Can an Oximeter replace CPAP?

[Julie]

One last word if Too Tall is still reading, if not responding... The people (like e.g. Black Spinner) who more recently responded to you may sound rude or impatient, but I understand their point of view. They feel frustrated at your lack of acknowledgment re liners - they are the gold standard of help for your problems yet you have ignored (from what we can see) their advice. It is not expensive to try them out and they will solve your facial problems if nothing else. Frustration can lead to anxiety and lack of politeness when trying to be helpful... certainly being 'nicer' would be desirable, but if you want help, forget nice just for the moment and listen to what they're trying to get across to you - to solve your problems.

[Sludge]

Or try this:

http://www.irollover.com/?option=com_vi ... Itemid=106

[Too tall]

I got flamed pretty good for asking this question but I tried it anyway and it actually works pretty well. I bought a Nonin 2500A, the one with an Alarm from Turner for $575 and the Profox software for the Nonin oximeters. About a grand investment. I got the sensor that slips over the finger as opposed to clamping down on it. It's a really quality setup and I've learned so much from sleeping with and without the CPAP. I set the Alarm usually around 90 to 92 and if it goes off I roll over on my side or whatever to get my O2 headed back up. As I mentioned in a previous post, I had AFIB and had an ablation performed. Sleeping on my side, I don't need the CPAP as my O2 runs around 96 to 98. It's just when I try to get in the supine position is where I have problems.

I've been able to give my face a break and heal from the face mask and the nasal pillow is working well for me. The Cardiologist says, he's not worried about sleep apnea till you get up to 15 AHI, I'm an 8.1. The Sleep doctor told me if I could tolerate the cpap, he wasn't concerned. But I'm determined to use it as I want to get as much air as I can.

The question I have now, is it seems like 88 to 90 is the accepted O2 lower limit. My question is, how long can one stay at 88 to 90 without any worries. When my alarm goes off, I'm usually less than 30 seconds at 90 before I'm back above 92. I know I'll get a few flames again but that's ok. My experiments have shown me that some of these self professed experts like Black Spinner, had rather bully people than try to work with them.

The Oximeter is such a valuable tool and along with sleepy head, you can really see what's going on when you're sleeping. I just have so many things I'd like to learn about. It's a fascinating study. I've found that I'm pretty much 100% apnea free when on laying on either side but I can go the entire night like that as I need to sleep on my back for a while. The neat thing about having the oximeter with an alarm is I can experiment without worrying about getting into a dangerous desaturation level. My next question to the cardiologist is, how long is an acceptable time to be at 90 or so. Is 30 secs insignificant? Don't know. I'm speaking strickly of how it relates to my previous AFIB. Not sure anyone, even the experts can answer that question as it seems, there is no hard data that says Apnea causes AFIB.

Another thing I'd like to know is if there's any way to correlate or convert Oximetry data to AHI. There's some intesting reading on the internet on this subject.

[BlackSpinner]

My experiments have shown me that some of these self professed experts like Black Spinner, had rather bully people than try to work with them

It is called refusing to watch people screw them selves into the ground or drowning themselves in the river of denial. Your doctors have thrown up their hands and basically said "Whatever dude" they have more interesting patients to deal with. Enjoy your deterioration health and finish your bucket list. Sleep deprivation and low O2 has done a number on your brain so be quick because with every single event your heart gets stressed and your system floods with stress hormones damaging it more.

[Pugsy]

I don't know how long a person can go at 88% saturation but for Medicare to pay for additional O2 it has to be a substantial length of time during the day or night or extenuating circumstances.....

Best discuss this with your doctor...there may be other factors involved that would maybe create extenuating circumstances.
Also remember, we don't go from 98% to 90% in the blink of an eye...the desat happens slowly and goes up a bit slowly. So there is more time involved that we don't see with a 30 second desat that is spent at say 89%

[Too tall]

I don't know how long a person can go at 88% saturation but for Medicare to pay for additional O2 it has to be a substantial length of time during the day or night or extenuating circumstances.....

Best discuss this with your doctor...there may be other factors involved that would maybe create extenuating circumstances.
Also remember, we don't go from 98% to 90% in the blink of an eye...the desat happens slowly and goes up a bit slowly. So there is more time involved that we don't see with a 30 second desat that is spent at say 89%

Agree, and I'm taking the conservative route even though my sleep doctor and Cardiologist Electrophysiologist say my apnea is not a problem with my heart. What's interesting is, I actually stay in desaturation longer when on the CPAP. The pulse oximeter has a 4 second recorder so i'm seeing within 4 seconds of how long I'm in desaturation. The reason is because the oximeter alarm goes off and I can address it faster than with the cpap only because I have no clue as to what's going on with just the cpap. Needless to say, I'm not going to go against my doctor's advise. I'm actually more conservative as I said.

I certainly have a lot to learn but one misunderstanding some folks have is that because you have an 8 AHI, that means the alarm goes off 8 times an hour. O2 desat and AHI are two different things. From the few test I've run without the CPAP, the alarm only went off 1 or 2 times during the night max when set at 90%. By the time I flip onto my side, it's typically not more than about 30 seconds.

Don't get me wrong, this is certainly not the way I want to spend every night, just hoping to make conversation on the relationship between O2 and AHI and I appreciate your feedback.

[zoocrewphoto]

I certainly have a lot to learn but one misunderstanding some folks have is that because you have an 8 AHI, that means the alarm goes off 8 times an hour. O2 desat and AHI are two different things. From the few test I've run without the CPAP, the alarm only went off 1 or 2 times during the night max when set at 90%. By the time I flip onto my side, it's typically not more than about 30 seconds.

Not every event has a desat. That means that those events will go for awhile, and then your brain relases adrenaline, you start breathing again, and repeat. So, while your oxymeter only wakes you up once or twice an hour, you are probably still having mini arousals, and that will eventually damage your organs like your heart. I have an ultrasound of my heart wit no visible damage. But my high blood pressure has been constant for years due to sleep apnea. Had I started treated this 10 years ago, it never would have gotten this bad.

Honestly, I wouldn't trust my health to something that wakes me up and counts on me to stop the events. The whole point of cpap is to *prevent* the events.

Keep in mind that sleep apnea is known as the death of a thousand cuts. Each single event is not dangerous. A single night is not dangerous. But add them up over the years, and they are very dangerous.

Also, I really doubt medicare and insurance would pay for so many machines between 5 and 15 ahi if they didn't consider it a long term savings by treating it before it gets bad. And most people do get worse over time. I didn't always snore. I'm sure my sleep apnea first started, I wasn't anywhere near the severity I am now.

[Lukie]

One question to ask is why are you desaturating? Is it totally related to apneas? Probably the only way to know is to get an overnight recording oximeter and check your desaturations against the times of your apneas on your sleepyhead software. I have a similar problem. I have very mild sleep apnea and desaturate to low enough numbers to qualify for O2 at night. The problems with O2 at night if you are having apneas the O2 can't get to where it is supposed to go. So fortunately for me CPAP has lowered my apneas and my 02 sats went from 85 to 90 median. Now CPAP has raised my O2 sats I no longer qualify for O2 which is fine with me.
Getting an O2 monitor to wake you up every time you desaturate would give you very fragmented sleep and your heart issues would not be helped. Giving CPAP a long trial could be beneficial with A-Fib. Finding the right mask that doesn't do things to your face is a trial and error process that you and your provider must keep at until you are comfortable. Mask Liners like Remzees or Pad a cheek can help. Cloth masks like the weaver might be an option. It is frustrating and takes a long time but worthwhile.
I don't have A-Fib yet but I have apnea related heart issues that are pretty serious. I hope you can sit down with your doctor and do a lot of research and come up with solutions that work for you. It is a long learning curve. I had sores from a full faced mask and now use a nasal mask with a chin strap. This solution seems to be working for me. I take some meds to slow my heart down.
Hopefully with a few years of good sleep and more Oxygen these things will straighten out but we are getting older so things don't go on forever.

[Lukie]

Did your cardiologist explain to you that when you have an apnea or ceasing of breathing that your heart sends signals that it needs air to your adrenals and your adrenals pump out tons of fight or flight chemicals like adrenaline to wake you up. So if you are stopping breathing 8 times an hour, you are getting toxic loads of these chemicals which cause your heart to have its arrythmias. Getting a oximeter will not stop the release of these chemicals because by the time the beeper goes off the chemicals from not breathing will have already been sent into your blood stream. So either CPAP or some kind of oxygen delivery is necessary. Do you understand the mechanism? I notice you have been compliant. Is it getting any better?

[Too tall]

One question to ask is why are you desaturating? Is it totally related to apneas? Probably the only way to know is to get an overnight recording oximeter and check your desaturations against the times of your apneas on your sleepyhead software. I have a similar problem. I have very mild sleep apnea and desaturate to low enough numbers to qualify for O2 at night. The problems with O2 at night if you are having apneas the O2 can't get to where it is supposed to go. So fortunately for me CPAP has lowered my apneas and my 02 sats went from 85 to 90 median. Now CPAP has raised my O2 sats I no longer qualify for O2 which is fine with me.
Getting an O2 monitor to wake you up every time you desaturate would give you very fragmented sleep and your heart issues would not be helped. Giving CPAP a long trial could be beneficial with A-Fib. Finding the right mask that doesn't do things to your face is a trial and error process that you and your provider must keep at until you are comfortable. Mask Liners like Remzees or Pad a cheek can help. Cloth masks like the weaver might be an option. It is frustrating and takes a long time but worthwhile.
I don't have A-Fib yet but I have apnea related heart issues that are pretty serious. I hope you can sit down with your doctor and do a lot of research and come up with solutions that work for you. It is a long learning curve. I had sores from a full faced mask and now use a nasal mask with a chin strap. This solution seems to be working for me. I take some meds to slow my heart down.
Hopefully with a few years of good sleep and more Oxygen these things will straighten out but we are getting older so things don't go on forever.

.

Good points, thanks. After 4 mask they gave me the nasal pillow which is working just fine. It seems to be less invasive than the others. I did exactly what you recommended with sleepy head and looking at the oximeter at that time but haven't had time to correlate it yet. the most important thing is the pap is working pretty well but I do have some high ahi periods that I haven't figured out yet. It looks like air leaks, the p,isle o2 doesn't seem to change during that period of time. But since I started on the cpap on oct 23' 2013' my ahi is averaging 2.2. The sleep folks say that's fine. I could get it lower if ki could figure out the high ahi. Like 15 for an hour or so. I know it's not a good number but I don't know the terms well enough to troubleshoot the issue yet. I need to get a grasp on some of the terminology a little better. Another words, I'm an idiot.

[chunkyfrog]

Even with an AHI of 13, I was pretty close to jumping off a bridge; which is too close,
--living across the street from a tall enough overpass.
I never miss a night, even though it took me several months to learn how to do this "properly".
The masks are often the biggest obstacle--it took me 2 years and 20 masks.
Most people are not as odd-sized as the frog.

[Jim-Bob]

So with this added information above, can I pose the question again, is the concept of having an oximeter with an alarm set at a high level aid replace the need for the CPAP.

There is going to be a time lag between the start of the apnea and the oximeter alarm. If that time lag is in the neighborhood of 20 seconds or more, then it will be too late for prevention. If you already have an oximeter, play around with it and see how long it takes for the levels to drop appreciably after you begin to hold your breath. I'll bet the time lag is too long for this method to do what you want it to.

But definitely with an ahi of 8, you are likely a very good candidate for an oral appliance.

Beyond that, mask liners will prevent your skin from touching the mask. Some people make them out of old t-shirts.

Good luck to you.

[Lukie]

So now you are doing okay with the nasal pillows, but are still having some leaks and AHIs. Is air leaking from your lips in little puffs or bubbling or are the leaks coming from air leaking from your pillows. If you are opening your mouth and leaking air out of your mouth, that could cause you to have a run of apneas thus jacking up your AHI. In this case, a chinstrap might help. My favorites are the Ruby Red by care fusion and the ResMEd chin strap. Practice placing your tongue against your teeth and swallowing and then flattening your tongue against your teeth to make a seal. Also you could place a small hardish pillow or dog toy under your chin and hold it their by positioning your arms against it on your side. Sleeping on your side will reduce the number of obstructive apneas as well. It probably won't help with centrals though. What kind of Apneas predominate? Since you have a low AHI to begin with, it should be easier to bring your daily AHI to a pretty decent number.
What kind of oximeter are you using and how much was it. I am looking for one that records overnight. I have one that just gives you a reading but that is not good enough because if you desaturate in sleep, by the time you wake up the number has risen up to 97 or 98.

[Too tall]

Even with an AHI of 13, I was pretty close to jumping off a bridge; which is too close,
--living across the street from a tall enough overpass.
I never miss a night, even though it took me several months to learn how to do this "properly".
The masks are often the biggest obstacle--it took me 2 years and 20 masks.
Most people are not as odd-sized as the frog.

I don't know about that frog, those damn things don't fit well on a square head either. But as you, I will continue to pursue it. My wife says I'm crazy, but that's no news.

[Too tall]

Did your cardiologist explain to you that when you have an apnea or ceasing of breathing that your heart sends signals that it needs air to your adrenals and your adrenals pump out tons of fight or flight chemicals like adrenaline to wake you up. So if you are stopping breathing 8 times an hour, you are getting toxic loads of these chemicals which cause your heart to have its arrythmias. Getting a oximeter will not stop the release of these chemicals because by the time the beeper goes off the chemicals from not breathing will have already been sent into your blood stream. So either CPAP or some kind of oxygen delivery is necessary. Do you understand the mechanism? I notice you have been compliant. Is it getting any better?

I feel it's somewhat better as i've resigned myself to seeing this through whether I need it or not. The nasal pillow resolved the irritations where the conventional style mask were touching my face. My biggest problem is I'm not sleeping and falling asleep at work. The sleep efficiency showed a 10% drop when I did the follow up sleep test with the cpap. But, I assume I'll just have to deal with that.