Overnight Oximetry Report - Please Comment

[Bluebonnet_Gal]

My sleep doc ordered an overnight Oximetry. I got the report today:

http://www.box.net/shared/bvltr0dd9i

Those of you that are familiar with these, please comment. My O2 dipped below 90 for a very minimal time. Is that acceptable?

My ResScan report for the same night was not one of my better night. Not my worst, but worse than most nights. My AHI for the night was 4.9 with an AI of 1.1.

[ww]

I assume the report was made while sleeping with your CPAP machine operating. I think he was trying to determine whether you need to sleep with oxygen and cpap. Do a little work and post your cpap data for OAI and AHI and your oxygen plot on the same page so you can see when the desats take place. When I do this test, I see NO desats even though there are several apneas recorded.

[Gerald]

Bluebonnet.....

I think you're doing pretty well. If you work on it a little bit......and drop your AHI score down to where it stays under 2.5, my bet is that your O2 saturation level will stay at 93% and above all night.

Also, you might want to experiment with a slightly higher low-end pressure....if your machine is an auto. Evidently, you still have a problem with Hypopneas.....and you've got just enough pressure to keep them from progressing into Apneas. But, the Hypopneas are still causing some "suffocation".....and if you "get-em before they can grow-up", your O2 saturation levels will increase from where you are now.

I have never agreed that an AHI under 5.0 is OK. Actually, now.....after 2-1/2 years on the hose....I'm not happy unless my AHI is under 1.0.....and you can get your AHI down too, if you try. I found that getting rid of mouth leaks made all the difference. Once I minimized the leaks, the AHI dropped like a rock.

Gerald

[Bluebonnet_Gal]

Bluebonnet.....

Also, you might want to experiment with a slightly higher low-end pressure....if your machine is an auto. Evidently, you still have a problem with Hypopneas.....and you've got just enough pressure to keep them from progressing into Apneas. But, the Hypopneas are still causing some "suffocation".....and if you "get-em before they can grow-up", your O2 saturation levels will increase from where you are now.

Thanks for the feedback. When the nurse called me this morning, she said my report was GREAT! After seeing it, I thought it was pretty good, but not GREAT! On the good side, most nights are better than this particular and I'm pleased that I was able to get the results on one of my "not so great" nights, just so I know the "worse case scenario".

My Min EPAP is currently 16 and my Max IPAP is 25. I've raised the Min EPAP from 15 to 16 this month. My goal is to get it to 17 or 18. The challenge is keeping the leaks under control under the high pressure. I was waiting to get over a cold before my next pressure increase. I'm about over it, so thinking of bumping the Min EPAP to 17 tonight to see how it goes.

[ww]

I am sure you realize that the minimum EPAP is strictly to control apneas. How many are you having each night? Why is your goal to get it to 17cm or 18cm? The max IPAP is to get rid of the Hypopneas. How many do you have each night? As you get the EPAP and IPAP too close together you cease BIPAP operation and are trying to set your machine up as an APAP. Did you have any centrals in your sleep test?

[Bluebonnet_Gal]

I am sure you realize that the minimum EPAP is strictly to control apneas. How many are you having each night?

It fluctuates a lot. I've had as few as one apnea and as many as 19 if I remember correctly. Generally around 5 - 8.

Why is your goal to get it to 17cm or 18cm? The max IPAP is to get rid of the Hypopneas. How many do you have each night?

I haven't been counting hypopneas, but I've posted reports for the last 10 nights. Note the night of the 18th is the night of my oximetry.

http://www.box.net/shared/sva64dx91i

As you get the EPAP and IPAP too close together you cease BIPAP operation and are trying to set your machine up as an APAP. Did you have any centrals in your sleep test?

My Max IPAP is on 25 - as high as the machine will go. It's never gone over 21. I did not have any centrals in my sleep test. The reason I'm trying to get to 17 or 18 is because when I was on APAP, my 95th percentile pressure ran around 17 or 18. As you probably know, ResMed units do not respond to frank apneas over a pressure of 10. The higher I get my pressure, the less the unit responds to apneas. I don't think they're centrals. I think I simply need to get my Min EPAP high enough to prevent most apneas. I'm not as concerned about Hypopneas because I know Resmeds tend to report them high. I am curious why my HI rose considerably when I upped my pressure to 17 last night. I know it's only one night though, so I'll wait to see how things pan out after a few nights.

[TSSleepy]

That looks similar to me. Without treatment, I desaturate into the low 80%'s during REM sleep.

With treatment, my AI is down under 1 but I still have a pulse oximeter trace that looks something like yours (3 to 5 obstructive apneas spread throughout the night and 1 to 3 brief spikes where I desat under 90%). I feel much better, but I'd really prefer to knock out those last little bit of apneas and desaturation.

That period on your graphs from about 4:50am through 5:30am look like a nice big section of REM sleep to me (your pulse gets more variable, your average O2 saturation goes up but you have some strong desaturation spikes). Those are the periods where I get my desaturations too.

What happened to the three hours between midnight and 3:15am? Finger clip fall off?

Anyway, I think that looks good. But I hope you can find some settings that get rid of those last few apneas and desat spikes down under 90%. That's what I'm working on now.

I put some pics of my traces before and after treatment in this thread, if you're interested. viewtopic.php?f=1&t=39605&p=346420#p346368

[Bluebonnet_Gal]

I don't know what happened between midnight and 3:15, but I'm guessing the finger clip fell off. I woke about 3:15 and adjusted covers and noticed it was off.

That's really cool the way you diagnosed yourself and have the video to see what goes on when you sleep! I hope you get your stats where you want them. I know I'm going to keep trying!

[skiman]

The bottom line with any overnight medicare guidelines are below 88% for 5 minutes or more the report looks great