The Importance of Oximetry to Monitor Therapy

[slaaplekker]

There are 3 reasons for hanging out at CPAPTalk.com

1. You are a CPAP survivor and a good Samaritan and are willing to help others through a difficult adjustment.
2. You are new to CPAP, going for a sleep study, seeing your Dr after a study and don't know what to expect.
3. You are having problems or someone you love/know is having problems with Sleep Apnea or therapy.

I guess you could be a combination of any or all of the above 3 or even be a vendor but I think those 3 categories cover most people.

The majority of folks likely to belong to the 3rd group or the 2nd group, I'm one myself being new, and having problems with a some of 1st thrown in which is why I'm writing this post.

As important as a the CPAP/APAP statistics that you get from your data capable machines are they are just part of the Sleep Apnea therapy puzzle for many people. There is a reason that during your sleep study they had you hooked up to an Oximeter all night long, your O2 Saturation is a major indicator of general health and a specific indicator of pulmonary function and sleep apnea.

From my observations and discussions in person and on line with Sleep Apnea patients there appears to be a general failure by many sleep therapists (Drs, Respriatory Therapists etc.) to validate effectiveness of Sleep Apnea therapy through the use of a follow up overnight Oximetery study. Of course a follow up sleep study while on your own machine would be even better, but that is a lot of expense when a relatively inexpensive Oximetery study will at least validate that you are at least getting enough O2.

I discussed with my doctor when he wrote the APAP prescription that I wanted a follow up Oximetery study to verify that the low O2 saturation observed during the initial over night Oximetery study and during the two Sleep studies were now gone, he agreed and we decided to do one after the first month of therapy.

Since I'm a firm believer that no two nights of sleep are the same I decided to purchase my own Oximeter to evaluate my on going sleep therapy over time rather than having to wait for the Dr. to order one. At least with my Sleep lab an overnight Oximetery study is only $50 so if you don't want to buy an Oximeter getting a study is still reasonable.

While we can make sure we use our equipment, control our leaks, and monitor our AHI and other statistics, which is the important first line of attack in treating our disease, but validating the effectiveness of Sleep Therapy should rely on something more then just how we feel each morning, since that can be influenced by many factors.

With my leaks under control and an AHI of less then 2, here is what my Oximeter showed



It is a good thing I followed up with Oximetery, since it was necessary to add supplemental O2 to my Sleep Therapy. Had I relied just on the statistics from my APAP I would have continued to suffer from nightly O2 deprivation.

If you are happy with your sleep therapy and feel great you probably aren't reading this, if you aren't happy or feeling better after sleep therapy I recommend getting an overnight Oximetery study done or purchase your own Oximeter so that you can monitor your O2 saturation levels while sleeping.

Now if I can get my other problems, RLS, PLMD, Pain and waking up because my mask bothers me under control maybe I can get some decent sleep again but at least I know I'm not starving my body for oxygen every night.

Besides checking the stats in my APAP weekly, I will continue to do twice monthly Oximetery to verify that I'm getting the O2 that I need from my Sleep Therapy.

Good Luck Everyone.
John

[Hospiceangel]

Good food for thought, John
I had a overnight oximetry study because my insurance has it as part of their criteria for CPAP.
I have the f/u appt with the pulmonologist this week. I haven't heard from the DME about it and I'm concerned that my Sp02 may be low as it was showing 88% even when I was awake in the am and rolling over to turn the CPAP machine off. I have a finger pulse ox but it's not continuous.
Hmmmmm.....
Shar:)

[Gerald]

Great post, John.............

You're going in the right direction.

Gerald

[Emma47]

My sleep doctor ordered this for one night after I was on the Cpap for a few weeks. My oxygen dipped into the 80s so he raised my pressure from 7 to 8. At the subsequent office visit when I asked about a follow up with an oximeter he was irritated and said it's not necessary. I'm in the market for one of my own as well -- and a new doctor too.

[slaaplekker]

it was showing 88% even when I was awake in the am and rolling over to turn the CPAP machine off. I have a finger pulse ox but it's not continuous.
Hmmmmm.....
Shar:)

Hi Shar,

If you are showing a spot 88% O2 Sat with your CPAP on I would follow up as soon as possible. A overnight study will show you what is going on during events and it may be lower during those events. The CPAP is supposed to keep that from happening that is its job so to speak.

Good Luck with the follow up.
John

[mars]

With my leaks under control and an AHI of less then 2, here is what my Oximeter showed



It is a good thing I followed up with Oximetery, since it was necessary to add supplemental O2 to my Sleep Therapy. Had I relied just on the statistics from my APAP I would have continued to suffer from nightly O2 deprivation.

John

Hi John

Very useful post.

I guess if the events are few in number but together and lengthy, desaturation could still occur. And it obviously does with some of us. I always check for clusters, but fortunately, so far, they have been made up of short events, with no desaturation.

Nevertheless, I try (with due respect to Dori and Yoda) to do a weekly check-up with my oximeter.

A recent Forum poll indicated that only 26% of voters had an oximeter. If only one of them (such as yourself) still had desaturation, then that would suggest that about 4 out of 100 Forum members still had desaturation, even with cpap.

This a actually a disturbing thought, and I hope all those who do not have an oximeter will soon get one, or borrow one if that is possible.

cheers

Mars

[torontoCPAPguy]

Here is mine from last night and you can be darned sure that I am going to follow up on this like flies on poop. Anyone with SO2 under 90% even at rest should be looking at the reasons for same. THIS is what kills. It shoots your blood pressure up, increases your heart rate and lots of other nasty stuff. The director of my rehab centre even suggests that it will have an effect on medications being taken, their efficiency and their interactions and how well your liver processes the byproducts to get rid of them. THIS is probably the most serious of the effects of OSA and its relatives. Anyway, mine from last night.... I will post mine from tonight in the morning on the forum somewhere so have a look. And I will also post what my Respirologist and GP have to say about it. Probably just refer me for another sleep study to get me out the door since there's no pill to prescribe.

[Madalot]

This thread really confirms for me that my pulmonologist is good and knows her stuff. She has ALWAYS ordered overnight oximetry as a part of her evalulation of my therapy. Downloads from the machines, PLUS oximetry, were used to up my pressure on the cpap AND switch me from cpap to bipap.

I purchased a recording monitor a while back and do overnights once or twice a week. I told my doctor I would be doing this and she was in favor of me watching this myself. She also said she would definitely accept results from my monitor. The last five or six tests have shown almost no desaturations and nothing below 90%.

But I think some of you are correct -- if people aren't monitoring this, they may not be getting as effective therapy as they think.

[torontoCPAPguy]

My readings from last night using the Contec 50E recording oximeter (and some masking tape to keep it stable on my finger). Not as bad as the night before, but I have a feeling, based on how tired I am this morning, that I did not get a great night of sleep (only thing that will confirm this is an EEG of course). So numbers need to be taken with a grain of salt and repeated constantly to get a good picture of your situation. And you cannot depend on having an AHI of 0.0 to tell you things are well as the numbers from your APAP are only PART of the overall picture as I have just discovered. Like being splashed with a bucket of cold water. WAKE UP GUY! Don't let the numbers that look so darned good lull you into a sense of well being when you have a gut feeling that something is still not quite right. I find myself waking up in the morning with a mild feeling of anxiety as of late. Lots going on in our lives right now but this is different and I cannot explain it at all. Just a feeling of anxiety and minor (very) nausea or butterflies. Go figure. In any event, for your viewing pleasure here are my oximeter readings from last night and if I can get the detailed data out of my SD Ramcard I will post those to go along with the oximetry data so you can see what I expect you will see. An almost perfect AHI with few events and oximetry that shows I am just a shade lower than I should want to be.

[happysleeper]

Thanks all, You've convinced me to invest in a recording oximeter. My AHIs are currently under 5 and improving with mouth taping, but I still am waking up tired. I think I'll get the CMS 50E, since it has an alarm to wake me if if my oxygen saturation levels get low.

I wish that there was an easy, affordable way to connect the oximetry data into my S9 for one easy comparison read within my ResScan format, but I understand from other threads that it's quite expensive to do at this point.

Happy Sleeper

[M.D.Hosehead]

I wish that there was an easy, affordable way to connect the oximetry data into my S9 for one easy comparison read within my ResScan format, but I understand from other threads that it's quite expensive to do at this point.

You're right. An xpap machine that cannot accept oximeter data and print it out on the report is incomplete IMHO.

[LoQ]

You're right. An xpap machine that cannot accept oximeter data and print it out on the report is incomplete IMHO.

But the S9 CAN do that. You have to buy an adapter and an oximeter. I think the adapter costs about $150. I'm not sure which oximeters it accepts. I believe I read that it accepts some NONIN device, but it's been too long and I can't remember.

[torontoCPAPguy]

There is no easy way to connect oximetry data to your ResMed blower nor into the ResScan software as of yet; the best you can do and the least expensive route to take is to use a program like SNAGIT to get a screen shot cropped and in a specific time frame for both your ResScan data and for your oximeter data (graphs) and then simply stretch and align them (make sure you output from SNAGIT in jpg or other picture formate that can be stretched). You will then have a pretty good picture of events vs SO2 side by side.

And after what I have learned this week I can only say that regular oximetry data is essential as part of a good clinical diagnosis and follow through. Regular, like 7 nights a week at first is good.

BUT, then the question arises, do we still need other parts of the picture filled in? Things like EEG, EKG, BP, etc. that are all part of the equation? And how often? In an ideal world one would be able to take in EEG, EKG, BP data every night and have them as part of the graph (with software doing all of the manipulations to make life easy). So, the question I have now is: Why has medical technology for OSA (etc) sufferers not kept up with what's available on the market or adapted to what is needed? Imagine being able to simply email your nightly results to your MD's for their input rather than having to undergo a gooey sleep study at their whim now and again.

This is pertinent clinical data that is needed on a regular basis. Comments?

[LoQ]

There is no easy way to connect oximetry data to your ResMed blower nor into the ResScan software as of yet;

But you have an S9. There is certainly an easy way to do it. There may not be a cheap way to do it. The easy way is to buy the adapter for your S9 and buy one of the specified pulse oximeters. Easy Peasy.


Cheap way? Dunno. Cheap is in the eye of the beholder, anyway.

[mergh]

I have COPD, without the Oximetry I think I wouldn't been put on oxygen like I was by my plumb (lung) doctor. I wore it over night for them to come up with how low my oxygen drop.
I wore and Oximeter during my first sleep study as part of them wiring you up.
I show I needed oxygen during my sleep again.

today I am still getting use to the machine and mask. I don't wear mind that often, I do try every month. I do wear my oxygen tub everynight. beside during the day.

I will have to have my mask fitter to my head to get good use out of it.