Fugly SpO2 line with low AHI

[BasementDwellingGeek]

My OSA seems to be well controlled with a long term average (almost 6 months) AHI of 1.5. Last night scored a 0.84 consisting of:
1 OA lasting about 12 seconds, desaturated to 92% followed by another 15 seconds of insignificant flow that resulted in a couple pressure pulses but no apnea events registered.
1 CA during awake breathing prior to getting out of bed.
4 hypopneas, one of which was during awake breathing prior to getting out of bed.

There was a period of about 25 minutes of significantly reduced SpO2, as deep as 73% (the dark dotted line, 90% is the red dotted line) and that only registered as several VS2 snores, never more than 8 in a 2 minute period. Total leaks were 35 to 36, well within the expected range. During with 25 minute period my SpO2 averaged 80%. This started with the CMS50 losing signal, the orange line. I normally expect to see 6 to 10 seconds of weird data after it re-syncs. But this was mondo weird.




Zeo said I was in light sleep up until the trailing edge of the the “W”, about 12:53, where the heart rate starts rising. At that point I entered REM until waking about 1:07.


light sleep phase


REM sleep phase

I have only been monitoring my SpO2 for a month. I have not seen any thing like this before. I'm thinking that it is real and not an aberration. I do feel more than a little vacant today. Is this what I used to feel like every day but didn't notice it because it was “normal”?

[MaxDarkside]

I vote an aberration. I've seen similar with my CMS 50E and if I don't see a clear confirmation in the breathing signal, like I stopped breathing for > 40 seconds for such a desat, or other data series not from the CMS 50E, I discount such. I've seen similar, both directions. Recently mine went the other way, where the CMS 50E goes "goofy", it says my heart rate jumps into the 200's, then flat lines, then flails here and there for quite some time, then goes to what it should be.

[HoseCrusher]

Wow, that is weird.

It looks like it did recover quickly, but dropped a decimal place in the process. Something to keep in mind is that the blood oxygen level doesn't suddenly drop or suddenly raise. The process is a little gradual and shows up kind of like stair steps. When your signal drops like falling off a cliff or suddenly raises like being launched from a rocket, it is most likely an artifact.

Usually the unit will reset in 10 - 15 seconds as the moving average stabilizes, but I have seen something similar when you bump the unit several times in a row. This may be difficult to do while sleeping, but it is possible...

[torontoCPAPguy]

Let me just say that the low SpO2 (anything under 90%) is cause for immediate concern. I would confirm the numbers and if they are right, you need to be supplementing with O2 infused into the air line so that your Sp)2 remains well above 90% ALL NIGHT LONG. Five seconds below 90% is totally unacceptable. One second below 90% is unacceptable. Dropping down into the 70's and low 80's is a surefire prescription for "he died peacefully in his sleep"... of a massive coronary or BP skyrocketing and sending a clot somewhere you don't what it to be. If your heart rate has slowed down sufficiently; if you suffer from silent aFib; if, if , if.... you are at risk. An oxygen concentrator (I have the Everflo Q and infuse about 4L/M into my airline) will resolve the problem in a flash. And you will sleep better and you will be healthier. ACTION STATIONS!

[MaxDarkside]

Let me just say that the low SpO2 (anything under 90%) is cause for immediate concern....ACTION STATIONS!

OK, here's some data. 1,680,233 spO2 readings for me since January 23rd (LOL!) Bwhahahaha.... (ok, I'm a data geek). In there are:

%O2 - Occurrences
--- --------------
81% - 40 times
82% - 80 times
83% - 76 times
84% - 476 times
85% - 641 times
86% - 710 times
87% - 930 times
88% - 923 times
89% - 1403 times

More than 4,000 readings, give or take.
I must REALLY need to get to my Action Station!
(that would be only 0.2% of the time below 90%, which really isn't too bad, I would suppose)

[BasementDwellingGeek]

Thanks for the feed back, I feel more comfortable now.

More than 4,000 readings, give or take.

Have you done any correlations to those reading and signal loss?

[MaxDarkside]

Have you done any correlations to those reading and signal loss?

No, and the chart I'm showing has a "Clip" function applied removing anything outside 100% and 80% spO2 in an effort to not show signal losses. I would presume signal losses would relate to positional changes, that is, I moved, the finger re-oriented in the device and the signal goes goofy. I would guess that signal aberrations along with other "funny things" in other data series would help count brief wakes.

[torontoCPAPguy]

What I can tell you is simply this...
Anything below 90% is considered 'respiratory distress' and a medical professional or EMT would administer oxygen immediately. Anything below 90% is going to likely increase your BP and heart rate, neither of which are healthy things to have going on. I had a very similar issue and thought it was caused by lung damage due to severe pneumonia (they almost lost me) in 2009 as a result of H1N1 Influenza and three weeks on total life support in lala land. It turns out it was both this and Atrial Fibrillation. What brought on the aFib? No idea. Could have been the pneumonia and life support; could have been a combination of factors. I went from MD to MD.... I had specialists for my specialists. No clue. So I asked a simple question. What can we do to resolve the issue? No response. More tests. LOTS more tests. TONS more tests. At one point they were even testing me for allergies. My lung capacity was 70% at best on a good day.

I went out and bought an oxygen concentrator and titrated to 4L/M (minor infusion of oxygen into my CPAP air line). My SpO2 remained above 90% all night, every night and I slept like a log. Maybe too well as I always awoke groggy and early. Lots more energy by comparison but still not right. Then by fluke they discovered I had aFib. Bingo. Started TIKOSYN in December and have been in Normal Sinus Rhythm ever since.

This is something that demands immediate attention and you will need to be your own advocate and ask questions.

My first question would be... is my low SpO2 related to entering L4 or REM sleep? Shallow breathing=low SpO2=autonomic response of awakening.

Good luck.

[Kairosgrammy]

I think (won't swear on it) during my sleep study that I desatted down to 80% while on my back even with only a few OAs. I'd watch it. Could be a symptom of some kind of problems you'd rather not leave untreated.

My OSA seems to be well controlled with a long term average (almost 6 months) AHI of 1.5. Last night scored a 0.84 consisting of:
1 OA lasting about 12 seconds, desaturated to 92% followed by another 15 seconds of insignificant flow that resulted in a couple pressure pulses but no apnea events registered.
1 CA during awake breathing prior to getting out of bed.
4 hypopneas, one of which was during awake breathing prior to getting out of bed.

There was a period of about 25 minutes of significantly reduced SpO2, as deep as 73% (the dark dotted line, 90% is the red dotted line) and that only registered as several VS2 snores, never more than 8 in a 2 minute period. Total leaks were 35 to 36, well within the expected range. During with 25 minute period my SpO2 averaged 80%. This started with the CMS50 losing signal, the orange line. I normally expect to see 6 to 10 seconds of weird data after it re-syncs. But this was mondo weird.




Zeo said I was in light sleep up until the trailing edge of the the “W”, about 12:53, where the heart rate starts rising. At that point I entered REM until waking about 1:07.


light sleep phase


REM sleep phase

I have only been monitoring my SpO2 for a month. I have not seen any thing like this before. I'm thinking that it is real and not an aberration. I do feel more than a little vacant today. Is this what I used to feel like every day but didn't notice it because it was “normal”?