Measuring oxygen overnight as a correlate to OSA?

[Jade]

I'm currently considering whether to seek out a new sleep dr and pursue making PAP treatment work.

Given that I may have UARS rather than severe OSA (about 70 AHI but only hypops, based on only 1 study), and
Given that I found using cpap for several months (on 2 separate occasions) to induce a gradual but eventually unsupportable decrease my level of daytime functioning...

What's your opinion about whether or how accurately a recording pulse ox can indicate the presence of something that actually needs to be treated? Would you trust that not having low desat's, coupled with a sense of rested sleep and overall well-being for the most part, makes my situation less dire than it might be?

[edited to correct some grammar]

[Lizistired]

....Would you trust that not having low desat's, coupled with a sense of rested sleep and overall well-being for the most part, makes my situation less dire than it might be?

I would discuss it with a sleep doctor, but If I felt better without the machine and my O2 was good, I would park my machine. My recording oximeter is why I use my apap.

[Mary Z]

I have moderate OSA and my O2 sats rarely went below 90% and were usally 95% or better. I would not consider the lack of desaturations as a reason the "park" the machine. Your hypopneas need to be treated. Good luck.

[Lizistired]

The key is feeling more rested than with the machine.

[rested gal]

I would discuss it with a sleep doctor

Good idea.

The key is feeling more rested than with the machine.

That might very well be true for the original poster, but a problem with going by that (for many other people) ... there are many people who absolutely do need to use CPAP but who, for reasons largely to do with sleep disturbances due to equipment issues (mainly the mask) feel worse when using CPAP than they did "before CPAP." If they went by a comparison of how rested they felt before/after CPAP, they could very well give up in a short time. Before they had worked out ways to make using CPAP and a mask comfortable enough to actually be able to "sleep."

Using CPAP can involve a trade-off. Trading off the sleep disturbances caused by apneas (hypopneas in the case of the OP) that the person might not even be aware of, for sleep disturbances caused by the therapy itself. Sleep disruptions caused by the equipment can easily leave a person feeling sleepier and more worn out than before.

All that said (mainly for the benefit of newly diagnosed people just now starting -- "I feel worse on CPAP than before!") there are people who have given it every effort, have tried multiple masks, have gotten their CPAP sleeping environment optimized, and still feel worse. But before I set the machine in a closet, I'd do what you said in the first quote, Liz. I'd try to find out what a very good, sensible sleep doctor had to say about the pros/cons of stopping treatment, given what the OP has said about her observations...and what the sleep study showed.

[Jade]

I have moderate OSA and my O2 sats rarely went below 90% and were usally 95% or better. I would not consider the lack of desaturations as a reason the "park" the machine. Your hypopneas need to be treated. Good luck.

Ah, but do you have symptoms when you're not using the machine?

[Jade]

I would discuss it with a sleep doctor

Good idea.

I don't have a sleep doctor at the moment. Finding a new one just to ask this question might be opening a can of worms, if you know what I mean.

Looking forward to other's input as well...

[jskinner]

Given that I may have UARS rather than severe OSA (about 70 AHI but only hypops, based on only 1 study), and
Given that I found using cpap for several months (on 2 separate occasions) to induce a gradual but eventually unsupportable decrease my level of daytime functioning... What's your opinion about whether or how accurately a recording pulse ox can indicate the presence of something that actually needs to be treated? Would you trust that not having low desat's, coupled with a sense of rested sleep and overall well-being for the most part, makes my situation less dire than it might be?

If your having mostly hypopneas then its unlikely that you will be having oxygen desats along with them. If your problem is mostly UARS then I would recommend trying a dental device rather than CPAP. As you have discovered CPAP can sometimes cause sleep disturbances itself. People with UARS tend to have sensitive nervous systems and CPAP can just be intolerable. In my experience dental devices are quite effective (but not as good as CPAP) and much easier to tolerate. I have used the Klearway device myself since 2009. http://www.klearway.com/ There are newer dental devices now that allow you to open your mouth that would be even more comfortable.

I would recommend buying a Zeo sleep stage monitor so that you can actually monitor your sleep architecture each night. That way you will have a much better idea what is going on sleep wise and help adjust your therapy. http://myzeo.com

[Jade]

jskinner, good point about UARS and desats! The really funny thing is that cpap wasn't intolerable. I actually didn't mind the setup. The mask fit comfortably and didn't leak. The air blowing was like being outside in a breeze. It was kinda peaceful. Though my log of those times indicates I probably woke up a bit more often, it wasn't such a change that I would have expected my body's reaction. I've had a couple periods

Now, a dental appliance would probably bring out all kinds of tolerance sensitivities. What can I say, I'm an odd duck.

rested gal, I just saw your additions to your post. I think my former sleep doc was good and sensible. And the pros/cons discussion we had was fairly inconclusive. There's not really any objective measures to say whether or to what degree the hypops are doing bad things to my body. And my subjective sense of things tells me I feel better for the most part without it than with. So she said the only reason to continue would be to bet on the numbers (which aren't really as compelling as it seems most people think), or just hope the bad would bottom out and get better, or to tweak things on my own (no changes warranted based on her interp. of the sleep studies).

It's probably not a bad idea to try and hunt up a good sleep dr for a 2nd opinion... I'd love to know how to tell who a good one is before making an appt.

[Muse-Inc]

If your having mostly hypopneas then its unlikely that you will be having oxygen desats along with them....

Uh, in my PSG, I only had hypops and ended up with an AHI of 62 and desats to 83%. That drove my life-long low blood pressure to 215/110 with accompanying blood test results that no one could make sense of. Hypops are serious and do need treatment. Might be convenient, might be wide-spread to assume they aren't serious but they are.

I'm getting a recording pulse-ox to get my baseline data using xPAP and then to check when anomalies occur; I never intend for my health to be the reflection of a single doctor's opinion ever again, that's just too much like gamblling in my book -- my docs are my medical consultants, best I can afford, but I have to make decisions and commit to change. Borrowed one of our local forum meetup group pulse-oxs while mine's in shipment to see if my recent episodes of increased pulse are accompanied with desats -- thank goodness not or I'd have been in my sleep doc's office last Monday morning first thing with the results of 2 nights of sleep Now I just think it's just the effective of forgetting several afternoon's doses of magnesium citrate as they're disappearing now that I'm back to my previous intake.

UARS and SDB and OSA are so closely tangled, it's hard to ascertain what to try to improve health and the bottom line is improved health. As I've said before, I thank God for this forum and the helpful suggestions from our community...I hope the OP is helped as much as I've been!

[Guest]

If your having mostly hypopneas then its unlikely that you will be having oxygen desats along with them.

I would disagree with this.

An unfortunate myth has sprung up on this board, that somehow hypopneas are not as bad as apneas, and that sometimes they can be ignored. It's too bad respected members of this forum have said things that have led many people astray. Hypopneas cannot be discounted. Without knowing details about the event(s) in question, it is never appropriate to draw a conclusion about what harm that event may or may not be doing.

[SleepingUgly]

Given that I may have UARS rather than severe OSA (about 70 AHI but only hypops, based on only 1 study)

There are a couple of threads running concurrently in which people seem to believe that hypopneas = UARS and not OSA (Personally when I think of UARS, I think of RERAs and FLs. When I think of OSA, I think of OAs and Hypopneas.) I guess the confusion may be due to the differences between the AASM Recommended and the AASM Alternative scoring criteria for hypopneas. If a lab requires the former, they won't score something as a hypopnea unless it's associated with a desaturation. So what are they going to do with all the hypopneas that are associated with arousals, but not desaturations? Probably relegate them to an RDI. That doesn't make it UARS. It just means they are using what in my opinion is a too-conservative definition of hypopnea.

See this article:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635578/

What's your opinion about whether or how accurately a recording pulse ox can indicate the presence of something that actually needs to be treated?

Desaturations indicate something needs to be treated; however, the absence of desaturations doesn't mean there's nothing that needs to be treated.

Would you trust that not having low desat's, coupled with a sense of rested sleep and overall well-being for the most part, makes my situation less dire than it might be?

I like the word "dire" in there... I think we know less about the serious risks associated with SDB associated with only arousals, and no desaturations than about the cardiovascular risks associated with desaturating. Dr. Guilleminault pointed out that snoring, along with other variables, may cause sensory nerve damage that leads to the progression to OSA. But IMO, you already have OSA, and I don't know if the research has been done to suggest whether people who already have OSA worsen when they continue to snore untreated.

Would you trust that...

I think you DON'T trust that, or we wouldn't be having this conversation. That said, I don't blame you for not wanting to do CPAP when you feel worse on it. My motivation to do it is that I feel badly on it. Still, if I weren't going to do it, I would go see a leading expert and get their opinion on whether I was doing untoward harm to myself by not treating it. And actually, I would investigate a dental device. But that's just me.

[jskinner]

An unfortunate myth has sprung up on this board, that somehow hypopneas are not as bad as apneas, and that sometimes they can be ignored. It's too bad respected members of this forum have said things that have led many people astray. Hypopneas cannot be discounted.

I didn't say hypopneas where not bad. The majority of my events where hypopneas (AHI 55) so I know all to well how bad they are. All I was trying to say was that apneas are more likely than hypopneas to cause desats. Sorry.

[dwynne]

What's your opinion about whether or how accurately a recording pulse ox can indicate the presence of something that actually needs to be treated? Would you trust that not having low desat's, coupled with a sense of rested sleep and overall well-being for the most part, makes my situation less dire than it might be?

My recording oximeter was less than $100 delivered from Amazon and seems to work well. A couple of times I didn't have it on my finger quite right and hosed the results, but the rest of the time it works fine. During part 1 of my sleep study I was severely desaturated but during part 2 (on CPAP) I still was. This prompted me to spend the money to monitor my O2 levels myself. I am on supplemental O2 and a Bilevel PAP and feel a lot better (my study AHI was 171.1 so anything would be an improvement).

I would think a cheap recording oximeter should be used by anyone with sleep breathing problems "just in case". One DME would rent me a "real"one for $75 but the insurance would not it so I purchased my cheap model myself (also not covered).

[Guest]

All I was trying to say was that apneas are more likely than hypopneas to cause desats.

I guess we'll just have to agree to disagree. There's a reason why hypopneas are defined the way they are--hint: they begin to cause problems at the level of definition. Most people generally cannot be deprived of 50% of the oxygen they should be getting and not start to suffer.

Sorry.

Not a problem. We just disagree.