Quantcast

Bookmark and Share
General Discussion on any topic relating to CPAP and/or Sleep Apnea.
azdj
 

Results of pulse oximeter use - Interesting findings!

Postby azdj on Tue Aug 12, 2008 10:43 am

I have been using a Bipap ST from about 1month, with some improvement, but still general feeling of fatigue and poor sleep. My pressures are set at 14 / 10. While the information from the Bipap St smartcard and Encore viewer is helpful (it is not as detailed as the other M series machines, in particular it is poor at giving detailed apnea information), I thought is would be helpful to add a pulse oximeter to check the status of my oxyen saturation during the night. So I bough a PC68B Wrist Pulse Oximeter from Devon medical for $298. It is a good machine that will monitor sO2 and pulse continuously over the night (1, 3 or 8 second intervals) and allow a computer download and print-out of results. After using for several nights, I found some interesting (initial) results:
1. My oxygen saturations were falling into the 80s and even as low as high 70s during my ramp-up time and particularly just as I fell asleep towards the end of my ramp time. After full pressure was achieved, the results improved.
2. I was diagnosed with break-through centrals, hence the ST. The doc put me on a backup rate of 14, but said could decrease to 8-10 if necessary for comfort. I did that after a couple of weeks because my natural breath rate when awake is much lower than that and 14 was uncomfortable. However, the pulse oximeter together with my Encore results showed that when my breath rates was 10 or lower, my sO2 were going below 90%. I think I was breathing shallower in sleep than awake so even at the same breath rate, I was not sufficiently oxygenating at night.
3. My overall sO2 results were worse with my nasal mask than with my full face mask, even when the results were in the 90s, it appears the numbers are higher with full face. I will continue to monitor this over a longer time, but my initial thought is that the nasal mask is just not letting enough air through (especially during ramp up), or perhaps it was not exchanging CO2 quick enough. even at the same pressures. But for some reason, the full face mask seems to allow me to oxygenate better (and I don't think it was because of mouth leaks with the nasal mask - I use a chin strap and do not have dry mouth or other signs of mouth leak, and my leak rates are always consistent at 30 which is right on for my mask).

Based on this, I adjusted the ramp pressure to start at 8 rather than 4. I also increased the back-up rate to 11 and have started using the full face mask as preferred mask. Based on the last several nights, I have both slept much better and my oximeter results have shown no incidents of going beyond 90% over the entire night. Indeed, my results have generally run pretty consistently at 95% or better over the night, which I feel very good about.

based on this, I think that having an oximeter can be very useful. As many have said in this forum, we often are prescribed these therapies based on 1 or 2 nights sleep study with little follow-up. The more information we have, the better off we are. Certainly your O2 saturations are a critical part of therapy, and one that the machines will not give us directly. As long as I know my O2 sats are nomal, and I subjectively feel like I had good sleep, I feel my therapy is a success. I will also use the oximeter when I go up to my cabin at 8,000 feet to check my 02 sats at high altitude when using my machine, and to test my sats after a night out drinking, etc - all of those variables that 1 night at the sleep study doesn't check for!

Just thought you might find that interesting or helpful....


User avatar
ozij
 
Posts: 8721
Joined: Fri Mar 18, 2005 11:52 pm
Gender: Female

Postby ozij on Tue Aug 12, 2008 11:42 am

:D
Both interesting and helpful.
Thanks!
O.

_________________
Machine: S9 AutoSet™ CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Software: Updated version of ResScan. First machine (5 years) was PB420E. Tried others including Autoset S8 II
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

jmblack6307
 
Posts: 1
Joined: Tue Aug 26, 2008 1:46 am
Location: Phoenix AZ
Gender: Male

Re: Results of pulse oximeter use - Interesting findings!

Postby jmblack6307 on Tue Aug 26, 2008 5:23 pm

I just used my pulse oximeter for the first time and also have interesting findings. I purchased an fda approved pulse oximeter CMS 50-F and just used it for the first time. I only slept 4 hours but it seems to work well. I wanted to see what my oxygen saturation without cpap is since I lost a couple pounds. My results today were mostly 95-96 and lowest it dropped was 92 which was very brief. 3 months ago in sleep clinic, I averaged in low 90's without cpap and it had dropped as low as 88%. With cpap it did not drop below 95 and averaged 96. Tomorrow I will measure with cpap on. I don't know what to think yet. I do feel the weight loss (bout 10lbs so far) has helped. I plan to lose about 10 more. I just find it strange that it has made that much difference. I was diagnosed with severe OSA and didn't think weight loss would make that much difference since I was never obese, just have a little extra around the waist. Has anyone else lost weight and had success eliminating or reducing apnea? I wonder if this software has a way to average out the readings like in the sleep clinic?

James

User avatar
Gerald
 
Posts: 1353
Joined: Thu Sep 07, 2006 6:32 pm
Location: Central Louisiana
Gender: Male

Re: Results of pulse oximeter use - Interesting findings!

Postby Gerald on Tue Aug 26, 2008 5:46 pm

Azdj.......

You're doing some quality work.....thanks for letting us look over your shoulder.

Gerald

User avatar
Snoredog
 
Posts: 6415
Joined: Sun Mar 19, 2006 5:09 pm
Gender: Male

Re: Results of pulse oximeter use - Interesting findings!

Postby Snoredog on Tue Aug 26, 2008 6:38 pm

azdj wrote:I have been using a Bipap ST from about 1month, with some improvement, but still general feeling of fatigue and poor sleep. My pressures are set at 14 / 10. While the information from the Bipap St smartcard and Encore viewer is helpful (it is not as detailed as the other M series machines, in particular it is poor at giving detailed apnea information), I thought is would be helpful to add a pulse oximeter to check the status of my oxyen saturation during the night. So I bough a PC68B Wrist Pulse Oximeter from Devon medical for $298. It is a good machine that will monitor sO2 and pulse continuously over the night (1, 3 or 8 second intervals) and allow a computer download and print-out of results. After using for several nights, I found some interesting (initial) results:
1. My oxygen saturations were falling into the 80s and even as low as high 70s during my ramp-up time and particularly just as I fell asleep towards the end of my ramp time. After full pressure was achieved, the results improved.
2. I was diagnosed with break-through centrals, hence the ST. The doc put me on a backup rate of 14, but said could decrease to 8-10 if necessary for comfort. I did that after a couple of weeks because my natural breath rate when awake is much lower than that and 14 was uncomfortable. However, the pulse oximeter together with my Encore results showed that when my breath rates was 10 or lower, my sO2 were going below 90%. I think I was breathing shallower in sleep than awake so even at the same breath rate, I was not sufficiently oxygenating at night.
3. My overall sO2 results were worse with my nasal mask than with my full face mask, even when the results were in the 90s, it appears the numbers are higher with full face. I will continue to monitor this over a longer time, but my initial thought is that the nasal mask is just not letting enough air through (especially during ramp up), or perhaps it was not exchanging CO2 quick enough. even at the same pressures. But for some reason, the full face mask seems to allow me to oxygenate better (and I don't think it was because of mouth leaks with the nasal mask - I use a chin strap and do not have dry mouth or other signs of mouth leak, and my leak rates are always consistent at 30 which is right on for my mask).

Based on this, I adjusted the ramp pressure to start at 8 rather than 4. I also increased the back-up rate to 11 and have started using the full face mask as preferred mask. Based on the last several nights, I have both slept much better and my oximeter results have shown no incidents of going beyond 90% over the entire night. Indeed, my results have generally run pretty consistently at 95% or better over the night, which I feel very good about.

based on this, I think that having an oximeter can be very useful. As many have said in this forum, we often are prescribed these therapies based on 1 or 2 nights sleep study with little follow-up. The more information we have, the better off we are. Certainly your O2 saturations are a critical part of therapy, and one that the machines will not give us directly. As long as I know my O2 sats are nomal, and I subjectively feel like I had good sleep, I feel my therapy is a success. I will also use the oximeter when I go up to my cabin at 8,000 feet to check my 02 sats at high altitude when using my machine, and to test my sats after a night out drinking, etc - all of those variables that 1 night at the sleep study doesn't check for!

Just thought you might find that interesting or helpful....


My opinion:

1. You were most likely mouth breathing while using the nasal mask, that would explain doing better on the Full Face mask.
2. Back up or Timed mode only kicks in when you are having a central apnea, so keeping the BPM higher would be advise, I mean if you slept "Normally" at a lower BPM rate you wouldn't need the machine would you? While it may appear uncomfortable you don't want to "mimic" mimic poor sleep with the back up rate, the idea is to get you breathing again where the machine switches back to Spontaneous mode, so any "Timed" mode should feel uncomfortable. I would try a 10-12 range backup rate.
3. Pulse Oximeter is a good idea, it can show you how you are doing separate from the machine. More important than SAO2, what is your pulse or heart rate doing after these periods of recover from low SAO2 levels? You might want to share that info with your Cardiologist.
4. What you experienced during Ramp is to be expected, and the sleep onset events after that expires, probably the first 30 minutes of sleep will be garbage. You might try lowering the Ramp timer, calculate it out based upon pressure/time if you are only 1 or 2 cm lower than it may not be helping you fall asleep at all.
5. You mention your pressure is 14/10? Interesting, very interesting, I wonder if that is not your problem. EPAP=10 and central apnea seems a bit high to me. Not knowing what your AHI is or what the PSG titration showed, I would be highly suspect of that EPAP setting.

IF there was any change I would make, it would be to pay attention to that heart rate, discuss it with your cardiologist if need be and if I felt I needed improvement I would lower EPAP from 10 to 9 and correlate SAO2 report, I would even try EPAP=8 and again watching what that SAO2 report looks like. Try to observe periods on the SAO2 report where oxygen levels are near baseline and note the heart rate. Then compare periods where SAO2 levels are down and heart rate is extremely low then races. You want to avoid the racing heart. If you are unsure, take a sample SAO2 report to your Cardiologist, they will circle the areas to avoid. Then you manipulate machine settings to avoid those conditions.

Those events at the onset of sleep, they are more likely shallow breathing or you simply relaxing so far where you forget to breathe. I would also expect mouth breathing to be associated with that more so with relaxation than congestion.

Sorry, I missed reading the paragraph above made bold. I see you found the reason for the low desats during ramp. Starting at 4 cm would starve you for air so that makes sense.

Just keep in mind if you have Central apnea, I would use caution increasing that EPAP pressure above 9 cm, reason I questioned it above. You are probably greater at risk of pressure induced central apnea then the general population, so even for them going above 10 cm can increase your risk of inducing central apnea. The one that counts is EPAP, while no one likes to use more pressure than needed doing so in your case could create a train wreck. Ideally, you want to observe AHI more specifically AI and adjust EPAP "just" to the point it reduces those down, but as you suggest your machine doesn't appear to provide that info. So without it you are in the dark, with known CA I would think you need to keep your EPAP at or below 9 cm. I wouldn't move above that without a PSG. IPAP or the top pressure should be increased only to encourage breathing by manipulation of volume and/or for hypopnea.

When you were on CPAP Auto, what was your pressure found there?
someday science will catch up to what I'm saying...

User avatar
feeling_better
 
Posts: 738
Joined: Sun Jun 01, 2008 7:08 pm
Gender: None specified

Re: Results of pulse oximeter use - Interesting findings!

Postby feeling_better on Wed Aug 27, 2008 12:55 pm

azdj wrote:I have been using a Bipap ST from about 1month, with some improvement, but still general feeling of fatigue and poor sleep. My pressures are set at 14 / 10. While the information from the Bipap St smartcard and Encore viewer is helpful (it is not as detailed as the other M series machines, in particular it is poor at giving detailed apnea information), I thought is would be helpful to add a pulse oximeter to check the status of my oxyen saturation during the night. So I bough a PC68B Wrist Pulse Oximeter from Devon medical for $298. It is a good machine that will monitor sO2 and pulse continuously over the night (1, 3 or 8 second intervals) and allow a computer download and print-out of results. After using for several nights, I found some interesting (initial) results:

azdj, Thank you very much for the informative post. What exactly are the two FF, nasal ones you used? Do you have the intended leak rate at your pressure for each, and the dead space volume for each? If you have urls to the two masks, it would be also helpful.

How does the oximeter connect to your computer? How long does the battery last? Is there a way to connect it to a the cpap machine (I have M-series Auto) so that the reading can be integrated in the display of data from my cpap machine? I am thinking of buying an oximeter, and the one you mentioned appears to be the least expensive recording type ??
M-series Auto A-flex in Cflex mode, HOME-MADE HH (replacing the integrated HH), Swift LT nasal pillows with outport control

User avatar
OutaSync
 
Posts: 2058
Joined: Sun Sep 23, 2007 8:49 am
Location: Virginia
Gender: Female

Re: Results of pulse oximeter use - Interesting findings!

Postby OutaSync on Wed Aug 27, 2008 1:52 pm

Feeling_better,

Hold on to your money. As a result of azdj's post, I went to Devon Superstore and bought that very same oximeter that he was talking about. (Please notice that he has not posted again and there is no way to PM him). The software appeared to be installing correctly on my laptop (with Vista). The unit is from China and the instructions are translated pretty well. However, when it comes time to upload, an immediate error comes up and there doesn't appear to be any way around it. Numerous calls to the Customer Service line were not picked up and after my second email to them this morning, I just got this response:

"In some cases, PC68B Wrist Pulse Oximeter Sleep Unit can not run properly because of the operating system setting. Our technical department is still working on this matter. We are sorry for this situation. Please send the item with RMA# ************* back to 1100 First Ave, Suite 100, King of Prussia, PA 19406. We will process the full refund for you. "

I hope I don't have any problem getting my money back. :roll:

Bev

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: REMstar Heated Humidifier
Additional Comments: 3M MediporeTape, Respironics Premium chinstrap, CMS 60D Oximeter
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

User avatar
feeling_better
 
Posts: 738
Joined: Sun Jun 01, 2008 7:08 pm
Gender: None specified

PC68B Wrist Pulse Oximeter problems?

Postby feeling_better on Wed Aug 27, 2008 2:02 pm

OutaSync wrote:Feeling_better,

Hold on to your money. As a result of azdj's post, I went to Devon Superstore and bought that very same oximeter that he was talking about. (Please notice that he has not posted again and there is no way to PM him). The software appeared to be installing correctly on my laptop (with Vista). The unit is from China and the instructions are translated pretty well. However, when it comes time to upload, an immediate error comes up and there doesn't appear to be any way around it. Numerous calls to the Customer Service line were not picked up and after my second email to them this morning, I just got this response:

"In some cases, PC68B Wrist Pulse Oximeter Sleep Unit can not run properly because of the operating system setting. Our technical department is still working on this matter. We are sorry for this situation. Please send the item with RMA# ************* back to 1100 First Ave, Suite 100, King of Prussia, PA 19406. We will process the full refund for you. "

I hope I don't have any problem getting my money back. :roll:

Bev
OutaSync, Thank you for that warning! Hope you get your problem resolved. My pure guess here is that the problem is compatibility with Vista. Unfortunately Vista still does not have many drivers working with it, and small outfits like the one above are the last ones to make an existing product upgraded to work with Vista.

Do you have another machine with WinXP where you can try that?

Is there anybody in this forum using this meter? Please respond
Last edited by feeling_better on Wed Aug 27, 2008 2:40 pm, edited 1 time in total.
M-series Auto A-flex in Cflex mode, HOME-MADE HH (replacing the integrated HH), Swift LT nasal pillows with outport control

User avatar
OutaSync
 
Posts: 2058
Joined: Sun Sep 23, 2007 8:49 am
Location: Virginia
Gender: Female

Re: Results of pulse oximeter use - Interesting findings!

Postby OutaSync on Wed Aug 27, 2008 2:12 pm

I also suspected Vista compatibility to be the problem, although the instructions were specifically for Vista. Vista doesn't like Encore Pro, either. Sometimes it works and sometimes it fails in the middle of a download. Unfortunately, my main computer (with Windows XP) had a hard drive crash and forensics is still trying to salvage my info. :(

Bev

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: REMstar Heated Humidifier
Additional Comments: 3M MediporeTape, Respironics Premium chinstrap, CMS 60D Oximeter
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

azdj
 

Re: Results of pulse oximeter use - Interesting findings!

Postby azdj on Wed Aug 27, 2008 2:28 pm

I get the same error message on first opening the software, but if you just click OK or ignore, the message goes away and the software then performs properly on my Windows XP computer. It does not appear to affect the function or data at all. Perhaps if you are running Vista, you might be having a more significant problem, but try cancelling the error message. For this low a price, I am willing to put up with some little kinks in the software as long as the unit appears to be workng well! The software is not very sophisticated, but gives the necessary basic information. Otherwise, the unit appears to work well and if you can trust the QA results they give, it is accurate. I have used it for several weeks now and it appears to be pretty good quality. As the instructions warn, major movements of the finger with the oximeter sleve can cause brief fluctuations of the pulse rate to where it looks like a few seconds your pulse rate went way high or way low. This reduces the value somewhat because when you are asleep and are moving around it may seem like your pulse went higher than it really did for a brief period, but I think that is probably a common issue with most wrist type oximeters.

I have been using it to monitor at 4 second intervals for the night and then downloading when I download my SmartCard data. There is no way to synchronize the data other than pullling up both screens and looking at the corresponding time lines. At that frequent a monitoring level, I need to replace the AAA batteries about every 4-5 days of actual use. I will post more on the results later - right now I am tweaking with Snoredogs suggestions to see if I can improve my centrals.

User avatar
OutaSync
 
Posts: 2058
Joined: Sun Sep 23, 2007 8:49 am
Location: Virginia
Gender: Female

Re: Results of pulse oximeter use - Interesting findings!

Postby OutaSync on Wed Aug 27, 2008 2:52 pm

Adzj,

Thank you for responding. I was hoping you would come back. Yes, the first error message that comes up can be passed by, but when I try to upload it goes crazy. It pops up a hundred error boxes with a little noise with each one. They keep on coming until you can shut the thing down. I had an IT guy come look at it and it does the same thing for him. Now, I'm more sure that it is a VISTA thing since it works well with your Windows. I don't mind kinks, but it won't work at all on my computer.

Keep us informed with your progress.

Bev

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: REMstar Heated Humidifier
Additional Comments: 3M MediporeTape, Respironics Premium chinstrap, CMS 60D Oximeter
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

User avatar
feeling_better
 
Posts: 738
Joined: Sun Jun 01, 2008 7:08 pm
Gender: None specified

Re: Results of pulse oximeter use - Interesting findings!

Postby feeling_better on Wed Aug 27, 2008 3:34 pm

azdj,

Which were the FF and nasal mask you used in your intial post on this thread?
M-series Auto A-flex in Cflex mode, HOME-MADE HH (replacing the integrated HH), Swift LT nasal pillows with outport control

Guest1
 

Re: Results of pulse oximeter use - Interesting findings!

Postby Guest1 on Sun Aug 31, 2008 8:38 pm

OutaSync wrote:Adzj,

Thank you for responding. I was hoping you would come back. Yes, the first error message that comes up can be passed by, but when I try to upload it goes crazy. It pops up a hundred error boxes with a little noise with each one. They keep on coming until you can shut the thing down. I had an IT guy come look at it and it does the same thing for him. Now, I'm more sure that it is a VISTA thing since it works well with your Windows. I don't mind kinks, but it won't work at all on my computer.

Keep us informed with your progress.

Bev



OutaSync,

I have also recently purchased the PC68B Wrist Pulse Oximeter Sleep Unit from Devon Medical and I have been very happy with it. With the software, I also get the out of control pop-ups you describe, but I have found it is an issue of the Oximeter being in the correct "state" to upload the data (I am using Windows XP). Before you click to start the data upload, the oximeter seems to need to be showing the regular display screen (showing "No Signal" since it is not taking readings while I'm uploading data). If it is in any other mode (dormant, or menu screen), it doesn't seem to be able to make the connection to the software. Anyway starting the software again with the oximeter in display mode has worked for me every time.

Incidentally when I brought my readings in to my doctor, they did not believe that I could be having the desaturations that it was showing. So they had me rent a hospital grade oximeter to make sure, and I have been able to compare its readings to my PC68B results, and so far it is right on the mark.

Good luck with it, I hope it works for you too.

User avatar
feeling_better
 
Posts: 738
Joined: Sun Jun 01, 2008 7:08 pm
Gender: None specified

Re: Results of pulse oximeter use - Interesting findings!

Postby feeling_better on Sun Aug 31, 2008 8:54 pm

Guest1 wrote:Incidentally when I brought my readings in to my doctor, they did not believe that I could be having the desaturations that it was showing. So they had me rent a hospital grade oximeter to make sure, and I have been able to compare its readings to my PC68B results, and so far it is right on the mark.

Good luck with it, I hope it works for you too.


Thank you for providing this info. This is an independent check on the accuracy!
Last edited by feeling_better on Mon Sep 01, 2008 8:41 am, edited 1 time in total.
M-series Auto A-flex in Cflex mode, HOME-MADE HH (replacing the integrated HH), Swift LT nasal pillows with outport control

User avatar
OutaSync
 
Posts: 2058
Joined: Sun Sep 23, 2007 8:49 am
Location: Virginia
Gender: Female

Re: Results of pulse oximeter use - Interesting findings!

Postby OutaSync on Mon Sep 01, 2008 7:44 am

Guest,

I made sure it was in the "no signal" mode. It still only will display numerous error signals. I'm glad to hear that it works on your XP.

Bev

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: REMstar Heated Humidifier
Additional Comments: 3M MediporeTape, Respironics Premium chinstrap, CMS 60D Oximeter
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

Next

Return to CPAP and Sleep Apnea (CLICK HERE TO READ POSTS)

Who is online

Users browsing this forum: AzureJay, chunkyfrog, cnaumann, EMTunit31, library lady, palerider and 45 guests