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padre
Unread post  Post subject: 1st snapshot/Few Q's  |  Posted: Sun May 17, 2020 1:46 pm

Joined: Fri May 01, 2020 3:03 pm
Posts: 20
PAP Mask: F&P Simplus; ResMed Quatto FX; ResMed AirFit P10
PAP Machine: ResMed AirCurve 10 ST
Humidifier: ResMed AirCurve 10 ST; Auto Set; Heated Hose
Pressure Setting: 11/15

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So, my first attempt to attach a file. Process seems a bit different than described in Oscar but....Anyway, can't see the image I'm posting about as I'm writing but know it will attach and open when posted as I did somewhat of a trial run. In any event, I am an insomniac but am quite confident the snapshot is at a time when I was asleep. While not in the screen, the area before and after the snapshot seems to be a nice regular sleep breathing pattern (my novice interpretations from previous readings). I think I am ok with my general status (AHI) but as my machine does not map OA's and CA's but only H's and UC's, I am most curious about the one UC in the snapshot and any information that that may convey. My Oscar history is predominated by H's (mostly of the sleepy/awake clutter that Pugsy and some others talk about) and the occasional UC. I chose this snapshot as not only did it have the UC but also the three (asleep) H's in the same general area. Does the fact that the "mask pressure" seems to clearly change in at least three of the events lend to any interpretation or would that be normal. Some events seem to last a long time or at least seem to last more than 10 seconds--yes/no. As, I said, my first effort and while I have no burning issues any general thoughts would be appreciated. Thanks.

p




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padre
Unread post  Post subject: Re: 1st snapshot/Few Q's  |  Posted: Tue May 19, 2020 9:44 am

Joined: Fri May 01, 2020 3:03 pm
Posts: 20
PAP Mask: F&P Simplus; ResMed Quatto FX; ResMed AirFit P10
PAP Machine: ResMed AirCurve 10 ST
Humidifier: ResMed AirCurve 10 ST; Auto Set; Heated Hose
Pressure Setting: 11/15

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I'm thinking that maybe something is wrong with my post. Typically, it seems that I would have received at least some type of response if only someone posting to say that something is wrong with my post. So, if anyone can enlighten me as to how I can improve this post I would appreciate that.

p.


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Respirator99
Unread post  Post subject: Re: 1st snapshot/Few Q's  |  Posted: Tue May 19, 2020 7:41 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 38
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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G'day Padre. Nothing wrong with your post, other than a rather vague formulation of the question. ;)

I really know nothing about ST machines, so my comments are really more in the way of questions. I see you're set in ST mode and according to the manual: [quote=Resmed]ST mode
In ST mode, the device augments any breath initiated by the patient, but will also supply additional
breaths should the patient breath rate fall below the set "backup" breath rate. [/quote]

And looking at the trace your respiration rate is dropping at the same time as the flow rate is decreasing. Once you get to the machine's pre-set rate, it kicks in and starts increasing the respiration rate. You can see this quite clearly in both the flow rate and mask pressure graphs. It seems your machine works at fixed EPAP and IPAP so the rate is the only tool available to it to keep your respiration on track.

My question (and I don't see the answer in previous threads) is why are you on this particular machine? From the manual, this device is for the treatment of obstructive sleep apnea. But the waxing and waning patterns look more like a central apnea / Cheyne Stokes pattern.

NOTE: I am not a medical professional, just some bloke on the internet.

Did you have a diagnostic sleep study, and if so, what was the outcome? Do you have comorbidities such as heart condition, asthma, chronic obstructive pulmonary disease (COPD) or similar? Any of these conditions might indicate that you need a different machine or else a review of the fine tuning of your ST. For example, you will have settings for Ti (inspiration time), trigger, cycle and rise time. Maybe one or more of these need to be optimised for you, or maybe the respiration rate needs to be set higher.

At this point my knowledge is exhausted, but it might hopefully help you in your quest.

_________________
Regards from Australia

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padre
Unread post  Post subject: Re: 1st snapshot/Few Q's  |  Posted: Thu May 21, 2020 1:36 pm

Joined: Fri May 01, 2020 3:03 pm
Posts: 20
PAP Mask: F&P Simplus; ResMed Quatto FX; ResMed AirFit P10
PAP Machine: ResMed AirCurve 10 ST
Humidifier: ResMed AirCurve 10 ST; Auto Set; Heated Hose
Pressure Setting: 11/15

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G'day R...99, how are you going? Yeah, " rathervagueformulationofthe question" seems to be my middle name. Despite that you did a yeoman's job. Ta mate.

I have been diagnosed as having complex apnea and have been in somewhat of a snit with the Sleep Center, Insurance Company, and the DME for several years. That's another story. I have afib and am/was in afib at the time of the snapshot. But, from what I have read that should not be a major factor in my graphs. I was very naive before I was diagnosed and have learned a lot in the past several weeks since joining this forum. I will apply that to my next visit at the sleep clinic.

I guess I am just trying to familiarize myself with what events would look like and if there were not superimposed or delineated on the event graph could I be able to identify these if scrolling through my (say) Flow Rate. And as my machine is somewhat data neutered (no OA, CA analysis) could an observer (you, me etc) be able to differentiate between on OA, CA, H, or UC etc.? Kinda like reading the graph without benefit of the machine. Going from left to right, H2 and H4 look relatively similar with regards to their duration and effect on the mask pressure graph while H1, H3, and the UA look very similar in terms of their duration and the effect in the flow rate graph. Just by looking at those is it reasonably possibly to re-categorize any of the H's or the UC into either an OC or CA? I guess what I'm wondering is if the machine is not classifying those how can my Sleep Doctor tell if my OA's or CA's are improving or not since virtually all of my events are of the H variety? Which I guess leads to your observation or thought regards that perhaps some of these "could" be CA's or even Cheyne-Stokes breathing. If, as has been suggested, that the Sleep Doctor sees the same data as Oscar how can decisions be made regarding my therapy, what machine I need, etc. I know the general AHI can be useful but it seems that more granular data should be looked at which this machine does not give. So, am I close to even being on the right track and would asking questions about that would seem to be reasonable..or not?


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Respirator99
Unread post  Post subject: Re: 1st snapshot/Few Q's  |  Posted: Fri May 22, 2020 2:05 am
User avatar

Joined: Mon Apr 27, 2020 1:06 am
Posts: 38
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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The higher-end Resmed machines don't bother to differentiate between central and obstructive apneas - they see an apnea then just get on and treat it. This is very obvious in an ASV, where you can see the mask pressure ramp up if flow rate falls. It's not a fault, just a design decision that Resmed took. I think they figure it's more important to squelch the apnea rather than wasting time figuring out what type it is. With the ASV machine, Resmed literature actually states that all central apneas are eliminated and any residual events can be regarded as obstructive. I don't know if that's the case with your ST, and I'm not sure I entirely believe it anyway.

The waxing and waning pattern I see in your screen shot makes me think that these events are all central in nature - if your machine hadn't intervened all those hypopneas would have gone on to be central apneas (and reported as UA).

As to what data your doctor sees, I'm not so sure. Resmed have two clinical software programs, ResScan and AirView. ResScan requires the data on an SD card and gives similar details to Oscar, but is much less intuitive. AirView is the new whizz-bang solution, which is all about compliance and patient management. It receives the data over-the-air, which (I understand) severely limits the data available to the doctor. If your doc is just using AirView, I wouldn't mind betting that you have far more data at your fingertips than he does.

I suggest you have a deep and meaningful conversation with your doc, and take the Oscar screen shots with you. I've been hanging around apnea forums for over 6 years now and it is a very consistent complaint that docs do not look at the data. They see compliance, first and foremost, then AHI. They might ask you how you're feeling, well your numbers look OK, see you in 12 months. That'll be $400 please. A good RT (like Lanky Lefty) is probably a much better bet, but eventually the doc is the one who writes prescriptions and signs reports.

In your situation, I'd be seeking some confirmation that the events you're having are OK, and not indicative of a deeper problem. There is probably nothing wrong at all, but it pays to make sure.

_________________
Regards from Australia

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* Oscar help
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padre
Unread post  Post subject: Re: 1st snapshot/Few Q's  |  Posted: Fri May 22, 2020 1:20 pm

Joined: Fri May 01, 2020 3:03 pm
Posts: 20
PAP Mask: F&P Simplus; ResMed Quatto FX; ResMed AirFit P10
PAP Machine: ResMed AirCurve 10 ST
Humidifier: ResMed AirCurve 10 ST; Auto Set; Heated Hose
Pressure Setting: 11/15

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Respirator99 wrote:
The higher-end Resmed machines don't bother to differentiate between central and obstructive apneas - they see an apnea then just get on and treat it. This is very obvious in an ASV, where you can see the mask pressure ramp up if flow rate falls. It's not a fault, just a design decision that Resmed took. I think they figure it's more important to squelch the apnea rather than wasting time figuring out what type it is.


Thanks heaps for the reply it was very helpful. Thought that was interesting. Seems like something along the lines of "less is better." I am starting to gather information to take with me to my next Clinic appointment. I will take along some snapshots as you suggested. I know the clinic will be backlogged because of CoVid but I hope I can squeeze enough of their office time to sort through some of my concerns. Stay safe down under.


p.


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