Blood oxygen levels

jskinner · Post by **jskinner** » Tue Mar 20, 2007 10:25 am

A very kind person from this form has been gracious enough to lend me their pulse Oximeter. I will be monitoring my O2 levels over the next few days to see what my stats are and to hopefully get some proof that I can use with my Dr. to show the seriousness of my current situation.

I'm curious to know what normal levels are levels are during the day and night. Also what qualities as a desaturation event and how many does one need for it to be considered serious?

I've done a bit of Googling found the following:
- Normal oxygen saturation is 92-94%
- A desaturation is defined as a 4% drop below baseline
- A serious desaturation is anything below 85% (some say 88%)

Is this correct? What should I be looking for in my recording (values and trends)

During my sleep study my SPO2 levels dropped to 83%. However I didn't sleep very well at all during the night of the study so I expect on a bad night it could be worse. (I base this on the fact that I only got into REM once during the night of the study and I only had hyponneas that night where I normally have many apneas every night.)

Any feed back and knowledge from those of you who regularly use a SpO2 monitor would be appreciated. thx

DogFace · Post by **DogFace** » Tue Mar 20, 2007 10:31 am

I don't regularly use a monitor, but of course I did during my sleep study. Also, my wife is an intensive care nurse and all her patients are on O2 monitors, so she gave me a little lesson.

She says she gets worried when any of her patients drop below 95 or 96. That's where most otherwise healthy people should be most of the time. During my sleep study I got as low as 68 and my average was 85. When my wife saw that she freaked out.

NightHawkeye · Post by **NightHawkeye** » Tue Mar 20, 2007 10:37 am

James,

You've already got a good handle on using an oximeter. Normal saturation for me runs in the 94% - 99% range while sleeping, a little higher than you indicated. Desats occasionally take it lower. Otherwise, I don't know that there's much rhyme or reason for where it is within that range though.

Regards,
Bill

dsm · Post by **dsm** » Tue Mar 20, 2007 4:52 pm

James,
as Bill says you have the basics.

The ideal is for your SpO2 to remain constant within a band of 4% for the night. Naturally this doesn't always happen and it may not be a big issue if the variations are minor outside that band.

Some examples of problems (IMHO )

>SpO2 starts at 96% for the night then after a few hours slowly declines to say 91% & stays there for a while. A sleep clinic would probably increase your cpap CMS to get the SpO2 back up to 95%-96%

> SpOs drops to below 90% for a few minutes - this shouldn't happen but if the PO is sensitive to electrode & cable movement, that may be more the cause.

see this link for an example of what SpO2 should not look like
http://www.internetage.com/cpapdata/menu_110107.html

see this link for an example of what is more normal but still with a few glitches
http://www.internetage.com/cpapdata/menu_130107.html

I have some really good charts but can't find them just at this moment

Cheers

DSM

jskinner · Post by **jskinner** » Thu Mar 22, 2007 9:34 am

Well I have been monitoring my SpO2 levels for three nights now. Of course now that I am doing so Murphy's law has kicked in and I have been having some pretty good nights. In one way this is good since I haven't had 3 good nights in a long long time and its helped me gain some strength back. On the other hand I was hopping to get hard some data I could talk to my dr to show him the seriousness of the situation.

I've had desatruations in the 93-88% range every night but given that I don't feel too bad after those I assume that those are nothing to worry about? I've only had one tiny desat below 85% at this point.

Here is my cart from the first night which I am using as a baseline (since I felt pretty good after that sleep).

SleepySandy · Post by **SleepySandy** » Thu Mar 22, 2007 9:51 am

How are your xPAP numbers for the same 3 nights? Do they show improvement from the period of time before the pulse oximeter?

Slinky · Post by **Slinky** » Thu Mar 22, 2007 10:04 am

James, that 93%-88% range was selected for a reason. It is an acceptable range for sleeping tho the less time at 88%-89% the better. 90% is a more "comfortable" lower end as it gives some "leeway". Awake and active the pulmos like to see 95%-99%. Most healthy people are in the 97% - 98% upper range at rest by late middle age. But I never got around to discussing the sleeping ranges for average folks w/my sleep pulmo.

Almost 94% of your sleep time spent w/sats of 94%-100% is good. But I don't believe it is "normal" for your age (just guessing your age from your two pictures you've posted). Unless you were a previous smoker my guess would be that your sleep pulmo should consider your sats somewhat under par. But then I don't know you entire health history either and he most certainly should be taking that into consideration.

I understand the pleasure at feeling more rested after all you've gone thru and the disappointment of not (yet) getting the data to support what you HAVE been going thru. (Ever think of showing him the "before and after" pictures you posted here for him to compare to how you look now?) Seems like "they" would show your usual you, the "damaged" you and the too slowly recovering you.

Good luck and God bless.

jskinner · Post by **jskinner** » Thu Mar 22, 2007 10:09 am

SleepySandy wrote:How are your xPAP numbers for the same 3 nights? Do they show improvement from the period of time before the pulse oximeter?

Unfortunately I have been using the trail BiPAP the last few nights. Its ancient and doesn't have data capabilities. I do think the fact that its a BiPAP may be helping somehow. It seems to produce less 'flopping' around of the upper pallete when I use it even with the same upper pressure (hard to describe what I am talking about if you haven't used an Oracle interface).

Here is the incredible old beast:

The Bi-level is set to 10/5 so I'm wondering if that slight pressure increase is helping a bit. When using my auto I normally run it 8-10 but its usually averaging about 9. I'm normally scared to get to close to 10 since anything more seems to result in NRs for me. I'm wondering if a Bi-level might be less prone to produce NRs?

Slinky · Post by **Slinky** » Thu Mar 22, 2007 10:27 am

Whoa! She's a big beastie all right!! You gonna be on the bi-level straight thru to your ENT/pulmo appointment? Is he/she the one who ordered the bi-level?

If maybe you could get 3-4 nights or maybe even a week in on your regular xPAP to compare w/the results on the bi-level w/that oximeter ....... (I"ve forgotten when your appointment is except I thought April some time).

jskinner · Post by **jskinner** » Thu Mar 22, 2007 10:37 am

Slinky wrote:But I don't believe it is "normal" for your age (just guessing your age from your two pictures you've posted). Unless you were a previous smoker my guess would be that your sleep pulmo should consider your sats somewhat under par. But then I don't know you entire health history either and he most certainly should be taking that into consideration.

Yeah I'm 38, non smoker, regular jogger for 10 years (until it last Nov when things got bad). I've always been in generally good health up until recently. Until about a year ago I was always a very active person, jogging, biking, skiing, etc. As my apnea got worse i just lost the energy.

Slinky wrote:(Ever think of showing him the "before and after" pictures you posted here for him to compare to how you look now?)

In fact I just went to walmart the other day and made copies to show him on my next visit. I emailed him them but he never responded, drs don't seem to respond to email often.

Before: (a year+ ago)

After: (Now)

Slinky wrote:You gonna be on the bi-level straight thru to your ENT/pulmo appointment? Is he/she the one who ordered the bi-level?

Yes the Resperologist that I saw a couple of weeks ago for the first time wanted to try it as a first attempt. (followed by dental device and then look at surgry)

My regular DME couldn't get me a bi-level for 3-4 weeks so I got it from a smaller place that seem to have much better service.

Slinky · Post by **Slinky** » Thu Mar 22, 2007 11:52 am

Oh my goshes!!!!! I thought you looked like h*ll in your avatar but I gotta tell you, James, you look like you've been shot at and missed and sh*t at and hit in this after picture you just posted! You sure you weren't dead and just didn't know enough to lay down???

I know, I know, that just makes you feel so good.

Better service from the smaller DME doesn't surprise me in the least. DMEs must be pretty much the same all over, the larger they are the crappier service so often.

Have you given any thought to just a simple echocardiogram??

Snort! 38?? You're just a babe in the woods and still wet behind the ears. We gotta get you up and running in your age group again, guy. You don't belong w/us old fogies in this health situation bit!

jskinner · Post by **jskinner** » Thu Mar 22, 2007 12:08 pm

Slinky wrote:You sure you weren't dead and just didn't know enough to lay down???

Yep pretty much feel like I'm dead on the mornings when I wake up like that. When I was home for Christmas and my parents saw me look like that they rushed me to the local hospital. Of course by the time I got there and sat for a while your color was coming back. The ER doctor say "apnea isn't really dangeroius. It will just make you sleepy" and sent me home.

Slinky wrote:Have you given any thought to just a simple echocardiogram??

I had one on Dec 12. It came back negative.
Honestly my GP seem to have completely lost interest. I think he thinks its all in my head. It reminds me of the way he acted before I got diagnosed and every time I complained about sleeping he said I needed to go see a shrink.

dsm · Post by **dsm** » Thu Mar 22, 2007 1:11 pm

jskinner wrote:
SleepySandy wrote:How are your xPAP numbers for the same 3 nights? Do they show improvement from the period of time before the pulse oximeter?
Unfortunately I have been using the trail BiPAP the last few nights. Its ancient and doesn't have data capabilities. I do think the fact that its a BiPAP may be helping somehow. It seems to produce less 'flopping' around of the upper pallete when I use it even with the same upper pressure (hard to describe what I am talking about if you haven't used an Oracle interface).

Here is the incredible old beast:

The Bi-level is set to 10/5 so I'm wondering if that slight pressure increase is helping a bit. When using my auto I normally run it 8-10 but its usually averaging about 9. I'm normally scared to get to close to 10 since anything more seems to result in NRs for me. I'm wondering if a Bi-level might be less prone to produce NRs?

jskinner · Post by **jskinner** » Thu Mar 22, 2007 1:35 pm

dsm wrote: You SpO2 numbers can and should be improved.

Can I suggest you change your BiLevel settings from 10/5 to 10/7 & perhaps a few days later try 8/11 - see if that makes a noticeable difference.

Well I would if I could. The BiLevel is so old that it has dial settings for the pressure! The tech used a special meter to calibrate it (forget what they are called?) So I have no way to adjust it myself.

One thing that I think is significant is that CPAP works very differently for me though my mouth as compared to via my nose. (In fact it doesn't work well at all) It seems to take more effort to keep the airway open and then my palate/uvula seems to 'flap' regardless of the pressure. Its as if once the mouth and throat are pressured then the nasal passage has to equalize and this requires the pallate to move to allow pressure up the nasal passage way. Once this happens then the then it flaps back to open up the oral passage. Its like the combination of my pallate and tounge make trap door that keeps swinging in the wind. Its really quite unpleasant and makes it hard to fall asleep sometimes. (The Oracle interface in general is not fun)

As time goes on and I feel more desperate and I am tempted to get my uvula removed to see if it would help any. However I'm trying to resist that urge as I don't want to end up regretting it. My Uvula does however sit on the back of my tongue most of the time and feel unpleasant even during the day. I find myself swallowing alot just to try and move it. When you look into my relaxed mouth you don't see the bottom of my pallet or any of the uvula at all.

http://james.istop.com/apnea/reports/Mouth.jpg

Julie · Post by **Julie** » Thu Mar 22, 2007 2:39 pm

James, you have to get another GP, no question! A respirologist is a good thing, but if there are other issues that relate to other 'systems', he may or may not pick up on them and a good GP should be able to at least have some idea about who else you should see (though still see the respir.). When's the last time you saw... a neurologist? Just thinking about the tingling, etc. which COULD be stress related, but not absolutely. What about an allergist (haven't followed everything so if you've done that, please ignore)? Unless you've gained a lot of weight in general, you definitely need to do something (and I can hear you saying "Duh") .