Looking for Advice

[SleepyGuyJPN]

Hi All,

I've been diagnosed with mild to moderate sleep apnea and am looking for some advice from others on my data.

OSCAR CPAP graphs and some graphs from the pulse oximeter I own (Wellue O2Ring) are included below.

Here's a little about me:

I'm a Southern Californian expat living in Yokohama, Japan, 34 year-old male, 5'11", 180 lbs, I was exercising regularly but fell off the wagon a bit lately after a traumatic past few months, have a history of asthma and pretty terrible allergies to things like dust and dander. I've got a bum right ankle that I fractured about 13 years ago.

I'm presently taking anti-anxiety and anti-depressant medication after being diagnosed with acute stress disorder and depression around August, 2019. Anxiety/Depression 'started' and peaked around that time, and I've been taking the medication since. I had a super stressful job back in the States and have had a whole slew of nasty health issues hit me all at once in the last year, which caused the aforementioned trauma. I get heartburn easily, brain fog, difficulty concentrating, fatigue, eye pain/dry eyes, and unrefreshing sleep. Lately the heartburn, and to some small extent, my sleep, has been just a tiny bit better since I've begrudgingly pulled alcohol and coffee from the menu for the last few months.

I'm retrognathic and have a large neck and small airway, but unfortunately haven't been evaluated by an oral surgeon yet.

I talk in my sleep (sometimes in Japanese ), and have done the talking ever since I was a kid, generally on the morning side of things an hour or two before waking up.

I don't snore much, and the wife never noticed I stopped breathing when I sleep because she falls asleep instantly (always before me) and sleeps like a log.

That said, my nose is always, and I mean always, severely congested in either one or both nostrils in the evening as soon as I lay down and continues to remain that way through the night until whenever I wake up. I've tried nasal sprays, neti pots, antihistamines, you name it; NOTHING stops my nose from getting stuffed up every night. This is why I have to use a full face mask with my CPAP, and I wouldn't be surprised if my nasal congestion was at least a small contributor to my sleep problems. An ENT I've been seeing recently says I have a deviated septum, but I haven't had it evaluated by a surgeon yet.

I was officially diagnosed with sleep apnea after my first sleep test at a small sleep clinic out here back in July of 2019, but suspect I've had it for at least a few years now. I've been using my Philips DreamStation Auto CPAP and full face mask since January this year.

I had another sleep test earlier this month sans-CPAP at my current sleep clinic, and results haven't changed much from my first.
I just began taking 3mg of melatonin based on recommendation from my sleep doctor at my last visit.
They raised my Philips DreamStation pressure to Min. 6/Max. 11, up from Min. 4.5/Max. 10. Since they've done this, I've seen a small increase in the number of regularly occurring CAs.

Seems a lot of people recommend setting Auto CPAP max pressure to the highest level available; I've never seen my pressure hit maximum, so not sure that will help me much, but willing to try.

One of my biggest concerns is that my blood oxygen will often make deep drops to 84-85% SpO2, oftentimes right after or right as I start falling asleep. Other times, it seems to occur when I go into REM.

Lastly, back when I had something that was akin to a panic attack that really set off my depression 5 months ago, I had severe insomnia that was caused by these kind of terrible jerks/'brain zaps' that would jolt me awake right as I was falling asleep, over and over again all through the night, driving my anxiety off the wall. I've had hypnagogic jerks before, and buddy let me tell you, these are nothing like them. These things feel absolutely terrible and instill a sense of dread. Thankfully these episodes have subsided for the most part, but I can still get one or two of them while falling asleep from time to time, especially on days where I'm feeling significantly stressed.

Here's some data for the last few nights (a couple more in the post below):

2-20.png (120.45 KiB) Viewed 1164 times

Pulse oximetry from that same night:

spo2-2-20.png (222.42 KiB) Viewed 1164 times

Interested in hearing any comments or suggestions.
Cheers!

[SleepyGuyJPN]

Another day with some additional data:

2-19.png (129.51 KiB) Viewed 1161 times

Accompanying pulse oximetry data:

spo2-2-19.png (224.79 KiB) Viewed 1161 times

Finally, one more day for which I don't have any pulse oximetry data:

2-15.png (127.13 KiB) Viewed 1157 times

Thanks again to anyone who cares to look!

[Pugsy]

It's the minimum pressure that is the most critical pressure setting for prevention the airway collapses.
It has to be high enough to hold the airway open optimally for the most part and close enough to the higher pressures you might need sometimes during the night (REM stage sleep or maybe sleeping on your back or maybe a combination of the 2).
The maximum setting doesn't really matter all that much if you never hit it.
Now if you saw yourself pegging out the max setting a lot...then for sure more maximum is needed.

What are you complaints or questions that you need answers to?
I got all this history but nothing really that was in the form of a question that I could maybe answer.

While your AHI isn't horrible...if it were mine I would try to clean it up a bit more once I determined if I was asleep or not when those events got flagged.

Are you spending much time with the mask and machine on? Or do you sleep soundly for the most part?

[hueyville]

Your low numbers on the pulse oximeter seem to be very short spikes, with average spO2 of 97% and healthy resting heart rate I would not overly worry about that too much. Looks to me like most of the low O2 drops followed the short spike in heart rate which wonder you moved around, had a bad dream or woke up with stress attack. I take nothing for stress and don't have significant issues but some days and nights I bring work home with me if it's not going well and it will bother my sleep if don't do some mental relaxation which is praying for me.

[SleepyGuyJPN]

Thanks for your reply, Pugsy.

I guess I'm just looking for recommendations based on my data. Are my settings looking like they are doing their job from a general standpoint, or should I change things up? That sort of thing.

I wake up a few times each night, either from discomfort from the mask, leaking, or just in general because I've always been a really light sleeper. Generally, I keep the machine and the mask on for ~6 hours each night, then remove it an hour or two before waking up for the day. I've been working on keeping it on longer, so times have been increasing little by little; before I'd find I'd tear the mask off after a couple hours of use.

Also, with my SpO2 hitting mid to low 80s, is there another device I may want to look into, or possibly supplemental oxygen, or are the periods so brief in my data that I'd be overreacting?

Hope these are some more useful questions to go on.

Thanks for your time!

[SleepyGuyJPN]

Your low numbers on the pulse oximeter seem to be very short spikes, with average spO2 of 97% and healthy resting heart rate I would not overly worry about that too much. Looks to me like most of the low O2 drops followed the short spike in heart rate which wonder you moved around, had a bad dream or woke up with stress attack. I take nothing for stress and don't have significant issues but some days and nights I bring work home with me if it's not going well and it will bother my sleep if don't do some mental relaxation which is praying for me.

That's reassuring to hear that the periods are so brief that I shouldn't be too worried about it.

I hear you, my job had me on the hook 24/7 and I'd never turn off, so I'd be working from home until 2 and 3am and be completely unable to turn my brain off when trying to go to sleep, on top of it always taking 20 mins or so anyway. With all the new health issues, I'm taking a break from working for a spell, but am concerned that I still have these spikes even though I'm feeling a lot less stress than before and am taking medication that's supposed to help with it. :/

You make a good point though, I should make some time to do some mental relaxation exercises to see if that helps.

Thanks!

[Pugsy]

Very brief sudden drops in oxygen and pulse rate spikes are most likely related to loss of contact artifacts and the device takes a few seconds to establish contact again and normalize the data it is sensing.
I would ignore those.

Real drops in oxygen levels or changes in pulse rate show up as lasting longer and are more gradual in the changes.
We don't suddenly go from 95% O2 to 85% in a matter of a few seconds.
Put your oximeter on....hold your breath for 30 seconds...does it change much if any?

I guess I'm just looking for recommendations based on my data. Are my settings looking like they are doing their job from a general standpoint, or should I change things up? That sort of thing.

I wake up a few times each night, either from discomfort from the mask, leaking, or just in general because I've always been a really light sleeper. Generally, I keep the machine and the mask on for ~6 hours each night, then remove it an hour or two before waking up for the day. I've been working on keeping it on longer, so times have been increasing little by little; before I'd find I'd tear the mask off after a couple hours of use.

Actually base on what you say ....I am betting some of your AHI is awake/arousal related more than airway related.
Go here and watch the videos and you will understand what I am talking about. If you aren't asleep...they don't count other than maybe pointing out that you have crappy sleep quality.
http://freecpapadvice.com/sleepyhead-free-software
My AHI usually runs between 1 and 2 but 80% of it is related to arousal/awake breathing false positive flagging. I have some pain issues that cause a lot of brief arousals and tossing and turning.

Be careful with yielding to the little devil on your shoulder who is telling you it's okay to take the mask off at 4 AM and sleep to 6 AM without it so you can get some "real sleep"....that's a really bad habit to get into and you know the deal about bad habits....easy to make and really hard to break.

If you look at your flow rate and decide a lot of those flagged events aren't real asleep events....
I wouldn't change anything right now. I would concentrate on mask fitting and comfort and all that stuff that annoys us and makes our sleep quality go in the toilet.

Anything that wakes us up is unwanted because it messes with the normal sleep cycles. Keeps us from progressing through each stage like we should and keeps us from getting the needed amount of sleep in each stage.
Read this article and while I know it is talking about alcohol and sleep....what he says about the sleep stages and sleep quality holds true no matter what it is that is messing with our sleep quality and quantity.
So substitute leak, or mask fiddling or whatever for alcohol and it's still true.

https://www.sleepfoundation.org/article ... tity-sleep

PS....I just looked at your pulse ox reports again...all those dips look like loss of contact artifacts to me.
If it were my report I would shrug my shoulders and move on.

[hueyville]

Will try to do some screen captures and then upload to my photobucket account and share on my pulse oximeter. I initially see four graphs with O2 level, heart rate and other data. It's hard to look closely at spikes in that entire session view but can hit a drop down and change from entire session to whatever resolution I want from a single minute to several hours. My four graphs run width of monitor so if set it for thirty minutes to one hour resolution can really look at spikes whether high or low while comparing with data from other graphs and get a better handle on why something went out of normal range. When change time shown on graph can use a slider to go from beginning of session to end or anywhere along the timeline.

Have been instances where I adjust the resolution down to one to three minutes on graph to really dial in on an event but this is generally just for physical training. I ride bicycles a lot and used to race competitively so knowing your heart rate, O2 level and other parameters based on how many watts of energy the body is putting out over a period of time is important to figure max heart rate before you hit a point of "crashing" and losing time. Thus have purchased top line pulse oximeter that looks like a watch with wire that tethers to cup that slides over finger and cycling gloves keeps it all neat. My heart monitor wear around chest under jersey and display mounts on handlebars and synchronizes with watt meter in rear hub of my training bicycle. Allows me to track data when riding up steep hills or in sprints to lines for bonus points or when a group tries to drop as many riders off the lead pack. At end of race when see the finish line nobody cares about max heart rate and endurance as we will kill ourselves to hit the line first but most know how long and how hard they can sprint thus when see the 1 km, 500 meter, 300 meter, 200 meter, 100 meter lines the smarter sprinters can use their knowledge of bodies ability to best decide if want to break away or ride a wheel then slingshot around someone from the draft at a certain point.

As the technology for gathering performance data for sports I have also used it for my sleep apnea as well. Just lIke putting data from four devices that track everything the body is doing compared with watts output, speed of bike, grade of slope gear ratio and rpm of pedals in matching time lines along with calories consumed during ride and when can shave seconds to minutes off a race some of the devices have found their way into my sleep apnea data. Can wear my pulse oximeter and heart monitor to bed then am able to synchronize with data from my BiPAP autoSV, align all the graphs of data and generate reports that my doctor says rival the sleep lab. In fact my data collection has been refined so well have not been asked to do a sleep study in several years when initially it was every few months, to biannually then annually till finally between past studies and my improved data tracking as better devices have come out doctor has all he needs. I even record the elevation I sleep at as my numbers vary if sleep at the beach basically at sea level or at 10,000 feet at a ski resort.

I use a daily planner in my computer or tablet to record most days activity as it relates greatly to my sleep. If I do a lot of manual labor at work my AHI will generally be lower than days I do computer design and worst are days I deal with whining clients. Mental stress whacks me more than physical labor. A long day of skiing or cycling may tire me but am mentally much more relaxed and usually sleep with better numbers. Busted up my lumbar spine in a motor vehicle accident in 2007 along with my neck, fractured skull in fall from a cell tower because went back to work too soon after MVA then had a deer run out in front of my motorcycle early 2008 as recovering from the head and neck injury. I had never had any sleep issues till the head injury which explains the centrals to me but not the obstructive unless fact that my physical training for sports decreased significantly. Ended up missing most of two years of work as was rear ended a second time end of 2008 breaking two disks in my thoracic spine.

Without telling me what it was one of my doctors put me on an anti-depression medication during this as I told him I was stressing about missing work and draining my savings to pay bills. I almost lost my mind and went totally loopy so he changed me to a different anti-depression drug that had me thinking I was going insane. Due to injuries, new issue with sleep apnea, new issue with migraines when never had a headache in my life before head injury, thyroid going out along with adrenal glands requiring adrenaline suppliment and testosterone level dropping from 16 to 2 I had five different doctors consulting and adding medications which I was so whacked from the stress didn't realize they had put me on anti-depression meds when I was not clinically depressed just stressed. When realized I was on a very strong and new antidepressant I got upset and just quit taking it which didn't know once on them if quit cold turkey was even worse. Had to go back on, lower dose every two weeks till weaned myself off and felt much better.

Can't diagnose you but have several friends that found themselves on antidepressants and said they felt worse than ever. Most figured out how to come off them and felt much better. Our society and medical profession has come to a belief there is a pill for everything. When I was a kid my dad showed me a belt if got out of line, teachers and principal had paddles at school for that. Now that corporal punishment is cruel and inhumane it's the school teachers that are recommending behaviour medicines for children that have cautions of increased chance of suicide and other issues which the parents and doctors hand out like corner dope dealers. Worst I have ever felt about myself and highest my stress level became was when on those antidepressants. Not telling you to quit but maybe research what your taking and side effects others have noticed. We are all our own best health advocate if we educate ourselves and learn what is best for us.

During the day if stressed I generally take a "shooting break" as have an indoor shooting range at my business which busting a few caps will calm me right down. If can't shoot due to too many helpers in shop or out of shop keep a pair of running shoes and with work cloths on will take just 15 minutes to do a mile or so jog and find my stress level well under control. Early mornings and nights if worry gets to me will read a few minutes out of my Bible then pray or just sit quietly and listen for God to speak to my heart. I take so many med that there is no choice such as my thyroid, adrenaline and testosterone it's easy to get wound up, especially the day of and day following my weekly testosterone injection. Adding more med to counteract side effects of these medicines seemed to be making me crazy so learned how to deal with them in other ways. Same with work stress, run it off, bike it off or pray it away.

But on your heart rate and O2 levels you may want to be careful in how you relate them to your apnea. While I believe one can affect the other make sure there are not other factors and have a way of checking your data for anomalies that are "hardware" related errors or due to some other issue. Just taking off my mask and going to the bathroom will raise my heart rate and lower my O2 level. When went through some prostate issues doctor wanted me to track how many times I went to bathroom during the night so I wrote down the time as well. Turned out when I got out of bed to go to bathroom or kitchen for a snack those numbers would swing drastically sometimes.

[SleepyGuyJPN]

PS....I just looked at your pulse ox reports again...all those dips look like loss of contact artifacts to me.
If it were my report I would shrug my shoulders and move on.

I thought that might be the case as well, at first, but SpO2 drops happen on the regular for me; the spikier graphs were just recent examples. Just to be sure these weren't just artifacts, I tested the device on my wife, who sleeps very well, to see if it produced anything similar to my results. Unfortunately, comparing her results to mine is like night and day. If the device loses contact, it doesn't dip, it just flatlines at whatever the last SpO2 level was that it had contact then jumps to whatever it reads when it regains contact.

Some nights, especially mid-last year when I was having my stress episodes (and before CPAP), I could feel my body/brain just stop breathing as I was falling asleep, if you can believe it. Scared the you know what out of me. Like the jolts, the body not breathing on its own thing still happens from time to time, but thankfully occurs much less frequently these days.

Here's how my wife's data looks compared to mine:

Wife's pulse oximetry results:

wife-SpO2.png (198.3 KiB) Viewed 1079 times

Some additional examples of my pulse oximetry on a couple of my rougher days:

12-02-SpO2.png (259.14 KiB) Viewed 1079 times

10-07-SpO2.png (282.06 KiB) Viewed 1079 times

I agree that my average heart rate and average SpO2 don't look too bad, but I just have a hard time getting over the drops. If these still look like artifacts or not too bad in general, then I'll do my best to pay them no mind.

Apologies for the giant images, I don't see a way to make them a more manageable size.

[Pugsy]

As you well know it is entirely normal for O2 levels to drop during sleep...as much as a 4% drop is normal from what I have read.

You never spend much time below 90% and 88% is the cut off for needing added O2 during the night....and you would have to be at 88% for a certain amount of time to earn added O2 and I don't remember exactly how long.

If this really bugs you then I strongly suggest that you have a serious chat with your doctor about it. He's really the best person to discuss this with and not all us armchair quarterbacks here on the forum. He know all your history and what shape your body is in and is in the best position to know if what you are seeing is worth worrying about.

[Miss Emerita]

Sounds like the brain zaps have subsided, which is good. I'm sure you've googled the phenomenon yourself, but just in case you haven't:

https://www.anxietycentre.com/anxiety-s ... zaps.shtml

[SleepyGuyJPN]

Sounds like the brain zaps have subsided, which is good. I'm sure you've googled the phenomenon yourself, but just in case you haven't:

https://www.anxietycentre.com/anxiety-s ... zaps.shtml

I've tried finding some information on it, but don't believe I've seen this article. Thank you for sharing!

[LoftyNotions]

Just to put your O2 desats in perspective, here's one of mine before CPAP.

O2 Desats.jpg (291.42 KiB) Viewed 1001 times

[SleepyGuyJPN]

Just to put your O2 desats in perspective, here's one of mine before CPAP.

Thanks for sharing! This does help put things into perspective, which I honestly don't have a lot of when it comes to this kind of thing, so it helps.

How do your results look now that you are on CPAP and were you/are you on supplemental O2?
Any other details you wouldn't mind sharing about yourself to help give me some additional perspective?

Cheers!

[LoftyNotions]

Here is this morning's O2 report. This is the best one I've seen yet.

O2 Desat Post CPAP.jpg (244.39 KiB) Viewed 949 times

I've never been on supplemental Oxygen. My awake O2s typically run 96%. I've been on CPAP for 2 weeks today. AHI was 2.6 this morning.

I'm a 70 year old male living at around 3000 feet ASL, currently waiting to get off Plavix so I can have my Aortic Valve replaced.

If you have any questions, feel free to ask.

Larry