Low SO2: Attention Will Robinson! Low SO2! Seek Shelter!

[torontoCPAPguy]

Well, after blabbering about low SO2 for a week I decided to check mine again (have not done so for weeks) and guess what I just found? I'm going to call my respirologist and put this graph together with my ResScan Data for him to have a look at. Perhaps this is the reason I am not TOTALLY rested in the AM? (Although I am a million times better than I was). Take a look at this, and this is a good reason to have a recording pulse oximeter as part of your diagnostic tools gang. Much worse than this and the alarm bells would be sounding here. I personally consider anything under 90% during sleep as unacceptable. Anything under 80% as an URGENT situation that demands immediate medical attention. What got me wondering was one forum member's comment that he was taking O2 insertion into his mask during the night in small quantities. This is like the never ending story. Will post the corresponding ResScan data later today as soon as I can for your reading enjoyment. I feel like a little worm struggling and squirming after a heavy rain here. Without further ado....

Edit to add: Darned thing has cut off my last bit of data... at the end my SO2 drops even further and awakens me. I am going to try and correct the image to get it all on the screen but can't deal with it right now. I gotta go back to sleep for a couple of hours. I am bagged.

[M.D.Hosehead]

Tonto,

I agree; that would bother me a lot.

An unpleasant surprise, especially after you had been thinking you were getting things under control.

Keep us "posted".

[torontoCPAPguy]

OK. Resized the chart and it has pretty much everything on it now. Note that I dip into the 70%'s at around 4:30 a.m. and again at just before 8:00 a.m. which awakens me. I am 100% sure that the dip at 4:30 awakened me as well; but it was short lived (pardon the pun) and I went back to sleep breathing properly. Regretably the data from ResScan for last night is all messed up as I actually got up during the night and changed beds so as not to disturb my wife, etc. I may have been feeling "hot" as well and changed rooms to a cooler room (hot flash=low SO2=high BP?).

The reason this is such a surprise is that my other numbers, negating the blood oxygen saturation, have been so darned good. I have even had several nights with AHI = 0.0; no apnea events, no hypopnea events, etc.

So what does this tell us? Caution Will Robinson! Caution! Your data is incomplete! We are in DANGER! (I am dating myself.... no, I watched this program on reruns in syndication, yeah, that's the ticket... reruns!)

Just because our blower decides to show that we are miraculously better with nothing happening under its benevolent treatment of our OSA means diddly squat. You need ALL THE INFORMATION! I am charging up the oximeter for a second night of recording; reformatting the data card for the S9 Auto so that I get a solid night of data and locking the bedroom door and blocking it so I don't go anywhere else to sleep and have solid data for the night to marry up with the oximeter data. My guess is that it is going to show a few hypopnea events as usual, nothing major and perhaps one apnea event at most (and I'm not even confident that this event that pops up now and again is valid as it seems to me that it shows up when I remove the mask to go to the bathroom... so I am going to keep a notepad by the bedside to note the time(s)).

Jeez. Just when I figured I was getting everything under control and wondering why I was still not quite 100%. I am good during the day but getting going in the morning is not what it used to be... I am groggy and slow to get up to speed these days. I used to awaken and bound out of bed with 110% energy. I suppose that was the fact that I wasn't really asleep fully in hindsight.

Now, after posts by others on the forum, I am going to look at getting an oxygen concentrator and adding a minor amount of oxygen to the mix to see what that does for my blood oxygen during the night. I am also going to make an appointment with my respirologist and show him the graphs and data to get his opinion. Perhaps cranking up the pressure or going to bipap is an option? One thing for sure... more air needs to be getting into my lungs during deep sleep.

Comments?

[Muse-Inc]

Tell us how the next few nights' data looks.

[elena88]

OMG, Im so glad you caught that!

I just wanted to say I hope whatever you try next works out really well, and I ALWAYS learn so much from your posts.
You are a little " google" in your own right!

[KatieW]

That is reason for concern, I'm glad you found this out. Let us know how tonight goes.

[torontoCPAPguy]

Thanks to all for your concern and thoughts; and most of all thanks for this forum without which I never would have realized that with perfect numbers coming out of my S9 Auto I could still be suffering from low blood oxygen concentration resulting in my autonomic nervous system whispering to my body to wake up and breathe deeply to get that SO2 back up!! The 50E recording oximeter is charged up and ready to go. I am going to cool the room down one degree F and make sure the mask is perfectly fit tonight (Quattro FFM) and even take an antihistamine to help with the allergies although it rained today and kept the pollen count down.

If tomorrow morning reveals similar results with anything showing under 90% SO2 during the night, my first call is going to be to my respirologist, followed by a call to my GP for a prescription for an oxygen concentrator so I can get the ball rolling with the insurance company and Ontario's assistive devices programme who just might pay a good portion of the cost between them. I see one advertised for $150 refurbished - it's an Invacare Mobilaire. I'm sure there are others all around me here but am going to grab this one for starters just in case I need one and cannot find another.

Stay tuned. NEWBIES! This is a learning experience for me.... it has GOT to be a learning experience for 99% of newbies. So I repeat. My numbers have been close to perfect! AHI of 0.0. No apnea events. No hypopnea events. No leakage beyond normal venting. The best numbers that you can get (arbitrarily based on what the machine thinks it should put out) and here I am with LIFE THREATENING results of low SO2.... which is exactly what the name of the game is to start with. Sic.

Explains much. And it goes to prove one thing if nothing else. No matter how many times it has been said on the forum.. if you spot something that needs saying, PLEASE PLEASE say it!

[torontoCPAPguy]

Whew. So here is the next night of results and from what I can see it is not as big an issue as originally though. Maybe. I intend to now monitor myself every night for a week or two to see what the results show in detail.

What have we learned? A very important lesson to be sure. Simply this: That perfection in your numbers given by your APAP machine (and it appears that each manufacturer can use a different algorithm in producing their numbers and may even base it on marketing 'jazz') are important clinical data but are by no means a complete picture nor a picture that I would want to base any firm conclusions on. Only a proper sleep study can give anything approaching a full story and it may take SEVERAL sleep studies over time to get that picture; the sleep study needs to include oximetry data and EEG data as well as all the other good information that they tend to collect like body movements, EKG, blood pressure, etc. Otherwise you have half a picture and while you think you may be improving treatment and getting better results it is all smoke and mirrors.

To wit: My AHI has been running under 1 on a regular basis and even 0.0 for several nights. Great, right? WRONG! My blood oxygen saturation was the pits as seen from the earlier graph. And looking at the graphs from last night? Not too bad, huh? So we have also learned that the data collection needs to be over time and not a 'snapshot' of one night or part of a night.

Thanks to all who have given input on various threads. This has been one of the most important learning experiences that I have had on the forum to date. I have even made arrangements to pick up the only oxygen concentrator I have seen advertised in this region of about ten million people; a refurb unit for $150. Can't do any harm to have it on standby should long term evaluation indicate that a dash of O2 might improve my nightly blood oxygen saturations and lead me to better and deeper sleep with greater comfort. We shall see.



And my blood oxygen sat for the same period:

[M.D.Hosehead]

Toronto, I've learned a lot following your oximetry posts. Some questions occur to me:

1. Can you line up clock times of the xpap and oximeter records, and does that indicate that the desats occur concurrently with obstructive events?

2. Do you think your surprisingly large desats--large considering the low AHI--may be a result of lung damage you recently sustained?

3. I would definitely want supplemental O2 if I had the oximeter tracings you do. I don't fully understand how the O2 concentrators work with xpap, but some posters indicate that it's hard to raise your O2 sat by piping O2 into the mask, perhaps because the venting blows the O2 away before it can be inhaled. Would it make a difference if the O2 went into one of those prong-type nasal cannulas worn under a FFM? (I realize the resulting leak problem would have to be addressed.)

[Slinky]

I have COPD so I'm much aware of the difference between when I use just my bi-level auto alone and when I add 2L of 02 via an adapter that fits between humidifier and mask hose.

[roster]

I have COPD so I'm much aware of the difference between when I use just my bi-level auto alone and when I add 2L of 02 via an adapter that fits between humidifier and mask hose.

How to use O2 with a mask is a subject I never looked into. My FFMs have little ports to which you could attach an O2 hose. Is that the appropriate way to do it when using an FFM?

What you are doing with the adapter seems like it would more effectively deliver the O2. Does Johnny sell those adapters?

[Uncle_Bob]

To wit: My AHI has been running under 1 on a regular basis and even 0.0 for several nights. Great, right? WRONG!

Better to have eliminated obstructive events from the many possible causes of your low So2 levels, so i would say great.
It looks like the machine is doing its job so i don't understand why you are throwing all your toys out the crib with regards to the CPAP machine.

I would say see your respiratory doctor before you go buying stuff you may not need. There are numerous reasons why your Os2 could be low. Just because you pump yourself up with loads of oxygen does not guarantee that the oxygen exchange is going to take place in your respiratory system.

Its good that you have identified this problem and can now work on it. Its an example to the rest of us of the value of owning your own pulse oximeter

[Slinky]

Yes, RosterRooster, cpap.com does sell them. Look under Oxygen Equipment (or Accessories, I forget which). Look for Adapter. If I remember correctly cpap.com sells the blue clear plastic one about 2 inches long w/a nipple off the side w/a cap on a strap. When using your PAP w/o the 02 bleed in you put the cap over the nipple. When using 02 you attach the 02 tubing to the nipple. There is also a white one, I forget where I saw it and bought it, that I like better in that while it is about the same size, instead of a nipple off the side there is a backward L shaped "nipple" (for lack of a better term) and the top of the L is "ribbed" so that the 02 tubing stays on better. I like it better simply because twice I've had the 02 tubing slip off the blue adapter's nipple which is smooth. But then that's partly my fault that I didn't replace it - or replace it more often - as I've had it happen to me twice in 3 years of use. Both times the "nipple was bent a bit sidewise. I "think" my provider told me Medicare would pay for one every 3 months. I forget. Since they call me every 3 months and go thru the list of things I am eligble for I just tell them what I need from the list so we aren't wasting a bunch of items I don't need and Medicare would be paying for.

[torontoCPAPguy]

To wit: My AHI has been running under 1 on a regular basis and even 0.0 for several nights. Great, right? WRONG!

Better to have eliminated obstructive events from the many possible causes of your low So2 levels, so i would say great.
It looks like the machine is doing its job so i don't understand why you are throwing all your toys out the crib with regards to the CPAP machine.

I would say see your respiratory doctor before you go buying stuff you may not need. There are numerous reasons why your Os2 could be low. Just because you pump yourself up with loads of oxygen does not guarantee that the oxygen exchange is going to take place in your respiratory system.

Its good that you have identified this problem and can now work on it. Its an example to the rest of us of the value of owning your own pulse oximeter

Uncle Bob:
Did not mean to give the impression that I was tossing out the CPAP stuff; only that I was going to continue recording my S9 data and corresponding blood oxygen saturation information and take that to the MD. I am picking up a used but refurbished O2 concentrator tonight because it is the only used one I have seen in my area or within a few hundred miles of me and it is priced well. I'm going to ask questions and have a close look at it first of course.

To answer other questions; it is indeed that my lungs were severely damaged during my three weeks on life support this past summer. I had acute pneumonia for a long time and that hardened the bottom of my lungs and as well they had to physically suction fluid out of my lungs to save my life and that damaged the insides. Top this off with atrophy of my diaghram and you have what is probably the cause of my low SO2 readings even though the S9 says I am having no apnea or hypopnea events (they have been taken care of... without the S9 or APA of some kind I am riddled with them).

Murray

[torontoCPAPguy]

I have COPD so I'm much aware of the difference between when I use just my bi-level auto alone and when I add 2L of 02 via an adapter that fits between humidifier and mask hose.

Where does one get this adapter and the hosing so that the concentrator can be put outside the bedroom door and the line run before going to bed to keep the noise in the bedroom down? Thanks in advance.
Murray