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Hypopneas - Should I care?
#1
I think my therapy is going pretty well, to the point where my obstructive apneas are near zero for the night.

However, the flip side is my hypos are up and make up the majority of my AHI index now. I also get some centrals, but they're minor compared to the hypos and usually resolve in 10 to 12 seconds.

My index is less than 3 most nights, but I'm seeing hypo events lasting up to 2 minutes at a time. I've tried searching about this, but I've come up empty.

So my question is this: is this a big deal, one that's worth scheduling a doctor visit about?
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#2
Dunno - depends on what the readings are. You COULD just shoot the chart to your doc, circling the parts you are not sure of, with a note asking is this all right. and usually you'll get a quick response, no charge.

My problem is that Resmed measures this differently than Philips does, so I can't be sure, and not seeing the chart, it is difficult to say.
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#3
(10-27-2013, 01:40 PM)DocWils Wrote: Dunno - depends on what the readings are. You COULD just shoot the chart to your doc, circling the parts you are not sure of, with a note asking is this all right. and usually you'll get a quick response, no charge.

It's cheaper to just go see him. It cost me $150 for him to read my sleep report.

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#4
Wow! If someone sends me their chart or a question (for my speciality, not sleep medicine) if it takes me less than five minutes to read it and less than two minutes to draft a reply, I don't charge. I know a lot of doctors here who do, and we have a special tax point (that is how were charge things, based on a point system) but I always figure it takes more time to enter the tax point data than it does to read and reply, so I don't bother.

If it is complex, then I charge, but a chart read is not a complex thing normally.

(And no, that is not an invitation for you all to send me your charts to read. I only read charts of my registered patients, and this forum does not allow me to be so generous at any rate, due to legal issues, nor am I inclined to be so generous. And sleep medicine isn't my speciality anyway.)
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#5
(10-27-2013, 12:55 PM)mdh235 Wrote: My index is less than 3 most nights, but I'm seeing hypo events lasting up to 2 minutes at a time.
Where are you seeing it? zooming-in flow charts. ResScan display Hyponea by blue rectangle, duration of events in seconds are not shown above the symbol as in the case of obstructive or central apnea

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#6
(10-27-2013, 05:38 PM)zonk Wrote:
(10-27-2013, 12:55 PM)mdh235 Wrote: My index is less than 3 most nights, but I'm seeing hypo events lasting up to 2 minutes at a time.
Where are you seeing it? zooming-in flow charts. ResScan display Hyponea by blue rectangle, duration of events in seconds are not shown above the symbol as in the case of obstructive or central apnea

I don't have the data on this computer, but I believe it was Sleepyhead that gave me the duration. I'll update this when I get back to my main computer.
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#7
Looking at your detailed nightly pressure plots, do you see the pressure maxing out at your limit of 12 for any duration of time? It may be that you need just that bit of extra pressure to completely eliminate your Hypopneas. You should consider raising your upper pressure limit from the current value of 12 (according to your profile). Personally, I like setting the upper limit at the maximum machine capability (ie. 20 for your machine), since the machine will not provide that pressure unless it thinks it needs to.
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#8
(10-28-2013, 04:51 PM)RonWessels Wrote: Looking at your detailed nightly pressure plots, do you see the pressure maxing out at your limit of 12 for any duration of time? It may be that you need just that bit of extra pressure to completely eliminate your Hypopneas. You should consider raising your upper pressure limit from the current value of 12 (according to your profile). Personally, I like setting the upper limit at the maximum machine capability (ie. 20 for your machine), since the machine will not provide that pressure unless it thinks it needs to.


I've tried higher pressures, but not 20. When I do, I start to see a lot more centrals. I'm afraid if I take your suggestion and max things out at 20 it will send my mask leaks through the roof, but, why not? What's the worst that could happen?

My goal, I think, is to control or eliminate OAs. My current setup does that pretty well. My recent increase of Hypos bothered me because I hadn't seen that happen before.

One thing I did discover by going over my old data of a couple of months is that the EPR value matters. If I set it to 1 or 3, my CAs and Hypos increase. Setting it to 2 seems to be the sweet spot for me.

Maybe my expectations are too high, but I'm finding the total lack of interest from my doctor/DME about how my treatment is going puzzling. Other than the 30 day compliance data, no one seems to have any interest at all about whether this is working for me or not. That's unique in my experience with medicine. That's why I'm really glad this site is here.

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#9
(10-27-2013, 05:13 PM)DocWils Wrote: Wow! If someone sends me their chart or a question (for my speciality, not sleep medicine) if it takes me less than five minutes to read it and less than two minutes to draft a reply, I don't charge. I know a lot of doctors here who do, and we have a special tax point (that is how were charge things, based on a point system) but I always figure it takes more time to enter the tax point data than it does to read and reply, so I don't bother.

If it is complex, then I charge, but a chart read is not a complex thing normally.

(And no, that is not an invitation for you all to send me your charts to read. I only read charts of my registered patients, and this forum does not allow me to be so generous at any rate, due to legal issues, nor am I inclined to be so generous. And sleep medicine isn't my speciality anyway.)

Here in the US, "HIPAA" (confidentiality law), tradition, insurance policy, corporate thinking, and financial reward tend to make doctors less willing to do email interaction with patients.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#10
(10-29-2013, 12:11 PM)archangle Wrote:
(10-27-2013, 05:13 PM)DocWils Wrote: Wow! If someone sends me their chart or a question (for my speciality, not sleep medicine) if it takes me less than five minutes to read it and less than two minutes to draft a reply, I don't charge. I know a lot of doctors here who do, and we have a special tax point (that is how were charge things, based on a point system) but I always figure it takes more time to enter the tax point data than it does to read and reply, so I don't bother.

If it is complex, then I charge, but a chart read is not a complex thing normally.

(And no, that is not an invitation for you all to send me your charts to read. I only read charts of my registered patients, and this forum does not allow me to be so generous at any rate, due to legal issues, nor am I inclined to be so generous. And sleep medicine isn't my speciality anyway.)

Here in the US, "HIPAA" (confidentiality law), tradition, insurance policy, corporate thinking, and financial reward tend to make doctors less willing to do email interaction with patients.

About half of my replies come down to see me in the morning, please". The rest are usually something along the lines of "we expected to see that, don't worry, and keep your scheduled appointment with me". Most of us consult on the phone or via e-mail, and have appropriate charge points for those. If there is something I thought would risk stepping outside patient confidentiality, I would say for them to come in, but we go from here assuming that any correspondence is privileged (and a rider is inserted into every e-mail anyway).
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