Oximeter results worse with xPAP then without

[Sammy_J]

I had an overnight oximeter and this time my DME was alarmed that the results were worse now compared to the time when I was using an oral appliance. I used my xPAP in auto mode with the recommended pressures. My DME is sending the results to my sleep doc but I won't be able to see him until late next month.

I reviewed my Encore data and it wasnt a bad night either. My total AHI was around 7. If I increase my pressure any more then my AHI always is higher. My body just can't tolerate the higher pressures, I assume.

Any thoughts?

[Sergey45]

Before I’d give any thoughts it would be interesting to see Oximeter results with and without xPAP.
Not the verbal description of better/ worse, but actual numbers.

[Sammy_J]

I dont have the actual results. I dipped to below 89% for a period of time with xPap compared to around 92% with the oral appliance.

[Sergey45]

Well, then it is actual numbers. That’s actually the thing. What I think many of as including myself just sort of overdoing CPAP treatment. I think it would be a nice idea to have my own oximeter to monitor O2 consumption on a daily basis. And than based on the results tune CPAP equipment accordingly. But that means another $500 out of family budget. And looks like it is endless.

[Sammy_J]

What I am leaning toward is Complex Sleep Disordered Breathing where events are made worse with xPAP treatment.

But, yeah it would be nice to have all these toys but they are darn expensive.

[Wulfman...]

I had an overnight oximeter and this time my DME was alarmed that the results were worse now compared to the time when I was using an oral appliance. I used my xPAP in auto mode with the recommended pressures. My DME is sending the results to my sleep doc but I won't be able to see him until late next month.

I reviewed my Encore data and it wasnt a bad night either. My total AHI was around 7. If I increase my pressure any more then my AHI always is higher. My body just can't tolerate the higher pressures, I assume.

Any thoughts?

WHAT were the recommended pressures? (range)

If you have a lousy setup, you'll get lousy results.

Den

[Sammy_J]

WHAT were the recommended pressures? (range)

If you have a lousy setup, you'll get lousy results.

Recommended pressure is 11 or 12 on CPAP. But, in the lab I started getting mixed and central events throughout the night starting at 9 and then getting worse at 11. So, to balance things I have the pressure at 8.5 to 10. At 11 or higher at home events are very high.

[Wulfman...]

Have you tried a straight pressure of 9?

Den

[Sammy_J]

Yeah, it is too low. As bad as 11.

[Wulfman...]

Yeah, it is too low. As bad as 11.

Well, I'm about out of ideas (Centrals are a different "ballgame"), but what happens (or has happened) if you tried working up from 9 in .5 cm increases?
If I understand this.....below a certain point, the pressure isn't enough, but above a certain point, the Centrals start taking over?

Den

[Snoredog]

wished you'd seek out treatment for it and stop asking the same questions over and over again, think we've only answered them for you here about a half dozen times now.

Because once you get answers you only show up with a new name like Justin_Case asking them again. In some threads you provide your own answers, some of us are aware of your little game and crack up seeing you answer your own posts. You did the same thing over on TAS, how many names did you use over there?

[Guest]

Sammy, here's something to think about: a lower sat doesn't mean you're sleeping worse. EVERYbody desats a little while they sleep. Even people that don't need xPAP. I can see a scenario where you desat a little more wearing your PAP simply because you're staying asleep continuously, as opposed to having numerous arousals. Just some food for thought: Maybe your DME is wanting to tack on an O2 charge to your ins? If the lowest you desat to is 89%, then you're doing fine.

[Guest]

Yeah, it is too low. As bad as 11.

Well, I'm about out of ideas (Centrals are a different "ballgame"), but what happens (or has happened) if you tried working up from 9 in .5 cm increases?
If I understand this.....below a certain point, the pressure isn't enough, but above a certain point, the Centrals start taking over?

The events are greater in proportion to the pressure and also when too low at least at home. I have recently changed sleep doctors and he is unsure what is going on. My former sleep doc isn't sharing information to my new doctor so the onus is on me to provide my new doc with as much information. My current new sleep doc states my situation is very very complicated and he was the one who suggested to go back do an overnight oximetry and other tests. For now, he says to carry on to what I have been doing. There is no happy medium with my pressures. We are in the "fact finding" stages but the good news is that he (my current sleep doc) is definitely receptive to opinions and suggestions unlike the opinionated sleep doc that I had before. However, he is not sure based on my PSGs that I do have complex sleep disordered breathing then again, he doesn't have that much experience there either.

[Sammy_J]

Sammy, here's something to think about: a lower sat doesn't mean you're sleeping worse. EVERYbody desats a little while they sleep. Even people that don't need xPAP. I can see a scenario where you desat a little more wearing your PAP simply because you're staying asleep continuously, as opposed to having numerous arousals. Just some food for thought: Maybe your DME is wanting to tack on an O2 charge to your ins? If the lowest you desat to is 89%, then you're doing fine.

Thanks. As a reference when I had a PSG done to determine if had OSA or not (no titration) my o2 saturation was 89%, the same as it is now with xPAP. With oral appliance the o2 numbers are better but I still feel like crap. And the fact I feel worse with xPAP therapy is puzzling everyone. Now, I have my o2 numbers to maybe support how I feel. I was told the "normal" range of o2 is 90-100% but these values may not be true for everyone if you are having issues. Maybe one day these ranges will be narrowed

[Goofproof]

Maybe is as simple as you need to address mouthbreathing, the number one cause of treatment failure in patients that use nasal interfaces. Jim