Replies to This Discussion

Permalink Reply by mollete on April 28, 2012 at 6:12am

You don't happen to have one more graphic that has the desaturations, do you?

 

Interestingly, a search to determine what version of Nicolet that was used in your study uncovered an old photograph of a WWII antiaircraft gun crew manning what looked to be an 88.   Yet, the crew were Americans!

 

 

Further investigation revealed that it was an American-made 90mm with protective armor (which I thought was not standard issue, and certainly a problem when it was used for ground support).

 

Who woulda thunk...

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Permalink Reply by Daleen Palmer on April 28, 2012 at 7:33am

Mollette:  my words are ver batim the report.  Not sure where RockR fot that unless it's buried in the pdf of the rest of the pages.  My words are off of page 1 which is here at home where I had tried to scan, and subsequently forgot and left it at home, so when at work, I only had the remaining pages to scan and email. 
 
mollete said:

RockRpsgt said:

You have associated with severe arousals and low o2 desaturations.

Daleen Palmer's report said:

Mild OSA/HS, associated with mild desaturations and significant fragmentation.

 

Mollete asks:

Now I'm confused. Which is it?

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Permalink Reply by Daleen Palmer on April 28, 2012 at 7:38am

Thanks, Mollete - I personally think that's why they pulled the machine.  They knew they screwed up.  Will you please expound on what you mean by this:   spurious data relative to the rest of study, they are probably artifact and should have been discarded.

 

Also, the actual HRS is 71/32/193  - that 57 is the lowest desaturation
 
mollete said:

It is also noted in your report that:

Low Heart Rate was 32
High Heart Rate 193
Low Heart Rate was 57

Clearly, all these events represent Critical Values which would have required the technician to immediately intervene. Since they did not, and certainly appear to be spurious data relative to the rest of study, they are probably artifact and should have been discarded.

However, they were not, and instead submitted in the report signed by the physician, which now makes them "valid". So what this tells me is that overall this is one sloppy piece of work and makes everything suspect.

So what you need to do is call up Singh and say "Hey Singh, you reported all these horrible events in my study but didn't do anything about it. Either clean it up using crisp interpretation of AASM 2008 or send me the raw data on a disk so I can bring it to a third party expert to do some Interscorer Reliability QA."

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Permalink Reply by Daleen Palmer on April 28, 2012 at 7:41am

Thanks!  Yes, I did have a lab titration study and I want to get copies of it but I didn't even see the report - I will ask for it. 

So much shoddy everything - the sleep spec tech told me I did not sleep at all when orignially tested and I pressed for clarification 'did that mean I didn't enter REM or Stage 4?' and she said 'yes' - but looks to me like I did.

 

Also, she told me the dr said my machine could be set as high as a 9.  I did see the handwritten recommendation it the dr said 11.

 

So, do you think, because the biggest question I have is what could have been going on those six nights I did use it and woke feeling so ill . . . that a pressure of 4 could actually have aggravated the muscle atonia and I WAS waking up with radically reduced oxygen?
 
RockRpsgt said:

The desaturations are caused by breathing events. These events are caused by a muscle atonia(loss of tone). Atonia is a safety mechanism brought on by years and years of evolution that keeps us from acting out our dreams. Atonia is progressive starting at onset and peaking in stage REM when we are parylized from the loss of tone. Right now reading this your airway is like a plastic straw, solid on all sides allowing air to move through freely. As soon as you fall asleep your airway goes from the plastic straw to an old wet paper straw. Remember how they made noise when you blew through them? That's snoring. As you breathe through a flacid airway the sides vibrate and come together at times causing snoring,flow limitations, and/or apneas. Cpap increases the atmospheric pressure in your airway and has a ballooning effect allowing it to combat the loss of tone.

 

Many things can cause arousals, including breathing events. It is also very possible that your body is reacting to prevent events due to the nature of your o2 levels and desaturations. Both PTSD and the meedicines to help this disorder can cause sleep fragmentation or a disruption in your sleep architecture.

 

With desats as severe as yours reaching REM once is a good start.

 

My interpretation of your report(which isn't much as I am no doctor) is much the same as yours. The arousals and the sleep fragmentation seems to be the bigger problem. Sometimes these along with the breathing events are cured with PAP treatment. With those types of o2 desats and heart issues I would not come off of PAP without medical advice. This could be tragic in your case. The most important thing you can do at this time IMHO is find a doc or team that is more available and willing to listen to your needs.

 

Did you have an in lab titration study?

 

• ▶ Reply

Permalink Reply by Daleen Palmer on April 28, 2012 at 7:44am

And, RockR, I had already not used the machine one night, and both my clinic dr and the sleep sp tech instructed me the next day to not use it.  Then, when I went, expecting to get a full face mask and the machine checked, which I what I had been told, she took the machine, saying maybe the CPap wasn't for me.
 
Daleen Palmer said:

Thanks!  Yes, I did have a lab titration study and I want to get copies of it but I didn't even see the report - I will ask for it. 

So much shoddy everything - the sleep spec tech told me I did not sleep at all when orignially tested and I pressed for clarification 'did that mean I didn't enter REM or Stage 4?' and she said 'yes' - but looks to me like I did.

 

Also, she told me the dr said my machine could be set as high as a 9.  I did see the handwritten recommendation it the dr said 11.

 

So, do you think, because the biggest question I have is what could have been going on those six nights I did use it and woke feeling so ill . . . that a pressure of 4 could actually have aggravated the muscle atonia and I WAS waking up with radically reduced oxygen?
 
RockRpsgt said:

The desaturations are caused by breathing events. These events are caused by a muscle atonia(loss of tone). Atonia is a safety mechanism brought on by years and years of evolution that keeps us from acting out our dreams. Atonia is progressive starting at onset and peaking in stage REM when we are parylized from the loss of tone. Right now reading this your airway is like a plastic straw, solid on all sides allowing air to move through freely. As soon as you fall asleep your airway goes from the plastic straw to an old wet paper straw. Remember how they made noise when you blew through them? That's snoring. As you breathe through a flacid airway the sides vibrate and come together at times causing snoring,flow limitations, and/or apneas. Cpap increases the atmospheric pressure in your airway and has a ballooning effect allowing it to combat the loss of tone.

 

Many things can cause arousals, including breathing events. It is also very possible that your body is reacting to prevent events due to the nature of your o2 levels and desaturations. Both PTSD and the meedicines to help this disorder can cause sleep fragmentation or a disruption in your sleep architecture.

 

With desats as severe as yours reaching REM once is a good start.

 

My interpretation of your report(which isn't much as I am no doctor) is much the same as yours. The arousals and the sleep fragmentation seems to be the bigger problem. Sometimes these along with the breathing events are cured with PAP treatment. With those types of o2 desats and heart issues I would not come off of PAP without medical advice. This could be tragic in your case. The most important thing you can do at this time IMHO is find a doc or team that is more available and willing to listen to your needs.

 

Did you have an in lab titration study?

 

• ▶ Reply

Permalink Reply by mollete on April 28, 2012 at 7:56am

Daleen Palmer said:

"Will you please expound on what you mean by this:   spurious data relative to the rest of study, they are probably artifact and should have been discarded."

Much of the data in sleep study is automatically scored by the software. Depending on the software package, it can also discriminate artifact (such as motion that can generate erroneous values, like very high heart rates) and exclude it from the report. However, the MD is required to manually review the record and remove spurious data so as not to make it appear that you are something that you are not. Those high heart rates in the graph look like artifact because they are associated with a wake event and could be the result of say, turning over.

 

In my view, they did not review this as carefully as they should have.  One could easily argue that they did not review it at all.

 

If the very low desats are similarly associated with motion, then they must be excluded as well. Consequently, you may not (probably not) be a person with a desat of 57 and must use CPAP or you're gonna die, but perhaps more like an 89 and obviously far less urgent (more on that later).

 

Hence, seeing the oxygen saturation graph would be very helpful in confirming this.

• ▶ Reply

Permalink Reply by Daleen Palmer on April 28, 2012 at 8:02am

Thanks!  You guys are of tremendous help!

mollete said:

Daleen Palmer said:

Will you please expound on what you mean by this:   spurious data relative to the rest of study, they are probably artifact and should have been discarded.

 

Much of the data in sleep study is automatically scored by the software. Depending on the software package, it can also discrimiate artifact (such as motion that can generate erroneous values, like very high heart rates) and exclude them from the report. However, they are required to manually review the record and remove spurious data so as not to make it appear that you are something that you are not. Those high heart rates in the graph look like artifact because they are associated with a wake event and could be the result of say, turning over.

If the very low dessats are similarly associated with motion, then they must be excluded as well. Consequently, you may not (probably not) be a person with a desat of 57 and must use CPAP or you're gonna die, but perhaps more like an 89 and obviously far less urgent.

Hence, seeing the oxygen saturation graph would be very helpful in confirming this.

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Permalink Reply by mollete on April 28, 2012 at 8:06am

Please reread my response, I added some comments.

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Permalink Reply by Daleen Palmer on April 28, 2012 at 8:52am

In my view, they did not review this as carefully as they should have.  One could easily argue that they did not review it at all.  Is this what you added?

mollete said:

Please reread my response, I added some comments.

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Permalink Reply by Daleen Palmer on April 28, 2012 at 3:20pm

I am not sure about what's going on - it appears that I received a resend on Rock's post . . .

 

RockR - in re-reading your post - boy, alot of things make sense.  I know this is an apnea forum and we're in agreement that my bigger fish that needs fried is the fragmented sleep and assuming it is PTSD.  You talk about the 'not acting out our dreams' evolution thing.  Well, BINGO - what drove me to the psychologist I'm working with now, although my former therapist was helping tremendously with EFT, was what I call crashes.  They'd been happening for quite some time but I finally connected the dots when I had a good day and worked out with the girls from work.  Working out - didn't get winded, didn't break a sweat, working with 3 lb weights and wishing I had 5 lb weights - and 1.5 afterwards, I felt my energy drain as if a plug was pulled and it took 10 days to recover.  That scared me and that's what spurred the sleep study recommendation.  In the meantime, I have experienced this drain/crashing many times - when I get excited, be it good excitement, fear, or nerves and PTSD triggers.  The psychologist explained that the excitement is activating the other side of my brain and my brain is refusing to communicate (remember) and shuts down.  She said this was happening in sleep, as well, because REM is where you process.  I had posed this thought, not in so much detail, to my dr who ordered the sleep study and he realized he did not know the answer (was I not sleeping because my body [apnea] or my brain [PTSD]).  So, what I am so excited to tell you is we blasted through some really heavy stuff yesterday in therapy - and, last night, when I ran to pick up more rhodiola, I picked up Holy Basil, too (both adaptogens) and before bed, listened to some great alpha wave meditation music.  I SLEPT SEVEN SOLID HOURS  without waking up!  And, I laid down a bit ago for a nap - and I DREAMT!  It will be two years ago this June/July that this sleeping - lack of - surfaced and whereas I am a dreamer, the dreams almost completely ceased.

 

I seriously think the PTSD is the big issue and if I can continue sleeping, my energy will come back and my peace/calm will be restored and I can start exercising and put these cigarettes down - and maybe I can get that AHI down to 5 or below and not need a machine!

 

What do you think?
 
Daleen Palmer said:

Thanks!  Yes, I did have a lab titration study and I want to get copies of it but I didn't even see the report - I will ask for it. 

So much shoddy everything - the sleep spec tech told me I did not sleep at all when orignially tested and I pressed for clarification 'did that mean I didn't enter REM or Stage 4?' and she said 'yes' - but looks to me like I did.

 

Also, she told me the dr said my machine could be set as high as a 9.  I did see the handwritten recommendation it the dr said 11.

 

So, do you think, because the biggest question I have is what could have been going on those six nights I did use it and woke feeling so ill . . . that a pressure of 4 could actually have aggravated the muscle atonia and I WAS waking up with radically reduced oxygen?
 
RockRpsgt said:

The desaturations are caused by breathing events. These events are caused by a muscle atonia(loss of tone). Atonia is a safety mechanism brought on by years and years of evolution that keeps us from acting out our dreams. Atonia is progressive starting at onset and peaking in stage REM when we are parylized from the loss of tone. Right now reading this your airway is like a plastic straw, solid on all sides allowing air to move through freely. As soon as you fall asleep your airway goes from the plastic straw to an old wet paper straw. Remember how they made noise when you blew through them? That's snoring. As you breathe through a flacid airway the sides vibrate and come together at times causing snoring,flow limitations, and/or apneas. Cpap increases the atmospheric pressure in your airway and has a ballooning effect allowing it to combat the loss of tone.

 

Many things can cause arousals, including breathing events. It is also very possible that your body is reacting to prevent events due to the nature of your o2 levels and desaturations. Both PTSD and the meedicines to help this disorder can cause sleep fragmentation or a disruption in your sleep architecture.

 

With desats as severe as yours reaching REM once is a good start.

 

My interpretation of your report(which isn't much as I am no doctor) is much the same as yours. The arousals and the sleep fragmentation seems to be the bigger problem. Sometimes these along with the breathing events are cured with PAP treatment. With those types of o2 desats and heart issues I would not come off of PAP without medical advice. This could be tragic in your case. The most important thing you can do at this time IMHO is find a doc or team that is more available and willing to listen to your needs.

 

Did you have an in lab titration study?

 

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Permalink Reply by Daleen Palmer on April 28, 2012 at 3:30pm

1.5 hours (left out hours) - in case that totally confuses you :)
 
Daleen Palmer said:

I am not sure about what's going on - it appears that I received a resend on Rock's post . . .

 

RockR - in re-reading your post - boy, alot of things make sense.  I know this is an apnea forum and we're in agreement that my bigger fish that needs fried is the fragmented sleep and assuming it is PTSD.  You talk about the 'not acting out our dreams' evolution thing.  Well, BINGO - what drove me to the psychologist I'm working with now, although my former therapist was helping tremendously with EFT, was what I call crashes.  They'd been happening for quite some time but I finally connected the dots when I had a good day and worked out with the girls from work.  Working out - didn't get winded, didn't break a sweat, working with 3 lb weights and wishing I had 5 lb weights - and 1.5 afterwards, I felt my energy drain as if a plug was pulled and it took 10 days to recover.  That scared me and that's what spurred the sleep study recommendation.  In the meantime, I have experienced this drain/crashing many times - when I get excited, be it good excitement, fear, or nerves and PTSD triggers.  The psychologist explained that the excitement is activating the other side of my brain and my brain is refusing to communicate (remember) and shuts down.  She said this was happening in sleep, as well, because REM is where you process.  I had posed this thought, not in so much detail, to my dr who ordered the sleep study and he realized he did not know the answer (was I not sleeping because my body [apnea] or my brain [PTSD]).  So, what I am so excited to tell you is we blasted through some really heavy stuff yesterday in therapy - and, last night, when I ran to pick up more rhodiola, I picked up Holy Basil, too (both adaptogens) and before bed, listened to some great alpha wave meditation music.  I SLEPT SEVEN SOLID HOURS  without waking up!  And, I laid down a bit ago for a nap - and I DREAMT!  It will be two years ago this June/July that this sleeping - lack of - surfaced and whereas I am a dreamer, the dreams almost completely ceased.

 

I seriously think the PTSD is the big issue and if I can continue sleeping, my energy will come back and my peace/calm will be restored and I can start exercising and put these cigarettes down - and maybe I can get that AHI down to 5 or below and not need a machine!

 

What do you think?
 
Daleen Palmer said:

Thanks!  Yes, I did have a lab titration study and I want to get copies of it but I didn't even see the report - I will ask for it. 

So much shoddy everything - the sleep spec tech told me I did not sleep at all when orignially tested and I pressed for clarification 'did that mean I didn't enter REM or Stage 4?' and she said 'yes' - but looks to me like I did.

 

Also, she told me the dr said my machine could be set as high as a 9.  I did see the handwritten recommendation it the dr said 11.

 

So, do you think, because the biggest question I have is what could have been going on those six nights I did use it and woke feeling so ill . . . that a pressure of 4 could actually have aggravated the muscle atonia and I WAS waking up with radically reduced oxygen?
 
RockRpsgt said:

The desaturations are caused by breathing events. These events are caused by a muscle atonia(loss of tone). Atonia is a safety mechanism brought on by years and years of evolution that keeps us from acting out our dreams. Atonia is progressive starting at onset and peaking in stage REM when we are parylized from the loss of tone. Right now reading this your airway is like a plastic straw, solid on all sides allowing air to move through freely. As soon as you fall asleep your airway goes from the plastic straw to an old wet paper straw. Remember how they made noise when you blew through them? That's snoring. As you breathe through a flacid airway the sides vibrate and come together at times causing snoring,flow limitations, and/or apneas. Cpap increases the atmospheric pressure in your airway and has a ballooning effect allowing it to combat the loss of tone.

 

Many things can cause arousals, including breathing events. It is also very possible that your body is reacting to prevent events due to the nature of your o2 levels and desaturations. Both PTSD and the meedicines to help this disorder can cause sleep fragmentation or a disruption in your sleep architecture.

 

With desats as severe as yours reaching REM once is a good start.

 

My interpretation of your report(which isn't much as I am no doctor) is much the same as yours. The arousals and the sleep fragmentation seems to be the bigger problem. Sometimes these along with the breathing events are cured with PAP treatment. With those types of o2 desats and heart issues I would not come off of PAP without medical advice. This could be tragic in your case. The most important thing you can do at this time IMHO is find a doc or team that is more available and willing to listen to your needs.

 

Did you have an in lab titration study?

 

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Permalink Reply by Terry Vella on April 28, 2012 at 5:51pm

Dr Park, Dr Park, Dr Park or one of the other Doctors, I'm the one that suggested that Daleen join Sleepguide, even though she is getting advice from Rock etc, I still think she is confused as to what course of action to take now. Could one of you guys have a look at her data and give some recommendations on the next steps she needs to take as I sure it is very frustrating for her as she wants to comply and get the benefits out of CPAP, but is having troube getting over that first hurdle.

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