SPO2 to be concerned or not

Hello everyone,

If any one could offer some advice I'd be very grateful. I'm still new to all this and I have tried my best to read as much as I can but I am struggling to find any clear or definitive answers regarding SPO2 and desaturation problems, or at least what constitutes a real problem.

I've posted some links to last night's Sleepyhead data and to a pulse oximeter (not synced). There are two occasions where my o2 levels drop somewhat. The first period on the graph confuses me a little as I am fairly sure I was still awake, as afterwards I got up to close the curtains, I may have fallen asleep and forgotten but I don't think so. The second dip in the oximeter graph (around 2.30) corresponds with some OA, Sleepyhead just after 1am.

Should I be concerned with these brief dips? Or is o2 a little like pulse/BP that it can briefly fluctuate apropos of nothing? I note that only 3.7% of the time was I below 95% and only 0.2% below 90, all brief spikes.

http://imgur.com/lkEadRD
http://imgur.com/fB7vEdi

One other question relating to pressure. After reading many posts here I upped my minimum pressure from 5-8 and maximum from 16-20. I'm not so worried about my AHI right now (terrible weather, other reasons for bad sleep, experimenting with masks etc.) but the OA seem to end quicker since the max. went up. Is it safe to try an increase to 10 for minimum pressure, or would this be regarded as an abnormally high min. pressure? (The initial OA and CA on the Sleepyhead graph, as stated above, I am fairly sure I was awake then).

Thanks in advance for any help and thanks again to all of you who have shared so much information and your time with us newcomers.

Fenelon

I wouldn't worry too much about the 02 drops that are short and not terribly low... i.e. if you had many, and they routinely went to below 80's or 70's, they would need addressing, but you seem to be doing very well otherwise. And raising your min. pressure to 10 is quite ok providing you continue to keep an eye on things to be sure you don't start seeing overnight 'centrals' (vs the few clear airway events you might experience at the start of the night and just before waking).

To me, your O2 levels look fine....Raising your min pressure to 10 would definitely be reasonable.....10 is not considered high. My minimum is 11. I'm pretty sure the min increase will bring down your AHI. Give it a try. If you were partially awake during the 11-12 hour, the CAs could be regarded as junk and ignored.

Thank you very much for the quick replies, I appreciate them greatly!

Have a wonderful weekend!

I would consider positional therapy first, look at tucking your chin to your chest and obstructing the airway or back sleeping. I'd get a soft foam cervical collar for $10 from a drugstore.
Then I would reevaluate and see where you stand.

I would zoom in on those very pointed drops to see if they were loss of contact artifacts. Usually shows as a gray/black line you can see when you zoom in.
Most real desats don't drop that fast or come back up that fast so some of that time below 90 could be an artifact.

Pugsy wrote:I would zoom in on those very pointed drops to see if they were loss of contact artifacts. Usually shows as a gray/black line you can see when you zoom in.
Most real desats don't drop that fast or come back up that fast so some of that time below 90 could be an artifact.

Thank you xxyzx and Pugsy - one question Pugsy, if I may. You mention loss of contact - I can't see any grey/black line (other than for events) nor can I actually see a proper zoom function, the software for the D50+ is fairly underwhelming. I am interested in your comment 'most real desats don't drop that fast' - given that there is no way for me to be 100% certain about loss of contact, how would a real desat normally look (if there is such a look)? I had the device strapped to my finger with medical tape, however, I am fairly sure I was awake for the first pointed drop, and I am fairly sure I was moving about a lot trying to get comfy and I know movement can affect these devices.

One other question about masks, to anyone who may have some advice - I'm a mouth breather due to my ENT internal anatomy. I tried the Airfit F10, which was ok but left terrible marks on my face. I then tried a mouth only device which was about as much use as a chocolate teapot. Now I am using the Airfit F20, which seems ok, less marking on the face. But I was also sent a SilkGel mask and have just purchased privately an AirTouch F20, though it won't be brought to Europe for another two weeks. I realise how important the mask is, but how long would you try each one for? Is one week enough time to make a decision? I know some of you will have tested many masks and I'm genuinely interested in your opinion(s).

As always, thank you for your help and your time.

Best wishes,
Fenelon

There is a zoom in function but I don't know how to tell you to find it. It's been way too long since I have used one of the overnight pulse oximeters.
Maybe someone more familiar with it can chime and tell you how to do it. All it takes is a very brief loss of contact for the pulse ox to have to recalibrate itself and you end up with a very quick drop in the readings while it is doing this. A 10 second loss of contact won't see seen until you can zoom way in. If you were awake when the first drop occurred you can pretty much bet on that one being a loss of contact artifact.

About masks...Have you tried or look at the Respironics Amara View. Less area to have contact with the skin and thus less chance of mask marks.

You might also look at a mask liner...you can make your own or buy a ready made mask liner.

As far as how long to give the mask a chance before you give up on it. I once gave up on one after 90 minutes. So you see about how much patience I have but then I have been doing this long enough I can tell fairly quickly if I am going to do well with something or not. That one is up to you. I see no sense in prolonging a bad situation myself....2 or 3 nights would be more than enough for me to decide if it was something I wanted to work with or not.

If you didn't know about mask liners search the forum for them...there's even a pattern for a DIY mask liner you can do using an old TShirt.

Thank you very much Pugsy!

Hate to hijack this thread, but can you have apnea without SPo2 drop?

herefishy wrote:Hate to hijack this thread, but can you have apnea without SPo2 drop?

I have a friend who had an in lab sleep study and ended up with AHI of 60 something per hour but her O2 levels never really dropped all that significantly.
Her baseline was around 97% and she never went below 94% and most of the time was at 95 to 96%.
So yes...you can have apnea without significant O2 level drops. It probably isn't all that common but it can happen and that's the reason I don't jump on the "let's use a pulse ox for sleep apnea screening" bandwagon. It can sometimes in some people give them a false sense of security that they don't have sleep apnea...seems like it especially would pertain to those people already up the DeNile River.
While it could obviously point to probably sleep apnea when obvious marked desats are seen...the absence of desats doesn't always mean no sleep apnea.

BTW it is normal for the O2 levels to drop a little when we fall asleep and doesn't necessarily mean anything at all. By a little I mean 2 to 3%.

Fenelon, I find it interesting that your oxygen report states the amount of time spent in artifacts as 0.2% and that matches the amount of time spent < 88%.

This makes me think that the drop was caused by an artifact.

You need to display your heart rate graph along with the oxygen level graph. If your oxygen level drops and your heart rate spikes you have a concern. If the heart rate remains mostly stable, the oxygen level indication is an artifact.

HoseCrusher wrote:Fenelon, I find it interesting that your oxygen report states the amount of time spent in artifacts as 0.2% and that matches the amount of time spent < 88%.

This makes me think that the drop was caused by an artifact.

You need to display your heart rate graph along with the oxygen level graph. If your oxygen level drops and your heart rate spikes you have a concern. If the heart rate remains mostly stable, the oxygen level indication is an artifact.

Thank you so much for your reply. I've posted the heart rate graph below, though I think it is ok. Please note that the first large spike(s) before the 1:00 I am almost certain I am awake and I was moving about in bed, a very hot night and I was restless and annoyed. I've also posted a second graph which was the night after next. To have two brief spikes to 80bpm is not causing me much concern (I'm new to xPap but in the last 18 months I've had overnight holter tests for heart rate and blood pressure etc. and everything was ok) but I value your input.

Thanks again.

http://imgur.com/a/czBYQ
http://imgur.com/a/nOXDN

Looks good.

Keep in mind that while we are focusing on heart rate and oxygen saturation there are many other things going on as you sleep. A vivid dream can spike heart rate, as can a cat fight in the alley or someone kicking over a garbage can.

In spite of all this "noise" there are patterns that show up and when you see those patterns you have a place to start defining the problem.

Thank you everyone - your input, opinions and time are all gratefully appreciated.