Questions about overnight pulse oxymetry results.

[lee_leses]

Hello All:

So, before my questions, a few bits of information first.

1) I've been on CPAP for about 6 years. I use it every night.
2) When I sleep more than 5-6 hours, I feel a lot sicker in the short run (groggy and no energy), but over the next few days the extra sleep helps me a lot. Example, if I sleep 10-12 hours on Friday night in to Saturday, I often feel horrible all day saturday, but then Monday to Wednesday when I sleep 5-6 hours a night, I feel a lot better than if I had not gotten the extra sleep on the weekend.
3) I've tried to adjust to a full mask, so far no luck, I just lay there all night unable to fall asleep with the d--- thing on. I'm using the Breeze nasal pillow headgear, which I can tolerate well. I tried taping my mouth thinking I was opening my mouth too much, and taping did not seem to make me feel any better.
4) I have a LOT of trouble tolerating the sleep studies. My main problem sleeping is I wake up every 1-2 hours, and try waking up with all those wires on all night long! It's NO fun.

So, I met a sleep therapist who was running a sleep seminar for other sleep therapists (or whatever you call them, maybe they're techs? I forget.) He told me to try a few nights of overnight pulse oxymetry, he said they've found it's a good option for people who have trouble tolerating a full study. So I did that on a Friday and Saturday night, and one night I had 4-5 episodes where I was as low as 89%, the other night 4-5 episodes where I was as low as 91%. So I sent the results to my doctor, asking him if I could try sleeping on CPAP with extra O2 just to see if it made a difference, understanding that long term maybe I need to have another study and maybe find a different interface that works for me. Well the doctor came back with, you have to go for another study. Also, does someone know if that's significantly low O2, 89% and 91%, and could that be what wakes me up all night long that my O2 and CPAP therapy in general is not where it needs to be?

Any thoughts would be really appreciated!

Lee

[Julie]

Hi, first of all, your oximeter results are in the normal range, and 02 wouldn't necessarily be the answer even if they weren't. Second, has it occurred to you that you feel better a couple of nights after a long sleep because you're now sleeping fewer hours, rather than assuming the long sleep was responsible? Sleeping longer than you actually need to is not necessarily a good thing, and there are many factors to consider, like ... are you drinking coffee at any time of day prior to sleeping... how much and when? Same question re alcohol and a similar question about strenuous exercise (not a good idea before bed). What meds do you routinely take, if any?

As far as not sleeping with the mask, and/or a FF one, have you tried getting acclimated by wearing just the mask while e.g. watching TV or reading, so that you stop being so aware of it? How comfortable is it and how many other (FF) masks have you actually tried?

There's a lot to take into account sometimes, so don't assume anything about equipment or yourself til you've actually looked into it all some more... good luck.

[Arizona-Willie]

From what I understand, normal O2 is 95%.

Down to 89% is not real good. The question is --- how long were you down there?

If just a minute .. no big deal probably.

If 10 minutes then it would be time to be worried I think.

Most nights I don't get below 90 for very long, but when I do daytime tests, especially when I'm having daytime sleepiness I often get down in the mid 80's.
And when I fall asleep when I wake up my face and hands tingle --- pretty sure it because of low O2.
I'm going to have to see the doc and see about oxygen myself. Just been too lazy to do it.

[rhuszar]

I was preliminarily diagnosed with sleep apnea when in the hospital for pneumonia and every time I feel asleep my O2 stats would drop to the low 70's or less.

During my titration study without oxygen using BiPAP I still drooped into the low 70's. I suffer from COPD and have been on oxygen 24/7 for over 3 1/2 years. After the sleep study oxygen bleed in was included in my BiPAP prescription.

I have read of people who do use oxygen at night only but they would still need to meet the minimum requirements.

Your low reading of 89 while it is at the lower end it's still in the normal level. From what I've been told it needs to be 88 or less before insurance and such will cover the cost of oxygen for the most part.

I'd recommend you discussing your O2 levels with your doctor but I don't think it's causing your problems. Different people require different amounts of sleep. While 7 to 8 hours is what most people need that doesn't mean the 6 or 7 hours is what you function better on.

As Julie stated there are other factors that could cause your symptoms.

[jnk]

Here is another attempt to say all the same things that have just been said above by others:

In my opinion as a patient, I would not compare how rested I felt after a certain amount of sleep until I was SURE I was using the right amount of pressure and keeping my leaks within reason, since only then could I know for sure that I was getting effective PAP therapy, not just PAP therapy. There is a big difference between the two.

For example, if my pressure was not sufficient to keep my airway open in supine REM, then the nights I had a lot of supine REM (which would tend to happen for me on the nights I slept longer, if my sleep hygiene was messed up), I would tend to feel terrible from all the breathing difficulties that night. I would be exhausted from the hormones that my body had used the night before to panic me awake. But then the nights that I had very little supine REM (which would likely be the nights I slept less than usual, if my sleep hygiene was messed up), I might feel better because of having had fewer bad-breathing events. That is only one example of many in which another factor, beyond simple amount of time asleep, can affect how we feel in the mornings.

How a person feels in the morning can also have a lot to do with what stage of sleep he happens to wake up in, as well. That is why good sleep hygiene, especially waking up at the same time every morning, can be particularly important for anyone with any sleep problem and even moreso for someone with sleep-breathing problems. Your brain needs to plan out (in a sense) its REM timings based on your sleep habits. Getting close to the same amount every night and waking up at the same time every morning can be as important for some of us as having the optimal pressure, as far as feeling rested in the mornings.

Keeping a sleep diary can be as informative for some as keeping track of machine-reported AHI. It is the combination of EFFECTIVE PAP therapy AND good SLEEP HYGIENE that gives us the best chance of feeling our best during the day. Take away either one, and we won't feel our best.

So what I would do would be to track my leak and home-machine-reported AHI to make sure my pressure was sufficient and my therapy was as successful as possible. Then I would start working on my sleep hygiene, especially waking up at the same time every morning for a while and getting the same amount of sleep every night. Perhaps "titrating" for yourself exactly how much time in bed that you need and then getting that amount every night will help you as much as titrating the right pressure for you.

Just some thoughts to consider from a fellow patient.

Oh, and as I understand it, for most of us with OSA and OSA alone, therapy has to get pretty bad before that is reflected in our sustained O2 numbers (which is what home pulse-oximeters are designed to track). If we keep home-machine-reported AHI as low as possible, O2 will take care of itself as a general rule--unless, as has been said, we are dealing with something beyond simple OSA.