Hospital O2 Sats never below 90 - What do you think?

[jagzoo]

I'm going to try to keep this short but would really like to hear your thoughts on this.

I was diagnosed with sleep apnea back in December 2012 and the CPAP has been going well. My AHI averages below 2. On my sleep tests the main problem was that I was having O2 desats down to 80. At that time I was on prednisone of average of 25 mg for over 2 years and was in full blown Cushing's Syndrome with the puffy neck, face etc. the only problem was that my sleep was very fragmented with lots of awakenings and little stage 3-4 sleep.

I have been off the prednisone for the last 5 months and have lost 15 of the 20 lbs that I gained and all the Cushing Syndrome and swelling of my neck etc is gone.

This past week I was admitted via ambulance from our local hospital to the local teaching hospital/ medical center for a problem unrelated to sleep apnea. As it was an emergency, my CPAP did not go along for the ride. By the next day, when I was lucid enough to mention my sleep apnea, I had already had over 24 hours of continuous blood sats recordered: all of them in the 90s! I was there for 3 nights, with SpO2s never dropping below 90 so none of us thought I needed to add a CPAP machine to all the rest.

So now I am home and debating about the CPAP machine. I am finding that my sleep seems less fragmented and I am waking up less without it. I haven't used my Zeo yet as I'm still acclimating to being home. When I used it before it would show me awake just about all night with occasional short episodes of REM, no deep sleep.

What do you think? I am thinking about just leaving the CPAP off until they have figured out what else is wrong with me. And then see about a repeat test. My Sleep MD is useless, haven't even ever met him - see a PA whom is nice but doesn't even have the equipment to read my smart card - I bring it to my DME for the required compliance checks and otherwise am responsible for my own therapy, with the help/ guidance of this forum, and am not in shape for another sleep test at this time.

Any thoughts?

[oak]

I agree with your idea to wait until they figure out what else is wrong. Trust your instincts. Regards, Oak.

[Todzo]

Yes listen to your body and go with your gut - but - watch like a Hawk!

I would start at least recording the audio for the night and if you can add video tape that is even better. The audio wave form (on a computer wave form editor) should inform you of any events and the video may well help to further identify what general kind of event you are looking at.

In the mean time I would rig to use your xPAP's data capabilities. If you do see/hear/or feel the need to use the xPAP the data will help to see what is going on as you use it.

I would be checking blood pressure and making a record of morning feel, daytime productivity, and how the day went.

You have a great deal going on with your body right now. Watch like a Hawk!

Take care,

Todzo

[Julie]

Can you at least make a point of not sleeping on your back, or even using a recliner, until you know for sure? A few days off might mean you're going on the effects of the previous Rx and not necessarily out of the woods 100%.

[mollete]

This past week I was admitted via ambulance from our local hospital to the local teaching hospital/ medical center for a problem unrelated to sleep apnea. As it was an emergency, my CPAP did not go along for the ride. By the next day, when I was lucid enough to mention my sleep apnea, I had already had over 24 hours of continuous blood sats recordered: all of them in the 90s! I was there for 3 nights, with SpO2s never dropping below 90 so none of us thought I needed to add a CPAP machine to all the rest.

Were you on supplemental oxygen during this period? If so, desaturations could have been masked by a much higher than usual baseline.

[jagzoo]

Thanks to all for your thoughts.

To reply to the points raised. I am sleeping in a recliner at home as that is the only position that my shoulder pain isn't too severe to keep me from being able to sleep ( both shoulders have rotator cuff tears and the pain is worsen by my fibromyalgia).

I never received any supplemental O2 either in the ambulance or after as my O2 Sats were so good it was obvious that wasn't the problem. So the readings should have been very accurate.

I'll give it a few nights and then check with my, not as accurate, wrist SpO2 for a night and also ZEO and see what those readings are. But, for now, I'm comfortable not using the CPAP after being monitored for 3 nights in the hospital and no desats.

Again, I really appreciate all your thoughts,
Gail

[ems]

Maybe not a popular response, but if my 02 stats didn't drop below 90, and everything else checked out okay, I'd put my machine in the closet.

[chunkyfrog]

Since it is possible for events to be so short that oxygen stays at optimum levels,
we must also address the effects of short events, which can disturb sleep and also elevate levels of stress hormones.
In my sleep study, my lowest desats were in the high eighties, but I still felt like poop.

[McHale]

During my sleep study I was diagnosed with severe sleep apnea with a 57 AHI, however 92.5% my O2 saturation was 90-100% and only .4% between 80-90% for 389 mins with a sleep efficiency of 90% with half being hypneas. I had more awakenings during my titration study 29 vs 21 with only a sleep efficiency of 78% for 314mins. Another sleep doc questioned tHese studies. I had also put in 6 pillars to stiffen my clumsy palate since. Any thoughts?
I really hadn't used my CPAP in 3 years nice but recently stated again sometimes after my recent AFIB ablation.

[Julie]

Just curious, but do you think you'd have needed the ablation for Afib if you'd been on Cpap all along?

[McHale]

Julie,
I actually was on CPAP the first 9 months but it made no difference, actually many times it set it off from the air rushing into my nose. Many times in AFIB went to bed and I was fine in the am. Dr Natale one of the best in the world performed the procedure, He did the standard PVI, then hit the posterior wall, coronary sinus and superior vena cava which has a 3rd fat pad linked to sleep apnea. It had to be done either way as it was progressing. My cardiologist sends all his AFIB patients to the sleep clinic, and the majority have sleep apnea. This is not easy for me as I am still single. Anybody doing well with Winx here?

McHale

[echo]

Since it is possible for events to be so short that oxygen stays at optimum levels,
we must also address the effects of short events, which can disturb sleep and also elevate levels of stress hormones.
In my sleep study, my lowest desats were in the high eighties, but I still felt like poop.

I had similar - my desats never went below 90% yet I had 35+ events (arousals from hypopneas) an hour and those were enough to wreck my sleep. Personally I'd *keep* using the cpap until it was proven to me otherwise that I didn't need it.

[JamesAllen828]

It could also be positional. Normally in the hospital they don't lay you completely flat like you would be in regular bed. Even the slightest elevation can have an effect (positive or negative) on your O2 sats.

[jagzoo]

Hi, just an addition: I slept with my ZEO last night and received a Z-score of 95. All I've ever received in the past was a high of 26! That certainly backs up my feeling that i am sleeping well.

I'm going to use my wrist/ finger SpO2 tonight and see how that records.if it also shows, like in the hospital, a normal SpOs, then I am going to talk to my MDs representative a week from Wed during an already scheduled apt.

I know that I didn't start snoring ( per husband) until after I had gained all the prednisone throat/ neck swelling - sure would be nice if the problem disappeared with the swelling gone. Oh well, it will be a while before I know for sure. I know I would need another sleep study and I don't know how long it would be before insurance would pay for another one.

Cheers

[johnthomasmacdonald]

in none of my in hospital sleep tests did my o2 go below 90 - 92 in fact. The sleep doctor told me that your o2 going up and down - even if it NEVER goes below 90 can do damage - worse damage he claimed than if you just slowly went down into the high 80s and then up again. Whether or not this REALLY has been well supported by research, i have no idea