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[Treatment] Noob; wondering about equipment, info dump below
#11
RE: Noob; wondering about equipment, info dump below
(03-24-2020, 11:24 AM)bonjour Wrote: For the PSG, best to copy, remove personal info, and post the resulting image.

Yeah, I have no physical results from it, nothing to take an image of or scan...
The results are all in the EPIC "MyChart" system (which I can access via browser), and it provides the results in a super janky format. Every line is prefixed with "Transcript[tab]" and then text that is hard-wrapped at ~80 columns. There are no graphs / images, just poorly formatted text.

I pasted my actual PAP levels / data a few posts up using [code] tags to keep it as formatted as it was originally provided.
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#12
RE: Noob; wondering about equipment, info dump below
Request a hard copy from you prescribing physician. If they tell you it's available electronically, tell them you are unable to produce a printable copy and you want one.
Crimson Nape
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: Noob; wondering about equipment, info dump below
(03-24-2020, 11:26 AM)ZPrime Wrote: One of the things mentioned in the info for the HSAT is that it can underestimate obstructive apneas. Would this mean they are then interpreted as central instead, possibly causing my centrals to read higher than they actually were?

There was also this line from the lab PSG: "Some respiratory events that were scored as central events in this in-lab PAP titration appear to be related to obstruction in nature when looking at the respiratory flow shape." Is this just the interpreting MD not wanting to believe I'm having that many centrals even on PAP support?
The premise in the HSAT is that you were sleeping the entire time. you stated that you took a bathroom break.  When we move at night we hold our breath, this is frequently misinterpreted as central apnea, during manual interpretation we dismiss this as SWJ or Sleep Wake Junk.   This would not change my overall read of your results.

There are breath forms that demonstrate aspects of both obstructive and central apnea.  Obstructions are often present through most of the night, Flow Limits are the lowest form of this, with frequent centrals you have to see some that exhibit the characteristics of both, this is 'mixed-apnea".  This is likely what is being observed.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: Noob; wondering about equipment, info dump below
I have the ASV from ResMed after going the long and painful journey from one bad choice of machine to another. I had to travel from CPAP to DreamStation BPAP. The BPAP was dangerously the wrong machine; it added more CA events due to it's nature of interacting with my pre-existing CA.

I went to complaints 101 to shape my discussion of, and complaint about, extremely poor treatment on the BPAP. I took the initiative, and with hard copy of the PSG sleep study, I showed the nurse the numbers at my pulmonary care office. I mentioned the high CA numbers, and asked if that indicated an ASV. It did, she agreed I must have one, and only then did I get one.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#15
RE: Noob; wondering about equipment, info dump below
ZPrime

I have formatted your data and included a screenshot in your post above: http://www.apneaboard.com/forums/Thread-...#pid341700

It's just a matter of dumping your numbers into a spreadsheet and using text-to-columns.

Following up the discussion, there seems to be a deep reluctance on the part of doctors (and insurance companies) to get patients onto an ASV. Some of this is due to old-school conservatism and some of it is a fear factor because of the study I mentioned earlier. ASV machines are expensive so insurance companies would prefer to spend tens of thousands on extra tests to save themselves a couple of thousand on the machine - makes no sense.

A lot of doctors get defensive about their judgement being questioned, especially when the patient says "I read it on the internet". You'll need to use your emotional intelligence to "read" the doc and work out how best to put the questions to him/her. Maybe the place to start is "I don't understand why there was so much central apnea in the first study but it wasn't diagnosed as such". Followed by "The results of the titration seem to indicate that the central apnea is not properly treated by the bilevel machine. Do you think we should try ASV?"
DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: Noob; wondering about equipment, info dump below
(03-24-2020, 07:54 PM)DeepBreathing Wrote: It's just a matter of dumping your numbers into a spreadsheet and using text-to-columns.
As someone who has spent over 20 years in IT... I probably should've known that. In my defense, I barely ever use Excel. Wink

Quote:A lot of doctors get defensive about their judgement being questioned, especially when the patient says "I read it on the internet". You'll need to use your emotional intelligence to "read" the doc and work out how best to put the questions to him/her. Maybe the place to start is "I don't understand why there was so much central apnea in the first study but it wasn't diagnosed as such".  Followed by "The results of the titration seem to indicate that the central apnea is not properly treated by the bilevel machine. Do you think we should try ASV?"

I have another friend (not on these boards) who is also a hose-head, and his wife is an MD... he basically gave me the exact same advice. Smile

It's all somewhat moot at this point, as I can't even get the Cleveland Clinic to give me an appointment for a sleep MD referral/consult. The sleep department is "in a holding pattern for 2-3 weeks for new patients" at this point. (I started all this process through my GP, he and his NP ordered the HSAT and the titration, but I've never been a patient of an actual sleep doctor yet.)

So I get to twiddle my thumbs while COVID-19 runs its course. I've been living with garbage sleep for about 2 decades so hopefully a few more weeks won't be the end of me. :p
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