help with oximetry report, please

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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stevealive
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help with oximetry report, please

Post by stevealive » Sat Oct 02, 2010 11:51 am

Hello again, all. I'd like some help interpreting an oximetry study that was done a few nights ago after my settings were changed to straight cpap at 9cm. Previous discussion of my treatment is at viewtopic.php?f=1&t=55279&st=0&sk=t&sd=a. This forum is a life-line, maybe the only place I can consider what is going on with people who understand. Pardon the length of this post, but I have a few things I'd like to cover.
Below is a composite of the first two pages. There are pages of expanded charts and text, which I could post if it would help, but thought I'd save space for now. I gather that <88% seems to be the point of concern, and I'm not sure how significant it is to be there for 20 seconds, and then an additional 8 seconds spread thru the other events. I've seen a comment by JohnBFisher that desat events even above 90% can be significant, and I have 136 of them total. My sleep study in May listed a low of 84%, but there is no duration listed and the chart is pretty small and hard to read. I've tried to read up all I can about interpreting these results. I can't find real info about how to interpret duration vs %, what all the desats above 90% mean, and the fact that the only really flat line is about 1/2 hour long. This forum is my best source, so any comments would be greatly appreciated
Image
Since my last posts, I've started using a chinstrap, which seems to help with the leak rate, and definitely lowered the Systems One's recorded AHI. I'm still averaging AHI in the high teens, this week one night at 12 and one at 25. This is the chart from the night in question- Image
This is all in the context of trying to work with my understaffed local sleep center. It sounds like I'll have to go through all the intermediate steps for them and the insurance company as I aim for an ASV titration. The DME took one look at these results and said the time below 90% wasn't large enough to qualify for supplemental oxygen. That was Thursday, and there's no one in the sleep center until Monday, so I'm waiting to hear what the doctors think.
A few other things to mention. I've been traveling a lot over the last few weeks. I drove 12 hours to Jackson Hole WY, 300 ft lower than my home in Durango, CO. That night I slept almost 10 hours, which I haven't done for years, with an AHI of 1.2. I felt rested in a very unfamiliar way. Two nights later I didn't sleep more than 4-5 hours, but had an AHI of 3.3. I still felt great, and spent two hard days cutting firewood for a friend. These two nights are unique since my treatment started. The other nights there were more like my usual. I also spent 8 nights on a houseboat at Lake Powell, elevation 3650 (my home is 6500). I took with me an Everest3 cpap, with only compliance data capabilities. My nose had been developing sores over a week prior, and after the second night was bleeding a little. I didn't use the machine for the rest of the trip. I felt great, did lots of hiking, and didn't feel bad until I spent my first night at home with no machine. I'm back on it since that night, and feel better, but I'd swear the thing that really does the trick for me is an hour of good exercise each day. Maybe it oxygenates my system enough to overcome the effects of less than optimum treatment to this point. I've been considering that all this might lead to moving to a lower altitude. I know it's my health and I may have to do it, but the magnitude of such a thing gives me pause.
Any thoughts about all this would be a big help. Thanks in advance.

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M.D.Hosehead
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Re: help with oximetry report, please

Post by M.D.Hosehead » Sat Oct 02, 2010 1:44 pm

I'm certainly not informed enough about CSA to comment on your data and hope others will be along to contribute soon. I also have learned a lot from SWS' links. A couple of observations, though:

1. I noted in one comment that you take sleeping pills. I wonder whether they might contribute to obstructive and/or central events.

2. Albuquerque is where Dr. Barry Krakow practices. He's a well-regarded sleep disorder specialist and author. That's where I'd go.

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-SWS
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Re: help with oximetry report, please

Post by -SWS » Sun Oct 03, 2010 11:43 am

A bump...

Hoping for additional thoughts/opinions/ideas for stevealive.

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snnnark
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Re: help with oximetry report, please

Post by snnnark » Sun Oct 03, 2010 2:47 pm

Doesn't altitude increase periodic breathing? http://www.traveldoctor.co.uk/altitude.htm

If Stevealive can't get the ASV and his heart and lungs are in good shape, then maybe he can consider a re-breathe system like I use.
viewtopic.php?f=1&t=50536&p=465451#p465451
I have been on it for 7 months now and it is working. I even spent 3 months at a ski resort (8200ft) and had some of the best sleep ever!
Rainout is still a problem because the drier air from the machine only gets past the vent once the re-breathed air is taken in. So the very humid lung air condenses in the re-breathe tube, even with a hose cover on! But it's a small price to pay for decent sleep.

Just a thought.

Deon

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stevealive
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Re: help with oximetry report, please

Post by stevealive » Sun Oct 03, 2010 3:19 pm

M.D. & SWS, thanks for the help. I found Dr. Krakow on the web, and will read about his program. Inquiring minds want to know, so without comments from anyone else, I played around in Photoshop with the charts, and came up with the image below. Maybe this is no news to anyone else, but I found it informative to see the oximetry chart lined up with the sleep flag chart. I added a green line at 88% and an arrow at the longest desat event below 88% at 1:19.
Image
So there's lots of desaturation by 2-3 going on almost constantly, with the exception of that 1/2 hour starting at 4:15. Is that normal? Swings of four or more are considered events, and most of them take place between 90% and 95% and line up with the periodic breathing and CA's and OA's. That's pretty interesting. The event marked by the arrow, the one of 20 second duration that the oximetry report specified, occurred when the PR auto reported no apnea events going on. That's pretty interesting to me also.
Also, it looks like I started the night at about 97%, went down to 90% with the first CA, and with the second CA bottomed out at 86%, at which point a long stretch of periodic breathing started, maybe in an attempt to reach equilibrium. I remember SWS talking about pressure swings causing a looping chain of events, and while I can't say what causes what, and I'm running a flat 9cm, it's pretty easy to see that the factors line up. Some of the other segments of periodic breathing look like they may start the same way, but I'm guessing too much and I'm not sure the graphs are accurate enough for such inferences. Still, I find this pretty educational. Maybe it will help others.

I'd still appreciate the educated comments of others. Snnnark, I just saw your post, and will look into the links you listed. Thanks alot.

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stevealive
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Re: help with oximetry report, please

Post by stevealive » Mon Oct 04, 2010 8:03 am

Snnnark, thanks for the comments. The rebreathing concept is interesting, and I applaud your inventiveness in pursuing it. For me, I'm going to follow thru with my docs a bit more before trying anything else. By following your link I learned alot, especially the thread started by phorts and it's related links. That was an education in itself, and good exposure to the high level of support afforded by this community. What a godsend! Thanks again. Hopefully I'll hear from my sleep doctor today. I'll post what happens.

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OutaSync
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Re: help with oximetry report, please

Post by OutaSync » Mon Oct 04, 2010 9:36 am

Great job getting those reports aligned. I think that will help people who don't have oximeters see what happens during an apnea.

I'd like to see you try an Auto SV.
Diagnosed 9/4/07
Sleep Study Titrated to 19 cm H2O
Rotating between Activa and Softgel
11/2/07 RemStar M Series Auto with AFlex 14-17
10/17/08 BiPAP Auto SV 13/13-23, BPM Auto, AHI avg <1

seeker of good sleep
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Re: help with oximetry report, please

Post by seeker of good sleep » Mon Oct 04, 2010 9:56 am

I am not sure this would apply to anyone else, but I have found that when I take a sleeping pill at bed time, my AHI goes from about 4 to about 15.

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stevealive
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Re: help with oximetry report, please

Post by stevealive » Mon Oct 04, 2010 7:22 pm

Thanks for everyone's comments. Seeker, I've considered the possible role of my sleeping pills (Trazadone, 75mg). I've dealt with insomnia for years, and have been on the pills for long stretches of time. When I was diagnosed with apnea, I began to wonder how much of the insomnia was due to apnea arousals, and my overall early-to-rise lifestyle as well, but its not that simple. Looking back I see lots of indicators that I have probably had apnea for 20 years or so--falling asleep behind the wheel, while having lunch, in the middle of conversations etc. I think the apnea predates the pills, but that doesn't mean they don't have an effect. When I started CPAP in June, I was already back on the pills, and they seemed a big help when I was getting used to the mask. Then I tried to cut the pills down and my sleep was cut in half very quickly, so I stopped. I've gotten off the pills in the past, and maybe I'll have to try to do it again. I much prefer to be off of them.
So here's the latest interchange with the nurse from my sleep center. She's suggesting I add supplemental oxygen, not because my levels are low, but because it might help with my centrals. I'm not eager to go that way, as I'm pretty well aimed at an ASV trial. Being as tactful as I could be, I asked about the possibility of another sleep study with an ASV. She said I would qualify for one, and she would suggest it to the head doctor, along with her thought for the oxygen. I even had the thought to ask if their sleep techs were experienced with the ASV machine, and she said they were. So I have to wait until later in the week to hear a final decision. But at least I'm this far along! I couldn't have done it without the education and support of this forum. I'll let you all know....

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flash2

Re: help with oximetry report, please

Post by flash2 » Tue Oct 05, 2010 2:49 am

Trazadone is in a class of drugs that do affect apnea. My understanding is that ambien is the only sleep drug currently that does not affect the breathing.
good luck.

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stevealive
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Re: help with oximetry report, please

Post by stevealive » Tue Oct 05, 2010 6:23 am

Flash2, thanks for your comment. If the Trazadone is a known problem, I'd like to know. I took a quick look on the web, and found these two comments in different reports.
This one on SleepTalk : At the least, there has so far been no clinical indication of trazodone aggravating sleep apnea, and its widespread use indicates the likelihood that it has been used, at least inadvertently, in many depressed patients with unrecognized sleep apnea. Many psychiatrists have come to prefer trazodone to the conventional benzodiazepine sleeping pills (like temazepam/Restoril and triazolam/Halcion) for its apparently lower liability to tolerance and dependence and possibly stronger sleep-inducing effects.
This one on eMed: (Trazadone) has an advantage over traditional hypnotics in that it does not depress respiration, an attribute that could be relevant in patients with sleep apnea.
If you know specific information on Trazadone relating to apnea, I'd like to see it. I've tried Ambien and most of the other common sleep drugs, and they weren't very effective for me. Thanks for the help.

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