Please forgive me, but i'm a concerned newbie with Contec cms50d

[Erratic_Sleep]

I'm having a terrible time with sleep of late and suffering fatigue, and after having already scored low on a finger pulse oximiter that a friend had (during the day), i decided to buy a Contec CMS50d. The choice of the Contec was to record night time sleep levels.

Should i take this to a GP? I'm just as worried about being a hyperchondirac as i am about being ill, if that makes any sense.

I'd say this example is quite typical (though not sure how long it took for me to fall asleep), where the base sp02 is about 92%, and low point is usually 85%.

I'd say my daytime around-the-house average, watching tv and stuff, is just below 95%, recording just more than 5 desaturations per hour.

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[Julie]

Hi, low 02 is only part of the info needed to diagnose sleep apnea. Don't worry about hypochondria though, as it only will make you anxious and skew results of any testing. Why not get a referral for a proper sleep study and then come back to this thread with results, but also ask for lab work that would cover e.g. thyroid, sugar, other conditions that could affect how you feel and sleep. Btw, results from awake/daytime don't count as far as apnea is concerned because your breathing patterns as tested in a proper study would not be valid as they're always different from asleep ones.

[Erratic_Sleep]

Almost as soon as i posted i thought i was probably barking up the wrong tree. Reading my own comment about daytime levels i thought maybe it is more of a general breathing issue such as asthma/brochitis.

I have been complaining to my doc about the fatigue and disturbed sleep for last few years, ive had a series of blood tests done and was told everything is fine (i dont remember what was tested).

My complaints have been brushed off and I'm not at all confident i'd get a sleep study, that's why i was thinking of taking data like this along with me.

Question that crossed my mind earlier today: do people with apnea have "normal" day time Sp02 levels - i think the NHS in the uk say normal is above 95%?

Thanks for the reply.

[ChicagoGranny]

I have been complaining to my doc about the fatigue and disturbed sleep for last few years, ive had a series of blood tests done and was told everything is fine (i dont remember what was tested).

My complaints have been brushed off

Any chance to switch to a doctor that cares about her patients' problems?

[Erratic_Sleep]

Any chance to switch to a doctor that cares about her patients' problems?

I recently switched doctors.

A few years ago i used to break bones every year from doing sports (falling off my bike) and only ever went docs for pain relief. After hurting ribs a few times i was given anti-inflamatory drugs on top of teh usual codeine, which seemed fine, but i got a bad stomach reaction, acid reflux. I told the doc and was subsequently given antacids to go with the anti-inflamatory stuff, i said it was working a little but i was still suffering, so i was told i needed to take more antacids more often. This went on for well over a year until the pain got so bad i had to give up the sport. I guessed i'd developed stomach ulcers as the pain was so bad i wasnt even leaving the house. So i wet to docs and said i think i have ulcers. No you dont! was the curt reply. So i suffered for a few more months, did lots of diet changes and research online and went back and told him i had h-pylori infection. No you dont! was the reply. I went back online and looked at forums to see what others said to their docs to get attention. I got inspiration from that and went back to docs and said i sometimes feel like ive eaten broken glass after eating a meal. With some reluctance i was given an appointment for an edoscopy. Many months later on the day of my appointment i went in and said i thought they might not find anything as i wasnt in pain that day. To their amazement i was riddled with a severe case of ulcers caused by h-pylori, and they told me right there and then with no waiting for lab tests. Found it hard to believe i had just reported no pain.

My new doc seems worse than that.

And that's the current state of the GPs in the uk in my experience, but maybe it's the way i tell 'em.

Sorry, wasnt meant to start whinging and telling life stories.

BTW, last twice i broke a bone i never as much as took an asprin.

I dont have a lot of confidence when interacting with my GP and so want to go in as fully prepared as possible.

I get quite low Sp02 readings once in a while, down to 70, just once a night, maybe a couple of times a week. I thought they must be glitches as there seems to be no matching change in the heart rate, but i dunno.

I have never had an offical diagnosis of asthma or anything like that, yet i am known as someone with a wheezy chest, someone whose laugh turns to coughing turns to not being able to breathe. So i'm wondering if i've just reached the point where i have a condition that now affects my sleep whereas it never used to. I've just been looking at possible connections between asthma and hypopnea.

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[Julie]

Can you make a big, screaming fuss and get another doctor? You need to be tested (and I don't mean for covid) for who knows what potential problems, whether COPD, asthma, ulcers, gastritis, GERD, APNEA, and just whatever else might show up! Outrageous, unless you made up a lot. Do whatever you need to get seen properly!

[ChicagoGranny]

I went back online and looked at forums to see what others said to their docs to get attention.

I was hesitant to say it, but you could say your roommate says you snore loudly every night. That might help get a sleep study. Hey, I don't mind lying when my health is at stake and the doctor is an asshole.

[rick blaine]

Hi Erratic_Sleep.

Let's see if I can give you enough information for you to 'locate' yourself in the sleep apnea patient population – or realise you may need to pursue other investigation/ treatment paths.

1. "Should I take this to my GP?"

I'm not sure it would help. On their own, these numbers would probably not convince him or her that you should be investigated for sleep apnea.

IMO these numbers are borderline for low O2. In A&E, they regard anything under 94 as 'keep an eye on'. Under 90, that is a distinct sign. (Some docs who were taught in an earlier era say 'under 88'.)

And those opinions are pretty much the same for when the patient is asleep.

So while you do go under 90 – it isn't for very long.

And if you look at the graphic summary – even though you show us only three hours and not a whole six or seven – it isn't as if there are nine or ten 'under 90s' per hour.

The threshold for treatment for sleep apnea within the NHS is 15 'interruption events' per hour. Each lasting 10 seconds or more.

So, no, a pulse-ox reading like this doesn't make a very strong case.

Now, while I shouldn't be putting words into your mouth, what does make a strong case is a patient saying that not only are they 'tired all the time', and wake-up unrefreshed, but that they fall asleep during the day. Frequently. Often when they are driving.

That could get you an at-home sleep-study – 'just to make sure'.

But ... I had better tell you that sleep apnea has caught on in the UK over the last decade. Ten years ago, I got seen by the local sleep-medicine department within three weeks (and that wasn't because I was being 'fast-tracked'). There were fewer people being referred then. Sleep medicine departments (in the UK) were quite new then.

Now, the treatment having been shown to be effective and cost-effective, GPs are sending more and more patients to be seen.

And the waiting list just for that first stage, the diagnostic sleep-study, can easily be 14 weeks.

There is an alternative to that – one that may appeal to someone who was happy to pay for a pulse-oximeter. There are a couple of places which will do you a private at-home sleep-study as soon as you like.

There's a firm called Eu-Pap in Walton-on-Thames, which offers a sleep-study using the very reliable Watchpat device. Their fee is £199, including VAT. And their phone number is 0800 024 8050.

And there's a firm called ResMed UK in Abingdon which offers a sleep study using the same Watchpat device, but for only £144, including VAT. Their phone number is 0800 907 7071.

Now obviously, these firms are offering sleep studies in the private sector in order to have you, if you qualify, become a self-funded buyer of their machines.

But you don't have to embark on self-treatment with them. You can take the study just to find out if you indeed have sleep apnea.

And if you do, and if the AHI is 15 or above, then you can take the report they give you to your GP and ask to be referred to an NHS sleep-medicine department.

Alternatively, if the AHI is between, say, 10 and 15, you might decide that, while that is officially 'mild to moderate', it's enough to make your life miserable, and you are willing to self-treat. And the recommendation then would be to buy the ResMed AirSense 10 Auto. Price £680, with no VAT. It's the current 'best buy'.

ResMed are in fact having a summer sale at the moment, offering quite a bit off – across the board. But they will only sell you a machine if (a) you do a sleep study, preferably with them, to show that you need CPAP treatment, and (b) you get a letter from your GP, saying he or she approves.

And of course, there is the other possibility. That your private at-home sleep-study does not show significant sleep apnea. In which case, you and your doctor would need, as Julie says, to explore other possible causes for the fatigue.

[HoseCrusher]

Erratic Sleep, Your first graph shows mostly normal fluctuations in O2 levels during sleep. The desaturation just after 01:30:00 doesn't have the heart rate response that typically follows a respiratory related drop in O2.

The big drop in the second graph is most likely an artifact caused by turning over or something like that. Once again your heart rate response to the drop in O2 does not suggest an issue.

As others have indicated, drops in O2 are used to confirm changes in EEG and respiratory efforts during a sleep study. They are not a stand alone indicator.

If you feel like crap, continue your efforts to find the cause. The world is much more beautiful after you have had a restful restorative night of sleep.

[Erratic_Sleep]

Hi Erratic_Sleep.

1. "Should I take this to my GP?"

I'm not sure it would help. On their own, these numbers would probably not convince him or her that you should be investigated for sleep apnea.

...

Thank you, thank you for everything you said, that is exactly what i wanted to know, all of it, every bit, thank you.

[Erratic_Sleep]

Erratic Sleep, Your first graph shows mostly normal fluctuations in O2 levels during sleep. The desaturation just after 01:30:00 doesn't have the heart rate response that typically follows a respiratory related drop in O2.

The big drop in the second graph is most likely an artifact caused by turning over or something like that. Once again your heart rate response to the drop in O2 does not suggest an issue.

As others have indicated, drops in O2 are used to confirm changes in EEG and respiratory efforts during a sleep study. They are not a stand alone indicator.

If you feel like crap, continue your efforts to find the cause. The world is much more beautiful after you have had a restful restorative night of sleep.

Thank you!

[Erratic_Sleep]

Can you make a big, screaming fuss and get another doctor? You need to be tested (and I don't mean for covid) for who knows what potential problems, whether COPD, asthma, ulcers, gastritis, GERD, APNEA, and just whatever else might show up! Outrageous, unless you made up a lot. Do whatever you need to get seen properly!

I'm leaning towards having asthma.

No, it was exactly as i said. There is something to add to the ucler sob story: Due to a cockup between the docs and the chemist i was givern nearly triple the amount of recommended antibiotics to rid myself of the H-Pylori, and i had nearly scoffed them all before the itching started. I spent the next two weeks sitting in a bowl of yogurt!

And thank you.

[Erratic_Sleep]

I went back online and looked at forums to see what others said to their docs to get attention.

I was hesitant to say it, but you could say your roommate says you snore loudly every night. That might help get a sleep study. Hey, I don't mind lying when my health is at stake and the doctor is an asshole.

I'm worried the sleep study would end up being no help. Whereas with the H-pylori and ulcers i was 99% certain.

In fact i've been told i breath hardly at all to the point ive worried people i might have stopped altogether.

[Julie]

You say you're 'leaning' towards having asthma, but it's something you need to get diagnosed to see e.g. if you have a high eosinophil count on blood tests, apart from other things. It's not something you just decide you must have and then follow through with treatment, etc, and there is specific treatment.

[crave303]

Interesting. I have this exact device. I have very similar results to you - my basal SPO2 is always 92 point something overnight, and I can spend a minute or more under 88%. That big sharp downward spike is something I've seen too. But generally the results aren't CATASTROPHIC. Neither are yours.

I have always thought it was sleep apnea (may well be) but now I have begun to think it is just low SPO2 in general (while awake) which would only get worse while asleep where SPO2 levels are naturally lower......

Could you do a pulse ox recording while your awake to see what your basal SPO2 is?

I know it is a pain but if you are just chilling, watching Netflix or whatever, you could do an awake recording (longer the better).

I am going to do this as my SPO2 while awake can dip to the low 90s. and I have even seen 88% while awake! I don't have asthma, but I do have a deviated septum/blocked nose. Maybe your nose is constricted and you don't know it or as you say, asthma and it is giving you lower oxygen 24/7. This is what I suspect is my case, at least partially.

If you do an awake recording post the results, I will be doing one next time I have free time.