Pulse Oximeter & Possible Sleep Apnea?

[UndiagnosedGirl]

Hello Everyone!
Not sure if this is an appropriate place to pose my questions, but I would love to hear anyone's opinions on this. I do plan on following up with my general doctor, but in the meantime I would love to hear back from some of you.

Without going into TOO much boring detail, I have had pretty bad ongoing sleep problems for the past 10+ years. I usually have no issues falling asleep, but I always (consciously) wake up 1-2 hours after falling asleep. Typically I don't have problems falling back to sleep, however the remainder of my night, I wake up (very consciously/aware) several several times. I roll over, switch positions, etc...always aware that I am awake. If I had to guess I'd say this happens at least 20x per night. I rarely snore, but sometimes I have found myself catching my breath upon waking.

My primary care doctor has shrugged off my sleep complaints... I'm a fit, slender 38 year old female. And I've just ended up accepting that I'm a poor sleeper, even though my gut has said waking up so often is not normal! But what has alerted me now is that I've started to develop some odd physical symptoms the past 1-2 years that I haven't been able to find reasons for (however my doc thinks they're anxiety related). I can get into those symptoms later, if necessary.

My main question here though is... I have a pulse oximeter and this past week I have been using it to check my oxygen levels upon waking (in the middle of the night)... I've gotten readings as low as 74, 81, 85, 88, etc. If I lay there and take long deep breaths it slowly rises (but very slowly). During these episodes of waking, I also have finger/arm tremors and a general feeling of weakness. Light-headedness as well. I'm just wondering how accurate a basic pulse oximeter typically is? I feel like I'm "onto" something with what I've been researching... Could sleep apnea or UARS be what is causing all of my other symptoms? And even if not, surely having my oxygen dip to 74 cannot be good, right? (If it's accurate. And maybe it dips even lower than that since I'm already waking up when I'm testing it??!)

As I said, I will be going back to my doctor to beg for a real sleep study. But does anyone have any initial thoughts/opinions on this? I should have bought a recordable pulse oximeter but hopefully I'll get into the doctor soon and have some answers.

I appreciate any input!

[Julie]

Get a new doctor - one who takes you seriously and doesn't just lump you in with your gender, age, etc. (as yours seems to be doing). If nothing else you should have a sleep test that takes into account any other features besides oxygen. If you have low BP for instance, it might account for the lightheadedness, but so could a 100 other things (don't drive yourself crazy on Google though!) and same for the tremor. Not everything is about apnea, but whatever is going on - even if after testing they say you have 'anxiety' - you need to get definitive answers.

[UndiagnosedGirl]

Get a new doctor - one who takes you seriously and doesn't just lump you in with your gender, age, etc. (as yours seems to be doing). If nothing else you should have a sleep test that takes into account any other features besides oxygen. If you have low BP for instance, it might account for the lightheadedness, but so could a 100 other things (don't drive yourself crazy on Google though!) and same for the tremor. Not everything is about apnea, but whatever is going on - even if after testing they say you have 'anxiety' - you need to get definitive answers.

Thank you so much for your opinion Julie! I actually just made an appointment with an ENT for a sleep issue consultation. I was going to find a new general physician but thought getting in with an ENT who works with a sleep clinic might get me some answers more quickly. Thank you! And yes, I actually do have (what I consider to be) lower blood pressure. Years ago my numbers used to be around 120/80... Now they have been 90/60 at times. Ugh!

[A MESS]

Get a board certified pulmonologist/sleep DR. Yes with those reading I think you may have sleep apnea. This is hard to self treat as many do here. Once you know what you are doing and what has to be done then you can drop the doc. But for now see someone who specializes in this field to get started. .

[Julie]

Oh... be very careful about the ENT - they are focused on surgery and while there are operations supposedly to help apnea, most have been shown to be of temporary help at best, and some can even leave you worse off. Do NOT be talked into a UPPP, or other similar surgeries... at least come back here with whatever suggestions are made and we will show you very many instances of patients who went for the surg. and are now not only having to use Cpap anyway (if not in the few mos. post-surg), but whose anatomy is now irreversibly changed sometimes such that using Cpap is harder or less effective. I'm absolutely not advocating from any personal connection (financial, etc) for Cpap, but it is the 'gold standard' for apnea and there are very good reasons for that. The many people you might hear about that have 'failed' Cpap (if in fact you even need it in the end) are far and away the very many who have had no help in learning about how to use it properly, how to get masks that work for them rather than a one-size-fits-all, whose MDs do not understand about treatment, only the 'science' of apnea, but not about the equipment, etc. and that's where we come in - to help you adjust to Cpap - for me brushing my teeth is more of an issue now than throwing on the mask at night.

I do suggest you see either a pulmonologist or neurologist trained in sleep problems... but personally would stay away from surgeons, at least for the time being, whlle you still have all your parts .

[UndiagnosedGirl]

Oh... be very careful about the ENT - they are focused on surgery and while there are operations supposedly to help apnea, most have been shown to be of temporary help at best, and some can even leave you worse off. Do NOT be talked into a UPPP, or other similar surgeries... at least come back here with whatever suggestions are made and we will show you very many instances of patients who went for the surg. and are now not only having to use Cpap anyway (if not in the few mos. post-surg), but whose anatomy is now irreversibly changed sometimes such that using Cpap is harder or less effective. I'm absolutely not advocating from any personal connection (financial, etc) for Cpap, but it is the 'gold standard' for apnea and there are very good reasons for that. The many people you might hear about that have 'failed' Cpap (if in fact you even need it in the end) are far and away the very many who have had no help in learning about how to use it properly, how to get masks that work for them rather than a one-size-fits-all, whose MDs do not understand about treatment, only the 'science' of apnea, but not about the equipment, etc. and that's where we come in - to help you adjust to Cpap - for me brushing my teeth is more of an issue now than throwing on the mask at night.

I do suggest you see either a pulmonologist or neurologist trained in sleep problems... but personally would stay away from surgeons, at least for the time being, whlle you still have all your parts .

Wow! I really appreciate this information! Can you tell I'm out of my league here? Haha! I guess I just chose the ENT (whom I have been to in the past for allergy testing) because I noticed they deal with sleep disorders. I will start searching for a more appropriate doctor. Thank you so much! I really appreciate you sharing your knowledge to an exhausted newbie like myself.

[A MESS]

No ENT. He does ears nose and throat. Pulmonologist/sleep Doc. They r one in the same

[MaxINTJ]

Oh... be very careful about the ENT - they are focused on surgery and while there are operations supposedly to help apnea,

Not all of them! The one I saw yesterday asked how my CPAP was going, asked if there was anything she could do (in case I was having problems with the clinic) and was generally very helpful - did not even hint about any kind of surgery. She seemed to believe respiratory sleep disorders are best treated with CPAP, and surgery is the last resort.

[MaxINTJ]

To the OP.

As others have said, get a new doctor. Those are not normal things going on and one of the things could be a sleep disorder.

[LibtardsUnite!]

No ENT. He does ears nose and throat. Pulmonologist/sleep Doc. They r one in the same

No, they ARE NOT the same! A Sleep Doctor is a subspecialty certification by the Board of Internal Medicine, Pediatrics, or Psychiatry & Neurology; practitioners are trained in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, etc. Pulmonology is an area of medicine that focuses on the health of the respiratory system. Pulmonologists treat everything from asthma to tuberculosis.

Do not answer questions unless you know what you are talking about. You are as bad as xxyzx!

[rick blaine]

Hi UndiagnosedGirl,

I'm going to be cautious in what I say - where I live there are laws about giving medical information and advice via public media - even when someone like you asks for it. I'm going against the journalistic habits of a lifetime.

1. Your sleep pattern doesn't sound normal - if by normal is meant approx seven hours a night and the four or five times cycling down into delta-wave sleep and back up again into REM-sleep - which is called 'normal sleep architecture'.

The key thing is: how tired do you feel? Do you wake up reasonably refreshed? Ready to deal with the day?

During the day, do you find yourself nodding off? Not just napping, but when you wouldn't normally consider a nap - eg, when driving?

2. You say you're fit and slender - dare I ask what are your periods like? And are you getting enough iron in your diet? You might have anemia - anemia can result in lower oxygen levels - and that can exacerbate any tendency to apnea.

I would expect both a primary care practitioner and a specialist to do some blood work if presented with what you say - if only to rule that out. And while they're looking for that, they could do a full blood panel anyway - kidney, liver, and blood-sugar balance over the previous three months.

3. You may be the classic light sleeper. But if so, are you aware of how sensitive you may be to some of the most common sleep disrupters - caffeine, taurine, herb-based 'energy' drinks? Some light sleepers do best if they avoid these altogether.

And you can search this site for Chicago Granny's helpful list on sleep hygiene.

4. Are you on any routine meds which can affect sleep quality? There may be alternatives your physician can offer.

5. You mention "finger/arm tremors and a general feeling of weakness. Light-headedness as well" - these can be several things - and not all of them alarming.

For example, these symptoms are common in patterns of over-breathing - or hyper-ventilation. And hyper-ventilation can lead to temporary lowered oxygen uptake.

Hyper-ventilation is often found when the patient experiences very dramatic or active dreams, or dreams in which there is perceived danger.

Do you remember your dreams? Do they fit that description?

6. I certainly think you should be investigated. Amongst the range of options to do with sleep are:

a, a night wearing a WatchPAT - it combines a pulse-ox reader like you already have with a wrist-worn unit that records O2 levels across the hours.

b. a night taking part in a three-channel, at-home sleep study - checking out O2 as above, plus chest expansion (via an expansion tube) plus nasal airflow (via a light plastic cannula).

c. a full-on, overnight-in-a-sleep-lab, multi-channel sleep study.

7. It may well be that you have sleep apnea, and if so, the above testing should let you know one way or another. But the thing I've learned from this site and from specialists is that that quality of sleep is often multi-factorial. That is, getting good sleep depends on several factors, And getting them all right ... or even just most of them right ...

[Goofproof]

Pulse Ox, is just one little tool, not really great for diagnosing Sleep Apnea, You will have events that don't show up. It is better at seeing your overall O2 levels. Jim

[luvsbluberries]

I'll second the caution about ENT's. Of the three locally that work with sleep apnea patients, not one of them will manage a patient on xPAP. They are ONLY interested in doing surgery.

[UndiagnosedGirl]

Pulse Ox, is just one little tool, not really great for diagnosing Sleep Apnea, You will have events that don't show up. It is better at seeing your overall O2 levels. Jim

Thank you for your reply. I figured that, I just wanted to make sure I wasn't being a total hypocondriac. I've always thought I should probably get a sleep test done, but seeing the oximeter readings kind of shook me enough to really start thinking I need to get it done.

[luvsbluberries]

Oh... be very careful about the ENT - they are focused on surgery and while there are operations supposedly to help apnea,

Not all of them! The one I saw yesterday asked how my CPAP was going, asked if there was anything she could do (in case I was having problems with the clinic) and was generally very helpful - did not even hint about any kind of surgery. She seemed to believe respiratory sleep disorders are best treated with CPAP, and surgery is the last resort.

That hasn't been my experience. I need a new doctor. Original sleep doctor (neurologist) sucks, so thought to see an ENT I'd been referred to earlier this year (and liked him, and he lists sleep apnea as one of his specialties) but luckily called the office first to make sure he could/would manage my xPAP and was told that he only does surgery. Called 2 other ENT's and the same. They will only work with sleep apnea patients for surgery; they will not manage xPAP.

eta: Which isn't to say that there are no ENT's that will manage xPAP. But find out first, before you go to see them.