High MyAir Score but O2 Desats Continue

[ArthurDent1978]

Hi,

I really appreciate this forum and have been lurking for quite some time as I have started my CPAP journey. In looking into my PVCs my gastro doctor recommended I get a sleep study. To very little surprise I clearly have sleep apnea. I am using my Airsense 11 and started with a nasal mask but got lots of large leak results so I switched to the 30i. Anyway, my nights seem to be hit or miss, I have some amazing nights where my MyAir score is high and I have 0s under 90% O2Sat. I have other nights, like last night, that are terrible and my O2 is less than 90% for 13m26s. I just don't know what to do next.

Info on Me: Male, 293 lbs, 5 foot 11, 17.5" Neck Size

Sleep Study Results:

Sleep Efficiency: 84.1%
Wake: 59.5 minutes, Stage N1: 226.5, Stage N2: 120.5, Stage N3: 36.5 (REM)
58 Spontaneous Arousals, 8.9/hour
1 Obstrucive Apnea, 68 Central Apneas, 2 Mixed Apneas and 199 obstructive Hypopneas

AHI 41.33
ODI: 7.1, lowest SPO2 of 88%

I have Oscar installed and have my O2 readings all lined up. I am not exactly sure how to put the data on here so I ran reports for two days. 7/15 and 7/17. On 7/15 my AHI was less than 4 and I spent 40 seconds below 90% O2. On 7/17 my AHI was 8.8 and I spent 13 minutes and 26 seconds below 90%. It was my worst night in a while. Anyway, I am not sure what to do next. I make sure my mask seal is good. I get O2 drops right while I am falling asleep typically but last night was all O2 drops all night. I know the CPAP is helping me as I feel more rested and my PVCs are down to 3% of my heart beats already. I have been on CPAP since 6/20 so just under a month. I can tell the next morning right away if I had a good oxygen night before or not AND I can feel it all day if I have a not great night.

My baseline when I bought my O2 sensor and didn't use the alarm or vibrating warning was 148 drops over 9.9 hours, so 14.9 drops per hour and lowest SPO2 of 75% and my AHI was 43 for my sleep study. So even a "bad" night is better but I feel like my body can't heal unless I keep my O2 above 90% pretty much all night. I would appreciate any advice on what to do next. I don't have a sleep doctor yet, my primary care gave me the script for the CPAP.

Thanks,

Chris

https://drive.google.com/file/d/1FZ_h1- ... sp=sharing
https://drive.google.com/file/d/1y3bFao ... sp=sharing

[ArthurDent1978]

Does anybody have any insight to help me? I am getting a Pulmonary Function Test on July 27th, maybe that will provide some insight.

[Pugsy]

I am wondering if on the "bad" nights that your cpap machine simply can't deal with whatever is causing whatever kind of events you are having.

The pressure graph is useless and the Events graph at the top is so tiny I can't see what kind of events or the pattern of events you are having.
I tried enlarging the image so I could see it better but was unsuccessful.

You are using a fixed cpap pressure and appear to be have some sort of clustering of events during the night on the "bad" nights. I wonder if this is maybe related to sleeping positive...like maybe being more on your back on the bad nights than on the lower AHI nights. Something changed but we don't know for sure what it was.

Have you tried a different cpap fixed pressure or maybe auto adjusting mode with a range of pressures?

What does your flow limitation graph look like on the bad night???

I was waiting to respond to your questions to see if any one suggested a reformat of the image so we could see the more commonly needed format of graphs.
I know why you did what you did since your main worry is O2 drops but we have to start with the events that might cause the drops...so start with the basics and work from there.

My best guess is you are having more real apnea events on the bad nights because your fixed pressure isn't doing a good job preventing the apnea events and those events are clustered together enough to cause oxygen level drops..
One or two events randomly won't usually create a drop unless they are really long in duration but clusters of events, even if short duration, can do it when they are sort of back to back.

So you have to figure out what is going on that is different between the good night and the bad night...my best guess is maybe sleep position.
And if it is sleep position and you can't stay off your back (it's easier said than done) then maybe a setting change is in order that could maybe deal with any sleep position. Something that would prevent those "bad" nights with higher than we want to see AHI.
You either have to use a higher fixed pressure all night or use auto adjusting mode with a minimum pressure high enough to deal with the bulk of the events and be able to increase as needed, if needed, because of whatever the cause might be for the clustering.

I can't tell for sure based on the images shared but the 2 main things that could be varying and could cause OSA to worsen and need more pressure are supine sleeping and/or REM stage sleep. Something is changing between the nights and my first guess would be sleep position supine vs side sleeping or maybe a chin tuck kind of thing.

Some people might suggest a soft cervical collar as an option. It is an option but it does involve more "stuff" on the face/head and may not be particularly attractive...and we don't know if it will work or not.
It is an option though. I prefer to just have the machine be able to deal with it but others don't.

[Ray4852]

Does your doctor check your hemoglobin and hematocrit levels with a blood test. most of us that have sleep apnea have low oxygen levels while we sleep. my oxygen levels average around 93 most of the night. I had frequent level drops were my o2 dropped to the low 80s. when I got my blood test is showed my blood oxygen was not normal. I told my doctor I need a little oxygen while I sleep. he sent me to an oxygen doctor. he looked over my records and said I'm on the boarder line. I new I needed oxygen. he said if you want to start oxygen now we have to get it approve by medicare. it will take time. I told him. lets keep medicare out of it. I will pay for my own concentrator. medicare will not cover an portable concentrator. two days oximedical shipped me my concentrator. I'm on 2 liter of oxygen. my blood test come back normal now. I sleep a lot better and when I wake up. I feel like a new man. 2,300. dollars for my concentrator was money well spend. my oxygen level now stay up in the middle 90s most of the night and I get some drops that drop just below 90.

[ChicagoGranny]

most of us that have sleep apnea have low oxygen levels while we sleep.

Most of us? I don't think so.

I have some amazing nights where my MyAir score is high and I have 0s under 90% O2Sat.

This is an indication that your pulmonary function is good, and supplement O2 would be inappropriate. You should still undergo the pulmonary function test.

[Ray4852]

My air score is high everynight. I average 98 to 100. what lowers my score. I have to get up more than 2 times to go to the bathroom. I average 8 hours with the mask on and get 1 to 2 apneas per night. I drink plenty of water, and try to walk 3 miles everyday. still have to lose a little weight. never smoked, never took any hard drugs and haven't had a drop of alcohol the past 20 years. I think I made the right decision for me. I agree some people need to get further testing. take a good look at your lifestyle. did you smoke, do you drink. have you taken any kind of hard drugs, are you overweight. what kind of occupation did you do. your diet and alcohol is bad for sleep apnea. most of us are getting old now. we have to try and change our habits.

[clownbell]

Ray - I may be way out in the weeds here, but may I make an observation. Before starting CPAP, I would get up 3-4 times nightly to pee; I figured this was a consequence of enlarged prostate (BPH, medically diagnosed). After being on CPAP for a while, I noticed that on many nights I did not get up at all -- and when I did, it was no more than once and when I drank a lot of water well into the evening. The lesson to me: I had assumed a cause-and-effect relationship that was not true. Now I sleep soundly enough that wake-ups are rare. So when I read your post about getting up, I wondered if CPAP may cure that.

Second point, MyAir is a "feelgood app" that does not provide the level of detail provided by OSCAR. Also, MyAir does not measure oxygen desats.

Third point, if you get to where you are short of breath during the day, consider a Portable Oxygen Concentrator. They are great. Inogen is the market leader I believe. The folks at the oxygen concentrator store can help you.

[Ray4852]

2 years ago I was getting up 7 times per night. I was not on c-pap at this time. I was schedule to get my next PSA test. my test came back with number 4. doctors start investigate for prostate cancer. he found what he was looking for. prostate cancer. 4 cancer spots all with weak cancers cells. 5 weeks of radiation took care of this problem. I ask my doctor, I have to get up two to 3 times once in a while. he said this is normal for a guy my age. 69. now with being on o2 I can last about 5 hours of sleep. than I have to pee, get up 3 hours later and have to pee again. 2 times is very good. I have a new problem now. I have kidney stones. doctor said drink a lot of water to try and pass them. I don't need o2 during the day, just while I sleep.

enlarged prostate must be watched with PSA test every 6 months. if your father had prostate problems. theres a very good chance you will develop prostate cancer. my father had it. I got it too. I know a guy now who has prostate cancer. he didn't listen to me. I told him to get that PSA test every 6 months. he got the test. he waited to long. doctors gave him 3 to 5 years to live.

[mummmz]

I have polycythemia secondary to sleep apnea. When hemoglobin & hematocrit go above normal limits I go donate blood. This year I started waking up gasping for breath even while using my cpap. Went back to my pulmonary doctor and had a pulmonary function test where I walked for 2 minutes and my O2 went into the 80s. Did another minute with O2 added and it brought be back up to about 95. I was prescribed 24 hour O2 and a methacholine challenge test was ordered. That confirmed I have asthma and was prescribed Brio, a daily inhaler, and an albuterol rescue inhaler. I had to use the rescue inhaler for several days but the asthma has calmed down now and I only need the daily inhaler. Cpap keeps my airway open but doesn't do much for my asthma.

[ChicagoGranny]

Good work hijacking ArthurDent1978's thread.

[Pugsy]

Yes please.....let's get back on topic.
Unsure of the topic????...go back and read what was said in the first report.
It's not about prostate issues or cancer or blood diseases.

[mummmz]

My reply was meant to share my similar experience with O2 Desats, not to hijack the thread. He said he has a PFT scheduled for 7/27. That's a start and there are other tests that can be done as I suggested. And in my opinion a pulmonary specialist instead of a Sleep doctor or primary care doctor should be consulted for those tests. Also a Cardiologist should be consulted for the PVCs.

[Pugsy]

Pre-emptive "lets get back on topic" warning only. The trending was getting a bit derailed...I just wanted people to not go down the side track of talking more about their problems than the OP's problem or question.

It wasn't meant to slap any individual's hands at this point...just a gentle reminder to stick to the topic.

[ArthurDent1978]

What does your flow limitation graph look like on the bad night???

I was waiting to respond to your questions to see if any one suggested a reformat of the image so we could see the more commonly needed format of graphs.
I know why you did what you did since your main worry is O2 drops but we have to start with the events that might cause the drops...so start with the basics and work from there.

What is the right format? I can adjust to whatever is needed. Happy to in fact.

[Pugsy]

Read this.
Examples of the basic starting format is in this thread
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html