AHI staying below 4, but desats below 90 most nights

[WildMtnHoney]

So way back 2ish years ago, I was first diagnosed with sleep disorder NOS, and put on nocturnal oxygen, 2L/min because that study showed desats only. However that didn't solve everything, so several sleep studies later I was put on CPAP with a steady pressure of 11cm and they took the O2 away.

I realize I'm not even 4 months into therapy, and that I have confounding issues (my thyroid is freaking out on me - high to low and now possibly over medicated), but I'm not sleeping well, exhausted all day, still falling asleep during the day when reading (without CPAP, not good I know) and still morning headaches.

Awhile ago I bought a cheap pulse oximeter that works with sleepyhead. It is showing desats every night. Some nights pretty severe, other nights not so much -- like I can go down to 72 repeatedly one night, but then have a night like last where I only get as low as 88 a couple of times. According to Sleephead, my "last 6 months" % of time in desat is 4.65% -- would that be "enough" to put me back on O2, in theory? Of course last night was only like 0.25% of the night, and I didn't go below 88, with a baseline of 95.

What would you do in my shoes?

[HoseCrusher]

There are two causes of desaturations. One is an artifact, the other is a lack of oxygen. You should first check to see if you have any artifacts and take the information into consideration.

Usually, when your oxygen levels drop your heart responds by speeding up. The next thing you need to review is how your heart rate changes in response to your desaturation.

Once you have sorted through all of this, print out a report and discuss it with your doctor.

[Guest1]

increase EPR to 3 if you haven't already. EPR is a type of pressure support and it will help washout co2. This will increase your O2 levels. You can keep measuring your O2 levels for a week and see if it takes care of the problem.

You may need to increase your set cpap pressure (or min pressure on auto) to compensate if most of your AHI is obstructive apneas.

If you are already on max EPR then the next logical thing to do is use a bilevel machine. That can provide greater pressure support than 3cm of EPR. You may need a prescription for that OR you can buy one from some internet sellers.

[WildMtnHoney]

There are two causes of desaturations. One is an artifact, the other is a lack of oxygen. You should first check to see if you have any artifacts and take the information into consideration.

Usually, when your oxygen levels drop your heart responds by speeding up. The next thing you need to review is how your heart rate changes in response to your desaturation.

Once you have sorted through all of this, print out a report and discuss it with your doctor.

Thanks!

I actually have looked at artifacts vs "real" desats. And yes, each time I see a desat that appears to not be an artifact, about 1 second later, my pulse responds by going up 10+ beats/min or so (so from mid 70s to 90s or 100+).

So now I guess I print out some of this info and talk with my GP.

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Just saw the next response

My EPR is at 3. My AHI is a mix most nights, "last 6 months" in sleepy head shows it nearly even split between OA and CA.

[TangledHose]

I am in the same boat with good OSA therapy resulting in average low AHI, but O2 still persistently low so my primary wrote script to add supplemental O2 to the APAP. There is an Oxy heated hose now for the Airsense line, you can get one from our sponsors if your Doc thinks O2 should be added.

I have printed out reports from my pulse-Oxy recorder both with and without the added O2.........there is a noticeable difference with baseline and desalts ......the charts look much better with my added 2 lpm of supplemental O2.

Unfortunately I also have a thyroid issue due to some earlier side effects from an A-Fib drug that knocked out my thyroid function, I now take Synthroid every day. So although I would say my energy level is much better than before and I don't feel the need for daytime naps anymore, I still feel that my energy level is only about 75 to 80% of what it was before all these issues. Better, but not perfect and no real way to tell if it's due to thyroid or OSA, but my AHI is good, averages about 1.4 and even better than that if you discard some obvious Sleep/Wake Junk Centrals that would not be counted in a Sleep Study. I kinda feel like although the Synthroid brings my thyroid hormone numbers to normal, I just don't feel like synthetic thyroid hormone makes me feel as good as my own natural hormone, they make it from Cows for Pete sake

Anyway see if your Doctor thinks you might need to add supplemental O2 to your APAP therapy, if they do you can add it easily to your machine with the Airsense version of the Oxy Climatelineair hose.

[WildMtnHoney]

Thanks Tangled Hose - it's good to know that if I do need it, it's easy to add to the set up I have.

[tedburnsIII]

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[zoocrewphoto]

You have a full data machine. I would recommend getting sleepyhead and uploading the graphs from a few nights. We need to figure out whether the oxygen desats are from sleep apnea events or not, and if so, what type of events. Otherwise, we are really just guessing.

It is possible that you are having few events, but long events. But those could be obstructive or clear airway. It could also be separate from the sleep apnea.

[WildMtnHoney]

Give a bit, I'll grab a bunch of screen shots and be back.

[ChicagoGranny]

Give a bit, I'll grab a bunch of screen shots and be back.

Make sure to include the leak line.

[Strict Compliance]

increase EPR to 3 if you haven't already. EPR is a type of pressure support and it will help washout co2.

I don't think that is right.

EPR is pressure relief on exhalation. EPR of 3 means the exhalation pressure will drop 3 cm/l below the inhalation pressure.

A lower exhalation pressure will mean less flow through the exhaust port. Less flow through the exhaust port means less washout of CO2.

[WildMtnHoney]

Ok, here comes the pics:

First, summary:


Now the dailies.

I'll start with a day in May, first zoomed out:


Now starting to zoom in on a desat area:


And more fully zoomed:


Here is a night in June:


And zoomed:


Same day, different area:


Just a few nights ago:


Zoomed:


DRAT! I got all of these and just now see Granny wants the leak line, I'll edit a couple and be back, but here's a start

[palerider]

increase EPR to 3 if you haven't already. EPR is a type of pressure support and it will help washout co2.

I don't think that is right.

EPR is pressure relief on exhalation. EPR of 3 means the exhalation pressure will drop 3 cm/l below the inhalation pressure.

A lower exhalation pressure will mean less flow through the exhaust port. Less flow through the exhaust port means less washout of CO2.

well, there's plenty of flow through the vent to wash out co2 from the mask, however the greater tidal volume of the extra pressure support will help to reduce co2 in the body. sometimes too much, and a few people experience an increase in central apnea as a result.

[palerider]

Ok, here comes the pics:


DRAT! I got all of these and just now see Granny wants the leak line, I'll edit a couple and be back, but here's a start

I wouldn't worry about it, your leaks are under control according to the summary on the left.

[WildMtnHoney]

Same days, same order, with leak lines, then zoomed in:













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