How bad do I need supplemental oxygen?

[ajack]

Tell dr death it must have been an accident and apologise profusely, if asked.
Without a bpap, all I can offer is to increase the pressure to keep the o2 up. If you are just going to make one accident, make it count. Your o2 meter won't lie to you if it works.

[USMCVet]

I guess my question which I don't think anyone has an answer to is if all the pressure 8 through 15 kept up my oxygen levels during sleep and I used a pressure of 10 and it slowly became ineffective then why wouldn't that be the case if I went to higher pressure?

Way to early and not enough data but it seems like the more comfortable I become with the pressure and the more normal it feels when sleeping they more ineffective it is lol. It seems like it made my muscles stronger having to fight the pressure on exhale and I feel like I am breathing shallower again.

[ajack]

You are getting 2 hours where the o2 is low. Why this is happening now and not during the study, I don't know. We also only have the mean o2 values. The report didn't give your minimum o2 levels, that I could see. It's hard to tell what would be the mean value during those 2 hours from the chart you posted. It may be that the mean value was okay, even though there were considerable drops.
If you don't feel you can increase pressure, you could turn off the flex. That will return the peep value to 10. See if that helps. At the moment there is only one tool in the tool box and that is your peep pressure. If you do have a restrictive problem, they may move you over to an a/i VAPS. That has more options.

[Matt00926]

USMC, I will send you a bi-level machine if you want to test it out to see if it helps your oxygen levels. Just send me a PM if you're interested. I have an AirCurve 10S laying around.

[USMCVet]

You are getting 2 hours where the o2 is low. Why this is happening now and not during the study, I don't know. We also only have the mean o2 values. The report didn't give your minimum o2 levels, that I could see. It's hard to tell what would be the mean value during those 2 hours from the chart you posted. It may be that the mean value was okay, even though there were considerable drops.
If you don't feel you can increase pressure, you could turn off the flex. That will return the peep value to 10. See if that helps. At the moment there is only one tool in the tool box and that is your peep pressure. If you do have a restrictive problem, they may move you over to an a/i VAPS. That has more options.

So with flex of 3 I was under 88% one night for 5 minutes. Next night same settings I was under for 12 minutes. Last night I changed flex to 2 (gradual Transition to no flex) and was under 88% for 7 minutes. That was over 8 hours with 1 OA and 1 hypopnea.

The second half of the night my numbers always seem good. When I'm using machine. It's the first 2 hours when I get most of deep sleep that drops my 02. REM sleep doesn't seem to effect me as much as deep sleep does.

Tonight I'll record again with flex set to 1. I know during study EPR was on. I put hand next to vent on mask and pressure dropped noticeably on exhale and picked up during inhale.

[USMCVet]

USMC, I will send you a bi-level machine if you want to test it out to see if it helps your oxygen levels. Just send me a PM if you're interested. I have an AirCurve 10S laying around.

That is a very generous offer thank you!

I just got mail from VA today saying I need to call and make appointment to see my primary care doctor and it doesn't show Dr. Death! It has my old primary Dr's name on it who is chief there now. Monday I plan on calling to verify it's with her and if so I want to see how that appointment goes . She is a great Dr and may just prescribe me a Bipap.

If it's ok and offer is still open later I may take you up on it.

Oh and this is from other night when I had pulse oximeter on but fell asleep before putting on CPAP for first time.
Never again!

[ajack]

That's a real mess without cpap
The last few nights sound good, I wouldn't be concerned at those numbers for now. Ask if you can raise your pressure at the appointment. See if they will give you a range from 10 to up to 15.
The doctor will probably wait on the lung guy. A bpap will help a lot and I think I suggested it early on. See if you can get an iVAPS, it's the bee's knees for a restrictive lung.

[USMCVet]

Last 3 nights still qualify me for oxygen lol. I've been thinking about it more. If I do get to see my good primary doc at VA I will ask for Bipap and permission to make my own changes but send in reports on how things are going. The alternative being me constantly bugging them until treatment is dialed in and again when adjustments are needed.

My titration study also shows that I can safely go up to 15 cm h20 with risk of excessive centrals lol.

[ajack]

But it's not urgent and can last till they sort it out. I'm still curious to see what 13 will do.

[USMCVet]

But it's not urgent and can last till they sort it out. I'm still curious to see what 13 will do.

Here is my guess..... Raising constant pressure even with Max cflex will help for a few weeks before becoming ineffective again.

I make this guess because my hypertension has never been under control. It goes up so they increase dose. It goes down then creeps back up so they add new medicine. It goes down but creeps back up, rinse and repeat for 13 ish years.

I know one doesn't have anything to do with the other but I think my body wants to do what it wants to do, modern medicine be damned lol

[USMCVet]

I give up trying to make sense of things lol. AHI of 1 last night. 5 hypopneas 1 OA and 1 CA . So it's worst night I've had in a while..... 02 dropped to 88% as low and was great all night.

[Pugsy]

Quit trying to second guess and do the "what if" thing.
Proceed with the pulmonologist evaluations. Your O2 during the day isn't what a 30 something healthy young man should have.
Even if the machine fixed the nighttime stuff...you still have the daytime breathing stuff going on that would worry me if you were a member of my family.

Figure out the problem first and then you can choose between whatever options you might have to resolve the problem.
Right now we don't know what the problem is...all we know is that sometimes the machine helps and sometimes it doesn't.

[ajack]

Over 88% sounds a win. There is an old rule around here somewhere. "when in doubt, add more pressure"

[Matt00926]

I think he should just leave it alone until he gets more tests and more answers. While we are aware of the benefits of CPAP/EPAP, in general, there are potential drawbacks to raising the pressure in the absence of scored AHI events (reduced cardiac output, low blood pressure, etc). I think he should just use the CPAP pressure that treats his OSA, and if desired, use a low flow of supplemental oxygen to maintain a saturation above 88%. For all we know he could have a issue with respiratory ventilation while sleeping.

Just my .02 cents

[USMCVet]

Quit trying to second guess and do the "what if" thing.
Proceed with the pulmonologist evaluations. Your O2 during the day isn't what a 30 something healthy young man should have.
Even if the machine fixed the nighttime stuff...you still have the daytime breathing stuff going on that would worry me if you were a member of my family.

Figure out the problem first and then you can choose between whatever options you might have to resolve the problem.
Right now we don't know what the problem is...all we know is that sometimes the machine helps and sometimes it doesn't.

The increase in pressure fixed the daytime 02 Saturation mostly. Except for before bed my 02 is 96 to 99 mostly now.

But I am done trying to figure it out on my own and will just wait for my future appointments.