Sleep doc told me oxygen desaturations were "insignific

MrGrumpy · Post by **MrGrumpy** » Wed Jun 25, 2008 10:09 am

sleepydoll wrote:[quote: mine never mentioned the dangers of oxygen desaturation. I learned about that part on my own.
Fred

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Someone posted this excellent thread a few days ago :

http://www.resmed.com/en-en/clinicians/ ... 40x380.swf

click on MENU , then go to "APNEA"

These are the basics of sleepa apnea that everyone should know about...perhaps Mr ANONYMOUS was talking about deep sleep ( REM) where we do actually desaturate for short periods of time.
Let's not forget that we're "rested sleep" deprived due to lack of adequate oxygenation for years.
I think that the important factor TO US is that we rarely get to REM sleep beacause of our apnea situation...therefore desaturation accurs during all of our other stages, without ever getting to REM sleep. I got 5 minutes of REM sleep during my titration...this equals to just a little drop in the bucket of rest!

MrGrumpy · Post by **MrGrumpy** » Wed Jun 25, 2008 10:17 am

[quote="danmc"]I'm glad this thread was started. My oxygen levels during my sleep study hit the 50's. I though that sounded bad so I asked if I could buy or hire an oxymeter to monitor my progress. The sleep tech looked at me like I was insane. The sleep docs look at me like I'm asking for cocaine. I changed clinics. The new sleep tech laughed when I asked if I could hire one. "no, they aren't for patients" umm hello? ..I'm not a patient now? They wouldn't even let me BUY the software until I asked them to call resmed.

LOL, anyway, I spoke to the Resmed rep here about it today and he was horrified that they wouldn't hire me a reslink and meter. Without this thread and his response I was starting to feel like I was being silly. Really, the cost of extra monitoring, including oxymeter is well worth it I feel. No I don't work for resmed btw. I f I did s8's packages would include reslink standard..

danmc · Post by **danmc** » Wed Jun 25, 2008 10:25 am

LOL - theres nothing like pulse oximeter envy to stir a Doc up...

sleepydoll · Post by **sleepydoll** » Wed Jun 25, 2008 10:33 am

(Quote: I made an appointment today to see a new sleep doc, this guy is a full time sleep medicine doctor and doesn't do sleep medicine on the side..
Fred )

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Good for you, Fred ! I'm glad you're getting a second opinion /follow-up. Our health sould be taken seriously - first from ourselves. then from our doctors!
Keep us posted on how it went, and good luck!
D.

MrGrumpy · Post by **MrGrumpy** » Wed Jun 25, 2008 10:42 am

danmc wrote:LOL - theres nothing like pulse oximeter envy to stir a Doc up...

Why are some doctors so stupid? I'd like to know. <sarcasm>

Fred

danmc · Post by **danmc** » Wed Jun 25, 2008 10:51 am

Well, the standard is pretty low. It's just another job after a while for some I guess. It can't be fun having people moaning all day in their office (and lets face it, our demographic is not known for being bright and chirpy). Not everyone can be brilliant. I guess it's better to have the mediocre ones than only a few good ones. Maybe.

Snoredog · Post by **Snoredog** » Wed Jun 25, 2008 1:37 pm

problem is pulse oximetry is NOT very accurate, reason Insurance doesn't allow it to be used "alone" for obtaining a OSA diagnosis. It is only a "tool" used with other tests and methods for determining a diagnosis, then if you have poor circulation in the limbs what is that going to do the reading?

It can be an "indicator", but if the device is a cheapo it may not be very accurate, so how do you calibrate it? You got me.

What does it show for your base line level? Even if it wasn't very accurate, you would look for drops from your base line to lowest level, then you also look at your pulse rate and determine if during those periods your heart was racing.

I would lower your Minimum pressure down to 9.0 and put the Maximum up at 15 or 20 cm. If you are on the wrong side of the hump putting your Minimum up where you have it may be making the situation worse, but you don't know that because you may be already too high on the Minimum side. Allow the machine to work as designed, don't try to make an autopap a CPAP. If you allow the auto algorythm to work without limitation it may just fix things on its own.

If you widen the spread then observe the reports, you may want to put the Minimum back up, but at least you "know" where you are at.

SleepGuy · Post by **SleepGuy** » Wed Jun 25, 2008 1:58 pm

Fred, just to chime in and agree with the others--your doctor obviously doesn't understand some really basic ideas.

You might want to ask him if he will let you into his room tonight so you can intermittently smother him with a pillow in his sleep--but only if you promise not to go longer than, say, 90 seconds. And you promise to have a good stopwatch.

lvehko · Post by **lvehko** » Wed Jun 25, 2008 4:33 pm

MrGrumpy wrote:I purchased a Nonin "Wrist-Ox" pulse oximeter with nVision software several months ago and discovered I was still having lots of oxygen desaturations into the high, mid and even low 80s. This is despite using my CPAP diligently, never skipping a night.

I saw my sleep doctor today and brought with me copies of the home oximetry I did recently. I had been telling him since last December that my sleep quality was better in some respects, but basically, still very poor. He replied today after I showed him the copies of my home oximetry that the oxygen desats were "insignificant" and "not to worry about it."

Several nights ago, I had six events in the 89-85 range and one in the 84-80 range, with my lowest 02 being 83%.

Sunday night, I had 3 events in the 89-85 range, with two of them being 87%.

Last night, I had 8 events in the 89-85 range, with one of them below 88%, the event dropped to 85%.

To quality as an event on this Nonin gear, I had to have a drop in nocturnal 02 by at least 4% for a minimum of 10 seconds.

Im skeptical of what my sleep doc told me today, my understanding is anytime you have a desat less than 88%, its not acceptable if anything can be done about it. I have no history of heart problems or central apnea, just mild to moderate OSA.

When I told him my sleep quality was very poor still, he told me to contact my DME and to ask them what to do and maybe get a new mask, etc. I already have my mask situation squared away and use a Resmed Mirage Quattro full face mask. Ive already worked my DME hard in the past year and they cant do anything for me that hasnt already been done by them.

Im thinking this "sleep doc" is full of sh*t.

This sleep doc is a pulmonary doc who does sleep medicine on the side, sleep medicine is not this guy's primary function. I haven't been impressed with the followup he's given me after he put me on CPAP last summer. I'm seriously thinking of dumping him for a full time sleep doc, maybe one thats board certified in sleep medicine.

Any suggestions?

thanks,

Fred

Fred, not to be a smartass, but my suggestion is to find another doctor! At least just to get a second opinion -- Min

MrGrumpy · Post by **MrGrumpy** » Wed Jun 25, 2008 4:49 pm

[quote="Snoredog"]problem is pulse oximetry is NOT very accurate, reason Insurance doesn't allow it to be used "alone" for obtaining a OSA diagnosis. It is only a "tool" used with other tests and methods for determining a diagnosis, then if you have poor circulation in the limbs what is that going to do the reading?

It can be an "indicator", but if the device is a cheapo it may not be very accurate, so how do you calibrate it? You got me.

What does it show for your base line level? Even if it wasn't very accurate, you would look for drops from your base line to lowest level, then you also look at your pulse rate and determine if during those periods your heart was racing.

I would lower your Minimum pressure down to 9.0 and put the Maximum up at 15 or 20 cm. If you are on the wrong side of the hump putting your Minimum up where you have it may be making the situation worse, but you don't know that because you may be already too high on the Minimum side. Allow the machine to work as designed, don't try to make an autopap a CPAP. If you allow the auto algorythm to work without limitation it may just fix things on its own.

If you widen the spread then observe the reports, you may want to put the Minimum back up, but at least you "know" where you are at.

MrGrumpy · Post by **MrGrumpy** » Wed Jun 25, 2008 4:52 pm

SleepGuy wrote:Fred, just to chime in and agree with the others--your doctor obviously doesn't understand some really basic ideas.

You might want to ask him if he will let you into his room tonight so you can intermittently smother him with a pillow in his sleep--but only if you promise not to go longer than, say, 90 seconds. And you promise to have a good stopwatch.

heh...LOL yeah, the desats are indeed basically like being smothered or semi-smothered. I wonder how much stress hormones like adrenaline or cortisol is still being released into my body in my sleep due to residual oxygen desaturations.

Fred

Guest · Post by **Guest** » Wed Jun 25, 2008 6:45 pm

Hi Fred,

Lucky You:You have come to the right place to learn osa and understand more.
Fire:Don't be afraid to learn to fire a doc when things are not right.
Hire:Most importantly learn to get a good sleep doc.

Believe me, not many docs are as care as ourself when come to health. Many docs just earn for living and event some drinks and smoke.

Keep learning and good luck.

Mckooi

jules · Post by **jules** » Thu Jun 26, 2008 11:46 am

Since deleted posts have been reinstated, I am bumping this thread back up.

I hope someone (or perhaps several) lost there delete spam privileges. The posts that were deleted sure weren't spam.

MrGrumpy · Post by **MrGrumpy** » Thu Jun 26, 2008 2:46 pm

jules wrote:Since deleted posts have been reinstated, I am bumping this thread back up.

I hope someone (or perhaps several) lost there delete spam privileges. The posts that were deleted sure weren't spam.

The posts that were deleted were abusive posts filled with sarcasm towards myself and were trivializing my concerns and complaints regarding my medical condition. The posts that were deleted were also spam from the perspective that they were overly friendly towards the medical profession...they portrayed sort of a mental conflict of interest from someone who didnt like reading my medical profession bashing.

Fred

roster · Post by **roster** » Thu Jun 26, 2008 2:54 pm

MrGrumpy wrote:...
The posts that were deleted were abusive posts filled with sarcasm towards myself and were trivializing my concerns and complaints regarding my medical condition. The posts that were deleted were also spam from the perspective that they were overly friendly towards the medical profession...they portrayed sort of a mental conflict of interest from someone who didnt like reading my medical profession bashing.

Fred

Fred,

I did not see the posts and wish you had left them up. Some of us sometimes enjoy going at it with morons.

Rooster

Mask

Additional Comments: Started CPAP June 14, 2006, pressure set at 8.0

Sleep doc told me oxygen desaturations were "insignific

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