It is always a pleasure to watch, hear or view something that is unknown to yourself, especially when the person exhibits confidence and a vast amount of knowledge in what he speaks about. Thank you for sharing. I know very little, but I know more now than I did before I listened to your 34 minute video.
Thank you very much for your video! I have been working in sleep for awhile and really have no interest in scoring but, want to sit for registry. I am more of a visual learner and really have no one to show me and your video really helps!! :)
Excellent! Glad that it helped. I have a bunch of other crappy videos on scoring and other sleep related things if you're just getting started. Lots of really easy things that can trip you up.
This video was absolutely wonderful. I am sooooooo looking forward to seeing what the OmniLab Advanced software looks like at the RPSGT Station where you hang out. It is amazing that you have to do the laundry too. Wow. So you are the ones who have to do the washing of the sheets and the making of the beds in addition to everything else. Wow. I must say that I am profoundly excited to see the screen of the OmniLab Advanced software
I work in a lab where I do everything. In my ten hours, I hook up PT, Score study,Print final report for DR, Clean rooms, and to laundry. (sometimes file) when i hear about techs just overseeing the patient and ensuring the study is clear for the morning scorer.... i wonder how easy they have it lol. but! im sure you have to deal with a OCD scorer who scrutinizes the dumbest of things.
I'm a night sleep tech, we score and stage our own studies while our patients are sleeping and adjust the pressures as needed during the night. Then we clean the equipment and the rooms when the study is over.
Its really cool. Don't worry about the haters. Your videos are the best and most helpful. Some people are just jerks. I learn a lot from your forum and videos. My own sleep doctor isn't as good at explaining this stuff. keep up the good work.
Hi LankyLefty27! I am using my husband's youtube channel here and just wanted to say that I really appreciate you going through this study. I'm a newbie tech ...lol... and I am learning all that I can from wherever I can. Lol... I would like to ask if you would put a bilevel study up of a person with restrictive breathing, or COPD. Those are the most difficult ones to score. I understand that scoring is so subjective, and I think that is what some techs seems to forget when they are dissecting every little thing in a study that they feel one has not scored correctly. If you are able to put up a bi-level study, I would be most appreciative!! Thank you in advance for all u do!
Theres literally no difference in scoring stages of sleep or events on BiPAP S /CPAP with a patient with COPD or not. AASM rules dont change. If you're talking about a titration techniques, thats different. Basic fundamentals would be to understand the lack of effort on the expiratory drive for those patients. But you usually tirate all the same, just with closer eye on EPAP.
Please forgive my bad typing. I am always in a daze. A complete mental daze. That is why I say that I'm not actually falling asleep in front of the computer, but my level of consciousness is always drifting in and out of various stages. I have to chug more mountain dew for another quick energy burst or else my brain starts to hurt from just reading and typing. My concentration is hacked to the point some days I don't even know where I'm at, or what day it is. My oxygen does go down to the low 80's during some of my events, and I have a lot of those heart disturbances you posted on the other video, where my heartbeat can be 40 and then shoot up to 120, and then right back down again. I have had sleep paralysis a lot over the years and hallucinating before and right after waking up. I have heard people in my living room talking shit about me and then wake up and no one is in here lol. It's just hallucinations. My sleep doctor doesn't provide me with very much information. I want to try some stimulants, but they might not give me them. I'm having a hard time trying to get used to the BIPAP machine with a pressure setting of 24. If I can't get used to the machine, I'm pretty much doomed to sleeping my entire life away. It has already held me back both socially and economically. Any how, thanks for posting these videos. Don't let the haters stop you. They hate because they are jealous.
lol wow... sucks to suck, man. Sorry to hear. "want to try some stimulants, but they might not give me them." of course not, your issue is shitty sleep. BiPAP has TWO numbers, IPAP and EPAP... 24 must be your IPAP. What kind of mask are you using... if you say a full face mask, I may already be onto something as to why its not working assuming you are still having events.
lol, dont worry.... they probably enjoyed having to do absolutely jack shit with it. if you stay awake, theres literally nothing to do but access the patient once in a while.
Respiratory Effort Related Arousal. Very similar to a hypopnea, but without the 4% or more desaturation associated with it. Here is a link to my website that shows some samples. freecpapadvice.com/reras-and-uars
I found the info helpful I had a sleep study done in the clinic and a titration study and I would like to hear more about the cental apneas. I was told I also had hypopneas too. The one you did here almost made me think of my first one cause I was really nervous. Also, is is normal to have a patient not use their mouth guard for the first one? I was told I couldn't use mine and I woke myself like two or three times by biting my toungue. That is what I do automatically is stick my tongue between my teeth so when my mouth starts to clench down I wake myself up. And so it wasnt' till I had it back that I finally slept from like 2 30 am on till they woke me up.
Robert Coats I've never used it for sleeping, but it's a very gentle suction. I think that data says it's for people with low AHI or diagnosed with UARS, but don't quote me on that. It's worth a try if you're a candidate.
Is the pink bar the the snore sensor or leg EMG. If there isn't leg EMG how can you tell if the patient is truly having RERAs or if they are having arousing PLMS causing arouals and artificial desats. I agree that most of the wave forms do resemble RERAs, but they could be scored as hypopneas with arousals per AASM rules unless this patient is Medicare in which rules dictate a 4% desaturation.
Hi Rob. I call them RERAs because there is a decrease in airflow and thoracic and abdominal effort prior to the arousal. Not just one breath, but for 10 seconds minimum. There is almost always a desaturation associated with them (this video has them, just may be hard to see on screen) that is anywhere from 1-3%. A leg movement wouldn't explain the decrease in flow or effort, nor would it explain the desaturation. Also, once CPAP is applied, the attenuated signal cease and (if there was leg EMG used) PLMs decrease/cease.
+Rebecca Rozman I think this video was the older version of Alice. Alice 5 possibly....that's what it looks like anyway. Sandman would've been a better system to show it on, but getting clearance to use studies is extremely difficult, so I gotta take what I can get!
I was wondering what can cause oxygen levels to be under 88 percent for most of the night? Also, I have had three different sleep studies, with all of them showing progressively more events than the other. I do notice that there are night I can remember waking up 15 time, and some nights I dream a lot and wake up less, but I never feel rested. My first two tests sleep studies showed more arousals than hypopneas. I had like 67 arousals, but only 45 of them were Hypopneas. Could the other arousals be from UARS? I had no awakenings on the first two sleep study, but on the third one I had 55 awakenings, and an AHI of 20, with an AHI of 30 during rem sleep. I have 80 percent of time in stage 2, 11 percent in stage 1, none in stage 3, and 1.8 percent in REM. That's pretty weird since it was a titration study the third time. I actually had to take a sleeping pill and I made sure to sleep on y back that time so they could see me at my worst. I usually choke myself awake within seconds of falling asleep on my back, but apparently I have more Hypopneas on my left side. My first sleep study showed 20 percent REM sleep with an AHI f 8. The second sleep study showed only 6 percent in REM and 70 percent in stage 2, 7 percent in stage 3, no stage 4. I also had an AHI of 12 the second test, with an AHI of 25 in REM sleep. I had a hard time falling asleep during the first two tests. I sleep a lot, up to 16 hours a day and still can go back to sleep, but when they wired me up for the test I was like an insomniac. I sometimes get insomnia. I swing back and forth between the two. I have been sleeping my life away since I was a kid and underweight. I also wonder if I have a form of narcolepsy. Any how, do you think the Hypopneas are the cause of my low oxygen levels, being under 88 percent for the entire night? Can they have missed the severity of my Hypopneas because I was still not sleeping normally, even during the third test? I woke up to use restroom 5 times, and at home I don't always do that. My symptoms are pretty bad. I have never fallen asleep while driving or watching television, not when I drink coffee. I have to pound coffee all day on the days I want to be mentally functional in any capacity, but even on those days, I can go right to sleep if I allow myself. I can slam mountain dews and then just lay down and go right to sleep. Any how, thanks for posting this video. I like how you scored the UARS, because some sleep labs miss UARS which I also think I have because my tongue is huge, If you can help me with my answer I would greatly appreciate it.
I usually dont respond to this.. but you typed up so much I feel bad at least not skimming some of your questions. 1.Could the other arousals be from UARS? - Yes. Could also be spontaneous or related to anything else like being associated with leg movements, etc. 2.Any how, do you think the Hypopneas are the cause of my low oxygen levels, being under 88 percent for the entire night? -Of course. Usually, hypopneas cause your oxyhemoglobin saturation to decrease, only to return to normal when you experience a brief awakening (arousal)... however, there's cases where you just experience a bottleneck effect once your muscles relax that result in you not moving enough air to begin with (UAR) and you further have episodes of airflow reduction, followed by arousals or more desaturations in oxygen (Hypopnea) 3.Can they have missed the severity of my Hypopneas because I was still not sleeping normally, even during the third test? - The more you sleep the more the further your muscles relax, so sure. some sleep labs miss UARS - only ignorant lab ignore it. Insurances like medicare dont even really like justify CPAP for it, unless Dr. pushes it.
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It is always a pleasure to watch, hear or view something that is unknown to yourself, especially when the person exhibits confidence and a vast amount of knowledge in what he speaks about. Thank you for sharing. I know very little, but I know more now than I did before I listened to your 34 minute video.
Thank you very much for your video! I have been working in sleep for awhile and really have no interest in scoring but, want to sit for registry. I am more of a visual learner and really have no one to show me and your video really helps!! :)
Thank you for this video! I’m started a new job in a sleep lab and this helps me out a lot!
Glad it was helpful!
I am a patient and this was very valuable! Helped me prep for going over the results with my doctor
Excellent! Glad that it helped. I have a bunch of other crappy videos on scoring and other sleep related things if you're just getting started. Lots of really easy things that can trip you up.
I am a Doctor and I love this presentation ....
Thanks Doc!
This video was absolutely wonderful. I am sooooooo looking forward to seeing what the OmniLab Advanced software looks like at the RPSGT Station where you hang out. It is amazing that you have to do the laundry too. Wow. So you are the ones who have to do the washing of the sheets and the making of the beds in addition to everything else. Wow. I must say that I am profoundly excited to see the screen of the OmniLab Advanced software
I work in a lab where I do everything.
In my ten hours, I hook up PT, Score study,Print final report for DR, Clean rooms, and to laundry. (sometimes file)
when i hear about techs just overseeing the patient and ensuring the study is clear for the morning scorer.... i wonder how easy they have it lol. but! im sure you have to deal with a OCD scorer who scrutinizes the dumbest of things.
I'm a night sleep tech, we score and stage our own studies while our patients are sleeping and adjust the pressures as needed during the night. Then we clean the equipment and the rooms when the study is over.
I just started in the sleep field this video was helpful to ,me thanks for sharing 🙏
This was very interesting. I enjoyed seeing how this process works.
VMXGroove Thank you sir! It can be boring. This is a pretty uneventful recording compared to most that I see.
Its really cool. Don't worry about the haters. Your videos are the best and most helpful. Some people are just jerks. I learn a lot from your forum and videos. My own sleep doctor isn't as good at explaining this stuff. keep up the good work.
That reference to the "gold standard" made my night.
Hi LankyLefty27! I am using my husband's youtube channel here and just wanted to say that I really appreciate you going through this study. I'm a newbie tech ...lol... and I am learning all that I can from wherever I can. Lol... I would like to ask if you would put a bilevel study up of a person with restrictive breathing, or COPD. Those are the most difficult ones to score. I understand that scoring is so subjective, and I think that is what some techs seems to forget when they are dissecting every little thing in a study that they feel one has not scored correctly. If you are able to put up a bi-level study, I would be most appreciative!! Thank you in advance for all u do!
Theres literally no difference in scoring stages of sleep or events on BiPAP S /CPAP with a patient with COPD or not. AASM rules dont change.
If you're talking about a titration techniques, thats different. Basic fundamentals would be to understand the lack of effort on the expiratory drive for those patients. But you usually tirate all the same, just with closer eye on EPAP.
can't look at your website, says "database error..."
Enjoyed your video, I use your website a lot.
Thank you Sandy.
Please forgive my bad typing. I am always in a daze. A complete mental daze. That is why I say that I'm not actually falling asleep in front of the computer, but my level of consciousness is always drifting in and out of various stages. I have to chug more mountain dew for another quick energy burst or else my brain starts to hurt from just reading and typing. My concentration is hacked to the point some days I don't even know where I'm at, or what day it is. My oxygen does go down to the low 80's during some of my events, and I have a lot of those heart disturbances you posted on the other video, where my heartbeat can be 40 and then shoot up to 120, and then right back down again. I have had sleep paralysis a lot over the years and hallucinating before and right after waking up. I have heard people in my living room talking shit about me and then wake up and no one is in here lol. It's just hallucinations. My sleep doctor doesn't provide me with very much information. I want to try some stimulants, but they might not give me them. I'm having a hard time trying to get used to the BIPAP machine with a pressure setting of 24. If I can't get used to the machine, I'm pretty much doomed to sleeping my entire life away. It has already held me back both socially and economically. Any how, thanks for posting these videos. Don't let the haters stop you. They hate because they are jealous.
lol wow... sucks to suck, man. Sorry to hear.
"want to try some stimulants, but they might not give me them."
of course not, your issue is shitty sleep.
BiPAP has TWO numbers, IPAP and EPAP... 24 must be your IPAP. What kind of mask are you using... if you say a full face mask, I may already be onto something as to why its not working assuming you are still having events.
Thanks for the video. Is there a program for beginners that we can use to practice scoring and check our accuracy?
Not to my knowledge.....other than the Inner Scorer Reliability.
This is interesting! I had a day/night sleep study, slept for a whopping 15 mins total. I now feel bad for whomever had to deal with my information.
lol, dont worry.... they probably enjoyed having to do absolutely jack shit with it.
if you stay awake, theres literally nothing to do but access the patient once in a while.
Thans for the video. I have a question, what ist RERA?
Respiratory Effort Related Arousal. Very similar to a hypopnea, but without the 4% or more desaturation associated with it. Here is a link to my website that shows some samples. freecpapadvice.com/reras-and-uars
I found the info helpful I had a sleep study done in the clinic and a titration study and I would like to hear more about the cental apneas. I was told I also had hypopneas too. The one you did here almost made me think of my first one cause I was really nervous. Also, is is normal to have a patient not use their mouth guard for the first one? I was told I couldn't use mine and I woke myself like two or three times by biting my toungue. That is what I do automatically is stick my tongue between my teeth so when my mouth starts to clench down I wake myself up. And so it wasnt' till I had it back that I finally slept from like 2 30 am on till they woke me up.
Melissa- I was told to wear mine, they noted on the study that I wore it (tap3 sleep dental device).
What is your thoughts on the winx sleep apnea system thinking about talking to my doctor about it
Robert Coats I've never used it for sleeping, but it's a very gentle suction. I think that data says it's for people with low AHI or diagnosed with UARS, but don't quote me on that. It's worth a try if you're a candidate.
Amazing video. I was struggling trying to stage. You made it that much easier to understand!
Is the pink bar the the snore sensor or leg EMG. If there isn't leg EMG how can you tell if the patient is truly having RERAs or if they are having arousing PLMS causing arouals and artificial desats. I agree that most of the wave forms do resemble RERAs, but they could be scored as hypopneas with arousals per AASM rules unless this patient is Medicare in which rules dictate a 4% desaturation.
Hi Rob. I call them RERAs because there is a decrease in airflow and thoracic and abdominal effort prior to the arousal. Not just one breath, but for 10 seconds minimum. There is almost always a desaturation associated with them (this video has them, just may be hard to see on screen) that is anywhere from 1-3%. A leg movement wouldn't explain the decrease in flow or effort, nor would it explain the desaturation.
Also, once CPAP is applied, the attenuated signal cease and (if there was leg EMG used) PLMs decrease/cease.
Rob Goodwin dnnnnnnnn
I had the sleep study when I woke up to go the bathroom air was going up my nose why it wasn't on before what happened and why please explain. Thanks
You may have an a oxygen study half off half on O2.
IM RRT AND LOOKING INTO GOING THE SLEEP STUDY ROUTE..ANY ADVICE?
I'd stick with RRT work if I'm being honest with you. As an RT you can get hired pretty easily and just have on the job training.
What program are you running?
+Rebecca Rozman I think this video was the older version of Alice. Alice 5 possibly....that's what it looks like anyway. Sandman would've been a better system to show it on, but getting clearance to use studies is extremely difficult, so I gotta take what I can get!
Looks like Alice, not 5 though.
I was wondering what can cause oxygen levels to be under 88 percent for most of the night? Also, I have had three different sleep studies, with all of them showing progressively more events than the other. I do notice that there are night I can remember waking up 15 time, and some nights I dream a lot and wake up less, but I never feel rested. My first two tests sleep studies showed more arousals than hypopneas. I had like 67 arousals, but only 45 of them were Hypopneas. Could the other arousals be from UARS? I had no awakenings on the first two sleep study, but on the third one I had 55 awakenings, and an AHI of 20, with an AHI of 30 during rem sleep. I have 80 percent of time in stage 2, 11 percent in stage 1, none in stage 3, and 1.8 percent in REM. That's pretty weird since it was a titration study the third time. I actually had to take a sleeping pill and I made sure to sleep on y back that time so they could see me at my worst. I usually choke myself awake within seconds of falling asleep on my back, but apparently I have more Hypopneas on my left side. My first sleep study showed 20 percent REM sleep with an AHI f 8. The second sleep study showed only 6 percent in REM and 70 percent in stage 2, 7 percent in stage 3, no stage 4. I also had an AHI of 12 the second test, with an AHI of 25 in REM sleep. I had a hard time falling asleep during the first two tests. I sleep a lot, up to 16 hours a day and still can go back to sleep, but when they wired me up for the test I was like an insomniac. I sometimes get insomnia. I swing back and forth between the two. I have been sleeping my life away since I was a kid and underweight. I also wonder if I have a form of narcolepsy. Any how, do you think the Hypopneas are the cause of my low oxygen levels, being under 88 percent for the entire night? Can they have missed the severity of my Hypopneas because I was still not sleeping normally, even during the third test? I woke up to use restroom 5 times, and at home I don't always do that. My symptoms are pretty bad. I have never fallen asleep while driving or watching television, not when I drink coffee. I have to pound coffee all day on the days I want to be mentally functional in any capacity, but even on those days, I can go right to sleep if I allow myself. I can slam mountain dews and then just lay down and go right to sleep. Any how, thanks for posting this video. I like how you scored the UARS, because some sleep labs miss UARS which I also think I have because my tongue is huge, If you can help me with my answer I would greatly appreciate it.
I usually dont respond to this.. but you typed up so much I feel bad at least not skimming some of your questions.
1.Could the other arousals be from UARS?
- Yes. Could also be spontaneous or related to anything else like being associated with leg movements, etc.
2.Any how, do you think the Hypopneas are the cause of my low oxygen levels, being under 88 percent for the entire night?
-Of course. Usually, hypopneas cause your oxyhemoglobin saturation to decrease, only to return to normal when you experience a brief awakening (arousal)... however, there's cases where you just experience a bottleneck effect once your muscles relax that result in you not moving enough air to begin with (UAR) and you further have episodes of airflow reduction, followed by arousals or more desaturations in oxygen (Hypopnea)
3.Can they have missed the severity of my Hypopneas because I was still not sleeping normally, even during the third test?
- The more you sleep the more the further your muscles relax, so sure.
some sleep labs miss UARS
- only ignorant lab ignore it. Insurances like medicare dont even really like justify CPAP for it, unless Dr. pushes it.
Sleep Study done With Cpap done 3/21/17
All looks the same