Newbie asks how to monitor Sa02 while sleeping with CPAP?

HoseCrusher wrote:Based upon oximetery, 12 cm is better.

During your nap you never entered REM sleep. You recorded a Basal of 90% and had you drifted off to a deeper stage of sleep that would have dropped.

When might REM occur in a 30 minute nap? This is where my knowledge sort of stops. And I am also under the notion as to me that higher pressures are more likely to produce REM sleep, and that one has to pass through the other stages of sleep to get to REM.

In any event, my own very limited interpretation of the oximetry report as to my 30 minute nap is that 10 CM is Sp02 baseline adequate and that I actually did go to sleep because my heart beat did drop down to the low 60's and stayed there. I also had the benefit of knowing that I had napped!

I should probably just go with the recommended pressure by two professionals, neither of whom are my two treating physicians. The recommendation was 12 cm and the TREATMENT BREAKDOWN TABLE as performed during the sleep study is basically confirmed by my own spo2 testing. And, of course, 12cm is better Sa02 and Sp02.

Perhaps I should go beyond a 15 minute ramp at 12 cm by the sleep specialist and go for a bit longer ramp time.

See, I do feel like I am getting TOO MUCH AIR at 12 but I've only been at 12 now for about 9 or 10 days. If I increase the ramp perhaps it will help in some manner.

And I suddenly increased my pressure from an average of about 9.5 to 11.5 or 12 cm overnight at the beginning of this month.

On the contrary...

I believe if you are going to ramp a lower ramp time works better. Try 5 minutes. This will give you a small buffer to get used to the pressure and quickly get you into the therapy range that works best for you.

HoseCrusher wrote:On the contrary...

I believe if you are going to ramp a lower ramp time works better. Try 5 minutes. This will give you a small buffer to get used to the pressure and quickly get you into the therapy range that works best for you.

Your point may indeed be a valid one, but I have to weigh that against being able to fall asleep.

Perhaps I should sedate myself tonight as I did for the sleep study and ramp 12cm for 10 minutes, which is 5 minutes less than the sleep specialist physician had recommended in his report.

I have jury duty tomorrow and have not had to wake up at 5:30 a.m. for years. I live in a flexible jurisdiction so if I oversleep it is no big deal. My report date is actually April 15 but they permit you to appear up to two weeks before and after the report date.

I've decided to remain at 12 cm for now, will do another overnight oximetry report on it. Will not bother you all by posting unless it substantially differs from the one already posted.

Will ramp for the specialist-recommended initial 15 minutes tonight and will take your suggestion but in light of jury duty will wait until tomorrow night, and ramp to 10 minutes not 5. It is anticipated that I will drop down to 5 minutes ramp time, hopefully soon.

Thank you so very much for your input, hose crusher, and others posting in this thread!

I was up good and early to go to courthouse, but made a big mistake and drank two cups coffee after eating a large tangelo and got upset GI, so I will go tomorrow and not make the same mistake.

For those of you who have a pdf file that you want to convert to jpg or png, there are apparently four (4) ways to do it- http://www.wikihow.com/Convert-PDF-to-JPEG

Better link for Google Drive method: http://www.qoncious.com/questions/conve ... ogle-drive

Here's the method that I used (BUT SCROLL DOWN FOR EASIER, BETTER METHOD WITH ONLINE CONVERTER LINK): Uploaded pdf file to Google Drive, opened in Google Docs, there a few steps to make a zip of a png, uploaded to photobucket- here is the second overnight oximetry at 12cM (CTRl + to make image larger):


SECOND OXIMETRY REPORT- from last night @ 12CM:






Pressure raised on April 1 from Auto 9-15 to CPAP 12cm:



This link is working better for me than Google Drive/Google Documents: http://pdf2jpg.net/









Hope this helps someone else.

Comments?

I like what I see on the Oximetry report. It sounds like you have things pretty well dialed in.

Now cut your ramp time down to 5 minutes and fall asleep faster... Just kidding.

HoseCrusher wrote:I like what I see on the Oximetry report. It sounds like you have things pretty well dialed in.

Now cut your ramp time down to 5 minutes and fall asleep faster... Just kidding.

Yeah, probably good idea. I did go down to 10 minutes ramp for a 20 or so minute nap today. Noticed that my Sp02 declined a bit from last night due to short study. Oh, not so legible this time. Perhaps I'm running out of toner. But I had to print out the document and then make it a pdf by scanning, then use an online converter to make it into a jpg, then upload to photobucket. Something got lost in translation because the hard copy that was printed looks far more legible. Maybe I should use Google Drive for one page documents and sent to Paint and then make into a .png instead of a jpg.

Basal Sp02 was only 91% but that is probably attributable to half the nap consisting of 10 minute ramp from 4cm-12cm.



.png file using Google Drive and Google Documents:

on how I might use 'snipping tool' to better display my reports:

THIRD OXIMETRY REPORT- FROM LAST NIGHT- CPAP @12cm



Added 4-16-2015:

CPAP FOR 4-13-2015 @ 12cm:

LAST NIGHT THE xPAP MACHINE WAS SET TO AUTO @9-12cm FOR PURPOSES OF TESTING SpO2 AND COMPARING IT TO CPAP @12cm.



It appears that Auto @9-12cm (with average pressure of only 9.5cm) has acceptable SpO2 in comparison to CPAP @12cm! YMMV!


xPAP for yesterday/last night- nap was CPAP @12cm, nite was AUTO @9-12cm :




I've generated a report for the period where most recent prescribed setting was Auto 9-15cm (not 9-12cm) just to check my average pressures and compare:







SINCE NONE OF MY AVERAGE PRESSURES EXCEEDED 12cm WHILE MACHINE SET FOR 9-15cm, IT APPEARS 9-12cm WILL BE FINE FOR NOW TO CONTINUE SpO2 TESTING. IF SpO2 REMAINS HIGH ENOUGH OVER NEXT COUPLE OF DAYS AUTO @9-12cm, WILL KEEP AT THAT SETTING AND NOT STRAIGHT 12cm, WHERE I FEEL THERE'S TOO MUCH AIR AND I APPARENTLY SLEEP LESS. ONLY CONTINUED TESTING FOR A COUPLE OF DAYS AT 9-12cm WITH ADEQUATE SpO2 WILL CONFIRM.

DO NOTE THAT THE RECOMMENDED PRESSURE WAS STRAIGHT 12cm ACCORDING TO SLEEP STUDY:





(Full Sleep Study is here: viewtopic.php?f=1&t=105115 )

AND SLEEP SPECIALIST'S REPORT ON IT, BELOW. I WOULD APPRECIATE ANY INFORMED COMMENTS!

SLEEP SPECIALIST REPORT-SOME FINDINGS OF CONCERN:




BELIEVE THAT ON PAGE TWO THERE WAS A TYPO- 26 EVENTS PER HOUR, NOT MINUTE.

I wonder if there's any way to sort out the effects of all those meds on Cpap? I wonder how much they're affecting your a) apnea, and b) Cpap therapy... kind of a catch 22!

Julie wrote:I wonder if there's any way to sort out the effects of all those meds on Cpap? I wonder how much they're affecting your a) apnea, and b) Cpap therapy... kind of a catch 22!

Some of those meds listed were seldom used, if at all. It's more a history of meds I had taken in the past.,

I indeed took meds the night of the sleep study because I did not want to possibly go through the 'living nightmare' my bro-in-law went through when he was tested.

So, night of the test I took 2.5mg diazepam and 10mg Zolpidem (I was 'out' for the night!). Technologist was aware and told me when to take them, but she did not particularly encourage the taking of sleep meds, though my cardio and his tech (who was not the testing tech) said okay to take usual meds...I took more purposefully because did not want to feel uncomfortable for the night.

Those were the relevant meds for testing purposes. If I took Zolpidem and diazepam in the past for sleep, it was usually 0.5mg diazepam (tiny dose- 1/4 of 2mg tab) with 5mg Zolpidem.

I have amended first page of the sleep study report to reflect the meds that were relevant. And 'nicotine' (which I redacted) consisted solely of nicotine gum. Quit smoking cigarettes in '88 (20 pack-years of cigarettes). Smoked cigar for a few years mid to late 90's, smoked cigarettes for about 4 mos. when sustained knee injury with significant pain in 2012- nicotine gum since. Yes, I am addicted to nicotine gum.

I do have a bullae on lung. Had two CT scans, so far so good. Also had a 5mm lung nodule- unchanged. CT Studies were 6 mos. apart. Keeping fingers crossed.

For purposes of privacy, I use pseudonym here and on some other forums.

As an aside- my sister, who lives in FL, also has been dx with sleep apnea. Prior to my study, I had had significant insomnia, with inability to fall asleep, and many times had to take sleep med as late as 3:00 a.m. Same thing with her, also. Many times she would not fall asleep until 3:00 am.

Putting aside psycholgical issues, worry, and bad sleep hygiene, my technologist the night of the test, who was truly professional, suggested that perhaps one of the reasons that I, and my sister were finding it difficult to go to bed earlier, was that our BRAINS were in protective mode and were telling us that it was NOT SAFE to go to sleep at night. I thought that was a very interesting comment, but don't know if it's backed by any scientific evidence. But what she told me made some sense.

Just out of curiosity. I haven't seen any mention on this website about smart watches such as the Galaxy Gear 2 that will monitor pulse and SpO2 and save the data. Has anyone tried using a smart watch to monitor their vitals at night?

I will be researching the quantitative average difference between SaO2 and Sp02 because it may be relevant to my SpO2 findings.

Later: I have researched enough to determine that SpO2 reads generally higher than SaO2. I don't want to spend any more time on this, but the Sao2 is apparently more accurate and that is why it is used in sleep lab. Though I believe that I sleep mostly on my side, the sleep specialist report states that possible supplemental nocturnal oxygen should be considered (impliedly at 12cm). With that remark, I think that it would be better for me in my medical condition to go with the recommended straight 12cm, and just learn to live with it- and that may take a while. This is indeed a tough call for me because I don't see much difference when comparing the 12cm oximetry and the 9-12cm oximetry, and I am certainly more comfortable at 9-12cm. What do you all think? If Sp02 is very similar for both settings, SaO2 can not be known because I don't have the equipment. So, again, this is very tough call for me. I am going to call the sleep lab and speak to one of the techs who has helped me in the past. Maybe I can speak to the sleep doctor whom I've never seen, but I doubt it.


Later yet: I just spoke to a sleep technologist at the lab where my testing was performed. He was very helpful, and must've spent 45 minutes over the telephone with me. I gave him ALL the facts related here. I've come to the conclusion that Auto 9-12cm is safe and works better for me overall, with the caveat that I will continue to do SpO2 overnight monitoring on a frequent basis until I am truly confident that basal Sp02 remains at or above 90% with the absence of significant desaturations. Part of the reason for staying at 9-12cm is also that I was sedated for the sleep study, higher than in the past, and my titration study was done predominantly in the supine position, while I usually sleep mostly on my side. If I understood the technologist correctly, though my overall untreated AHI & RDI were 27.9, my AHI while supine was 76.2!!! And, Julie, the possibility of 'positional sleep apnea' was indeed mentioned by the technologist without solicitation by me, Julie.

The good news is that I will not be posting further graphs and charts in this thread!!!


Last night was the second night Auto @9-12cm. During the day yesterday, I did not feel any appreciable need for taking a nap, arose about 6 am and retired about 10:30 pm.

This morning- felt really good, well-rested, and I know there was REM.

I get more rest at the auto 9-12cm than straight 12cm, but that may be a matter of adaptation. I have felt like there was too much air yet SOB at the same time @12cm. the recommended starting pressure. That appears contradictory.

So, here are last night's charts @9-12cm:





Comments appreciated. And looking at the SpO2 graph with associated pulse graph, can one have any idea about sleep stages, or is that too speculative?

This will be my last posting of oximetry charts in this thread. I have the hang of it and I hope that anyone who is thinking of doing the same will find the thread to be of assistance.

I do recommend the http://www.coopermedical.com/overnight- ... meter.html . It does the job quite adequately for my purposes at a very good price point. So, if budget-minded, I would give it high marks!

Changed my mind- again! It seems that I have many more spo2 desaturation events (27 last night) while machine set at 9 to 12 cm in comparison to straight 12cm. My baseline spo2 was also higher and things were more consistent 12cm with lower AHI. Therefore I'm going back to straight 12cm tonight.

Amended again: 12cm is too high right now. I am resetting machine to Auto 9.5-12cm and will go up 0.5cm baseline cm every so often until I titrate up to a setting of 11-12cm. Thereafter, I will probably just go straight 12cm.

Updated: I did one night Auto at 9.5 to 12cm and desats were down and I was above 95% Sp02 for 35% of that time. Never went below 90% and believe I will stay with the setting for the time being. BTW. AHI was 0.8, 2 Aps, 2 Hyps, CAI was 0.2.

Updated 4/20/2015: Went to 10-12cm as final auto pressure. Last night and a few other nights' convinced me this is a fine pressure for me.

I had an anomaly with my PO last night that lasted about 4-5 minutes and even with that anomaly Basal Spo2 was 93.9, avg.pluse was 62.3, and Spo2 >90% 98.9% of time and >95% nearly 40% of the time:





Cheers,