Newbie asks how to monitor Sa02 while sleeping with CPAP?

[tedburnsIII]

Going to try SH in the meantime, but haven't a clue. Someone please give me a proper link. SH would, I guess, only be used for this pulse oximeter because SH not compatible with my xPAP machine, AFAIK.

Thanks!

Later: Starting to understand the software that came with the 50D Plus. I look forward to doing an overnight recording this evening. I am going to replace the batteries with newly charged ones, guess that I will lose previous data in doing so- no great loss as I messed up retrieving info from last night. Trial and error, live and learn.

Do be careful about battery orientation. It may throw things off if you assume things.

Suggest that any newbies to the 50D Plus or similar familiarize themselves with the software by doing a 10 minute or so 'Record On' awake test, something I should've done in the first place. In any event, I did one within the last hour and printed out findings. of which you can choose four.

I purposedly left record ON for about three minutes after I removed my finger from the device. I don't have a color printer, and I photographed the printed page.

IT IS IMPORTANT TO UNDERSTAND THAT IF YOU FOLLOW THE RED 'RECEIVING DATA PLEASE WAIT' that you have to take action and NOT WAIT. It will never happen unless you then activate the 50d Plus to UPLOAD to the program. Instructions how to do that are contained within the last two paragraphs on page 23 of the little user manual that comes with your 50D Plus device!!! You might tell that certain things were 'lost in translation', but once you understand it and do it, it will become simple to assure upload of your recent data to the software. Hope this helps someone, and recommend that you check out this useful page for help with the software: http://www.coopermedical.com/themes/def ... manual.pdf
.



This thing now seems kind of 'cool' for price paid. I look forward to the overnight monitoring.

This second test ended about 4:50 pm PDT today. I had the PO on for about 35 minutes- walked around, spoke to a friend in person, etc.

[tedburnsIII]

12cm from last night- 4 hours 20 minutes.

Please comment. Scroll down past first report for better depiction.

'

Subsequent better depiction:





Split- night study performed 1-21-2015:



Last night's CPAP readings:

[HoseCrusher]

Your Basal SPO2 sleeping is just a little below what it is while awake. No significant desaturations. Looks good.

The more important question is How do you feel?

[tedburnsIII]

Your Basal SPO2 sleeping is just a little below what it is while awake. No significant desaturations. Looks good.

The more important question is How do you feel?

On CPAP since 2/17/2015.

I apparently sleep longer at a lower setting than 12cm. I am just adapting to it for only a week or so.

I felt great this morning when I woke up at 6 a.m, but I do feel now at 10:30 a.m. that I may have to take a nap some time today because I only got about
3-4 hours sleep at 12cm last night.

You see, my AHI's are very good as low as 7-8 cm. The problem is low Sa02.

So, my last prescription was raised from 6-15cm to 9-15cm. Felt very good at that, even fantastic some days, but pressure average was about 9 to 10cm and not sure if my Sp02 was high enough at that average pressure. That was motivation to get the pulse oximeter and DO MY OWN titration study.

Do note that sleep tech and sleep specialist doctor (I later learned) had recommended starting pressure of 12cm. My cardio prescribed auto at 6-15cm, contrary to those recommendations. Wrong prescription, but that is debatable because of high dropout rate on CPAP. I can see why some doctors may hesistate to start a newbie on
12cm and choose to go auto. But 6-15 was too low a starting pressure for me.

My goal. which is without much doubt shared by many, (and accepting that 'feeling great' or 'feeling able to go out and slay some dragons' would be a given)- is to either go straight CPAP at the lowest pressure possible and have Sp02 above 90%, or go Auto at ideal setting.

I am now trying to decide what setting to test Sp02 tonight.

I am either going to set to Auto at 9-12cm or straight CPAP at 9cm. Which should I choose tonight? Comments welcome.

[HoseCrusher]

Fine tuning is always an interesting exercise. Keep in mind that the more data you have the better you are able to make a decision.

You may want to consider making changes once a week and collecting data to evaluate what is going on from week to week.

[tedburnsIII]

Thank you, hose-man. Appreciated.

Oh, and for those of you who are interested, I am very pleased and quite surprised this budget-minded overnight PO has worked so well! Once I got the software installation and operation issues handled, and saw last night's print-out, I noticed that the Sp02 throughout the night was consistent with the sleep lab's titration study for Sa02 while on CPAP at 12cm. Wow- interesting, seems accurate, and cool!

So far, I definitely RECOMMEND the (Contec) CMS50D+ aka the CMS50D Plus!!!

[Pugsy]

My thoughts about the "should I try 9 cm cpap or 9 to 12 apap" question.
If you had a machine that let you use traditional software so you could see what pressure the machine delivered when in APAP mode then I would suggest small apap range but if you can't tell exactly what pressure is being used then you have no way to know if your pulse ox reports are from using apap mode but the machine going to 11 or 12 for most of the night...or if it stayed at 9 for most of the night.
Even if there was limited data on the screen as to average pressure or 90% pressure it still has room for variables and you know with any experiment you want to eliminate as many variables as possible.

So if it were me and I was wanting to evaluate oxygen levels at various pressures I would stick with fixed pressures and do manual variations if needed. I wouldn't put the machine in auto adjusting mode if I couldn't see exactly what it was doing. If 9 cm allows desats lower than a person wants to see...then keep trying manual increases if needed but I would be controlling the increases so that I could better evaluate the results.

[tedburnsIII]

My thoughts about the "should I try 9 cm cpap or 9 to 12 apap" question.
If you had a machine that let you use traditional software so you could see what pressure the machine delivered when in APAP mode then I would suggest small apap range but if you can't tell exactly what pressure is being used then you have no way to know if your pulse ox reports are from using apap mode but the machine going to 11 or 12 for most of the night...or if it stayed at 9 for most of the night.
Even if there was limited data on the screen as to average pressure or 90% pressure it still has room for variables and you know with any experiment you want to eliminate as many variables as possible.

So if it were me and I was wanting to evaluate oxygen levels at various pressures I would stick with fixed pressures and do manual variations if needed. I wouldn't put the machine in auto adjusting mode if I couldn't see exactly what it was doing. If 9 cm allows desats lower than a person wants to see...then keep trying manual increases if needed but I would be controlling the increases so that I could better evaluate the results.

Good advice and I will follow it. Using the only guide that I have- the sleep lab titration study, indicates that 9 is a bit low re Sa02, correct? Perhaps I should go down to straight 11.5 or 11.0 tonight because I have to get up super-early for mandatory one-day jury duty tomorrow.

OTOH, I might sleep better, or at least longer, at 9cm.

With those additional facts presented, what would Pugsy do tonight if Pugsy were in my shoes?

Cheers,

p.s. My machine's software does show pressure throughout the sleep cycle while in APAP mode via graph for a given night. Via table it does show P95 and average pressure. I will go back to my data while at 9-15 for certain day or days and confirm.

[Pugsy]

What would Pugsy do in terms of experimenting in this situation?
Hmmm....whatever lets me sleep the best is what I would start with...so hours of sleep and sleep quality is always my primary goal in the absence of anything else to rely on.

[tedburnsIII]

I did go back to individual days using the machine's SD card, not the iCode.

I looked at the tables for a few days where machine was at auto 9-15cm but more importantly graphs depicting all pressure readings for given night and it looks like machine never exceeded 10cm of pressure when set auto at that 9-15cm.

I want to repeat that my issue is Sp02, not AHI, where most clear as low as 7 or 8.

[tedburnsIII]

What would Pugsy do in terms of experimenting in this situation?
Hmmm....whatever lets me sleep the best is what I would start with...so hours of sleep and sleep quality is always my primary goal in the absence of anything else to rely on.

It's difficult for me with low Sa02 in the study to determine what trumps oxygen in the blood.

I know that I can feel great at low fixed pressure somewhere at or above 9, where REM was also present, but 12cm was the recommended pressure due to low Sa02 below that level.

With jury duty tomorrow, perhaps length of sleep may trump oxygen content and I should set for straight 9cm and wear that pulse thingy and see what it indicates.

A bit later: I reviewed the TREATMENT BREAKDOWN TABLE (titration table), above, and decided to do oximetry study at 10cm tonight. Will only do a 10 minute ramp.

Hope this thread is of assistance to others.

Thanks!

[Pugsy]

I understand that oxygen levels are what you are wanting to look at.
Given a choice between a set cpap fixed pressure and auto adjusting pressure I would use set fixed cpap pressure.

Since you only have the sleep study report and last night's data to go on...it's really a crap shoot but I tend to always want to use the lowest pressure that get the job done and in this case the "job" is oxygen levels.

It's your decision if you want to start lower and work up (if needed) or start higher and work down.

Oxygen levels shouldn't vary much if the AHI is well within acceptable limits and if it does then there is likely something else involved or at least contributing to low levels.
A lot depends on how low it went during the sleep study when using 9 cm and also how long it stayed there and what happened when it was there to cause the drop.

If it were me and there was a marked difference in my sleep quality and hours slept between 9 and 12 cm....I choose sleep quality and hours of sleep until I have proof in my hands that whatever pressure I slept better with wasn't working in terms of O2 levels.
Now if I thought that "OMG I slept 7 or 8 hours at 12 cm and I feel great"...and "I don't sleep so great or feel so great at lower pressures" then guess what pressure I would use no matter what the AHI showed or for that matter the pulse ox report.

I can't tell you which way to go...that's your decision. I can tell you which way I would go if I was in your situation but I am not you and you are the controller of your experiment....so you get to make the final decision.
I imagine at some time you are going to be wondering about what 9 cm does long term...if you sleep better using 9 cm then that's where I would start and then work up if needed. Going up slowly is always an easier adjustment for a person to make and there's no proven urgent need to make a big leap if that big leap causes poor sleep.

Edit: I see you decided to sort of split the difference and try 10 cm. It's a reasonable pressure to start with...you gotta start somewhere.

Good luck on the jury duty thing. I got called last month but right before I was supposed to report we had some really nasty weather and bad roads and it got postponed and so far I haven't been asked back.

[tedburnsIII]

Sleep specialist doctor wrote in his report, later-obtained by me, that supplemental nighttime oxygen should be considered and that my OSA was moderately severe (though my study RDI and AHI were both 27.9). I don't want to be placed on nighttime supplemental oxygen unless mandatory. I do have some respiratory issues and 65 years old, with 20 pack-years of smoking but quit in 1988. To me, I'd better keep my Sp02 above 90%. Awake, 50D Plus shows usually 95% or above. I take Spiriva every day, was given Dulera 2x day (which I have temporarily discontinued due to weight gain, along with Fluticasone Propionate- both corticosteroids), Also taking Singulair and other drugs. But with respect to my sinuses, I am finding that Ayr saline spray is doing a good job for me right now, along with the gel, sometimes neti pot (but only for acute sinus problems) and to reduce problems using pillow mask/nasal mask.

Sp02 is indeed important to me as it is apparently a real issue at the lower pressures. And sleep study without CPAP indicated my lowest Sa02 was at one epoch 82%. I hate to think of how sleep oxygen-deprived I've been for years. If one is not feeling great, or at least very good no matter your age, see a doctor! I am 65, at least 30 pounds overweight, lack of exercise past 2 years due to knee/foot problems, and I now feel overall great, despite the foregoing!!!

At the split-night sleep study, technologist said CPAP works 100% of the time. I then asked if she were a stockholder in it! Whoever heard of 100% effectiveness? Well, it's apparently true if you get it right. I can tell you that my overall physical and mental feeling of well-being has increased SIGNIFICANTLY since going on CPAP 2/17/2015. I have also been placed on a statin and before CPAP could not tolerate it, even at low dose. Now I am titrating up on it and don't feel anything near the side effects with it. I attribute the lessening of side effects to CPAP, which is truly remarkable. I think the key is to get AHI really low, reduce leaks, make sure your Sp02 is adequate, and sort of 'go with the flow' (double entendre)!

Cheers,

[tedburnsIII]

Took a 30 or so minute nap

Ramp- 10 minutes
Pressure 10cm
a few minutes into the ramp I started recording with 50D+ oximeter.

Comments appreciated!

[HoseCrusher]

Based upon oximetery, 12 cm is better.

During your nap you never entered REM sleep. You recorded a Basal of 90% and had you drifted off to a deeper stage of sleep that would have dropped.