Newbie - Advice and comments needed

[Bob192]

Hello there from the Colonial side of the pond.

I’m looking for some thoughts / comments on my home oximeter results below.
A bit of backstory.

I have been daily fatigued / tired for a year and half. Wake up feeling like I didn’t sleep.
I had a sleep study last year that said “very mild apnoea, unlikely to be causing all the fatigue” and was discharged. I don’t have a printout.
I have since been diagnosed with low testosterone and have started TRT, will soon be having surgery to remove a ‘Varicocele’
My wife has always complained about my snoring, has noted I stop breathing sometimes (when she’s awake and paying attention)

I have tired:
Jaw advancement, didn’t feel much improvement, mostly just sore teeth and jaw.
Keeping jaw shut, my nose isn’t the most clear so I struggle to breathe without my mouth
Getting fit and eating healthy, I am average build and enjoy exercise when I have the energy.
Nasal turbinate reduction to help breathing through my nose

I have recently purchased a home oximeter. I tested it both on myself and my wife as a comparison.
The light is in a ring that goes around the base of your finger
https://www.amazon.co.uk/gp/product/B07 ... UTF8&psc=1

It has a neat function where the ring can vibrate if your SpO2 drops below a user set figure (currently on 90%)

When testing on my wife the results showed a steady 96-98% throughout the night
My results are less-so. I typically move up and down between 90-95%, occasionally spend some time between 86-90%

Apologies that the graphs aren’t very ‘zoomed in’. I’m still trying to work out how I can get a more printer-friendly output.
For most of these graphs the ring was vibrating at 90% to either disturb or wake me up.
I’m actually scared when sleeping without the vibration alert now…

Warning the images come out quite large on my browser, sorry!


My Wife


Me:



I guess my question is two-fold:
Is my wife’s readout just really good, and mine is about normal?
Are my graphs typical of somebody experiencing fatigue / unrefreshing sleep.

My Dr is reluctant to NHS refer me again to the sleep clinic given their diagnosis last year. If he does it will be a 4 month wait to see somebody
I am more than happy to pay out of pocket for something like an Air Sense 10 with Autoset and deal with this myself / some guidance if it will improve my quality of life!

If you have made it this far, thank you for your time.

[ChicagoGranny]

I am more than happy to pay out of pocket for something like an Air Sense 10 with Autoset and deal with this myself / some guidance if it will improve my quality of life!

Get one and start using it. We can tell you how to save money on one by ordering from U.S.

[Julie]

Strongly suggest you make an effort to not sleep on your back if you do... it can make quite a difference for people with 'mild' apnea, but you'll probably need something to discourage back-sleeping - e.g. wearing a backpack with towels rolled up, or some kind of pillows behind you that stay there all night, etc. etc.

[rick blaine]

Hi Bob192,

A bunch of things:

1. The sleep study you did – was that at home, measuring three things (pulse/ox on the finger; concertina tube round the chest; two plastic tubes up your nostrils)? Or did they have you in hospital over-night, in what's called a sleep lab?

Sleep studies via the latter are relatively rare in the NHS. For one thing, not every hospital has the facility. For another, a sleep lab study is usually limited to the more complicated cases.

But I mention it (a) to find out, and (b) to introduce the topic.

You can get an over-night sleep study in the UK in the private sector. They measure up to 16 variables – ie, more than just the responses involved in sleep apnea. So this kind of sleep study could point to other things which can cause poor sleep.

2. When the staff at the hospital sleep-medicine department said 'very mild', did they give that a number? (Called 'the index' or 'AHI'.)

From 0 to 5 is considered 'normal'. From 5 to 15 is 'mild to moderate'. The NHS offers treatment only to those with 15 or above ('moderate to severe' and 'severe').

Which means that somebody with an AHI of 14 - or even 10 - may not be getting restful sleep, but they don't get treated on the NHS.

If such patients want treatment, they have to fund it their self.

3. Your O2 levels aren't IMO in the alarming zone. Normal is 96 to 98. Medical professionals in A&E take note if it drops below 94. But they aren't really worried unless the level goes below 90 – and stays there – ie, for more than a minute at a time.

What your O2 charts show is a great deal of variability.

Which could be for several reasons.

For example: tossing and turning; prolonged and troubled dreaming; what are sometimes called 'night terrors'; restless leg syndrome - these are just some of the possibilities.

4. You mention low T - have you also been tested for low magnesium? And though you don't mention your age, I'm guessing under 50. So a bit young for 'unable to process B12'. But that would be worth checking too.

5. What are your daytime breathing patterns like? Do you 'over-breathe'? People who hyper-ventilate during the day (which amongst other things can lead to fatigue) often have much the same poor or very variable breathing habits at night.

And doing special breathing exercises during the day – to the point where they become habitual – can lead to steadier, more regular breathing during the night.

There are a couple of paperbacks on the subject. But ideally, supervision from a physiologist who specialises in breathing is best. And that is available in most areas within the NHS. (Your GP would need to refer.)

6. You can buy a CPAP machine any time you want*, but I'm not sure from what you say that you need one. But if you did buy one, then a month's use would prove me wrong – and let you know for sure.

You can also hire a CPAP machine in the UK from a place in London. Costs £100 a week. Which I think is a bit steep. At that money, you'd be better off buying a second-hand machine. Which you could sell on if it it turns out, via such a trial run, that CPAP isn't what you need.

I mention both the hire and buy to give you the options.

* In the UK, if you buy a brand new machine, you need a 'scrip'. But your GP can write one for you.

There is one third-party retailer in the UK which will sell you a machine without a hospital or GP scrip. But to cover themseves, they insist you do a private at-home sleep study thru them. For something like £280.

So ... if you did need a scrip, have a chat with your GP.

[Snoregone Conclusion]

It’s a pity you don’t have the sleep study report at hand: AHI and desat numbers aren’t the only thing, there’s also RDI (Respiratory Disturbance Index) which some are more sensitive to, and have a higher RDI than AHI, and don’t need bad desats to be a problem, because the brain wakes you up before Apneas happen: this is UARS. In the US Medicare rules RDI and AHI can be used interchangeably to qualify for coverage from my research. My insurance follows those rules, and an external third-party firm used to assess medical necessity approved mine, despite an .9 AHI, though with the type III take-home sleep study I was at 90% spo2 for over 50% of the time IIRC but had intense bursts of RDI, which wake me up, often from violent nightmares.

AHI isn’t everything! If your sleep is disturbed, it’s disturbed, whatever the details are.

[Jas_williams]

Bob I have a low hrs Resmed auto set from a non smoking house, it’s run hrs are 907 so about 4 months use £300 shipped with humidifier and climateline hose if your interested in self purchase I purchased direct from Resmed at £600 it has 1 yr of warranty left

You would need to purchase a mask.

I do have dogs but they are not allowed upstairs.

I can provide a picture of the run hrs if you want