Oxy Sat levels and apnea

[snork1]

I have been "playing around" with a recording pulse oximeter and "dental device" as an alternative to my CPAP, with some promising results.

But I am still trying to figure out what a "good" blood oxygen saturation level is. I know the cutoff for "bad" is 90%. My usual waking is 97% percent according to the pulse ox machine. Most of the night when the dental device is in, so far, I have been running an average of 95-97% with occasional spikes up and occasional spikes down to 92-93%. I don't seem to dwell at the low end though for longer than seconds to maybe a couple of minutes.

Obviously this is a question for a trained professional, but my sleep doc seems pretty tight lipped on the subject, maybe because he might have to admit that his patient is being more thorough and knowledgable about apnea treatment options than he is being. He also has resisted suggesting a dental advice, and a doctor will never ever admit they were wrong.

sooooo....any "opinions or heresay" ?

I should mention that the device I am using now is for evaluation ONLY, and has a number of design issues, and I plan to fork out the non-insurance thousands to a qualified dental sleep doc if I am convinced the appliance approach will work for my particular apnea.

[NightHawkeye]

Most of the night when the dental device is in, so far, I have been running an average of 95-97% with occasional spikes up and occasional spikes down to 92-93%.

FWIW, I almost always get up feeling good when my PSO2 stays above 95%. Most nights I don't make that, but feel good anyway. Conversely, when my PSO2 gets down to 92%, I usually already know it's been a not so good night before I even see the oximeter results.

The saturation levels are affected by many things though, so even with PSO2 of 100% you could feel really lousy. Before starting xPAP, my body temperature was usually low by a degree or so, and this resulted in the oximeter displaying 100% saturation whenever I'd hook up to it. When I first went to rent an oximeter, the poor guy who rented it to me worked for ten minutes or so trying to figure out why my saturation level was constantly 100%, trying different probes and playing with the machine. I guess he'd never seen that before, but I think now it was simply from my being constantly cold then. (In the Nellcor manual there is a temperature compensation chart you may have seen - at least I think there's a copy there).

Obviously this is a question for a trained professional, but my sleep doc seems pretty tight lipped on the subject . . .

ROTFL. Is this your way of saying your sleep doc is something other than a trained professional? Don't ya just hate it that so many physicians display such little ability to process analytically in any way. At least that's my conclusion why it's rarely possible to discuss such things with them. Their diagnostic focus seems to be based simply on remembering threshold criteria.

I plan to fork out the non-insurance thousands to a qualified dental sleep doc if I am convinced the appliance approach will work for my particular apnea.

It'll be darned well worth it, too. I hope it does work for you. Didn't you say last week or so that you were seeing desaturations down to the mid 80's? If the only difference now is the dental device, it sounds like you've made a big improvement.

Regards,
Bill

[Ellen]

I have been on oxygen long before AutoCPAP and have had much experience with sats. I live at 6800 feet elevation and 96/97 is about as good as you can get at this elevation. When I go to my PCP who is about 7200 feet, about the best anyone can do is 95/96 so you see elevation has a great deal to do with o2 sats. When I'm at 4800 feet at back Dr I can pull a 98%.

I do not know the elevation of Kirkland Washington, but I am sure if a person did some internet research, there must be some kind of chart or infor that tells you this.

And yes, 90% is the critical point. Anything below 90% sats and you are not getting enough oxygen to your organs for them to function properly - bad deal. Sats always drop during sleep and even with low activity and pick up with activity unless you have a health issue that the activity puts too much on your heart and lungs to keep up. Before CPAP, but with supplemental 02 at 5L, I still only read 88-90 upon awakening. And sometimes through the day I will get 92/93. Since being on CPAP for 1 month with supplemental 02, my daytime sats are 94/95 which is GREAT for me.

Drs don't like to tell you that below 90% your organs are not getting enough oxygen - they don't like to as many patients will panic at that.

I have a respiratory disease that keeps my 02 sats very low BUT am hoping in time with CPAP that I can get totally off oxygen.

Hope this info helps

[feelinfab]

I don't have much info to share with you on the pulse ox issue, but I do want to thank you. I've been trying to get stats on the thresholds and despite all the material that's out there, I haven't been able to find this particular answer. So, thank you. I'm lucky to have a great sleep dr and regular internist who will always field all of my questions, but I always have so many questions I forget to ask half of them.

RE: dental device. Perhaps I can shed some light here. I work for a large, highly respected medical publisher, and we regularly publish articles on apnea topics. In fact, it was the possibility of a dental appliance that led me to seek treatment. (Just in time, I might add. Talk about pulse ox levels ... mine very quickly dropped to 40, possibly lower, during the night. The chart didn't go that low!)

The articles I have read -- which are all based on presentations at major medical conferences -- suggest that dental appliances may work okay for mild cases, but that CPAP is really the way to go.

Try searching our website, see what you can find: http://www.imng.com Our pubs are for md's, but I think you can do a search on them.

Good luck! And thanks again for the info.

PS -- I would just like to say, I think getting this job saved my life, since I saw so many articles on apnea. I wonder how much longer I might have gone without having a stroke .. but then again, I don't like to think about it!

[Snoredog]

Snork1:
what happend with that tongue sucker thingee you were trying?

[dsm]

Hi all,

Great thread & thanks for starting this one Snork.

I believe this type of discussion plus the feedback of others is a great learning opportunity that makes this forum so interesting.

I particularly enjoy it when people are willing to do useful research & share their findings here. I think there are so many people who welcome such info.

I am especially interested in SpO2 sat info and also keen to hear from anyone who uses supplemental oxygen. My interest is mostly curiosity as I keep reading how many people believe that occasional use of oxygen can prove highly beneficial. I do understand that medical conditions make supplemental oxygen a must for some people.

I understand that in some parts of the US there are walk in oxygen bars. This notion sounds amusing but if the evidence shows it does provide benefits I am keen to learn how & why.

As an interesting side note ...
Last week my brother was in intensive care with a viral lung infection. When he was still in danger I happened to notice that his SpO2 reading was 100%. Seeing he had lung problems & my best reading is typically 96%, I asked the nurse attending if he was being given supplemental oxygen to get such a high reading (plus it was being read off one of his toes ) - she said yes 40%. When his condition had improved they took him off his ventilator & he had a trach tube and a 'T' piece and this too was being fed a smaller amount of supplemental oxygen.


Following the comments re altitude & SpO2 sat, I am wondering if setting up an Oxygen bar is best in high altitude locations.
(assuming they do impart benefits).


DSM

[rested gal]

sooooo....any "opinions or heresay" ?

Several years ago I was able to buy a BUNCH of cpap masks, a REMstar Auto (before they had C-Flex), heated humidifier, the software, reader, a heated hose and all kinds of accessories. A woman who had been unsuccessfully trying for a year to get comfortable enough with cpap treatment to actually sleep finally gave a dental device a try -- the TAP II.

The TAP II got the job done for her. She could actually go to sleep and wake up feeling good. Very anecdotal, of course. When she reported that on a message board, people urged her to get another PSG while using the dental device.

Unfortunately (but understandably) she didn't want to go through the expense or hassle of another PSG when the TAP II keeping her jaw pulled forward while she slept was giving her such good subjective results. She did get her doctor to order several overnight recording pulse oximetry tests which showed her sats while sleeping were staying up great.

When she posted that she had boxed up her tons of cpap equipment, never to be used again, I made her an offer. That's how I got started on trying lots of different masks. She'd bought over a dozen different masks. She really had tried to make CPAP work.

Sooooo...there's some hearsay for ya, snork. Opinion? Yeah, I do think that wearing a dental device to advance the lower jaw during sleep could be a "cure" for some people. And I don't think it would necessarily have to be only people with "mild" OSA who would have a chance of a dental device taking care of their problem. Mild, moderate, severe -- all those labels are based mostly on AHI numbers, not on the root cause of each individual's OSA.

If getting the lower jaw and/or tongue forward is all it takes for some people's airway to stay open AND if they can tolerate the advancement device... Bingo!

[Guest]

Snork1:
what happend with that tongue sucker thingee you were trying?

I don't want to come off as though I am pushing the Aveo TSD tongue sucker, but that is what I am investigating on my own, while I try to "hook" my doc into helping me. I am trying to keep my discussions as generic as possible.

The aveo TSD does SEEM to work for ME since the results above are in reference to that device, but I am afraid it has a couple of design issues that may unfortunately preclude its long term use if I can't get used to it. At the very least its a $150 device that quickly lets someone know if the CONCEPT of pulling their tongue/jaw forward might work for THEM, before investing in the $2000 or so and months that a "regular" dental device adds up to when all is said and done.

the biggest issue with the "tongue sucker" seems to be adjusting the suction and getting it to stay on all night. The other problem is I have a short tongue and the the web under my tongue is having a hard time getting past the "extremely sore" stage.

I have been poking around some more on another forum that has a section just for dental devices and that has been very educational.

I also found another ox sat statistic that is bandied about and ties in with a comment my doctor made. Apparently one of the "qualifying" numbers for apnea "needing" treatment under medicare and by sleep docs is a 4% Reduction in ox sat.
i.e. for my 97% waking SO2, I could go down to 93% before they would start to worry. Looking at my limited samples so far with the aveo, I only occasionally drop for a few seconds to or below that 4% limit.

interesting stuff!

[SnoozeHunter]

Sats always drop during sleep and even with low activity and pick up with activity unless you have a health issue that the activity puts too much on your heart and lungs to keep up.

Ellen, I do treadmill in a physical rehab center every day during my lunch hour. In addition to the exercise equipment, they have pulse oximeters out for clients to use. I've noticed that sometimes my SaO2 drops when I exercise. I don't check it every day, but I've seen it go down to about 91. Usually, I'm between 94 and 98 during the day.

91 is still in the okay range, but can it be normal for SaO2 to drop like that from exercise?

Thanks!

[snork1]

The last mystery guest was me. Darn those log in issues....sigh....

[NightHawkeye]

I also found another ox sat statistic that is bandied about and ties in with a comment my doctor made. Apparently one of the "qualifying" numbers for apnea "needing" treatment under medicare and by sleep docs is a 4% Reduction in ox sat.
i.e. for my 97% waking SO2, I could go down to 93% before they would start to worry. Looking at my limited samples so far with the aveo, I only occasionally drop for a few seconds to or below that 4% limit.

Snork1, as much as I hate to add to confusion, I feel compelled to point out that there are a lot of opinions regarding what the scorable desaturation values should be. When I searched a while back, I couldn't find what I'd call a standard definition. To give you an idea how much variation is possible, here is the Desaturation Options screen for the Score software:



The values you see listed are the default values, but notice how many variables can be changed for scoring purposes. I've wondered when reading posts from folks who claimed to have only hypopneas, just how much of that was due to the scoring criteria used.

Regards,
Bill

[snork1]

interesting Nighthawkeye!
Those "default variable" numbers tie in with what I have stumbled across, with the 90% cutoff for "good" and 4% desat from baseline being significant, and the 10 second duration answers the question I was dancing around, wondering if duration was a factor.

It does seem odd that they are variable?

That default value for duration will be a good starting point for looking at my desat results combined with how I feel.

Sort of makes you think we this science needs a bit of flexiblity for diagnosing AND treating apnea. Some people need CPAP, some need dental devices and maybe surgery might even work for a few. Sorta would be nice if doctors didn't try to plug everyone into one solution....sigh.....

[krousseau]

Most doctors don't use a non standard approach because:
it isn't taught in medical school
it opens them to lawsuits
it takes more time
it isn't reimbursed
The ones who have non standard ideas sometimes go into research where it takes a long time to get the proof they need for their ideas to become "standard". And a few who have non standard ideas become quacks.
Keep working on your idea maybe this doc will get interested and learn some more or maybe you'll find a new doc. Dr shopping is expensive in itself and difficult.

[snork1]

Most doctors don't use a non standard approach because:
it isn't taught in medical school
it opens them to lawsuits
it takes more time
it isn't reimbursed
.

but when "non-standard" includes FDA approved devices and procedures, such as pillar and some dental devices and combining nasal surgery with CPAP, its really hard to justify their "caution".

As far as not being taught in medical school, I think its irresponsible for them to not continue their "education" after school as highly paid "professionals". As an engineer thats paid a whole lot less than doctors, I am EXPECTED to continue my "professional development" and what I learned in school is only a fraction of what I use on the day to day job after 23 years as a professional.

"it takes more time" I think pretty much nails it, along with it maybe diverting a few patients to spend SOME of their money elsewhere. Obviously good ethical rationale for not getting patients the therapy they need.

I am hoping I can goad my sleep doc into being a better doctor and realizing there is plenty of money to be made, even if he has to occasionally refer a patient to another professional or spend a few extra minutes with a patient. Maybe coming in with better research and instrumentation than he has will make his pride kick in and raise the level of his game.