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Saw my sleep doc today...changes
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cate1898 Offline

Advisory Members

Posts: 784
Joined: Aug 2015

Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #1
Saw my sleep doc today...changes
I'm kind of hopeful that I'll have more improvements in the coming weeks. I had an appointment with my sleep doc today and I complained about the following:

-still having morning headaches - although I confessed they are not as severe
-still just as tired
-still waking 2-4 times per night
-air pressure seems ok at bedtime, but wake up feeling like it's not enough


Pros:
-snoring has stopped (at least I've been told by family)
-full compliance since beginning CPAP
-sleeping about an hour longer on average in the a.m.


Upon hearing about the above, the sleep doc decided to increase my pressure from 6 to 7.5. And he wants to look at the data next time I come in, so he ordered the DME to provide me with a data capable machine (YAY!!)

So I've come home with a ResMed AirSense 10 Elite CPAP set at 7.6 (they can only be set in increments of .2). This is great as this is the machine I researched and plan to buy when the time comes!

So I've installed SleepyHead on my MBA and will look at the results when I get a chance in the next few days. I assume I need to lock the SD card before inserting it in the computer even if it is a MAC?? Or is the problem just with Windows PC's?

Only downside is that I broached the subject of getting an auto CPAP machine and the sleep doc is not a fan. He is probably 70ish (nice man), but probably not too good with technology.

He said that the auto machines "...are not the best. Their algorithms work on only 1 channel. We use 11 in here to decide when to change. The scoring gives you an AHI Apnea/Hypopnea index. You can't score a hypopnea without blood oxygen determinations or movement arousals. All this thing (auto CPAP) has is one lead."

I'm not trying to open up a debate about auto vs fixed, but it's a definite no for me qualifying for an auto CPAP. Unless I purchase on my own, and if I do that, my private insurance won't kick in cause I have to use the government insurance first! Talk about a catch-22!!

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
10-08-2015 03:47 PM
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sonicboom Offline

Advisory Members

Posts: 474
Joined: May 2015

Machine: Airsense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10, Dreamwear
Humidifier: Integrated
CPAP Pressure: 4.6-7.6
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Washington

Post: #2
RE: Saw my sleep doc today...changes
Here is a post of mine from a recent thread on the topic of low v actual AHI and recent literature:

28RE: LOW AHI vs actual REAL quality sleep
In follow up to my post (#21 above) and all of the great comments that followed I thought I'd do a quick internet search (by no means intended to be exhaustive) on what research has been done on the question of the accuracy of APAP AHI scoring versus sleep study (PSG). I found two studies that seem to be on point.

Title:
Accuracy of Auto-Titrating CPAP to Estimate the Residual Apnea-Hypopnea Index in Patients
with Obstructive Sleep Apnea on Treatment with Auto-Titrating CPAP.
Authors:
Himanshu Desai M.D.1, Anil Patel M.D.2, Pinal Patel M.B.B.S.1, Brydon J.B. Grant M.D.1 and M. Jeffery Mador M.D.1, 3.


"Bland and Altman plots demonstrate that the difference between auto-CPAP AHI and PSG AHI was not uniform with auto-CPAP overestimating the AHI at lower values of AHI and underestimating the AHI at higher values of AHI." (My quotes added)

http://www.acsu.buffalo.edu/~grant/94.pdf

The second study: (I have excerpted a few paragraphs. You should read the whole thing when you have time.)


Sleep Disorders
Volume 2013 (2013), Article ID 314589, 6 pages
http://dx.doi.org/10.1155/2013/314589
Research Article
Accuracy of Positive Airway Pressure Device—Measured Apneas and Hypopneas: Role in Treatment Followup
Carl Stepnowsky,1,2 Tania Zamora,1 Robert Barker,3 Lin Liu,4 and Kathleen Sarmiento2,3
1Health Services Research & Development Unit, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
2Department of Medicine, University of California, San Diego, CA 92037, USA
3Pulmonary Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
4Department of Family and Preventive Medicine, University of California, San Diego, CA 92037, USA

Received 30 April 2013; Revised 16 July 2013; Accepted 19 July 2013

Academic Editor: Giora Pillar

Copyright © 2013 Carl Stepnowsky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP) devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO), which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA) via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI) was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3) and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3). Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring.

……


Given the improved PAP data transmission technologies and resultant increased use of these data, we sought to investigate the accuracy of the PAP-measured AHI. We had the opportunity to conduct “PAP efficacy” studies in which participants wore PAP devices simultaneously with Type III cardiopulmonary recording equipment. Therefore, the goal of the present study was to specifically examine the accuracy of the identification of apneas and hypopneas by the PAP device.
…..

2.2. Equipment Used

The Embletta (Embla, Inc., Broomfield, CO) was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA) via a specialized cable that allowed for the direct recording of S8 data. Signals recorded include oximetry, chest effort, and body position. Airflow from the PAP device was used for scoring. RemLogic software was used for manual respiratory scoring. Apneas and hypopneas were manually scored according to the 2007 American Academy of Sleep Medicine guidelines, which included defining a hypopnea as being associated with a ≥4% oxygen desaturation [8]. AutoSet respiratory events were autoscored by the device, and summary statistics were obtained within RemLogic. Manual scoring was blind to the AutoSet-scored respiratory events.

…..


In this study of home-based PAP efficacy, as measured by the S8 APAP device, the PAP-scored HI was on average more than double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize that this particular APAP device may overscore hypopneas. The most likely causes of this discrepancy are (a) the use of a proprietary algorithm and (b) the use of desaturations in manual hypopnea scoring. Because the number of apneas was underscored relative to manual scoring, the overall AHI does not appear to be different from manual scoring. This study and the evolving literature in this area suggest that it is important to understand how a specific PAP device identifies both apneas and hypopneas.

…..

In summary, PAP devices have automated, proprietary algorithms for respiratory event detection. When event detection scoring is combined with PAP use duration in the denominator, a proxy AHI value is derived. Given the increased reliance on the PAP-scored events by both providers and patients, it is important to better understand the nuances of specific algorithms and how the PAP-scored AHI, HI, and AI values compare to those same values from manual scoring. Doing so is an important step toward making more informed treatment decisions.

http://www.hindawi.com/journals/sd/2013/314589/

Coffee
10-08-2015 04:04 PM
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ramblingasian Offline

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Posts: 56
Joined: Aug 2015

Machine: Resmed Aircurve10 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: Integrated
CPAP Pressure: IPAP 16, EPAP 12
CPAP Software: SleepyHead

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Sex: Male
Location: Toronto, Ontario, CANADA

Post: #3
RE: Saw my sleep doc today...changes
You should always lock your sd card even on a Mac - I don't believe there should be an issue but you should always be on the safe side.
10-08-2015 04:11 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #4
RE: Saw my sleep doc today...changes
(10-08-2015 03:47 PM)cate1898 Wrote:  So I've come home with a ResMed AirSense 10 Elite CPAP set at 7.6
The doctor has come to his senses, took some persuading
Congrats
10-08-2015 04:17 PM
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PaulaO2 Offline
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Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #5
RE: Saw my sleep doc today...changes
It is actually more important to lock it on a Mac due to it wanting to write something on the card. Always always always lock that card with your Mac.

What the heck is he talking about leads? 11 and it only uses one? He really needs to read up on the literature. This is a CPAP machine, not a polysomnograph. Bless his heart.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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10-08-2015 04:18 PM
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DariaVader Offline
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Monitors

Posts: 1,824
Joined: Nov 2014

Machine: Resmed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10 for Her
Humidifier: H5i humidifier with ClimateLine heated hose
CPAP Pressure: 8-15
CPAP Software: SleepyHead

Other Comments: diabetes II, Thyroidectomized, Primary Immune Deficiency, and the list goes on :P

Sex: Female
Location: Oregon

Post: #6
RE: Saw my sleep doc today...changes
I have linux which is where i usually check sleepyhead, but my work computer is a mac-book pro and I use it when traveling. I have never locked the card, and never had an issue. Wasn't the issue primarily with the older S9s? my S9 is one of the later ones and it never cares what else is written on the card. I have never put my card in a winders box... don't have one.

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
10-08-2015 05:00 PM
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PoolQ Offline

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Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #7
RE: Saw my sleep doc today...changes
nope. any SD card put in a windows machine will get an index file written to it. Resmed machines have a problem with that and will erase the card.
No idea what a mac does if anything.
10-08-2015 07:13 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #8
RE: Saw my sleep doc today...changes
[Image: sdcard-lock.png]
Very Important Warning
ALWAYS write protect CPAP data cards before inserting them into your computer.
Certain operating systems write index/cache files to the card without asking, and this could lead to data corruption, making your card unreadable by your CPAP machine. SleepyHead is read-only, and is definitely not the cause of this issue!
http://www.sleepfiles.com/SH2/
10-08-2015 10:17 PM
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big_dave Offline

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Posts: 411
Joined: Apr 2012

Machine: PR System One DS560
Mask Type: Nasal pillows
Mask Make & Model: F&P Pilairo Q or ResMed Mirage Activa
Humidifier: PR System One
CPAP Pressure: 14 - 20
CPAP Software: SleepyHead

Other Comments: Former ResMed S8 Autoset II user

Sex: Male
Location: Eugene, Oregon

Post: #9
RE: Saw my sleep doc today...changes
(10-08-2015 07:13 PM)PoolQ Wrote:  nope. any SD card put in a windows machine will get an index file written to it. Resmed machines have a problem with that and will erase the card.
No idea what a mac does if anything.

A Mac makes a mess, adding three system folders and another system file. I'm not really sure what they do. They don't bother my DS-560, so I leave the write-protect tab alone.

The folders are:
.Spotlight-V100
.Trashes
.fseventsd

The file is:
._.Trashes
10-08-2015 11:17 PM
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cate1898 Offline

Advisory Members

Posts: 784
Joined: Aug 2015

Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #10
RE: Saw my sleep doc today...changes
OK so night 1 down. Woke up just before 3am with a headache. (I know, patience!)

Anyway, here's info from sleep report on A10

AHI .7
Leak Rate 10L/min - ???

I got a happy face for mask seal. So I don't understand. Is 10L/min bad? good?

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
10-09-2015 03:56 AM
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