Frustrations with provider, etc, advice

Hello, My father is in a nursing home, I was hoping with his new machine (Resmed v10, I think) I would get useful data on whether his mask was put on correctly, whether he took it off, etc. (he is somewhat memory and thinking impaired, with some expressive aphasia). I was disappointed to see that the summary data that I had each morning was primarily geared to whether he used it or not, for reimbursement purposes I guess. Someone here suggested Sleepyhead, well, the kerfuffle over that on the web shied me away and I hoped a follow up to the doc would provide better information. The person (an NP for the first time, previous MDs gone) had no better data than I did, did not seem to understand my problem, and scheduled my dad for a mask fitting, which he doesn't need. (The first MD was great, expert in SA, made sure my dad had a proper fitting full face mask as he needs; he retired and second doc was not SA expert, but seemed to know what he was talking about). So, I went on line and downloaded OSCAR and today looked at my dad's data for the first time... Typically he starts out with a good seal and few events (the nurses are doing a great job putting it on), but as the nights continue the leek gets big, events start happening, and sometimes even when the leak is improved (nurse re-positioning, I imagine) his events still are pretty high (over 30-35). I am not sure what his pressure settings are, when we last did a study at the NH monitored by me, he had an AHI of 10 which was considered ok by the MD, I assumed my only issue was to verify whether or not it was on correctly. I do not feel confident in the practice we had been going to anymore. Not sure if I should return and request one of the MD's, or go to another practice, or if someone professionally will read the data and interpret it off of OSCAR. I have nothing against NP's in general, some are very good at what they do (I am an MD and have worked with them). So, I either need (I think) a person who can help me interpret the OSCAR data, or suggestions on someone I can have confidence in in Philadelphia or it's northern suburbs. Thank you.

Your first check should be to verify he has a ResMed that stores detailed data on the SD card. If it stores detailed data and have a cooperative sleep specialist you should be able to take the card to be read using ResMed software called Rescan (or something like that). It does basically the same as SleepyHead or OSCAR. However, if you have OSCAR and have the data on a PC or MAC you can do a screen capture and post the data here for comments as well. Here is one of my SleepyHead Daily screen shots from back when I first started CPAP.

Some comments on this chart:

1. The leak rate was not great and near morning at 6:20 I had some quite large leaks. In general I like to keep the time over the leak redline at less than 1%. Large leaks that get grayed out can cause the machine to stop reacting to events and when the leak stops you can get a burst of events.

2. The red and green pressure lines are inhale and exhale respectively. What you look for is the events at the top and compare them to the pressure. If the pressure is maxed out and you are still getting obstructive events it can mean that the pressure is not being allowed to go high enough. The other thing to look for is where central events are occurring, if any. Too much pressure can cause central events, while not enough can cause obstructive events. So it can be a tradeoff setting. I now currently use a fixed pressure of 11 cm as I was getting too much pressure at times in Auto. You can see an example of that toward the end of the night where pressure was causing numerous centrals with pressure getting as high as 15 cm.

That is the very brief basics. Hope it helps some. Post a screen capture if you want comments. After you do the screen capture just left click on it and drag the file to an open post here that you are composing.

As you noted some people are good at reading the data and some are not. This applies both inside the medical field and out. I'd be happy to give you my interpretation. I am the PM managing the development of OSCAR. OSCAR is being developed on a private portion of the ApneaBoard.com/forums and the developers monitor posts on that forum, others also, very closely and can answer very technical questions if needed.