Need help with pulse ox data

[Always tired]

A short bit of history.
After an overnight pulse ox study indicated desats, my PC doctor put me on O2 for most of 2011. After my sleep study, Nov 2011, I was told that I no longer needed O2 and never had the opportunity to use PAP and O2 together. An overnight pulse ox test was ordered by my pulmonologist about 10 months ago and he confirmed that I no longer needed O2.

I still feel like burnt toast most of the time and had the opportunity to borrow a CMS-50F Pulse Oximeter. Two recent nights are shown below.

In the first graph I was on PAP for the first half of the night and off for the second half. A test.
In the second graph I was on PAP the entire night. Both nights were pressure 5-8.

While I am no expert at Pulse Oximeter numbers, I think I may need O2 again and am asking for comments from a couple of experts out there.

I can’t get into see my pulmonologist until May 6, but may just copy these reports and hand carry them into the office and ask that he please get these reports ASAP.
Any comments or suggestions would be appreciated.
Thanks
Always Tired

[Julie]

Hi - In isolation, it does look like you have a problem, but I'd want to know more about your Cpap experience - do you track that? Because if it's inadequate, you can have all kinds of problems including low O2 rates, and if it's not helping, maybe it needs tweaking rather than your necessarily needing O2 again.... got any info? Graphs to post?

[Todzo]

Hi Always Tired!

In the treatment of Sleep Disordered Breathing (SDB) issues of breathing stability and carbon dioxide maintenance are often unseen or otherwise ignored. I think it may well help here to make your doctors aware of some of those resources[1,2]. Please do.

Have a great week!

Todzo

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

[Always tired]

Hi - In isolation, it does look like you have a problem, but I'd want to know more about your Cpap experience - do you track that? Because if it's inadequate, you can have all kinds of problems including low O2 rates, and if it's not helping, maybe it needs tweaking rather than your necessarily needing O2 again.... got any info? Graphs to post?

Julie,
Yes, I do track with SH and just posted the other day. Please see
viewtopic/t88138/viewtopic.php?f=1&t=88 ... 21#p807021

[Always tired]

Hi - In isolation, it does look like you have a problem, but I'd want to know more about your Cpap experience - do you track that? Because if it's inadequate, you can have all kinds of problems including low O2 rates, and if it's not helping, maybe it needs tweaking rather than your necessarily needing O2 again.... got any info? Graphs to post?

Julie,
This will make it easier for you, and everyone else to see a bigger picture.
Thanks,
A T

[HoseCrusher]

If you are at an elevation of 5000 - 6000 feet, your report looks good.

If you are at 500 feet you are bouncing against the lower limit. It would be interesting to change your scoring to use 90% as the low number instead of 88%. If you are planning on discussing this with your doctor reprint the report using 90% and drop off a copy.

In general your body will function better if the oxygen level is kept at 90% or greater at sea level. Of course there are always exceptions. If you feel "less that totally energetic" your levels may be a little low.

[Julie]

Hi - I asked you for graphs hoping someone like Pugsy (or Hosecrusher) would see them because I don't know as much as she does (or others) but do know things will be a lot more obvious to them and hopefully they'll be able to help more.

[Always tired]

If you are at an elevation of 5000 - 6000 feet, your report looks good.

If you are at 500 feet you are bouncing against the lower limit. It would be interesting to change your scoring to use 90% as the low number instead of 88%. If you are planning on discussing this with your doctor reprint the report using 90% and drop off a copy.

In general your body will function better if the oxygen level is kept at 90% or greater at sea level. Of course there are always exceptions. If you feel "less that totally energetic" your levels may be a little low.

I live at 4700 feet, and would kill for a feeling of "less than totally energetic." Why would those times at or below 88% not be harmful--or does elevation (pressure change ?) need to be calculated in?
Thanks,
A T

[Pugsy]

The baseline O2 level....what you would see if you checked the O2 while awake resting?????
I don't do a lot of nit picking on O2 reports but I will totally agree with what Hosecrusher has said.
The baseline O2 you need to talk to your doctor about.
Check it out while awake watching TV for an hour or so.

For sure talk to your doctor about it. Elevation may play a part but this needs to be discussed with your doctor.
He may be okay with it at your altitude.

[Always tired]

The baseline O2 level....what you would see if you checked the O2 while awake resting?????
I don't do a lot of nit picking on O2 reports but I will totally agree with what Hosecrusher has said.
The baseline O2 you need to talk to your doctor about.
Check it out while awake watching TV for an hour or so.

For sure talk to your doctor about it. Elevation may play a part but this needs to be discussed with your doctor.
He may be okay with it at your altitude.

Good idea Pugsy,
I'll read or watch TV and track for an hour or two.
Is the baseline determined during the day at rest? Or something else?
A T

[Pugsy]

Is the baseline determined during the day at rest? Or something else?

I have always thought of baseline as what we normally have while at rest....then go from there for during exercise or post exercise or whatever.

If you go to the doctor's office and they spot check it then it will be at rest.

[HoseCrusher]

If I may just throw out a comment or two...

The goal of "less than totally energetic" hardly seems worth shooting for. You need to shoot for "totally bouncing off the walls with energy..."

Oxygen levels drop with increases in altitude. Your report doesn't look all that bad when you factor elevation in.

Here is a rough chart that shows this relationship. You are looking at the red line and the scale on the right side of the graph.

http://www.high-altitude-medicine.com/SaO2-table.html

Here is a study done with children under 5 years of age at a little over 13000 feet.

http://adc.bmj.com/content/78/5/461.full.pdf

You would expect children to register on the high side of oxygen saturation. As you can see the mean value ranged from 80.0 - 85.9 when the children were sleeping. Note that this test was done at a little over 13000 feet and that these results are different from the table shown in the first reference. The differences have to do with acclimatization.

[Todzo]

Your report doesn't look all that bad when you factor elevation in.

He is at less than 2000 meters so his average should be SpO2 96% even without acclimatization according to your referenced materials.

He should not be seeing SpO2 below 93%. Something else is going on..

[Todzo]

http://www.high-altitude-medicine.com/SaO2-table.html

What does change a lot is the carbon dioxide blood gas level (PaO2) - about minus fifteen percent - less carbon dioxide reserve likely!

[Todzo]

You may well be correct about the oxygen. However I am suspicious that breathing instability (carbon dioxide maintenance issues) may be keeping your lungs from working properly. As I have learned to breath for proper carbon dioxide levels day and night my "summer allergies" have gone away. I breath less, circulation is better up there, it is a happy nose.

Perhaps if you breath in a manner which keeps all blood gasses in proper balance (which for me means breathing a lot less) the entire system gets happier.

A thought for you,

Todzo

Please share the references with your doctor!!!

Hi Always Tired!

In the treatment of Sleep Disordered Breathing (SDB) issues of breathing stability and carbon dioxide maintenance are often unseen or otherwise ignored. I think it may well help here to make your doctors aware of some of those resources[1,2]. Please do.

Have a great week!

Todzo

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721