Cpap pressure Increased, SP02 normal now, pls advise.

[Masta]

I have been on cpap therapy for 5 weeks. I wear an CMS-50F Pulse Ox every night. I track my cpap therapy and SP02 with Sleepyhead and I also download SP02 to the Sp02 Assistant program.

My cpap setting for the last 5 weeks has been 4-16 on my Airsense10 for Her, with no ramp. I havent been back to my doctor since I received my cpap machine. I will go back for my 2nd visit with my doctor next month.

I called my doctors office yesterday, I told my pulmonologist/sleep doctors nurse that my Sp02 readings are showing an Average Low below 88%: my reading is 86.7% every night (I can have anywhere from 3-33 events at that % range), my doctors office said that they look into problems when your 02 drops below 87%, anything above that is ok with them. I also explained to my doctors nurse that the setting of 4 was too low when I put my cpap machine on every night, I was having trouble breathing.

Conclusion from speaking the my doctors nurse:

My doctor has ordered an overnight Pulse Ox test to be done at home, I have to pick up the Pulse ox from my DME. I took my CMS-50F pulse ox in with my reports for my initial first visit with my cpap doctor. He said my reports looked like what he was used to, so I dont know why he wants to do a overnight Pulse Ox at home, why cant he trust my pulse Ox readings and reports and do something about it?

My doctor changed my settings from 4-16 to 8-16. Last night was the first night on the higher settings, starting off on 8 was difficult to get use to (so Im going to try the ramp feature tonight for the first time). I woke my husband up in the middle of the night with my mouth open, sounding like darth vader. I had a similar issue with pursed lips open when I first got my machine, that subsided quickly. I havent had an issue with leaks or opening my mouth until now. I have looked at my machines sleep report which says I'm at 8.6 pressure and on Sleepyheads statistics, I am at 8.64% at 90% pressure. My AHI this whole time on cpap looking at SH has been between 0 - 0.15.

SP02 assistant showed 02 last night on the new cpap setting at 91.1% which is awesome.

Questions:
1. Is it common for your oxygen to increase (be above 90%) when your cpap pressure has been increased?
2. Is 87% oxygen, too low? I thought we should stay above 90%?

[BlackSpinner]

Well your O2 increases when your events decrease. It is the apnea events (where you stop breathing) that cause the O2 to drop so less events = higher O2.

It sounds like you may need a full face mask - when your mouth opens you let out therapy air and events happen.

[Goofproof]

Well your O2 increases when your events decrease. It is the apnea events (where you stop breathing) that cause the O2 to drop so less events = higher O2.

It sounds like you may need a full face mask - when your mouth opens you let out therapy air and events happen.

DITTO: many O2 of 90 is where they set the bar for added O2. Jim

[Guest1]

Higher CPAP pressure typically improves O2 levels. But to get even better O2 levels on your machine you need to use EPR. Are you using EPR?

EPR of 3 does not fully kick in unless your pressure is 7 or above. EPR is kind of a pressure support and it helps increase O2 levels.

So use EPR if you aren't. And it doesn't kick in below 7cm pressure.

If your O2 levels are not optimal even after EPR 3, then next step is to get a bilevel machine. After that, supplemental O2 comes into play.

[Julie]

Your mouth is opening as a result of the higher pressure, but if you need higher pressure (4 is the default low setting of the machine and almost no one can breathe usefully at it - 8 is low average) then you do, so try out some FF masks and be glad you have a halfway intelligent doctor who's paying attn re your SPO2 (and wants to check it with a device he's familiar with).

[Masta]

Higher CPAP pressure typically improves O2 levels. But to get even better O2 levels on your machine you need to use EPR. Are you using EPR?

EPR of 3 does not fully kick in unless your pressure is 7 or above. EPR is kind of a pressure support and it helps increase O2 levels.

So use EPR if you aren't. And it doesn't kick in below 7cm pressure.

If your O2 levels are not optimal even after EPR 3, then next step is to get a bilevel machine. After that, supplemental O2 comes into play.

I didnt know what EPR meant when I read your reply. I googled it, then went into the clinicians settings on my machine. The EPR setting on my machine is set to be on full time and its set to level 3 already. The doctors office must have done this. I have not changed any of my settings since getting the machine.

Your mouth is opening as a result of the higher pressure, but if you need higher pressure (4 is the default low setting of the machine and almost no one can breathe usefully at it - 8 is low average) then you do, so try out some FF masks and be glad you have a halfway intelligent doctor who's paying attn re your SPO2 (and wants to check it with a device he's familiar with).

I am grateful my doctor is wanting to check. I am a little frustrated because:
1. I mentioned my low 02 to his nurse before my first doctors visit (I purchased the CMS-50Fpulse ox several weeks before my first doctors visit with him, I had a sleep study done by a different doctor and had my patient file and sleep test report transferred to my current sleep doctor because my original sleep doctor was inappropriate with touching and words during my visits with him, so I fired him, sent my file to the doctor im currently seeing).
2. I took my pulse ox with me along with 3 weeks worth of readings/reports printed to my current doctors new patient first visit. He said my CMS-50F reports look the same as the reports he gets from his Pulse Ox tests.
3. I just explained to his nurse this week that after being on cpap for 5 weeks, that my 02 readings are still low now that Im on cpap. The nurse thought I was already on oxygen, she told me to not use my oxygen during the Pulse Ox test that I will be doing using a machine they ordered me to use.
I wouldnt say my current doctor is halfway intelligent, its more of a case of me telling them multiple times that my 02 has been low before and during cpap. I have been monitoring it on my own. After complaining 3 separate times, they are finally going to order a test even though the doctor said the CMS-50 reports I gave him look identical the the ones he gets from his own machine. Thats all i was trying to say (out of frustration) during my original post.

[Julie]

EPR is for trouble exhaling, but otherwise is not 'therapy' itself and if you don't have trouble exhaling, I wouldn't bother with it. It also tends to raise AHI when you use it, not a lot, but a bit, and needs to be kept in mind.

[Pugsy]

If my memory serves me correctly the official cut off line for acceptable oxygen levels is 88%.
Like to qualify for added O2 at home it has to be at or below 88% for a certain amount of time.
Some docs may have developed their own personal "cut off" line as to when they start thinking about doing something.

Also remember...normal O2 levels can be affected by altitude.
While my O2 levels are well within normal levels here where I live now...if I moved to Denver or higher...my "norms" would likely be lower just because of where I lived.

There's a lot that goes into O2 evaluation besides just the %.
Your doctor wanting another testing with a DME pulse ox...mainly that's for verification on the off chance that your home unit isn't quite as accurate.

Do check your software leak records to make sure that leaks aren't maybe giving you falsely low AHI reports. It can happen but it takes some really BIG leaks that are prolonged to keep the machine from responding and recording accurately. Small infrequent large leaks that are short lived won't usually be that big of a problem in terms of therapy effectiveness and reporting events. It all depends on how big and how long they last (no matter if it is mouth breathing or just mask movement).
But do evaluate the leak data to make sure that leaks aren't the primary culprit.

[Guest1]

EPR is for trouble exhaling, but otherwise is not 'therapy' itself and if you don't have trouble exhaling, I wouldn't bother with it. It also tends to raise AHI when you use it, not a lot, but a bit, and needs to be kept in mind.

This is not the full picture. EPR of 3 is equivalent to pressure support of 3cm H20. It does have therapeutic significance. It helps flush out CO2 from the lungs. It is the same reason why some people get CA events on EPR because their body skips breathing for 10+ seconds because Co2 level in the lungs and blood do not trigger a breath (our breathing is triggered by a threshold of co2 levels and not O2 levels).

[Masta]

If my memory serves me correctly the official cut off line for acceptable oxygen levels is 88%.
Like to qualify for added O2 at home it has to be at or below 88% for a certain amount of time.
Some docs may have developed their own personal "cut off" line as to when they start thinking about doing something.

Also remember...normal O2 levels can be affected by altitude.
While my O2 levels are well within normal levels here where I live now...if I moved to Denver or higher...my "norms" would likely be lower just because of where I lived.

There's a lot that goes into O2 evaluation besides just the %.
Your doctor wanting another testing with a DME pulse ox...mainly that's for verification on the off chance that your home unit isn't quite as accurate.

Do check your software leak records to make sure that leaks aren't maybe giving you falsely low AHI reports. It can happen but it takes some really BIG leaks that are prolonged to keep the machine from responding and recording accurately. Small infrequent large leaks that are short lived won't usually be that big of a problem in terms of therapy effectiveness and reporting events. It all depends on how big and how long they last (no matter if it is mouth breathing or just mask movement).
But do evaluate the leak data to make sure that leaks aren't the primary culprit.

I Googled my citys altitude - elevation, its: 4718 feet

My first night on cpap with the higher pressure of 8, my minimum 02 was 91%. last nights minimum was 86 and 87%. I made sure to check for leaks. here are 2 screenshot of last nights data.

Here are two screenshots showing there are no leaks etc.
SP02 at 86%


SP02 at 87%

[M'ohms]

If my memory serves me correctly the official cut off line for acceptable oxygen levels is 88%.
Like to qualify for added O2 at home it has to be at or below 88% for a certain amount of time.

My insurance, and medicare's too I believe, is that SpO2 at or below 88% for a cumulative 4 minutes overnight qualifies a patient for supplemental oxygen.

[PoolQ]

As for using your consumer oximeter verses a lab quality, calibrated meter, this by itself is why your doctor ordered the lab quality meter. It's a liability issue and nothing else. You and I are sure your meter is accurate but your doctor does not KNOW that it is accurate.

It would be nice if everyone in a doctors office knew my history and chart every time I walked up to the counter, but they may see tens if not closer to a hundred patients a day in a busy office. It's not their job to know patients medical history and if they did know mine, I would like to know why they are reading my file. I also have no doubt that my doctor is scanning my file as he is walking to the examining room door and sometimes not until he sits down and pulls it up on the computer. Too many patients, too little time, and they don't want to make a mistake because they "thought" you were on O2.

I have no doubt that you have a lot of valid information that you worked hard to accumulate, but your doctor does not know that for sure. He is not questioning you personally, but he cannot just trust everybody that walks into his office and says "hey don't bother checking anything out, trust me all this info is good". This has lawsuit written all over it, not from you personally, but there are those out there that earn a living suing doctors.

Part of the problem is that when we are confronted with sleep apnea we have no idea what is important, does 90%, 88%, or 87% make a difference? how urgent is it? A while back someone posted that their O2 levels were below 50% and wanted to know if they had sleep apnea. Pretty obvious that 50% is way too low. The other thing to understand is that our bodies adjust to CPAP changes over time, days, weeks, and months- this is not a light switch kind of thing. Also damage caused is in terms of months and years, not a week or two. Of course there are extremes to everything, if you were at 10% O2 then yes of course it would be hours, but you would also be in an ambulance.

You sound like you have a good doctor this time, the nurse is there for specific functions and don't ask them to diagnose your condition (or even know about it), your O2 levels are not going to cause damage before you get your treatment sorted out

[palerider]

EPR is for trouble exhaling, but otherwise is not 'therapy' itself and if you don't have trouble exhaling, I wouldn't bother with it. It also tends to raise AHI when you use it, not a lot, but a bit, and needs to be kept in mind.

This is not the full picture. EPR of 3 is equivalent to pressure support of 3cm H20. It does have therapeutic significance. It helps flush out CO2 from the lungs. It is the same reason why some people get CA events on EPR because their body skips breathing for 10+ seconds because Co2 level in the lungs and blood do not trigger a breath (our breathing is triggered by a threshold of co2 levels and not O2 levels).

unfortunately, you are talking misleading information, EPR makes oxygenation WORSE.

yes, pressure support helps to flush co2, however, lower epap results in less oxygenation, and that's what EPR does.

you'd have to raise base pressure by the same amount as the epr to maintain the epap level.

[Guest1]

EPR is for trouble exhaling, but otherwise is not 'therapy' itself and if you don't have trouble exhaling, I wouldn't bother with it. It also tends to raise AHI when you use it, not a lot, but a bit, and needs to be kept in mind.

This is not the full picture. EPR of 3 is equivalent to pressure support of 3cm H20. It does have therapeutic significance. It helps flush out CO2 from the lungs. It is the same reason why some people get CA events on EPR because their body skips breathing for 10+ seconds because Co2 level in the lungs and blood do not trigger a breath (our breathing is triggered by a threshold of co2 levels and not O2 levels).

unfortunately, you are talking misleading information, EPR makes oxygenation WORSE.

yes, pressure support helps to flush co2, however, lower epap results in less oxygenation, and that's what EPR does.

you'd have to raise base pressure by the same amount as the epr to maintain the epap level.

Thanks for catching that. I forgot to add that EPAP should stay the same, and for that the APAP range has to move up by the same magnitude as the EPR level, when you switch on EPR.

[PoolQ]

EPR is also an average over 5 breathes and pressure support in a Bilevel machine is on a breathe by breathe basis