SnoozeHunter wrote:

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

But doesn't it give you that warm feeling when they call it "Lab Effect"?  Kinda like the same feeling you get when you scratch a blackboard with a fork?

Yeah, depending on the sensor, you can usually match up the snore with the flow waveform.  In the case of a flow transducer, you can make it part of the waveform, but I don't think a lot of people do that, it makes that waveform too busy.

Snoring (and obstructive events in general) tend to be inspiratory events, as the negative pressure generated behind the obstruction then contributes to it.  Exhalation will apply positive pressure to an obstruction and reduce it.

Formatting in phpbb is greatly aided by the use of a ball-peen hammer.  Some of the problem (as you probably figured out already) is the use of tabs.  You can put 'em into phpbb when you c&p from the external word processor, but you can't directly add them, you end up scrolling through the command buttons.  And in the word processors, tabs are set in inches, but phpbb makes them 3 spaces (at least today, anyway).  Maybe if Mike turned the html button on it would make things easier, but then you could also send in commands like <destroy entire forum><execute now> which might upset continuity.

Which reminds me, I gotta get another tracing for that LFCT thing up there, there may be a good reason why BiPAP creates so much havoc, whereas plain old CPAP may not (and this seemed to be borne out in the oximetry).
sleepydave

sleepydave wrote:

But doesn't it give you that warm feeling when they call it "Lab Effect"?  Kinda like the same feeling you get when you scratch a blackboard with a fork?

Thanks, Dave. I had to rub my teeth and pat down the hairs on the back of my neck when I read that.

Quote:

Yeah, depending on the sensor, you can usually match up the snore with the flow waveform.  In the case of a flow transducer, you can make it part of the waveform, but I don't think a lot of people do that, it makes that waveform too busy.

It wasn't a big deal anyway. I was just wondering if any of them were those weird exhalation things my kids have mentioned.

Quote:

Formatting in phpbb is greatly aided by the use of a ball-peen hammer.  

LOL! As my British SO would say, you nearly made me spit. Hopefully there are no more sleep studies in my near future to post, but I'll keep the ball-peen handy just in case.

Quote:

Which reminds me, I gotta get another tracing for that LFCT thing up there, there may be a good reason why BiPAP creates so much havoc, whereas plain old CPAP may not (and this seemed to be borne out in the oximetry).

That sounds interesting.

I called the sleep center yesterday to see if the other part of my report was ready and to ask again for the data files. The nurse had seen the report earlier in the day, but wasn't sure where it had gotten to just then. She was going to fax it to me right away but it hadn't come across by the time I left work. She seemed a bit stymied by my request for the data files. At first I thought she was telling me it wasn't possible as in "we could show you, but then we'd have to kill you", but I think she meant she had no idea how to get to the data and copy it and wasn't sure anyone there would know how. She said nobody has ever asked for them. I'll keep trying.

SnoozeHunter

Yesterday, the nurse from the sleep lab faxed some more papers to me. One is the sleep doc's interpretation that goes to the referring physician, which is basically a watered down version of the psg report. The others are progress notes that include a synopsis of history, psg results, and treatment plan. The nurse called me first to make sure I was in the office to receive the fax and to give me a message from the director.

About the data files, the director told her to tell me that they do not have that capability but he'd be happy to sit down with me anytime and pull the study up on his computer and go over it with me.

I'm trying to remain objective and open-minded. Really, I am! Since the other lab has the same software system and they were able to download the files and burn them onto a cd for me, I would think this lab would have the same capability. I'm pretty sure it's not an ancient version of the program because it's advanced enough that they trust it to do the scoring for them. So, maybe he means that they don't have a cd burner and they don't know another way to capture that much data onto portable storage, or they have a cd burner but don't know how to use it, or they don't have a clue how to copy files from one place to another.

Or maybe they just don't want to give me a copy of those files? Nah.

I might take the director up on his offer, and take my little 1gb flash drive along just in case. Gotta be a usb port on that computer somewhere.

SnoozeHunter

Hi All!

Just a quick update in case anyone wanted to know how all of this turned out. Last time I saw the sleep doc, he prescribed something to help me sleep at night. I don't remember what it was because I never got the prescription filled and I canceled my follow up appointment with him. I didn't bother seeing the director of the sleep lab. My pcp prescribed Wellbutrin because he said some people get an energy boost from it during the day. I didn't feel any change at all so I stopped taking it after a month's trial.

I am sleeping better without the machine. I fall asleep earlier and faster, and sometimes sleep through until my alarm goes off in the morning. Some nights I wake up early and don't go back to sleep, but I don't sleep in fits and starts any more, don't wake up feeling like I haven't had a breath in ages, and I don't wake up feeling exhausted even when it's a couple of hours before the alarm sounds. I'm dreaming normally again! During the day I still get sleepy, sometimes painfully so, but I don't zone out while driving, and I haven't fallen down in a long time. I have decided not to pursue a fix for the apnea again unless something dramatically different and more promising becomes available for folks like me who don't have apnea of the obstructive type. In my case, the standard treatment was worse than the disorder. I believe it was directly responsible for at least some of the worst symptoms I experienced last year. What a nightmare.

For those of you who benefit from pressure therapy, keep on papping and sleep well!

SnoozeHunter

Hi Snooze:
Always good to hear from you, your saga has been a great source of info for gaggles of folks.

One of these days we have to give the Adapt SV a shot.

If you do, when you walk into the door of the sleep lab, tell them, "Hi, I'm the Snooze, and don't go crazy with them dials!"
sleepydave

So, Snooze, did you ever get the data files? Did you have to take your flash drive in or were they finally willing and able to burn them to a DVD or CD for you?

Hi Dave!

Tha Adapt SV sounds like a step in the right direction for me. Problem is getting one of the docs around here to let me try it and write a prescription for it. They seem to have a one size fits all mentality. So the other condition that has to be met before I'd consider seeking tx again: new doctors in this area who have open minds, more knowledge, and better equipment. I never envisioned that the outcome of all these posts would be that I'd end up completely off pressure therapy, but until I find someone around here who can convince me that he/she has some expertise, I'm not willing to let them play with my health anymore.

I am greatly indebted to you for your time and invaluable advice regarding my sleep studies. If not for you, I'd still be suffering from sleepless nights and broken bones. I'm sure I was an auto accident waiting to happen. Please feel free to use my studies any time in your examples.

SnoozeHunter

ChronieToo,

I never did get the data files. I kept thinking about going back to the sleep lab, but figured it was pointless. I couldn't just walk in and call the director a liar, especially since it's possible he was telling the truth. Maybe their equipment really is so !@#! they can't download the data files. Either way, it was very unlikely that I'd get the files from him. That whole spiel about pulling the study up on the computer and going over it with me struck me the wrong way. He might have been sincere and thought he was offering good service, but it had the feel of condescension to me. I decided it wasn't worth getting irritated about or wasting any more time and money on so I cancelled both follow-up appointments with the sleep doc and let the whole thing go.

SnoozeHunter

Thank you, SnoozeHunter. I intend to try for mine when I next see my sleep pulmo. In fact, I'll ask about it next Wednesday when I go in to the sleep clinic to pick up my report.

This is a new clinic but one of the sleep docs was my sleep doc my first sleep study at another clinic about 10 years ago. When I had the sleep study earlier this year and went in to pick up my report and results the staff said they couldn't give it to me. So - I cancelled the titration study they had me scheduled for and told them I would continue elsewhere. This pulmo doc is only at this clinic every third week. He saw to it that I got the report and graphs. But by that time my family doc had put me on 02 overnight so he told me to come back in 3 months to pick up the pulse oximeter for an overnight oximetry, which I did. Then he scheduled me for this titration study. So we'll see. I think he knows me well enough by now that he won't refuse. I'm not bashful about saying right up front that I have my doubts if he says they can't make the CD/DVD or download the data files to my flash drive.

I come from the era when the medical profession liked to keep everything a big mystery. God forbid a patient should know their temp or BP back in the old days! Then they wonder why we don't trust them??? I don't tolerate that anymore. I get a copy of EVERYTHING including nurses's notes, etc. now. Or I get pushy. And eventually I get them.

[
OK, this is the beginning of the study.  And there's a couple of things wrong.  The biggest problem is that the Airflow channel is blown.  Or not even hooked up.  So all you get is a bunch of artifact.

The sleep centre here is smarter than you think, they are using cpap flow to measure airflow, this removes the need to place an airflow sensor under your nose along with the CPAP mask. The airflow is not blown at all but is seen in the CPAP flow, You are correct in this though being CPAP or BiPAP induced central sleep apnea. Also be careful of looking at a study where the central events are seen at sleep onset or right after an arousal, this is an indication of the patient struggling to breath against the CPAP device and is not considered significant unless they become repeated one after the other.


_________________
Iain Boyle MS, MLT(CSMLS), RPSGT

Ian!!! Welcome! What a pleasure to see your response and to have you assist in answering our questions! Thank you.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

IainB wrote:

[
OK, this is the beginning of the study.  And there's a couple of things wrong.  The biggest problem is that the Airflow channel is blown.  Or not even hooked up.  So all you get is a bunch of artifact.

The sleep centre here is smarter than you think, they are using cpap flow to measure airflow, this removes the need to place an airflow sensor under your nose along with the CPAP mask. The airflow is not blown at all but is seen in the CPAP flow, You are correct in this though being CPAP or BiPAP induced central sleep apnea. Also be careful of looking at a study where the central events are seen at sleep onset or right after an arousal, this is an indication of the patient struggling to breath against the CPAP device and is not considered significant unless they become repeated one after the other.

Unfortunately, the image links in this thread have deteriorated over time.  The image that you are referring to actually discusses tracking R-R intervals, and the thick red line is the EKG, which is highly compressed in that 1000 second view.

The image that referred to airflow loss is actually



Ed

IainB wrote:

[
Also be careful of looking at a study where the central events are seen at sleep onset or right after an arousal, this is an indication of the patient struggling to breath against the CPAP device and is not considered significant unless they become repeated one after the other.

I have seen other references like this and I don't quite understand why some events are considered significant and others not. Do not all apnea events equate to a cessation of breathing accompanied by the the resulting effects of not breathing, regardless of the cause of the event or the time at which it occurred? Or does lack of oxygen at the beginning of the sleep cycle or after an arousal not have the same effect on the body as at other times?

Thanks for any clarification you can offer.

buglet wrote:

IainB wrote:

[
Also be careful of looking at a study where the central events are seen at sleep onset or right after an arousal, this is an indication of the patient struggling to breath against the CPAP device and is not considered significant unless they become repeated one after the other.

I have seen other references like this and I don't quite understand why some events are considered significant and others not. Do not all apnea events equate to a cessation of breathing accompanied by the the resulting effects of not breathing, regardless of the cause of the event or the time at which it occurred? Or does lack of oxygen at the beginning of the sleep cycle or after an arousal not have the same effect on the body as at other times?

Thanks for any clarification you can offer.

Its not significant (IE not score-able) because its a central apnea that has NOTHING to do with the brains inability to get your muscles the message to breathe. For instance, a person may have a central apnea after yawning, however he would NOT be diagnosed with central sleep apnea.

Another example is movement effects on SPO2 values. If a patient moves around, his SPO2 may read at 0%, but techs realize that it isnt "real", thus it is a discounted value.

RAM_Sleep wrote:

Its not significant (IE not score-able) because its a central apnea that has NOTHING to do with the brains inability to get your muscles the message to breathe. For instance, a person may have a central apnea after yawning, however he would NOT be diagnosed with central sleep apnea.

Another example is movement effects on SPO2 values. If a patient moves around, his SPO2 may read at 0%, but techs realize that it isnt "real", thus it is a discounted value.

Thanks, RAM_Sleep. If I understand you correctly, the term "significant" then refers to whether or not they are considered scoreable and does not allude to whether or not they have any physical affect on the patient. That makes sense.

I still have a question. I understand why these events would not be considered "central sleep apnea", and I understand that a random post-yawn apnea has no adverse effects, but if a person is consistently having events at the onset of sleep and after arousals, and let's say these sleep onset and post arousal events occur more than 10 times per hour, is it not having the same physical affect on the body as an apnea event from a closed airway or a bio-signal failure? If not, why not?