Need help reading my charts

[sheepless]

"The doctors diagnosis was "my brain does not send the signal to my lungs to breathe"."

I don't mean to beat a dead horse, but to reinforce what's already been said:

this statement is completely at odds with your diagnosis. even though you had zero obstructive apnea you were dxed with obstructive sleep apnea. from the report: impression: osa and plm.

you had one apnea in your test and it was a sleep onset central, meaning it's discountable both in number and character. who knows about the hypopnea. we have to assume that they're central, otherwise why the statement above and move to asv? but I'm not convinced. your longest event was a 28 second partial obstructive (hypopnea). your lowest SaO2 was associated with a 38 second partial obstructive (hypopnea). nothing about centrals and signals to breathe.

you had 214 plm, 2 with awakenings. 7 leg movement arousals. 58 plm/hr. idk what LM is if not leg or limb movements and it also says you had 97 LM-with-awakening for an index of 26.3. 58 kicks/hr disturbing you and 26 LM awakenings is brutal. it's a travesty docs seem to ignore these. I sure hope I'm misreading this report.

if it was me, I'd really want a better explanation of the study report from my doctor and I'd make sure s/he addresses the plm. I couldn't get apap to work for me because of plm and it's taken a lot of struggle - far, far more than the medical establishment was willing to provide - to get vauto and asv to work okay. and those, only after getting partial relief from plm with meds. I'm sure your providers provide important support for your other conditions, but I really wonder if they let you down with respect to sleep.

[Rich66]

SarDave -- I ordered the Contec CMS 50F at $98.  I figured it had a good recommendation.    

Sheepless -- I did find it interesting that my last sleep study did not include me connected to any mask or pap machine.  But they did have me take the Ambien sleeping pill.  And the results weren't as bad as I expected them to be  -- although I didn't expect anything about leg movements.  I'm thinking I should have a talk with my general practitioner and maybe he will steer me in another direction for the PLMD.  But I'd really like to not be eating any other medications.

[Sleeprider]

I'm reluctant to second guess the use of ASV. The one and only chart we have seen shows the full range of PS is used to apparently maintain the respiratory volume, and I have little doubt that less sophisticated therapy like CPAP or no therapy is not an option. I have nothing in this thread to support a PLM/RLS cause, but a pulmonary specialist has diagnosed pulmonary sarcoidosis, which is something I'm unfamiliar with. In a multi-mode titration that physician determined ASV was appropriate. Again, I'm not going to question that judgement, but did suggest the periodic use of a pulse oximeter to evaluate efficacy.

I think it's a good idea to look into any other issues and improve sleep, but this case is beyond my experience. No problems with further evaluations of PLM / RLS as a possible contributor to sleep disorder. Personally, I don't feel we have nearly enough information to understand what is going on...one chart!

[SarcasticDave94]

OK yes the Contec CMS50F is identical to mine. OSCAR can pull in the data and put it within the chart. I'm also using a PC app to view data but that's probably redundant.

[Rich66]

           
If it helps, here's three different nights sleep -- even the AHI of 0.00 had me feeling terrible the next morning.

[sheepless]

"I have nothing in this thread to support a PLM/RLS cause." "I have little doubt that less sophisticated therapy like CPAP or no therapy is not an option."

Sleeprider, I nearly always defer to your superior cpap knowledge and experience, but on this I disagree.

there's nothing in Rich's sleep report indicating a need for asv. there may be other reasons for it and he's getting great results so apnea isn't the problem. nor is the machine a problem, at least with respect to apnea, but may be with respect to plm. IF, and I emphasize that 'if', plm is present, it easily explains the active ps. IF that's the case, relieving plm will stop that ps activity and IF there are no other reasons for asv, another machine (or none at all) could conceivably be an option. still, I completely agree that's way premature and I'm not in fact advocating another modality, but (here's where I disagree) instead responding to clear indications of plm: clear as day and big as life in the sleep test report, Rich's own statements, his feeling poorly despite low ahi and especially the zoomed flow rate pattern that in my experience corresponds to plm, all support a plm/rls cause of the active ps and unrefreshing sleep.

all this closely matches my own experience with plm and pap. one size rarely fits all so of course I may be wrong (in fact I hope I'm wrong), particularly in light of other health issues we aren't remotely qualified to talk about. I'm just saying that if Rich continues to feel his sleep is lousy, there is more than adequate 'evidence' of plm to take it seriously and at least rule it out.

sorry for the distraction, Rich. btw, if you can, show us some 3 minute views of a variety of hypopnea (and ua if you're seeing them). from other machines you've used (?) if necessary. maybe Sleeprider can tell us if they're mostly obstructive or central. I don't think it's related to the need to address plm but it might explain in apnea terms (as opposed to pulmonary or other issues) why you're on asv.

[Rich66]

   
       
Please, no apologies -- I'm grateful for any help I can get.  I bought a fixer upper two years ago and my sleep issues have gotten in the way of me doing any fixing up. Here's one night, three views, when I used the Phillips Respironics ASV.
PS -- I think I should call my sleep doc and see about getting the sleep reports from my previous two sleep studies. I've never seen them.

[sheepless]

I'm not confident enough in my ability to discern obstructive from central except in the most obvious cases. hopefully one of the more-experienced members will weigh in. meanwhile, if not too much trouble can you repost the zoomed shots with flow rate y-axis as close to 80/-80 as you can without lopping off any of the waveform? maybe it'll be clearer.

[Rich66]

           
Here's from the same day with the Respironics, and one additional close up with no hypopnea.

[SarcasticDave94]

I wish I had an analysis, but those are some odd breath patterns, frequently not like smooth consistent ones. Yours tend to have jagged and stepped shapes on the trace.

I'm just speculating without suggesting an action, I'm wondering if the doc is attempting to use the ASV like an NIV ventilator with AVAPS. I think I'd be doing 20 questions with doc.