New - Help with SpO2 graphs Please

[Rise]

First, thanks to all for the wealth of information on this forum, and thanks for reading.

Struggling with non-restorative sleep and 'brain fog'. The ENT says I have a deviated septum and enlarged turbinates. Suggested surgery is not high on my Christmas. I'll do it if necessary but want to fully understand the landscape before making any major decisions.

I'm 6'1", 170 lbs, so not overweight. Snore only intermittently. Spouse hasn't noted any complete sessation of breathing.

I'm on a high-deductible health plan and would pretty much be paying for a sleep study out of pocket so I figured I'd start at home with an oximeter (CMS50F).

Last night falling asleep. Conscious of a pattern of shallow breathing (with some annoying nose whistling) then taking a deep breath. Believe I was mostly awake for this but not sure.


Early this morning. No recall of this time other than my wife's alarm going off around 5:40



Not sure what happened at 6:48 - deep sleep?? (The data continues 'normally' shortly after this frame)

This is this morning sitting quietly at the computer reading. Didn't fall asleep but I'm pretty tired today and was getting pretty relaxed/sleepy toward the end.


I know these are not "serious" desats but it doesn't look "good" either.

Need help escaping the 'fog' - any feedback on interpreting the graphs and/or recommended search terms for study, etc. is very much appreciated.

Thank you

[Pugsy]

This is one of those situations where the pulse ox data doesn't scream out
"warning significant ...O2 drops possible OSA...please fix me".

Since you still have some sort of possible sleep disordered breathing symptoms it is hard to offer much more than the standard responses. Not everyone will have significant desats with sleep apnea events...not everyone has sleep apnea when they complain of symptoms that are common with sleep apnea.

Do you take any meds (even OTC) on a regular basis that might contribute to your symptoms? I mean look at all possible side effects....my sister recently changed her blood pressure medicine and notice an immediate improvement. Gotta look deep though.
Looked in deep and hard at anything that could contribute to poor quality sleep? Hours of sleep? Fragmented sleep? Insomnia? Pain? Bed comfort? General health issues? You get the idea....anything that might impact the quality of sleep or how we might feel during the day.

You know that the best thing to do is be evaluated by a physician. I know it is much easier to justify meeting that high deductible with a sleep study if your pulse ox report screamed out "low O2" but it doesn't.
Have you researched UARS? Upper Airway Resistance Syndrome....you might look at it.
The absence of significant drops in oxygen levels doesn't mean that sleep apnea isn't the problem though.

If you are wanting to avoid the high deductible there are ways to continue to try to self diagnose but they come with the disclaimer that says that there are things in a sleep study that are evaluated by a sleep tech that self diagnosing stuff just can't evaluate. In other words you might not still have an answer.

If it were me...I would first take a real hard look at meds and any external sleep quality issues and general health issues...that doesn't cost anything and needs to be done anyway.
Depending on how high the deductible is and how comfortable I felt with continuing to self diagnose I might go the "buy a full data machine" on my own and see what it shows and if it didn't show anything and didn't seem to help...then I for sure would bite the bullet and try to get professional help.

People like to blame all their unwanted symptoms on sleep apnea and sometimes sleep apnea is responsible but not always.
If it were that simple then people would wake up feeling like running a marathon pretty much from the beginning of therapy but it simply is that that easy or clear cut.

[greatunclebill]

you do know you can get all of that in one graph by pressing the m button and choosing the all data button or whatever it says? writing this justin case you don't.

[Rise]

This is one of those situations where the pulse ox data doesn't scream out
"warning significant ...O2 drops possible OSA...please fix me".

Since you still have some sort of possible sleep disordered breathing symptoms it is hard to offer much more than the standard responses.

Consistent with expectations, but it helps to have them confirmed. Thank you.

Do you take any meds (even OTC) on a regular basis that might contribute to your symptoms?

No medications at all. Nasal saline am and pm to help keep the mucus flowing, but that's been a significant improvement.

Looked in deep and hard at anything that could contribute to poor quality sleep? Hours of sleep? Fragmented sleep? Insomnia? Pain? Bed comfort? General health issues?

Could improve quantity but even days that have ample quantity seem to want seriously for quality. Believe fragmentation is a problem. Inquiry here is based in looking for cause. No insomia. Very light sleeper. Significant delay getting to sleep with zeo and pulseox but normally asleep in minutes (or less). No chronic pain issues. Have a good bed that's only a few years old. Generally in good health.

You know that the best thing to do is be evaluated by a physician. I know it is much easier to justify meeting that high deductible with a sleep study if your pulse ox report screamed out "low O2" but it doesn't.

Started at GP, then ENT. Got referal for sleep study but it's hundreds just to talk to them about it then thousands for the actual study. Haven't ruled it out but reticent to spend without substantial justification (or well set to pay).

Have you researched UARS? Upper Airway Resistance Syndrome....you might look at it.

I will look into that - thank you.

Depending on how high the deductible is and how comfortable I felt with continuing to self diagnose I might go the "buy a full data machine" on my own and see what it shows and if it didn't show anything and didn't seem to help...then I for sure would bite the bullet and try to get professional help.

My understanding is that would need to be sourced from a private party (e.g. Craig's list, etc)?

I don't belive I'm apneic, not in the acutally stop breathing sense, but as you noted I seem to have some issues. Would xPAP be expected to help if the issue is shallow breathing or nasal restriction?

The sawtooth SpO2 pattern looked suspiscious to me, and while the levels are not "screaming" low from what I've read they don't seem "good" either. But I'm not really qualified to judge, hence the inquiry with this community.

Likewise what is cause, what is effect, and what is orthogonal is always an interesting question and easily confused.

you do know you can get all of that in one graph by pressing the m button and choosing the all data button or whatever it says? writing this justin case you don't.

Actually I did not know that, thank you.

Thank you very much for your feedback.

Any additional feedback is most welcome, and if there is anything I can or should clarify or add, just let me know and I will update accordingly.

[Slartybartfast]

For what it's worth, I don't see any desaturations typical of sleep apnea there. Your numbers are all well above 90%, and trend within a fairly narrow range. One of the characteristics of REM sleep is disordered breathing. The CMS 50-series has a rather slow sampling rate, so the data as presented spikes spike up and down. What is likely happening is that your SPO2 is trending up and down gradually, not spiking. And the plateau you remarked on might have been caused by your moving in your sleep. Insufficient signal to get a good read, so the software simply connected the dots as best as it could. Without spending a night in a real sleep lab, or at least having one of the take-home sleep studies that some folks have reported about on this forum, it's hard to say whether you have any apnea issues.

As Pugsy said, there are lots of other things that can be responsible for the fog; it's not always sleep apnea.

[Pugsy]

My understanding is that would need to be sourced from a private party (e.g. Craig's list, etc)?

Yes, it can be done and takes a good bit of education on your part. Not rocket science though and pretty easy to figure out.
I did it for my sister and her husband. Long story there and private message me for more details.

I don't belive I'm apneic, not in the acutally stop breathing sense, but as you noted I seem to have some issues. Would xPAP be expected to help if the issue is shallow breathing or nasal restriction?

We don't have to totally stop breathing to have sleep apnea...just a continued low level obstruction (hyponeas) could be enough to cause symptoms.
Would xpap help if strictly problems related to the deviated septum or turbinate restriction? Unknown really.
If there is a low level collapse of the airway problem that is below the nasal cavity and should help.
I don't think that xpap pressure would be a solution if the problems were strictly from the nasal area restrictions. I suppose that direct air via nasal pillows might blow by some of the restriction and maybe make a person more comfortable breathing..that is a big maybe...as in maybe getting more air and thus maybe better sleep in general.

Fragmented sleep is a big factor in quality of sleep and thus how we feel the next day because each awakening tends to make the body start all over in the sleep cycle and we need the normal sleep cycle times in each stage to have the best chance of feeling better the next day. Problem is...figuring out what is causing the fragmented sleep and fixing it. Sometimes there just isn't any clear cut thing to try to fix...even then no guarantee that the fix (if found) will help but hey, we gotta try something...

I will mention Vitamin D levels which is something not often tested for...low vitamin D levels can cause sleep apnea fatigue, foggy symptoms. Thyroid issues are commonly thought of and tested for but not vitamin D.
For males...testosterone levels.
Isolating symptoms is also needed...fatigue vs sleepiness...2 different animals...brain fog could be associated with both.

You know it might be that the nasal restrictions themselves are contributing to poor sleep. I understand your reluctance to go under the knife though.
Your situation isn't clear cut...lots of maybes which makes all this doubly hard because often it is difficult to resolve symptoms even when we know for sure what the cause is.
Lots of detective work is involved.

BTW read up on hyponeas and obstructive apneas...hyponeas can be just as disruptive to sleep...especially if you have enough of them. We don't totally stop breathing with them...just have minor reductions in air flow.

[Rise]

I take a couple Vitamin D mornings. Perhaps I should up the dose. Thought about low-T but haven't been tested. From what (limited) I've read unless you're going on HRT there's not much they can do and I'm equally reticent to commit to a life-long regime of HRT, though perhaps that's a rock I should look under as well.

As far as fatigue vs sleepiness, that's a tough call. Pick a day and I'll pick a response. Most days it's not bad. I'm 'Ok', but it's clear that I'm 'off' as well.

Fragmented sleep is a big factor in quality of sleep and thus how we feel the next day because each awakening tends to make the body start all over in the sleep cycle and we need the normal sleep cycle times in each stage to have the best chance of feeling better the next day. Problem is...figuring out what is causing the fragmented sleep and fixing it. Sometimes there just isn't any clear cut thing to try to fix...even then no guarantee that the fix (if found) will help but hey, we gotta try something...

You know it might be that the nasal restrictions themselves are contributing to poor sleep. I understand your reluctance to go under the knife though.
Your situation isn't clear cut...lots of maybes which makes all this doubly hard because often it is difficult to resolve symptoms even when we know for sure what the cause is.
Lots of detective work is involved.

That's pretty much where I'm at...

I will continue reading.

Thank you both