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

[Arizona JC]

I registered for this forum because my mother, who is 88, was recently diagnosed with obstructive sleep apnea, and I want to get some opinions on whether or not she needs a new sleep study.

I've reviewed the data from Mom's first sleep study. She was able to sleep for 45 minutes, and her blood O2 dropped to 87, and they recorded 241 breathing cessations during this 45 minutes. This result was the basis for her diagnosis.

Here's what's bugging the heck out of me; her cardiologist recently opened a sleep study center in his office, and he's the one who sent Mom to it. He did so because she'd mentioned that she sometimes dozes off while watching TV, and then does not sleep solidly through the night. She only managed 45 minutes of sleep during the study (she has difficulty sleeping on her back, and in strange places - especially noisy ones). This got her diagnosed with obstructive sleep apnea. The doctor's office then set her up with their CPAP provider. What's bothering me is conflict of interest and also the study itself, and as such I don't fully trust the result.

Mom's currently using a CPAP, and has been for 3 days. She loathes it - she has long has severe dry mouth, and this agrivates it (in spite of the humidifier). She's also claustrophobic and non-technical, so this is a daunting thing for her (I'm sure that she can get over that, though.). I'm the one who preps and maintains for her CPAP machine, so at least she doesn't have to deal with that part of it.

Mom has great difficulty sleeping in the CPAP (initial setting 4, ramps up to because the higher pressure after ramp up wakes her. So, she has been taking the CPAP off at around 6am so she can get a few hour's sleep. (I'm aware she's not supposed to do that, and so is she).

So, here's my current plan; I want to verify whether she actually needs CPAP at all, because I don't trust that sleep study. I plan to go about this by buying Mom an 02 monitor (one that records all night, probably the CMS-50I based on what I've read in this forum) and seeing what her blood O2 is when sleeping both with and without the CPAP. And then, if my results don't show sleep apnea, I want to take her for a new sleep study, at a different facility, to see if she really needs the CPAP - and also if other treatment options might be available (I already know about the dental appliances; that won't work for her due to major dental issues). I just want to be absolutely certain that CPAP is needed, and if so, make it as easy for her as I can, because at the moment it's miserable for her.

A few possibly relevant data points; The sleep study clinic she went to is at an altitude of 5000 feet. Mom lives at 6000 feet. I've used a spot-check finger oximeter on her while she's sleeping without the CPAP, and the result was as low as 89 (as I understand it, anything below 90 is a problem). Her resting (awake) O2 level is usually 93, and usually rises to that within a minute of waking. (Small data set here; I've only done this 4 times)

What I'm also wondering is if she's got mild sleep apnea (not dropping below 87), is supplemental oxygen a possible CPAP alternative? I'm also wondering if I should take her to a low-altitude sleep study center if I take her for another sleep study? (If altitude is the culprit, I'm willing to move).

BTW, regarding what her medical options are - they aren't limited to whatever Medicare will do; I'm very willing to pay cash if need be for better studies, other treatment options, etc. I'm feeling very much alike a fish out of water here - there's so much to learn and understand.

Thank you, and to any moms out there, Happy Mother's Day.

[LSAT]

"I've reviewed the data from Mom's first sleep study. She was able to sleep for 45 minutes, and her blood O2 dropped to 87, and they recorded 241 breathing cessations during this 45 minutes. This result was the basis for her diagnosis."

If these numbers are right and she stopped breathing 241 times in 45 minutes.....that is severe sleep apnea. I would ask to see those results and I would definitely not do business with a sleep center and CPAP supplier that is affiliated with the doctor. I believe Medicare has some rule forbidding this association.

[palerider]

"I've reviewed the data from Mom's first sleep study. She was able to sleep for 45 minutes, and her blood O2 dropped to 87, and they recorded 241 breathing cessations during this 45 minutes. This result was the basis for her diagnosis."

If these numbers are right and she stopped breathing 241 times in 45 minutes.....that is severe sleep apnea. I would ask to see those results and I would definitely not do business with a sleep center and CPAP supplier that is affiliated with the doctor. I believe Medicare has some rule forbidding this association.

actually, I can't believe that what the OP is saying is anywhere near factual, because that would be an AHI of 321... and it would mean not breathing for 40 minutes out of the 45

[Arizona JC]

"I've reviewed the data from Mom's first sleep study. She was able to sleep for 45 minutes, and her blood O2 dropped to 87, and they recorded 241 breathing cessations during this 45 minutes. This result was the basis for her diagnosis."

If these numbers are right and she stopped breathing 241 times in 45 minutes.....that is severe sleep apnea. I would ask to see those results and I would definitely not do business with a sleep center and CPAP supplier that is affiliated with the doctor. I believe Medicare has some rule forbidding this association.

I'm glad to see I'm not the only one concerned about the conflict of interest.
I have asked for a full and complete printout of the data collected. I've so far been given that only for the second sleep study (the one with the cpap). I only have a summary sheet for the first - but I've been promised the full data set.

At this juncture, Mom and I both think that getting a new sleep study done elsewhere would be a good idea. My take on that; what's the harm? (if there is a risk I'm unaware of, somebody please let me know!)
Thank you!

"I've reviewed the data from Mom's first sleep study. She was able to sleep for 45 minutes, and her blood O2 dropped to 87, and they recorded 241 breathing cessations during this 45 minutes. This result was the basis for her diagnosis."

If these numbers are right and she stopped breathing 241 times in 45 minutes.....that is severe sleep apnea. I would ask to see those results and I would definitely not do business with a sleep center and CPAP supplier that is affiliated with the doctor. I believe Medicare has some rule forbidding this association.

actually, I can't believe that what the OP is saying is anywhere near factual, because that would be an AHI of 321... and it would mean not breathing for 40 minutes out of the 45

I spoke poorly when I said "reviewed the data". What I reviewed was their summary sheet, because I have yet to get my hands on the full dataset (I've been promised it though).

I too had issues with breathing cessation that many times in 45 minutes, but please bear in mind I'm very new to all this and thus pretty darn ignorant as to what things really mean. It just seemed very odd to me that stopping breathing so often in such a short period could match up with the blood o2 minimum of 87 they reported.

Thank you!

[palerider]

I too had issues with breathing cessation that many times in 45 minutes, but please bear in mind I'm very new to all this and thus pretty darn ignorant as to what things really mean. It just seemed very odd to me that stopping breathing so often in such a short period could match up with the blood o2 minimum of 87 they reported.

it's my belief that you're mistaken on the numbers. which makes it harder to suggest any course of action.

[Pap-Daddy]

anything below 90 is a problem)

Correct. That is a pre-cursor to other problems such as forgetfulness and memory loss and use of cpap can help with that. So how is she in those areas?
Keep in mind as we get older changes like wearing plastic on your face are hard to accept. If it turns out she needs it start the changes gradually by wearing it while awake watching TV, etc. and sleeping with it only a couple hours each nite.

Altitude could be her whole problem. Be sure to check her O2 when walking or after climbing stairs, etc. Leg muscles use quite a bit more O2, sometimes just standing up can drop O2. A lot can depend on any other health problems, meds, etc. which I have no knowledge of.

[Arizona JC]

I too had issues with breathing cessation that many times in 45 minutes, but please bear in mind I'm very new to all this and thus pretty darn ignorant as to what things really mean. It just seemed very odd to me that stopping breathing so often in such a short period could match up with the blood o2 minimum of 87 they reported.

it's my belief that you're mistaken on the numbers. which makes it harder to suggest any course of action.

You may very well be right on me being mistaken on the numbers. However, I've been promised the full data printout, and hope to have it tomorrow, so I'll post an update in this thread when I get it.
Thanks!

anything below 90 is a problem)

Correct. That is a pre-cursor to other problems such as forgetfulness and memory loss and use of cpap can help with that. So how is she in those areas?
Keep in mind as we get older changes like wearing plastic on your face are hard to accept. If it turns out she needs it start the changes gradually by wearing it while awake watching TV, etc. and sleeping with it only a couple hours each nite.

Altitude could be her whole problem. Be sure to check her O2 when walking or after climbing stairs, etc. Leg muscles use quite a bit more O2, sometimes just standing up can drop O2. A lot can depend on any other health problems, meds, etc. which I have no knowledge of.

Mom seems fine mentally, vastly better than most at her age (88), but I can't rule out there's some impairment; she's not as good at mental math as she was years ago, and isn't as good at recalling minor details as she used to be (for example, she'll remember all sorts of details about a stay at a hotel, even years later, but sometimes not the name). She does, however, have some other health issues that might well be impacted by sleep apnea, and she does sometimes doze off when watching TV. If she actually has apnea, I sure as heck support treating it. I just want to be absolutely sure she's not being railroaded into this by either conflict of interest or shoddy procedures. Regarding the latter, one of several that stood out to me on her sleep test was they didn't ask her if she was congested, and at the time she was suffering from severe congestion due to allergy to pine pollen (which was so bad that week that there was yellow dust everywhere). It just seemed sloppy to me that they didn't ask.

Thank you for the idea of taking her 02 while active. That hadn't occurred to me (I'm pretty clueless about all this, though reading all I can to rectify that). I'll do that. I do know that she's sometimes (it seems intermittent) short of breath when hiking uphill. A couple of flights of stairs doesn't bother her, but hiking uphill sometimes does. She gets short of breath, and has a drink of water to ease it (I have no clue why that works for her - though my guess is it might have something to do with her hiatial hernia). Also, she tires more easily than she used to - a 5 mile hike is about her max limit these days at high altitude (a mile or more), and even at sea level she has issues with going uphill for any significant distance. I haven't noticed (and it's something I keep an eye out for) and difference with her at 6000 feet to sea level regarding her uphill hiking problem, but an 02 meter would be far better for that, so I'll try.

We have started the changes gradually; she does start out by watching TV in bed, etc, and she does take off the mask around 6am (We're on day 3, so it's all very new). I think it'd help a lot if the ramp up button took longer (it's set at 20 minutes) but it looks as if it's not customer-adjustable and has to be done by the provider, so I'll have to wait until tomorrow to ask on that.

Thanks!!!

[Julie]

Old people fall asleep at the drop of a hat and it doesn't necessarily signify anything serious, OSA or not, so don't assume that's a sign of some kind.

I must tell you this however, the poster who goes by xyz (etc) is quite ignorant in many aspects of apnea, but makes definitive statements as if he isn't. I urge you to not take advice from him (I'm assuming it's a him), but do listen to others such as palerider, pugsy, LSAT, etc.

[Pap-Daddy]

I know before I started cpap I couldn't watch TV or a movie without falling to sleep, all I had to do was stop moving so I told the sleep tech I have no problem sleeping. Dx'd w/Severe OSA.
Google "Epworth Sleepiness Scale" for an evaluation of sleepiness.

[Arizona JC]

87 is bad
241 in 45 minutes is terrible bad

you need a breathing machine not more studies

never deal with a doctor sleep lab or DME that have any connections at all

they should have titrated it before prescribing it
so yes if money is not the issue get her an AUTO machine that adjusts itself
because our bodies keep changing constantly

and get an independent sleep lab to do a titration test for cpap bipap or ASV depending on what happens that night
you do NOT have to sleep on your back
all she needs to do is sleep

then take the results to a board cert SLEEP doctor and have him write the Rx from the data the lab found that worked
she may or may not also need O2 added via the machine
and I would demand an oximiter on the machine to ensure O2 levels do not go so low

I might be using bad figures on the 241 in 45 minutes, I'm only going by the summary I was given so I may be flat out wrong. I hope to have the actual full data tomorrow, so I'll post an update when I do.
Same with the 87, BUT, I was told that one verbally as well when I was asking the 'doc questions. (and a spot check by me has found her at 89 a few times while asleep without her CPAP)

She has a CPAP already, as of 3 days ago, so she does have a machine and is using it (mostly).

I'm currently looking at getting her a second sleep study (whether or not her insurance pays for it, I'll get it) and I'll certainly avoid any conflict of interest this time (I'm kicking myself for not objecting the first time). I'm also going to go for a low altitude one, probably Phoenix (1200 ft, and close - only 100 miles away). Thanks for the tip that you don't have to sleep on your back, I'll check for that - the one mom had would not allow that, and she did ask.

Thanks!

[Arizona JC]

Sorry for replying piecemeal, and my sincere thanks to all who have weighed in.

Old people fall asleep at the drop of a hat and it doesn't necessarily signify anything serious, OSA or not, so don't assume that's a sign of some kind.

I must tell you this however, the poster who goes by xyz (etc) is quite ignorant in many aspects of apnea, but makes definitive statements as if he isn't. I urge you to not take advice from him (I'm assuming it's a him), but do listen to others such as palerider, pugsy, LSAT, etc.

Thanks, I take everything I see with a large dose of salt. I'm definitely aware of one poster on this thread who's ignorant, and he's me. I'm also very, very unaware of the personalities and culture (and who's who) on this forum (I've got a lot of reading to do yet) so I'm a fish out of water in more ways than one.

I remember my grandparents when they were Mom's age; they were far more prone to dozing (both in frequency and duration). But, on the other hand, I have no clue if they had sleep apnea. I see your point though; don't take it as a sign. I'm going to do it right (at least, what I currently think is right) and get mom a new sleep study, at as highly regarded a facility as I can find. I'm hitting the phones tomorrow.

I know before I started cpap I couldn't watch TV or a movie without falling to sleep, all I had to do was stop moving so I told the sleep tech I have no problem sleeping. Dx'd w/Severe OSA.
Google "Epworth Sleepiness Scale" for an evaluation of sleepiness.

She got a 4 on the Epworth sleepyness scale (I just did it with her, thanks!). A zero on all but watching TV and while lying down to rest in the afternoon, and 2 each (moderate) on those. She'll take an afternoon nap about once a week, and doze off watching TV every other day or so, not counting when she's watching it while trying to fall asleep. She does doze off in a car (while a passenger) but only after a few hours and at night. She's much worse on the sleepiness issue for a day or so when she has major jetlag (anything more than 7 time zones), but my guess is that's a normal result of jetlag at her age (but that's only a guess). She's also been more sleepy since going on the CPAP. but I suspect that's because she's only getting a couple of hours of actual sleep a night, so far (It'll take some getting used to).

[Julie]

Not sure if this helps or is even relevant, but most relatively newer machines do correct for altitude changes on their own, though I'd double check with the mfgr (or product info pg on Cpap.com) to confirm.

[D.H.]

87 is bad, but it's much better than my baseline! However, even if blood oxygen saturation is normal or nearly so, sleep fragmentation is still very detrimental to one's health!

Of course, I don't know how bad the numbers are, since the numbers stated just don't appear to be accurate!

[Pap-Daddy]

Jetlag is rough. It takes me about a month to adjust after just a time change.

I remember my grandparents when they were Mom's age; they were far more prone to dozing (both in frequency and duration). But, on the other hand, I have no clue if they had sleep apnea.

Back then we didn't know what sleep apnea was. In fact, often thought it was normal when getting old to be forgetful or snore and fall asleep in the recliner. All attributed to "old age".

Also keep in mind that OSA can be heredity. A friend once told me that heart disease runs in his family. Well so does OSA which left untreated leads to heart disease.

You sound like you have a level head, this is a steep learning curve. Have your mom assign you as her "Healthcare Representative". Then docs (and others) won't be so shy about discussing her healthcare with you. Some today are nervous and like to use HIPAA as a lame excuse but HIPAA has nothing to do with this. You may be able to find a "Healthcare Representative" form from your state online or go to a lawyer or notary may be able to help. This way you can legally request her documents and when done in writing they have 30 days to comply.

Also keep in mind with enuff time and reading here and elsewhere you can prob do pretty well at home. You can also learn how to change the ramp time and pressure. Also keep in mind often what we think is a low pressure does not provide enuff air and people feel like they are suffocating and rip the mask right off.

[Soothest Sleep]

ArizonaJC, you win the award for Best Mother's Day Attention. Ever., in my opinion. Your commitment to helping your mother with her OSA/CPAP issues is commendable, and heartwarming. Beats the heck out of flowers, cards, dinners out, or chocolates (and those are all very nice, too; don't get me wrong). To see an adult child going the distance for an elder parent, in reciprocation of that parent's earlier efforts in raising the child, is inspiring. She must be so proud of you.

I'm still a relative newbie at all this, so haven't anything to add to what the experienced folk have given you. Just wanted to acknowledge your participation and patience with your mother's concerns. You're doing a great job.

Welcome aboard.

Jean