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[Treatment] Treating UARS with CPAP and bilevel - Printable Version

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RE: UARS and APAP - WillSleep - 11-15-2019

(11-15-2019, 07:21 AM)slowriter Wrote: Because I now have the oximeter and I was curious, I did last night with the same settings, but with the EERS-adapted mask.

Of note:
  • as with first time I tried, significant (20%) increase in median TV, but significant decline in 95% and max TV
  • MV is higher also; a bit higher than "normal"
  • from start until 3:30, looks to be roughly 2% improvement in median spo2 (from 93 to 95)
  • there's then a drop in spo2 after that; not sure why; including this, though, median spo2 is still higher than night before
  • no significant change in RR


Congrats on seeing a bump in SpO2 for at least part of the night.  Lets you know gains are out there to be found.

"- as with first time I tried, significant (20%) increase in median TV, but significant decline in 95% and max TV
- MV is higher also; a bit higher than "normal"

MV is derived from TV so lets focus on the TV change.  Especially from the decline in Max and 95% TV as the Median goes up I am starting to suspect that at least some of the higher TV and therefore MV are inaccurate readings from EERS impacts to the Vauto's very pressure sensitive sensors used to attempt to indirectly derive Tidal Volume.  

Yes we should watch these but for now I would consider abnormal VAuto MV & TV readings mostly "suspect" and bias to trust the Pulse-Ox a little more than the MV & TV.  

"- there's then a drop in spo2 after that; not sure why; including this, though, median spo2 is still higher than night before" 
You were not showing high pressure rate changes or flow limitations from 5-5am.   A review of 4-5am video is where that $25 IR camera purchase maybe will pay off to help you see what is going on.

Comparing heart rate levels and variability in both the Dreem and the Pulse-Ox at this time might help validate the Pulse-Ox.

Might use the cheap white paper medical tape to tie the Pulse-Ox sensor tightly to your finger to help make sure what you are seeing is just not poor readings from poor fit.        
    
Regardless of VAuto reported changes if you have you have not yet had the chance I would try to validate the Pulse-Ox's accuracy with other known reliable Pulse-Ox's from friends, quick clinics in the drugstore, your doctor's office etc.  


//////////

On my hopefully not slow journey to build out a professional level scientific research and testing environment.  

My NICO 2 arrived.  Additional kit is on the way.  
http://www.oem.respironics.com/Downloads/1027412_NICO2FldrLitPkg_SalesAid.pdf

[attachment=17080]


Unfortunately so far my Capnostat is not cooperating.   Oh-jeez


Good Luck!
WillSleep


RE: UARS and APAP - slowriter - 11-15-2019

(11-15-2019, 02:20 PM)WillSleep Wrote: Might use the cheap white paper medical tape to tie the Pulse-Ox sensor tightly to your finger to help make sure what you are seeing is just not poor readings from poor fit.        

This seems the most likely explanation.

(11-15-2019, 02:20 PM)WillSleep Wrote: Comparing heart rate levels and variability in both the Dreem and the Pulse-Ox at this time might help validate the Pulse-Ox... I would try to validate the Pulse-Ox's accuracy with other known reliable Pulse-Ox's from friends, quick clinics in the drugstore, your doctor's office etc.

The spo2 readings from the contec device are close enough to the other portable pulse oximeter I have (for high altitude travel). The HR data on the contec seems a bit higher than on the Dreem. But that occasionally has its own signal quality problems (also fit based).

Interestingly, spo2 from left hand index finger is a few points lower than on my right index finger; on both devices.

To sleeprider's concern, I'm only intending to get a general sense of the impact of EPAP and PS on my spo2 with this exercise. Once I figure out how it works, I won't likely be tracking it much.


RE: UARS and APAP - WillSleep - 11-15-2019

Sleeprider and Boujour, 

I appreciate the concern.

For a good portion of the population here, likely the majority, I agree wholeheartedly with the sentiments and concepts you are sharing.   

We also have people here in their 20's, 30's, 40's, 50's and some older for whom I do not believe those are always the right answers.

I personally have four decades to go, have a 'normal' bmi and apart from needing to improve sleep I am told I am otherwise completely healthy.  In the same way I see no reason why I should settle for an AHI of 5.0 as being treated I see it unwise to settle for a nightly SpO2 levels that the research on PubMed shows will have long term detrimental impacts to my cerebral tissue and more when I can achieve a higher SpO2.   I believe there are others here who feel the same way.  

The best research I have found thus far shows that pretty much that up to 60 years old average SpO2 nightly median (Sat 50) for health people is 96% and after 60 years of age it drops to 95%.  
[attachment=17081]

But why 'settle' for a SpO2 96% median if that is normal in a population inclusive of less active, non-health conscious people.  I am personally targeting a nightly median of 97-98%.  Why not?

Many can not but for those of us who can achieve a higher SpO2 median and live healthier, more effectively and maybe longer why not?  

I believe some (not all) people of all of ages who come here and post "I have had an AHI of less than 2 for 18 months but I am still tired. Please help" will find these topics helpful.


I don't yet know how to do this (lets brainstorm this) ... 
I propose the best outcome on this topic is that we find a way to bring this information normally into the conversations for those whom it is most likely to apply and also keep it out / not burden or distract from conversations where the topics of SpO2 and Minute Vent, etc. really are less likely to be helpful.  

Ideas? 

WillSleep


RE: UARS and APAP - slowriter - 11-15-2019

You echo a few points Will that I share.

Like you, I have a few decades left, am healthy, with only slightly elevated weight.  I am in the middle of a career that depends on mental acuity that depends on, among other things, sleeping well.

My goal is not just a low AHI, but to sleep well and feel well, and to adopt practices that work for the long-term.


RE: UARS and APAP - Crimson Nape - 11-15-2019

The oximeters normally found in use here, CMS-50 models, have an accuracy of +/- 2%. If your oximeter is reporting 95%, then the actual can be from 93% to 97%. Additionally, I've noticed that the reporting level drops as the CMS-50 models and their finger probe gain age. For these reasons they should be used to spot trends and not rely on their accuracy. Both my F and I models now report a 94-95% level, while I'm consistently 97-98% at the doctor's office. When they were new, they would match the doctor's results.


RE: UARS and APAP - slowriter - 11-18-2019

(11-15-2019, 02:39 PM)slowriter Wrote: Interestingly, spo2 from left hand index finger is a few points lower than on my right index finger; on both devices.

I was wondering whether difference between right and left was normal, and so did a quick search, and came across a research study that concluded:

Quote:SpO2 measurement from the fingers of the both hands with the pulse oximetry, the right middle finger and right thumb have statistically significant higher value when compared with left middle finger in right-hand dominant volunteers. We assume that right middle finger and right thumb have the most accurate value that reflects the arterial oxygen saturation.



RE: UARS and APAP - WillSleep - 11-18-2019

Thanks Nape. 
We have three Pulse-Ox from one vendor and one from another.  
In the fine print they all claim  +/- 2% accuracy and all are a little different from each other. 
We benchmarked them all early on and so we know how to read ... or so I thought.  Your point about accuracy fading over time is a good one.  Better go back and benchmark them again.  
 
  

(11-18-2019, 10:50 AM)slowriter Wrote:
(11-15-2019, 02:39 PM)slowriter Wrote: Interestingly, spo2 from left hand index finger is a few points lower than on my right index finger; on both devices.

I was wondering whether difference between right and left was normal, and so did a quick search, and came across a research study that concluded:

Quote:SpO2 measurement from the fingers of the both hands with the pulse oximetry, the right middle finger and right thumb have statistically significant higher value when compared with left middle finger in right-hand dominant volunteers. We assume that right middle finger and right thumb have the most accurate value that reflects the arterial oxygen saturation.
 
That is a great find.
 
One vendor I talked with on the phone pushed hard that his product should only be criticized for accuracy if reading incorrectly from the right thumb.  Now I know why.
 
WillSleep


RE: UARS and APAP - slowriter - 11-22-2019

Just wondering: what is the vauto seeing here that is causing it to raise pressure? 

PS is fixed, but Is it trying to raise EPAP or IPAP?

[attachment=17338]


RE: UARS and APAP - Dormeo - 11-22-2019

Flow limitations, probably. The ResMed algorithms respond to detected FLs and snores.


RE: UARS and APAP - Gideon - 11-22-2019

React to flow limitations, EPAP is increased and IPAP follows based on PS