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UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
#81
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(12-03-2019, 11:10 PM)DeepBreathing Wrote: Like Bonjour, I still can't understand what mper is actually trying to do. There's obviously a huge language barrier here, but I don't speak a word of Portuguese so I can't really help. I've tried to understand his explanations but everything is so incoherent and disjointed that I despair of ever understanding it. What I want to see is a simple step-by-step explanation of the theory behind the method, and how to apply the method. So far I haven't seen that.

I agree 100%.

I've been asking for clarification for months, and have basically given up.

But it occurs to me maybe the path forward is a native English speaker working with mpers to translate the ideas into the clear form a number of us are pleading for.

Sheepless, perhaps you might consider that? You have enough knowledge it seems to me.

FWIW, based on what I do understand, I think there are two distinct pieces:
  1. standard (quantitative; not semi anything) variable tracking; this part can (and maybe should) be summarized in simple spreadsheet formulas
  2. manual rescoring of events based on flow graph, TV, etc. (and of course he's looking for a wider range of event types to feed into 1)
The two things are completely distinct, and any explanation needs to clearly separate them.

The first can be explained through simple logic and even formulas.

The second needs visual examples, from OSCAR.
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#82
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(12-03-2019, 10:18 PM)bonjour Wrote: My problem is I think mper may really have something here,  I want to understand it, know why it works, what the indicators mper sees really are (not 'fake' anything) Then I'll feel comfortable going forward with it.  More than just some calc's that being used.

Fre, DB, thanks

_ UARS is a very serious healph impairment, hidden behind very low/none AHI, no O2 depletion and so on, yet with tons of comorbid situations.

_ Several aspects of UARS motivate me posted this thread some 3 months ago: (1) on my interpretation, a very large number of UARS cases (maybe some 60 cases this year coming to the Forum, I am still counting them and preparing asn analysis), maybe, almost epidemic. 

_Coincidence or not, after my thread, I have been observing much more concern on UARS; I can follow on the posts easily. 

_ Such increasing concern on UARS led me to the idea this Forum are moving quickily to a major MILESTONE, we could call as: BOOST ON THE OBLIVIOUS UARS CULTURE, which is going to be characterized by boost on:

(1) recognition and diagnostic of cases;
 (2) vocabulary; 
(3) recomendation of moving APAP to BPAP, going out of the deleterious effects of APAP on anomalous E:I ratio; or even ASV to BPAP
(4) P.S > other than only 4.0, but also...5.0...6.0...7.0...., and, consequent better beat of FL/RERA's.  Here would enter my semi-quantitative approach to contribute.
(5) maybe more careful recomendation of ASV to treat false CA's derived from tens/tons of arousals, so proper of UARS;
(6) changes on the way to see importance/sgnificance of waveforms to help recognizing arousasl/awakenings, PLMS-driven arousals, and so on.
(7) preparation of one protoclol to treat UARS, as I have suggested  on one post above;

Now, this milestone eventually would be better established once we further test my approach to quickly estimate tailored EPAPmin and P.S, beating flagged FL down to zero within some 15 days.

Therefore, for you guys follow how the approach works, not better than selecting some cases and keeping aplying/testing it. I would need support for these, concerning influence on our fellows, suggestions of cases, etc ( I have one or two mapped already, in which fellow are just moving to BPAP)

all the best
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#83
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(12-04-2019, 07:05 AM)slowriter Wrote:
(12-03-2019, 11:10 PM)DeepBreathing Wrote: Like Bonjour, I still can't understand what mper is actually trying to do. There's obviously a huge language barrier here, but I don't speak a word of Portuguese so I can't really help. I've tried to understand his explanations but everything is so incoherent and disjointed that I despair of ever understanding it. What I want to see is a simple step-by-step explanation of the theory behind the method, and how to apply the method. So far I haven't seen that.

I agree 100%.

I've been asking for clarification for months, and have basically given up.

But it occurs to me maybe the path forward is a native English speaker working with mpers to translate the ideas into the clear form a number of us are pleading for.

Sheepless, perhaps you might consider that? You have enough knowledge it seems to me.

FWIW, based on what I do understand, I think there are two distinct pieces:
  1. standard (quantitative; not semi anything) variable tracking; this part can (and maybe should) be summarized in simple spreadsheet formulas
  2. manual rescoring of events based on flow graph, TV, etc. (and of course he's looking for a wider range of event types to feed into 1)
The two things are completely distinct, and any explanation needs to clearly separate them.

The first can be explained through simple logic and even formulas.

The second needs visual examples, from OSCAR.
... Apologies, Slowriter,
We, early morning pop ups, might came at same time. I Will return later
Gl
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#84
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
On the topic of "fake central apneas", ResMed machines mainly use FOT (forced oscillation technique) to differentiate between obstructive and clear apneas.

So the question is, how accurate is that?
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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#85
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
Hi, Joey

Take advantage of your UARS case, in which i used to work a little while, including the encouragement to move from APAP to BPAP, and go for the UARS protocol, i would like to link your case here, from post# 130 on. It appears emblematic.

http/www.apneaboard.com/forums/Thread-Health-Interpreting-sleep-study-results-EERS-enhanced-expiratory-rebreathing-space?page=13

All the best
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#86
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(12-04-2019, 08:47 AM)JoeyWallaby Wrote: On the topic of "fake central apneas", ResMed machines mainly use FOT (forced oscillation technique) to differentiate between obstructive and clear apneas.

So the question is, how accurate is that?

I don't think anyone questions this part. The machines are really good at correctly flagging what's look like central apneas from your flow rate. 

The problem some people have and why we suggest rescoring manually some events is that the machine has only one signal though, the flow rate, to infer what's happening. When you have a real sleep study done, there is bunch of other sensors like a belt around your chest measuring your breathing effort and hopefully an EEG indicating when you are awake or not. 

So since the machine can't tell if you are awake or not, sometimes it will score events while you are awake.  And you can wake up briefly for many reasons during the night like changing position, taking a deep breath or after a respiratory event.  Where I think it really becomes a problem is when you are mostly dealing with RERAs. The machine are not able right now to detect correctly the majority of RERAs. So sometimes you'll experience a RERA, the machine doesn't flag it. Then you wake up, take a deep breath and hold your breath for a while which is perfectly normal but it get flagged as a central. So you end up with a central instead of a RERA when you check your data in the morning. And that's pretty bad because to deal with centrals, you usually decrease the pressure support but to deal with RERA you usually want to increase it. Hence why I think people experiencing mostly RERAs should take the time to review their events before thinking they are dealing with centrals and in some cases getting a titration done in lab is really worth it. Not everyone agree and it's fine but we really have to remember that the machine is not 100% accurate when it comes to centrals because it can't tell if you are awake or not.

Sometimes too the machine will scores a bunch of events during REM sleep but REM breathing is always trashy especially when you are dreaming. So sometimes a bunch of event will be scored but if you had an EEG measuring your brain signals, you would see that in effect you did not wake up and that you shouldn't care about these centrals (unless there was a big desaturation).

Another case which happens too me from time to time is that sometimes I am 'puffing' like closing and opening my mouth very quickly instead of breathing through my nose. The machine doesn't detect a major leak in this case. I'm using a Dreamstation so that might be different with a Resmed. The machines sees that I'm not breathing as much air though since some of it is coming through my mouth and therefore flag these events as centrals. Seems to be mostly happening during REM sleep in my case. So from times to times my CA index will jump from under 1 to something like 4 and when I look at my data I see tons of events in the early morning. Took me a while to figure out what was happening so something else to keep in mind.
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#87
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
Here's an example from last night in which I woke up for no apparent reasons and it get scored as a central but shouldn't be.

   

When you are really experiencing central apnea while sleeping, the flow will be usually pretty steady before the event or at least decreasing very gradually. When you see an abrupt change like that, it usually means you woke up not that you were having a central apnea.
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#88
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
....perfectly in LINE, alexp. I am used to disregard tens of events like from time to time. A perfect example of arousal/aw-sleep transition, which i score as "fake".
All the best
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#89
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
.....from time to time i am used to audio-recording and hear later on while following on Oscar...
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#90
RE: UARS/FL (PLMS): Yellow/R Lights For So Many Lingering Folks_“Is Bilevel the Answer?"
(12-04-2019, 11:11 AM)mper6794 Wrote: ....perfectly in LINE, alexp. I am used to disregard tens of events like from time to time. A perfect example of arousal/aw-sleep transition, which i score as "fake".
All the best

.....i could have said this better, i am afraid: i would disregard the CA, but count the arousal, that is, the true metrics for UARS, PLMS, and other sense-driven arousals (noise, warm, touch, etc). You might know, we UARS people are amazingly hypersensitive, with very low arousal threshold.

Gl.
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