packing in 50 awakenings, 67% sleep efficiency and 137 stage changes and/in only 5 hours of sleep, in making a priority list, I can see where treatment of insomnia jumps to the top.

Respiratory events contributing to that tho?  Still could be.  Low-level CPAP as an option?  Don't throw the machinery out yet.

Low(ish) oxygen level again, hmmm?  Now, once periodic breathing starts, it can be perpetuated and worsened by desats.  And although that was readily apparent in the sleep studies, the oximetries really didn't demonstrate that.  Did you get a clean pulmonary bill of health (PFTs, at least screening spirometry) lately?  
sleepydave

rested gal wrote:

SnoozeHunter, have you thought about trying a dental device, like the TAP II, or TAP titanium (whatever it's called)?

Might be difficult to sleep with, and isn't going to address centrals; but maybe would take care of the hypopneas.  Maybe?

I hadn't thought about it but it might not be a bad idea. I have TMJ syndrome anyway so maybe it would help that, too.

Thanks for the suggestion!

sleepydave wrote:

There are over 12,000 violent crimes per year committed as a direct result of phpbb formatting.

Your formatting Kung Fu is the best! How do you do that? When I use the "code" formatting it still looks terrible.

Quote:

I don't see any 45 meg data files.

I haven't seen any yet but I'm still working on them. As a matter of fact, they didn't even give me the report that goes to the physician. The sleep doc left the room and said that someone would copy all the papers and give them to me. But she told me the doc wanted to change some mistakes in the report so I should call her next week and she'll fax it to me. Hmm...wonder what that's all about. I'll remind her about the data files at that time if I haven't gotten them before then.

Quote:

Still like to look at the raw data first, tho.  I have yet to see a real obstructive event yet on the snooze during ambient pressure, only a pile of sleep-onset periodic breathing.

One of the papers they copied for me was the tech report, an hourly log sheet. At the bottom it reads, "Pt has sleep onset central apneas which cause freqent arousals." Also, she mentioned that I snored starting with the third check. (Ha! I thought I heard myself snore!) It seems that the deeper into sleep I get, the more I snore, but the apnea disappears.

The doctor said they couldn't determine whether the hypopneas were obstructive or central in nature.

Quote:

And that architecture...

Yeah, that architecture. I went back and looked at my 2003 diagnostic and my sleep architecture wasn't half bad then. Ahh...the good old days.

sleepydave wrote:

...packing in 50 awakenings, 67% sleep efficiency and 137 stage changes and/in only 5 hours of sleep, in making a priority list, I can see where treatment of insomnia jumps to the top.

Yes, it looked like I slept pretty well once I was able to get to stage 3. The problem is getting there. I haven't had much luck with sleep meds. The Lunesta works well for keeping me asleep once I get there, but I still have difficulty getting past stages 1 and 2. He gave me a prescription for Xanax. I haven't filled it yet because my family physician wants me to try Wellbutrin and the sleep doc said to wait and see if that makes any difference. The family doc says that some people who take it get an energy boost from it so, since I can't take the usual stimulants because of insomnia, he thought this would be worth a try. In 2 weeks I'm supposed to start the Xanax.

I have very mixed feelings about going the chemical route.

Quote:

Respiratory events contributing to that tho?  Still could be.  Low-level CPAP as an option?  Don't throw the machinery out yet.

Severus is standing by. I would swear it's the respiratory events that are waking me up, but the doc says I'm waking up and then having an event. He said the pattern was unusual. There was something else he said was unusual on my study but I don't remember what it was. When the tech handed me the copied papers I didn't look through them. I assumed they were the same ones the doc showed me in the exam room. They're not. So I'm really hoping to get the data files.

Quote:

Low(ish) oxygen level again, hmmm?  Now, once periodic breathing starts, it can be perpetuated and worsened by desats.  And although that was readily apparent in the sleep studies, the oximetries really didn't demonstrate that.  Did you get a clean pulmonary bill of health (PFTs, at least screening spirometry) lately?  

By coincidence I had a spirometry test last Friday. I went in for my weekly allergy shot but they wouldn't give it to me because I was coughing and had a fever. Instead they took my bp, which was pretty high that day, and did the spirometry. The spirometry looked very good but they told me to follow up with my family doc about the blood pressure. I did on Monday and that's when he gave me the prescription for Wellbutrin. When I asked, he said I didn't need to get my heart checked.

SnoozeHunter

I don't know about all of them, but some of them were environmental. I remember waking to the sound of the hospital's care flight helicopter landing, the sound of a flushing toilet, the sound of water running like someone was having a shower, and the sound of people talking a couple of times. And one time I woke myself up snoring.

Speaking of snoring, is there any way to tell from the tracings if the snoring is on inhalation or exhalation?

SnoozeHunter