I now have an oximeter. But I'm a little confused.

[Gregg]

I'd like to say how much I like this forum. I love when problems are solved. And you all are living examples of problem solving. I just hope I can find a solution.

This was my second night on my new oximeter. I'm actually disappointed that I didn't see much evidence of low oxygen saturations. I really want to find a problem to solve.


So today I feel lousy. My head hurts. General overall lousiness. So I reviewed the oximeter data from last night. And for the most part it's all in the 96-98% level. So why do I feel so bad. I went back to the data again to really look it over in detail. There are several spots where my saturation drops to 90% for a period of around 30 seconds. That hardly seems like something that would lead to problems.

So now I have to ask just what level of apnea does cause symptoms. I expected to see long durations of maybe 85% saturation. And then I'd be onto something. So here I am, as I expected, with little or no evidence. And wondering what to look for. I will keep the oximeter on until I have a day of agony, and then maybe the sats will show some evidence. But why would I feel lousy when only a few moments were 90-92%?

Also, I had horrible dreams. This happens on the nights before I feel lousy. I mean dreams where everyone hates me, or I'm getting a D on a midterm. And I graduated from college fifteen years ago. I think the dreams indicate something. But apnea? Who knows. I just want to be one of those who solves their problem.

[Snoredog]

Those 30 second periods could be from apnea runs, but what you don't know is what type they were either obstructive or central.

Pulse Oximeters are not very accurate in general reason they cannot be used alone for a diagnosis. They can aid in the diagnosis but in a lab setting they have other sensors and monitors to correlate the information seen with other data to come to a conclusion.

But overall they can give you an idea of how you are doing, but with only 2 30-sec bouts where it dropped to 90% I wouldn't see that as anything but a run of apnea. If you can compare that data to say a machine report timeline then it might show you what they were.

If those two events were caused by centrals that could explain why you feel so lousy. Don't know what it is but central apnea can make you feel 10 times worse than any obstructive runs.

What was your titration pressure found and what machine/pressure are you running now?

[dsm]

In monitoring my own SpO2, it seems to stay mostly in the 95-97 range. But, the few times that the next day has felt 'leaden' I have noticed some small bouts of SpO2 dropping to 88% - mostly in the hour before waking. Beyond that the SpO2 data for me shows what I take to be good steady results.

AFAIK 90% is not that big a problem if in very short bursts, as Snoredog has said, possibly indicates a looming OSA.

My readings from both Resmed & Remstar machines, show lots of hypops vs OSA. It was that hypop data that trigered me to get a PO.

What my PO did for me was to eliminate any anxieties about centrals & even excessive hypopneas, causing low SpO2.

Good luck

DSM

[Gregg]

I have a few more questions, now that I am back from the dead. I mean this absolutely knocked me off my feet. I've been in the bathtub the whole afternoon. The heat seems to take the edge off the dull aching head.

First, what is a PO? A sleep test? I couldn't find it in any search or the keywords in your post DSM. Thanks for that link, too.

Here's the thing I'm trying to accomplish. I want a cpap without the zillions of dollars of a darned sleep study. Or two. Especially since an autopap will supposedly work. And without dazzling evidence in my oximeter numbers, my doctor isn't going to just prescribe an autopap, for exmple. Or maybe he will.

And if an oximter overnight is so inconclusive, then why do they even use them to prescreen for apnea?

PS- none of this would even be necessary if we had health care in this country. But that's another subject.

[dsm]

PO = Pulse Oximeter

Cheers

DSM

[christinequilts]

What my PO did for me was to eliminate any anxieties about centrals & even excessive hypopneas, causing low SpO2.

How do you feel SpO2 levels can tell anything about centrals? Just curious

[rested gal]

Gregg, there are many other things besides "classic" O2 droppin' OSA that can disturb sleep. That's where a full PSG attended sleep study can be of importance.

You could have PLMD (periodic limb movement disorder) causing arousals that could be interfering with getting restful sleep. Perhaps causing many arousals throughout the night even though your breathing is ok. Need meds for PLMs.

You could have UARS (Upper Airway Resistance Syndrome) in which your brain is so sensitive to the slightest drop in O2 (like from 94 to 92) that your brain arouses you to "breathe better" BEFORE the O2 drops wayyyy down. Those arousals could be happening over and over and over again, all night, every night. Could certainly be wrecking your sleep without waking you up all the way. Could be be leaving you worn out. CPAP (or autopap) can help.

If you have insurance that will pay for all or most of a "real" sleep study, that's what I'd go for, if I were you. Find out what's REALLY going on in your sleep. Might make a difference in choosing what type of machine, if one is needed, would be best.

If you don't have insurance, then perhaps you can make a case to your doctor that you'd like to at least try "cpap". If you want to purchase an autopap machine from an online store like cpap.com, all that the Rx has to have on it is one word -- "cpap". Doesn't even have to state a pressure or pressure range if you are ordering an autopap, since autopaps come pre-set from the factory at 4 - 20 cm H20. You can change the range after you get the machine. When purchasing from most online stores, you'll get both the User manual and the therapy setup instructions.

If it were me planning to "do it myself", I'd get this machine:

Respironics REMstar Auto with C-flex and heated humidifier. I'd not get the "M" version machine at this time...I'd get the older (non-"M") REMstar Auto with C-Flex.

Do get the Encore Pro software and card reader. Especially important in order to see what's going on if you're going to treat yourself.

Don't need a prescription for masks, humidifiers and other "cpap" accessories. The machine is the only things that requires an Rx.

These links below might help you when talking to your doctor:

Powerpoint presentation at a meeting of the American Lung Association of the Central Coast - November 2004 - by Dr. Barbara Phillips (board certified pulmonologist and board certified sleep doctor) -- "Not Every Patient Needs to Go to the Sleep Lab."


This link is to a study that found the answer is "Yes."
Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Links about UARS:

http://www.clevelandclinicmeded.com/dis ... /sleep.htm

http://www.apneasupport.org/viewtopic.php?t=5443

http://www.chestjournal.org/cgi/content/full/115/4/1127

http://ajrccm.atsjournals.org/cgi/conte ... 161/5/1412

viewtopic.php?p=101358

[dsm]

What my PO did for me was to eliminate any anxieties about centrals & even excessive hypopneas, causing low SpO2.

How do you feel SpO2 levels can tell anything about centrals? Just curious

I am pretty sure that if a central is in progress, that just like a hypopnea (that may even have preceded it) there is going to be a drop in SpO2 level that will be noticeable. In fact IIRC, the authoritative definition for a hypopnea includes a defined drop in SpO2.

However, if a central has no noticable SpO2 drop associated with it then commonsense tells me the person may have been hyperventilating or have some other complication or the central is a 'non-event'.

My PO records at 12 second intervals and can go down to 3 secs, so am pretty certain I would see any obvious patterns.

DSM

[Offerocker]

.
This was my second night on my new oximeter.

Gregg, what type/kind of oximeter do you have?

[Gregg]

Well, darn it. I posted last night to thank you all, and I see it didn't happen.

Thanks Rested Gal. I've followed enough around here to know most of what you mentioned. I was not aware of UARS,

Yesterday was so bad, I'm still recovering. This is like high altitude sickness. Or a hangover. Really unpleasant.

I've prbably said it before, but after 15 years working in cardiology, I'm not anxious to set foot in a hospital. But without going through the gauntlet of tests, and eventually getting lucky, I may never know what is causing this.

I still can hardly think straight here. I'll just post this and later go over my saturation history for last night, which will undoubtedly be clueless.

All I can say is up until 40 I never had a headache in my life. Now I'm terrified of waking in the morning.

Offrocker, I just picked up a really nice Ohmeda 3900p. It's about as nice as they come.

I know one thing, this is night related. I feel horrible upon waking. Perhaps it's only migraines. But I know I stop breathing according to my last girlfriend. And that was long long ago. I must have gotten worse by now.

[Gregg]

I just went over last nights oximetry history. I think there's some motion artifact. But it looks very suspicious.

There is a segment from 12-1 in the morning where the sats are going up and down between 98 and 92 percent. That's not supposed to be happening. Then complete calm for a few hours. Then the same variation in oxygen saturation around 5am.

I suppose I should be posting this in my diary, and not on a forum. But since I'm just starting this, I thought I might get some direction from you here. And I have. And I appreciate your assistance.

So, another day lost to the nightmare of bad health. It's very discouraging. But that's why I like this forum. To see those who have overcome the monster. That is a beautiful thing. OK, enough of me...

[Snoredog]

I know what you mean when it comes to the cardio wing of a hospital, my experience is they are a bit too angiography happy if you ask me, but they do charge upwards of $21k for one so that may be why, a big revenue generator.

As already mentioned, pulse oximetry is not very good at identifying the type of events you may be having. While the girlfriend comment is one of the better leading indicators of SDB it doesn't tell you the type either. Hypertension that doesn't respond well to medication, night sweats are other indicators in addition to EDS.

The gold standard way to find out is with a PSG then they can correlate those drops to the actual event. If you are only having 2ea 30 second events per night then there is something else for the poor sleep. As RG mentioned they could be spontaneous arousals, arousal's from pain, from PLMD etc. Those would not cause a drop to SAO2 levels but could impact the quality of sleep you get.

If OSA was your main problem I would expect your O2 levels to be dropping much lower possibly down in the 60's and you would see many more during the early morning hours than late at night as you spend much more time in REM during the early morning hours of sleep.

There is only 1 test, a PSG in a lab, I would never go to a hospital for a PSG, I'd seek out a dedicated lab with a ABSM doctor.

[Gregg]

Night sweats. I occasionally have those. Several nights ago, in fact. But no EDS, that I am realizing.

I suppose I should be happy. After all, this might only be a mild sleep disorder, from extreme frustration, that is triggering migraines.

I guess the sleep study is going to be the only way. Only, I sleep like a baby most nights. This only happens several times a month.


Angiograph. Don't forget treadmills and ultrasound. Bloodwork. Pulmonary function. It's one thing when you're on one side of the fence. What a nightmare. We need health care in this country. We'd all be better off for it. /end of rant.