Very concerned about latest pulse ox reading

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Masta
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Very concerned about latest pulse ox reading

Post by Masta » Wed Jul 01, 2015 2:24 pm

I called my new doctors office this morning, I asked to speak to the doctors nurse. I explained how I'm a new patient (who hasnt been seen by the new doctor), and that I have done a sleep study at anothers doctors several weeks ago, and that I have an appt with the new doctor in 3 weeks, that my medical file is currently at their office to review and that I have concerns about last nights pulse ox readings on the CMS-50F wrist pulse ox I wear at night.

Over the last couple of days my readings have declined. Last nights reading my minimum Sp02 was 64. The last week I have been waking up feeling very disorientated, groggy, tired, have major head pressure, my tinnitus is louder than normal and I have a headache/migraine, this morning the headache was really bad. I explained my symptoms to the nurse, she said headaches are common with people who have untreated sleep apnea. She opened my file and quickly looked at my sleep study report, said I should try and not sleep on my back (one of the recommendations). I told her I dont sleep on my back.

I faxed my last 4 nights of pulse ox data to the nurse. The nurse said she would have the doctor look at 4 x night pulse reports I sent, as well as my sleep study report and she would get back to me today. She said the doctor doesnt like his patients go to below 89% Sp02.

I called the office back several hours later to see if the nurse received the fax and if she has had a moment to speak to the doctor, she wouldnt accept my call, she had the receptionist tell me she received my fax and that the doctor is out of the office until next Monday, he will look at my file then and then the nurse will get back to me.

My main concern is: are my numbers that low that I should seek help and not wait until my 23rd July appt with the new sleep doctor? The 23rd July appt, is to review my sleep study results, and to hopeful get prescribed cpap therapy.

My previous 3 night pulse ox results are here: viewtopic/t106491/CMS50F-Pulse-Ox-Results.html

Last night
Date: 06/30/15
Time Length Recorded: 5:52:27

Event Data ---- Sp02---- PR
Total Event:----- 142---- 80
Time In Event (min):---- 65.3---- 31.6
Avg. Event Dur. (sec):---- 27.6---- 23.7
Index (1/hr):---- 24.2---- 13.6
Artifact (%):---- 0.7---- 0.7
Adjusted Index (1/hr):---- 24.3---- 13.7

Sp02 Data
Basal Sp02 (%): 92.9
Time (min) <88%: 5.0
Events <88%: 19
Minimum Sp02 (%): 64
Avg. Low Sp02 (%): 89.8
Avg. Low Sp02 <88%: 85.3

PR Data
Avg Pulse Rate (bpm): 76.1
Low Pulse Rate (bpm): 62

%Sp02 Level---- Events---- Below (%)---- Time (%)
99-95:---- 0---- 100---- 100
94-90:---- 91---- 95---- 88.7
89-85:---- 48---- 90---- 4.3
84-80:---- 2---- 85---- 0.2
79-75:---- 0---- 80---- 0.0
74-70:---- 0---- 75---- 0.0
69-65:---- 0---- 70---- 0.0
64-60:---- 1---- 65---- 0.0

Analysis Parameters
Desaturation Event: drop n Sp02 by at least 4%, for a minimum duration of 10 seconds.
PR Event: Change in rate by at least 6 bpm, for a minimum duration of 8 seconds.

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Julie
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Re: Very concerned about latest pulse ox reading

Post by Julie » Wed Jul 01, 2015 2:53 pm

What machine & mask do you use? If you don't stick to one thread, you just confuse us and make us have to look up your info on others... and we should not have to do that - most would be disinclined.

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Masta
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Re: Very concerned about latest pulse ox reading

Post by Masta » Wed Jul 01, 2015 2:59 pm

Julie wrote:What machine & mask do you use?
I am not receiving any cpap therapy at all, so no machine and no mask. Im waiting to get diagnosed and treated, my appt is 23rd July (I had to switch sleep doctors after my sleep study was done due to inappropriate behavior from the sleep doctor).

Someone from this forum suggested I buy a CMS-50F pulse oximeter , which I did, from Cooper Med. I purchased it, so when I do go to my doctors appt, it'll save time with having to do an overnight pulse ox test (my sleep study showed I dropped to 84%, and my sleep doctor ignored it).

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Julie
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Re: Very concerned about latest pulse ox reading

Post by Julie » Wed Jul 01, 2015 3:15 pm

One low reading per one night does not an emergency make.

JDS74
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Re: Very concerned about latest pulse ox reading

Post by JDS74 » Wed Jul 01, 2015 3:30 pm

The time below 88% would qualify for supplemental oxygen if it is supported by a medical grade oximeter like those used in sleep studies. I have one and two CMS50F oximeters (old style) and for my small sample, my CMS50F oximeters read between one and two percentage points low as compared to the medical one. So, your reading might be above the 88% level. It is likely that the 64% low value is an artifact of movement at night. Sometimes, the oximeter loses synch and records a very low number. In my data, I see some 0 values around these exceptionally low ones. To see that, I had to look at the individual data values. It was more work than the information was worth and just confirmed what others have said about artifacts.

Bottom line is don't get too worked up. Sending copies to your doctor was good. Calling repeatedly after, not so good. Keep up with data recording, keep working on any sleep hygiene issues you might have, and try to relax and not stress out.

When you see the doctor, be sure to bring you oximeter so he can see the numbers compared to his office unit.

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Masta
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Re: Very concerned about latest pulse ox reading

Post by Masta » Wed Jul 01, 2015 3:37 pm

Julie wrote:What machine & mask do you use? If you don't stick to one thread, you just confuse us and make us have to look up your info on others... and we should not have to do that - most would be disinclined.
I'm new to the forum, sorry about that. I'll stick to one thread in the future.

My numbers have been below 88% for the last 4 nights. The 64% was a bit of a concern. Julie and JDS74, thank you both for easing my mind. I will take the wrist pulse ox with me to my appt .

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HoseCrusher
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Re: Very concerned about latest pulse ox reading

Post by HoseCrusher » Wed Jul 01, 2015 3:48 pm

Yes, you dropped below 90%.

Yes, you spent 5 minutes out of 352 minutes below 90% (or 88%).

Yes, you had 19 events below your threshold.

However, your artifacts were up and one of those artifacts probably caused the reading of 64%.

To get a better understanding of what is going on, load your data into the software. Now click on the tool box that has a screwdriver and wrench in it. Adjust the Drop for even to 4%, the Minimum Event Duration to 10 seconds, and set the Desaturation Criteria Level to 90%.

While you are there, put the Rate Change for a pulse event to 15, and set the Minimum pulse event duration to 30 seconds.

Close up the tool box and give us data from the report generated under these new parameters.

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SpO2 96+% and holding...

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Masta
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Re: Very concerned about latest pulse ox reading

Post by Masta » Wed Jul 01, 2015 8:50 pm

HoseCrusher wrote:Yes, you dropped below 90%.

Yes, you spent 5 minutes out of 352 minutes below 90% (or 88%).

Yes, you had 19 events below your threshold.

However, your artifacts were up and one of those artifacts probably caused the reading of 64%.

To get a better understanding of what is going on, load your data into the software. Now click on the tool box that has a screwdriver and wrench in it. Adjust the Drop for even to 4%, the Minimum Event Duration to 10 seconds, and set the Desaturation Criteria Level to 90%.

While you are there, put the Rate Change for a pulse event to 15, and set the Minimum pulse event duration to 30 seconds.

Close up the tool box and give us data from the report generated under these new parameters.
HoseCrusher: I have changed the parameters like you suggested and attached the pictures (with new parameters) so you can see.

Night 1:
Image

Night 2:
Image

Night 3:
Image

Night 4:
Image

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bwexler
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Re: Very concerned about latest pulse ox reading

Post by bwexler » Wed Jul 01, 2015 9:43 pm

I am not an expert like some of the folks here, but when my stats look like your I smile.
I use a high end ASV machine and supplemental oxygen at 3 litters per minute. So with your numbers on room air with no therapy, I would not worry at all. Just relax and wait patiently for your appointment.

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JDS74
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Re: Very concerned about latest pulse ox reading

Post by JDS74 » Wed Jul 01, 2015 9:45 pm

All those O2 drops that look like straight down and up lines are almost certainly movement artifacts. The rest of the graphs look pretty good with one dip down near 90% or so for two nights.

Hang in there. The new arrangement will be better.

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HoseCrusher
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Re: Very concerned about latest pulse ox reading

Post by HoseCrusher » Wed Jul 01, 2015 10:13 pm

Oops, it looks like the new settings didn't take.

How do I know?

The setting for SpO2 was supposed to be 90 and when I look on your report I see Time (min) <88%. If the parameters were changed to 90 it would say Time (min) <90%.

In addition we were looking for pulse parameters of 15 and 30 and when I look at your report I see under the Analysis Parameters pulse settings of 6 and 8.

However...

Since you added graphs we can take a look at those.

Night 1 has an interesting event at roughly 2:40. This could be an apnea event. The one at roughly 4:40 is an artifact.

Night 2 had two areas of interest. One at about 2:50 and the other at roughly 8:10. If we were looking at a threshold of 90% these would indicate apnea problems at those times. Also the pattern at roughly 5:50 would come up on the radar with a threshold set to 90%.

Night 3 started off a little rough but then things settled down. The spike at roughly 5:00 is an artifact. I am not sure about the spike at roughly 2:45 and would have to zoom in on that data to see what is going on.

Night 4 shows issues right at the start and then again at 00:30. The spike at 2:20 is an artifact and that is where the 64% number came from. You have another spike at roughly 3:40 that I am not sure about but the data at 4:30 shows some issues.

Based upon pulse rate and SpO2 levels it looks like xPAP therapy could provide some benefit to you. The next step is to add respiratory effort, brain activity, air flow, and leg activity to confirm what is showing on the oximetry report. This involves a sleep study.

To answer your question, don't be worried about the plunge to 64%. However there are some concerns about the other data.

By the way... If you do go for a sleep study be sure to wear your oximeter. This will give you a comparison to work from. That data along with the data you have already collect will help you see improvements should you start using an xPAP machine.

Some people respond to xPAP treatment by feeling better. Others don't seem to notice any difference. Having oximeter data that distinctly shows a difference can go a long way to helping you adjust. It is always exciting to see direct measurable results.

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Papit
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Re: Very concerned about latest pulse ox reading

Post by Papit » Wed Jul 01, 2015 11:43 pm

HoseCrusher or JDS74, Can you clear this up? Why are the figures not equal (19 vs. 51) in the data from her opening post at bottom?

Sp02 Data
Basal Sp02 (%): 92.9
Time (min) <88%: 5.0
Events <88%: 19

%Sp02 Level---- Events---- Below (%)---- Time (%)
99-95:---- 0---- 100---- 100
94-90:---- 91---- 95---- 88.7
89-85:---- 48---- 90---- 4.3
84-80:---- 2---- 85---- 0.2
79-75:---- 0---- 80---- 0.0
74-70:---- 0---- 75---- 0.0
69-65:---- 0---- 70---- 0.0
64-60:---- 1---- 65---- 0.0

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Machine: AirCurve 10 ASV, Mask: AirFit N30i
PulseOx Data-transfer to OSCAR4-23-12http://tinyurl.com/nzd64gu
Wireless SD Card Data-transfer to OSCAR 8-14-15http://tiny.cc/z1kv8x

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palerider
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Re: Very concerned about latest pulse ox reading

Post by palerider » Thu Jul 02, 2015 12:12 am

Papit wrote:HoseCrusher or JDS74, Can you clear this up? Why are the figures not equal (19 vs. 51) in the data from her opening post at bottom?
Events <88%: 19
89-85:---- 48---- 90---- 4.3
what's the differnce in <88 and 89-85?

I suspect the answer to your question lies there.

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Papit
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Re: Very concerned about latest pulse ox reading

Post by Papit » Thu Jul 02, 2015 12:35 am

Yep, that could be. The entire difference though, 29 events, would all have had to occur between 88 and 89%.

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PulseOx Data-transfer to OSCAR4-23-12http://tinyurl.com/nzd64gu
Wireless SD Card Data-transfer to OSCAR 8-14-15http://tiny.cc/z1kv8x

JDS74
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Re: Very concerned about latest pulse ox reading

Post by JDS74 » Thu Jul 02, 2015 5:26 am

The range 89% - 85% covers
89
88
87
86
85
and <88% only covers within this range
87
86
85

So it looks like there are 32 events distributed between the 89% and 88% categories.

BTW, I did use my CMS50F oximeter during my last sleep study as HoseCrusher suggests and got good additional data on the difference between this home type unit and the lab one. Good idea!

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