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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby Guest on Mon May 15, 2017 5:45 am

Ditto - Ditto

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby ajack on Mon May 15, 2017 6:02 am

you will need to google the altitude and o2 level curve, but high alt and 87 can be ok. this doesn't mean your mum doesn't need a cpap. get a full report, but the diagnosis would be correct.


http://www.high-altitude-medicine.com/SaO2-table.html

Image

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xxyzx doesn't know a lot and tends to misinterpret stuff, I would read elsewhere

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby HoseCrusher on Mon May 15, 2017 10:29 am

This may provide some perspective on this...

http://anthro.palomar.edu/adapt/adapt_3.htm

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby ajack on Mon May 15, 2017 2:17 pm

xxyzx wrote:
ajack wrote:you will need to google the altitude and o2 level curve, but high alt and 87 can be ok. this doesn't mean your mum doesn't need a cpap. get a full report, but the diagnosis would be correct.

===============

makes no sense

if low o2 is dangerous then it is dangerous
how does altitude change that ?

seems like everyone at high altitude is constantly being exposed to danger of low o2 levels


I guess that's why I started the post with "you will need to google" instead of writing a 10 page report on it.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby herefishy on Mon May 15, 2017 4:08 pm

When they first suspected I had OSA, they hooked me up to an oxygen machine to see if that would bring the O2 levels up, but after a while, they weren't much better, so they went to CPAP> the reason being, if you can't take in the air properly, you can't get the oxygen. So you are on the right track, to see what the O2 levels actually are over the whole night, then you could ask the doc to supply oxygen to see if that helps.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby TASmart on Mon May 15, 2017 4:39 pm

At high altitude low O2 is quite dangerous, just that for most people the effects of high altitude are not significant to well over 10,000 ft. Why do you think that high altitude mountaineers carry oxygen?

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby zoocrewphoto on Mon May 15, 2017 5:06 pm

Please be aware that there is more to sleep apnea than the oxygen saturation number.

For example, many people have adapted over time to have coping techniques. One is to sleep lightly and wake up quickly when the airway is blocked. So, they tend to have a lot of disturbances, yet the oxygen doesn't go down that much. My oxygen barely went below 90%, but I had 79+ events per hour. That means that my sleep was being disturbed more than once a minute.

Sleep apnea is about oxygen deprivation and sleep deprivation. Being disturbed hundreds of times per night means very poor quality of sleep.

It is very important that you find out how many disturbances she has per hour, how long they average, if they are clustered, and if she gets much REM sleep.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby Arizona JC on Mon May 15, 2017 5:21 pm

I now have the actual mostly-full Polysomnography report, and THE NUMBERS I POSTED UPTHREAD ARE WRONG. I think.

Okay, there were many comments about the breathing cessation number I gave in the initial post, and I can't find that number anywhere in the full report. I got it from a summary sheet Mom was given after the initial study. I'm assuming the number of breathing interruptions is in the full report somewhere, and I'm just too dumb to see it. I had to spend some time after getting the report looking up acronyms, because it has a lot of them and no explanation, but I still can't find the breathing cessation info - nor a number of any sort to match it (241).

Here's what I've been able to figure out so far.

Total Sleep Time (TST) 38.5 minutes. (this does not match the 45 minutes on the summary sheet).
Total Recording Time (TRT) 396 miniutes
Sleep period time (SPT) 309 minutes. (I think this means how long mom had to try to sleep).

Looks like Mom had two sleep times, N1, duration 4.5 minutes, and N2, 34 minutes.

There is an oxygen saturation 6 column chart. It gives the following for number of desats; wake, 2. NREM, 0, REM 64. TIB 64 TST 64
Mean SpO2%; Wake, 89. NREM, 88, TIB, 89. TST, 88.
Min SpO2% TIB 81 TST 81.

Cardiac summary, average heart rate 84.4, highest during sleep, 101, highest during recording, 255 bpm. (255 BPM for an 88 year old? Isn't that call-the-ambulance high?)
All the cardiac event observation boxes are checked "no".

The technician's notes are as follows,
"Sleep onset was delayed. No REM sleep was recorded. Sleep efficiency was very poor. In short period of sleep, pt did have a severe amount of obstructive events. Not enough sleep recorded to allow split. Snoring was frequent during sleep and was moderate to loud. Limb movements few. Normal sinus rhythm noted t/o."

The final page is a graph. the heart rate BPM line looks like it tops out at around 180 for a brief period around 2am, when mom was not asleep. The SPO2% line is squiggly, about one line width, centered on either 90 or 89 (the graph is of poor quality) and only slightly more squiggly (maybe two line widths) during the very brief sleep periods.

What I can't see anywhere in the report, except in handwriting on the front, is the number 87 (for hypoxemia) which was also told to me verbally when I asked during Mom's review appointment. Also absent, except in handwriting, is the AHI of 87. I also can't see, anywhere (except on the summary notes I was talking about upthread), is the number of breathing interruptions. Shouldn't that be in the report?

A further note; Mom had two brief sleep periods, and the second one ended when they woke her up at 4:30 AM (the sleep study office hours are 10pm to 5am). I was mom's ride to and from the study center (which is her cardiologist's medical office during normal hours, and he's the one who referred her) and they made it very clear (when I dropped her off at 9:30) that I had to pick her up by 5am. I found the tight hours to be rather odd.
Also, the cost (it ended up being fully covered by insurances) for this was $1249.84 (Which seems high to me compared to the prices I'm seeing while looking for a place to get a new study done) and it appears on the insurance billing form as "Electroenceph", but on the invoice itself as a sleep study. Mom did have a bunch of electrodes on her head for this (It took her a lot of work to get the goo out of her hair), so maybe an electroencephalograph is part of a sleep study?

BTW, I see several excellent new posts in this thread (thanks!) and I will reply, but I won't have time until tonight.
Thanks!!

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby guest two on Mon May 15, 2017 5:54 pm

See: How to interpret the results of a sleep study

www(dot)ncbi(dot)nlm(dot)nih(dot)gov/pmc/articles/PMC4246141/#S0004title

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby Julie on Mon May 15, 2017 6:33 pm

EEG's are standard for lab studies.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby robo2084 on Mon May 15, 2017 7:56 pm

Hi I didn't have a chance to read the many responses here, but keep in mind you can do a home sleep test, you don't have to go to a sleep center. Not sure what reimbursement would be for that given that you already have a diagnosis, but it's worth asking her GP about it. Basically the send you a device for two nights that measures breath, pulse, o2 and then you get a full sleep report.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby Pap-Daddy on Mon May 15, 2017 8:13 pm

Arizona JC wrote:Also, the cost (it ended up being fully covered by insurances) for this was $1249.84 (Which seems high to me compared to the prices I'm seeing while looking for a place to get a new study done)
I could be wrong but I thought most places bill around $3 to $5k - insurance doesn't pay that much tho.

Mom was prob nervous and couldn't sleep, which is understandable many have that problem. There is nowadays a home sleep study she can take but it is not as thorough as in the lab. Example - does NOT detect leg (Limb) movements which it does appear she may have some. Those also interrupt sleep.

For learning your new acronyms there is of course Google or you can go to the top of this page and click on the light bulb - CPAP Wiki then search for CPAPopedia.

Keep up the good work.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby zoocrewphoto on Mon May 15, 2017 8:23 pm

My sleep study was billed at over $6,000 and they were paid over $4,000. I had a split night since I was severe enough in the first 2 1/2 hours with enough time afterward for a titration.

The report really should say how many events there were, and the ahi, and not in handwriting.

It does sound like there were a lot of events as well as a lot of snoring, so while teh numbers may not be great, especially with such a short time. It does look like she has severe sleep apnea.

If you do another sleep study, do a home study or one with better hours. Mine let me sleep until 8am.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby Guest on Mon May 15, 2017 8:42 pm

Arizona JC wrote:Not enough sleep recorded to allow split.
That is a reference to a "Split Night" study. This when a diagnosis is the first part of the nite and if/when certain criteria is met (and the doc has ordered it) they can then go into the part where a mask is put on and they try to eliminate all events (if possible) by adjusting pressures - this is known as the "Titration" which may or may not be accurate given the time constraints.

Which btw is normally an early exit but not often that early.

fwiw - Medicare requires a minimum of 2hrs for diagnosis. That means the patient must sleep for at least 2 hrs. So now I am wondering since she didn't sleep 2hrs IF the billing code used was for something else and that is why
the cost (it ended up being fully covered by insurances) for this was $1249.84
.
See if you can find out what code was used and just maybe she can get yet another PSG= Sleep Study at home or elsewhere if needed.

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Re: Does a O2 level of 87 at high altitude really require CPAP?

Postby Arizona JC on Thu May 18, 2017 3:29 pm

Sorry I (original poster) have been absent from this thread; I managed to hurt my hand (just bruised, nothing serious) so can't type much today, and couldn't at all until now. (for those unaware, it's preferable to close your car door after, not before, moving your hand out of the way.. oops.).

I've read every post in this thread, and all I can say is THANK YOU ALL, so much. Having this interaction has been a rock in what, for me, was a very stressful and uncertain time. I'll reply as I can, which is hopefully soon (my hand is healing).

So, now the update on Mom. She's doing pretty well getting used to CPAP. Also, I have noticed she doesn't doze while watching TV anymore (she did occasionally before CPAP).
I also did a series of oximeter spot checks on her during a hike. She was pretty steady at 92 (approx... a point either way deviation) until we got to the uphill section a couple of miles in. It's a small climb, about 100 ft elevation gain at a 10% grade. Hiking uphill usually bothers her, and it did this time too. At the top, she was severely out of breath (she insisted on not taking it easier or pausing) and her 02 was 79, but came up very fast.
The elevation we were at was about 5700 feet.

I still find the sleep study she had to be dubious (not saying she doesn't need CPAP, just that I don't trust the sleep study). I've previously reported that the study report shows (in print, but not in the graph) that her heart BPM hit 255, which is incredibly dubious IMHO. I've now uncovered another discrepancy, this one certain; her AHI. It's not in the printed report, just in handwriting on the front (same is true for her hypoxia level) and is 87. BUT, on the CPAP provider's paperwork, Mom's AHI is 18, and further a "moderate" AHI, with range, is circled on their paperwork. Seeing as how 87 is not 18, somebody goofed. And, I want to know exactly where the CPAP provider got that AHI of 18 number, because it's not anywhere in the records I've been given, and I've been told I now have all of them.

My current plan is to ask a heck of a lot of questions next week, when I take Mom to the CPAP provider for her followup. I'm also still getting a logging oximeter to get more data.

Thanks!!

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