POLL: What is least harmful - Desaturations or Awakenings

[mars]

Hi Everybody

A some of you know, I am doing some experimenting with positional sleep apnea, oximeters, mars bars, horse collars and sleeping upside down

I need help. (don't laugh, I don't mean that kind of help, I am told I am beyond it )

No, this is a serious poll, and I want your opinion, view, or facts regarding a simple question -

1. Is is less harmful to have 1 to 8 awakenings during the night's sleep, and no desaturations

or

2. Is it less harmful to have an uninterrupted night's sleep, but still have say 1 to 8 desaturations during sleeping.

For the No 1 scenario let us assume that the awakenings are caused by an oximeter calibrated to set off an alarm if your SpO2 goes below 89 SpO2. It may take only seconds to get back to sleep, or it may take longer.

The No 2 the scenario can be either using a mask, but still getting a few desaturations (below 89 spO2), or not using a mask, and positioning the neck and throat to prevent most apneas, but again still getting a few desaturations (below 89 SpO2) during the night.

Now the poll gives everybody a chance to air their preference if they have one. And everybody has a chance to post whether they have a preference or not. (of course )

Nothing in the above should be taken as to what I am doing or not doing. I am still experimenting. But I know there is a lot of knowledge on this Forum that covers just about everything, so if you have anything to say - please say it

I acknowledge the poll rules are bit arbitrary, but staying within phpBB Poll guidelines makes bit a bit difficult to be more encompassing.

Thank you for helping. Free Mars Bars will be issued to all when they are available

cheers

Mars

[Pugsy]

Are we comparing overall perceived sleep quality (no awakenings) to better therapy (no desats and thus less potential harm to the body)?

Coming from someone who knows first hand how frequent awakenings make me feel... this is a tough one. I will need to think a bit on it. I would probably lean towards wanting to keep the awakenings limited and settle for a few desats as long as they weren't below 88%.

I had a bunch of awakenings last night so this memory is foremost in my mind right now....I have felt better than I do now.

[Madalot]

Coming from someone who knows first hand how frequent awakenings make me feel... this is a tough one.

Me too. We've got my desats under control, but in doing so, I'm waking at least a dozen times a night and I feel horrible.

This is a tough call for me too.

[mars]

Are we comparing overall perceived sleep quality (no awakenings) to better therapy (no desats and thus less potential harm to the body)?

Hi Pugsy

I guess the term "less harmful" leaves it up to you to decide how you determine what "less harmful" means, and whether or not your definition is about sleep quality, potential body harm, or both.

Trying to figure out what is best, for us as an individual, or for a generalised population, is part of the problem.

And is there any objective data available that can help us ?

I don't know, but I would like to.

Thanks for bringing that up Pugsy, it is always hard to cover all possibilities when starting a poll

cheers

Mars

[HoseCrusher]

My cardiologist, and several others that understand the body processes, has instilled in me that the arousal from desaturation causes a "fight or flight" response that causes harm to the body after the incident is over and the body tries to processes the various chemicals produced during the incident.

A "normal" arousal can produce the same response such as when you wake up hearing someone breaking into your house. However, a less dramatic arousal doesn't fall into the same response.

While a tough call I would say that desaturation arrousals are more damaging because every desaturation invokes damage, where normal arousal's may not invoke damage every time.

[Bright Choice]

For the No 1 scenario let us assume that the awakenings are caused by an oximeter calibrated to set off an alarm if your SpO2 goes below 89 SpO2. It may take only seconds to get back to sleep, or it may take longer.

Tough call on this poll. I too awakened last night and feel tired today.

Unless you really need to get awakened by your alarm because your desats are really low, I would turn that darned alarm on the oximeter off. Leave it to the next day to analyze what the desats are and how you can adjust your xpap to eliminate them for the next night's sleep. I would be po'ed if my oximeter was waking me up to tell me what I already know - duh, that desats are present.

The No 2 the scenario can be either using a mask, but still getting a few desaturations (below 89 spO2), or not using a mask, and positioning the neck and throat to prevent most apneas, but again still getting a few desaturations (below 89 SpO2) during the night.

Do you mean by "not using a mask" not using xpap at all? I don't know if positional therapy would be beneficial - if I was getting desats doing that, I'd get back on xpap right away.

FWIW, I had desats and my first doc said to experiment with settings to see if I could eliminate them. I couldn't figure out any relationship between settings and desats other than turning epr on seemed to help, but I don't know if that makes any sense at all. I ended up with new doc, new titrations(s) new S9 vpap adapt and now zero desats.

Good luck Mars! (Do they still sell "Mars bars"?)

[M.D.Hosehead]

Awakenings, such as from alarm, leave you sleep deprived and feeling bad. That's reversible if you can find a way to get more sleep.

Desats can cause organ damage that is potentially irreversible.

No contest IMO.

[Pugsy]

I don't/won't risk trying to limit my events using positional changes alone. Long story and no time to tell it.

I would give up few events (with a lower pressure) if I couldn't tolerate a higher pressure if those pressures were the sole cause of my awakenings in the effort to get fewer arousals. I would want to make sure O2 didn't go below 88% though.

So while I think desats are more harmful I think that there are times when a compromise could be in order when significant number of awakenings are severely impacting quality of life. As with so much about OSA and TX...depends on the individual.

[Lizistired]

I have to agree with bright choice. Turn the alarm off.
I usually have 5-6 blips in my O2 data that would have sounded the alarm when I turned over or messed with the hose and lost the signal.
The only time I use the alarm is when I'm not using the mask.

[avi123]

You need to specify the time length of the desaturated periods. Can you set your Oximeter to alarm only after a certain desaturated time and %?

[Goofproof]

My cardiologist, and several others that understand the body processes, has instilled in me that the arousal from desaturation causes a "fight or flight" response that causes harm to the body after the incident is over and the body tries to processes the various chemicals produced during the incident.

A "normal" arousal can produce the same response such as when you wake up hearing someone breaking into your house. However, a less dramatic arousal doesn't fall into the same response.

While a tough call I would say that desaturation arrousals are more damaging because every desaturation invokes damage, where normal arousal's may not invoke damage every time.

I feel the same way. I awaken gently about 5 to 10 times in 6 hours, change positions and drink a mouth full of cold water. My time awake is under 3 minutes per time. I don't wake up startled.

Destats cause panic, that brings bad body reactions that stress the heart. Jim

[jnk]

To me, that is like asking, 'Which is less harmful, malnutrition or dehydration?' We need food AND water. Likewise, we need air AND sleep.

But to give my answer to the question in the context of OSA according to my understanding, bad sleep is MUCH worse than occasional relatively mild desats at night--because the way OSA most often KILLS is from catastrophic accident from sleepiness and tiredness. And that can result in dead innocent bystanders, as well. And THAT is harm on top of harm, if the question at hand is about what is more harmful or less harmful in general.

I agree that sustained major lack of O2 can be more damaging to organs than slightly bad sleep, but I believe that few OSA patients on PAP therapy with anything near the right pressure suffer from that problem unless other problems are interacting. It is fairly easy to get an otherwise healthy person's O2 in the ballpark--the hard part is titrating out sleep disruptions.

Death (and manslaughter) from traffic accident is a very real risk for anyone who drives tired and/or sleepy. So I say fix Epworth results first so you have a live patient, and one who is not in jail, to work with.

Just my 2 cents.

[tony72]

Try having OSA and anxiety disorder.....not fun.

[mars]

But to give my answer to the question in the context of OSA according to my understanding, bad sleep is MUCH worse than occasional relatively mild desats at night--because the way OSA most often KILLS is from catastrophic accident from sleepiness and tiredness. And that can result in dead innocent bystanders, as well. And THAT is harm on top of harm, if the question at hand is about what is more harmful or less harmful in general.

Hi Jeff

I am wondering what your reasoning is for the above statement.

Given the guidelines I set down, you are saying that a few awakenings, maybe only for a few seconds each, is going to cause "bad" sleep, but a few desaturations under SpO2 89 will not, and that therefore awakenings cause more harm.

I cannot see that a few awakenings would cause "bad" sleep, but would be interested in your evidence for this.

Obviously it is better to have neither, that is not in question.

Thanks

Mars

[jnk]

But to give my answer to the question in the context of OSA according to my understanding, bad sleep is MUCH worse than occasional relatively mild desats at night--because the way OSA most often KILLS is from catastrophic accident from sleepiness and tiredness. And that can result in dead innocent bystanders, as well. And THAT is harm on top of harm, if the question at hand is about what is more harmful or less harmful in general.

Hi Jeff

I am wondering what your reasoning is for the above statement.

Given the guidelines I set down, you are saying that a few awakenings, maybe only for a few seconds each, is going to cause "bad" sleep, but a few desaturations under SpO2 89 will not, and that therefore awakenings cause more harm.

I cannot see that a few awakenings would cause "bad" sleep, but would be interested in your evidence for this.

Obviously it is better to have neither, that is not in question.

Thanks

Mars

I don't think that awakening after a sleep cycle is any big deal, if the person goes back to sleep, and if the stages are not fragmented. I consider that normal, actually, for many people. And I also think many very healthy people have a slightly lower sustained O2 at night than during the day (especially in certain stages), and that may be no big deal in their case.

However, I also believe that awakenings at night can at times be caused by things that ALSO cause sleep fragmentation that keeps a person from getting deep sleep and REM. And therefore awakenings should not be ignored or shrugged off without further investigation of the significance to the particular patient. And I also believe that sustained O2 below 90%, especially below 88%, needs to be thoroughly investigated, since that is likely to do damage.

Other than that, I'm not sure there is any way to know the significance of awakenings or of O2 without a sleep study. So my main point is that a person on PAP therapy needs to get it as comfortable as possible and at the best pressure so that a person isn't sleepy and tired, because being sleepy and tired is likely to cause death if the person drives. And death is harmful.

Anyway, there are many different kinds of desaturations of different lengths and different levels, and there are awakenings that matter and awakenings that don't. Given the "rules" you gave, there is no way to know whether O2 suddenly decreased but was high enough most of the night or not, and there is no way to know how many arousals were caused on the way to the full awakening. Such things are highly individual, as I see it. And those differences matter.

But I'm just an opinionated patient, not an expert or a doc. And I enjoy muddying the waters whenever possible--even in polls as excellent as this one is. Thanks for creating it, by the way. Good stuff. Makes us all think.