Nightly Hypops with Desats

Muse-Inc · Post by **Muse-Inc** » Fri Apr 23, 2010 9:10 pm

If last night is repeated, I just found out why I'm waking up at night: hypops with desats. 2 wakeups last night (only asleep 5.5 hrs), both times with increased breathing, increased pulse, and the last one with a body flush that had me turn on the fan (love that remote control). The CMS 50D that SuperGeeky loaned me shows 2 periods when I desatted: the first spiked <88 6-7 times then rose to the 99, the other was 40 mins prior to alarm wakeup and I spent the entire time under 88 if the graph is to be trusted but the report says time <88% was 1.8 mins...say what? Basal SpO2 93%. A few pulse spikes up to 100 with aver 72 & low 60. The low SpO2 appears to follow the hypops shown on my ResScan graphs. Oh, I drop to 92-93 (from 96-97) during the day if I slump forward (thanks fat gut) or just get distracted and don't breathe much...mom's been hypo for >20 yrs and while she sometimes breathes shallowly or holds her breath, her SpO2 is usually 98-99 & she just turned 80 today .

Will collect more data to see if this repeats. Meanwhile I'm gonna set the SpO2 alarm...now to set it for 90 or 88%?...tending to think 88% that way we (doc & I when I show him the rpts) will know how often I desat to 88%. Might need to use a clinical-quality recording oximeter to see what's really occurring overnight, don't know how long my temp job will last so any co-pay for another PSG will likely be too much.

Looking at my labs, the wakeups started when my TSH went >3, I started levothyroxine last Sept and still don't feel good at just under 3 where it was last Sept...no increase after last labs...maybe a mistake not to increase levo as I still have increased lower leg & periorbital edema, still in a wt stall that started when TSH went >4 (over last several months gained 12#s of the 57 lost, bummer, still have tons to lose), and still really really tired, too tired to exercise and I used to do an hr on my exercise bike easy...lousy sleep & hypo, bad combo.

Will post graphs when I get more data and figure out how to get it all working.

SleepyBobR · Post by **SleepyBobR** » Sat Apr 24, 2010 6:25 am

How long in duration are the hypopneas? (I assume that this can be determined from the length of the hypopnea bars and the detailed report graph). I ask because I am having the same problem resulting in multiple nightly awakenings. I have good AHI but feel bad in the morning.

echo · Post by **echo** » Sat Apr 24, 2010 6:46 am

Ahhh THIS is where you're posting the results

Just out of curiousity, why are you setting the alarms? Do you mean the beep that wakes you up? You can also set the thresholds in the SW (or the device? I forget) so that it counts the number of desaturations based on the percentage drop, like 3% or 4%. .. instead of having it wake you up. maybe I misunderstood what you meant.

How have you found the right amount of levo? My doc wanted me to increase by 12.5 microgram every few weeks until the number stabilized or until I started getting the opposite symptoms (high heart beat, anxiety, etc, indicating too much levo). Maybe you're not up to the right level yet? I stopped trusting the "numbers" since I was still in the normal range but on the border of the cutoff, yes the levo has helped me TONS. I started end of December.

Have you compared the SpO2 readings to the APAP readings? Correlations? Your machine should be showing events (or leaks)...

Sorry if this info is already elsewhere but:
- Are you still at 7-15 APAP?
- What's your 90% or 95% pressure?
- What's the recent average AHI?
- How are leaks (especially during those Sp02 drops?)

Unless you are having a central-apnea related SBD or other lung function issues (did you ever get the pulmo tests done?) requiring as Bipap or similar, there's no reason that you can't self-titrate at home with the APAP, the SW, and the Pulse-Ox. You might want the doc to prescribe you a rental pulse-ox that maybe fits a bit better, to use at home for a week or so.

Muse-Inc · Post by **Muse-Inc** » Sat Apr 24, 2010 8:54 pm

echo wrote:..Just out of curiousity, why are you setting the alarms?
No reason to make my brain hafta go into panic mode & flood body with stress hormones when an alarm will rouse me and likely faster than my brain's response to the lowering O2 levels. I'm gonna be waking up one way or the other anyway & I think the SpO2 alarm is less stressful.

How have you found the right amount of levo?
I don't think so as I'm just under 3 and that's considered normal. The articles I've been reading suggest at least to me that I should be treated until I quit complaining about hypo symptoms (and reach where I keep telling my doc I feel best which is <2) because I might be experiencing hypo-caused blunting of the respiratory 'drive' which I believe might be the cause of my wakeups. Only collecting more data will tell...but something's causing me to wakeup repeatedly throughout the night...and they started when my thryoid started to go south (which might turn out to be a coincidence).

Have you compared the SpO2 readings to the APAP readings? Correlations? Your machine should be showing events (or leaks)...
Date Range: 11/06/2010 - 4/23/2010
Leak:..Median 2.4
........95thcentile 9.6 (expected, the Hybrid vents more than the ResMed FFMs)
........Max 19.2
AHI=1.4, AI=0.1, HI=1.3.....Yesterday's AHI=1.3 all hypops
Pressure:..Median 8.2
............95thcentile 10.4
............Max 11.4
APAP range is still 7-15

So far (3 whole sleep sessions ): pressure rises a little or a lot following a hypop, desats (even moderate & in 90s) cause a pulse increase, pulse periodically increases for no apparent reason that I can see yet, but it's mostly staying between 60-90 with a few spikes 100+ which do not appear connected to anything (REM causing increases? maybe). Hypops occur at all pressures and all leak levels and occur throughout the night not clustered.

Doc to prescribe you a rental pulse-ox that maybe fits a bit better, to use at home for a week or so
Yup. He might let me borrow his Repironics loaner (the Nonin one) for several days like I did last yr over the July 4th holiday. It samples more often and its sensor is really comfortable, ya tape this really skinny flexible sensor to your finger ensuring the key parts are in the right places in the sticky tapes.

Muse-Inc · Post by **Muse-Inc** » Sat Apr 24, 2010 8:56 pm

SleepyBobR wrote:How long in duration are the hypopneas?

Haven't collected the data...hypops by definition don't last long.

echo · Post by **echo** » Sun Apr 25, 2010 5:24 am

Muse-Inc wrote:How have you found the right amount of levo?
I don't think so as I'm just under 3 and that's considered normal. The articles I've been reading suggest at least to me that I should be treated until I quit complaining about hypo symptoms (and reach where I keep telling my doc I feel best which is <2) because I might be experiencing hypo-caused blunting of the respiratory 'drive' which I believe might be the cause of my wakeups. Only collecting more data will tell...but something's causing me to wakeup repeatedly throughout the night...and they started when my thryoid started to go south (which might turn out to be a coincidence).

Have you compared the SpO2 readings to the APAP readings? Correlations? Your machine should be showing events (or leaks)...
Date Range: 11/06/2010 - 4/23/2010
Leak:..Median 2.4
........95thcentile 9.6 (expected, the Hybrid vents more than the ResMed FFMs)
........Max 19.2
AHI=1.4, AI=0.1, HI=1.3.....Yesterday's AHI=1.3 all hypops
Pressure:..Median 8.2
............95thcentile 10.4
............Max 11.4
APAP range is still 7-15

So far (3 whole sleep sessions ): pressure rises a little or a lot following a hypop, desats (even moderate & in 90s) cause a pulse increase, pulse periodically increases for no apparent reason that I can see yet, but it's mostly staying between 60-90 with a few spikes 100+ which do not appear connected to anything (REM causing increases? maybe). Hypops occur at all pressures and all leak levels and occur throughout the night not clustered.

Your max seems to fluctuate a bit.... combined with the hypo, the multiple awakenings, and the unresolved tiredness, have you already explored the sensitity connection and APAP mode? Have you ever run in straight CPAP mode?
The forum guru's have for a while suggested a connection between the (hyper) sensitivity and frequent arousals/awakenings (even in CPAP mode), so what's your "sensitivity score"?

BTW for me the more recent TSH (right before starting levo) was "just under 3" but based on the previous high measurements and the tiredness the doc went ahead and started me on the levo. I agree, I think TSH needs be < 2 but need to look at the whole panel too (T4, T3, free T3, T4, etc). You're reading blizzardboy's thread, right?

Muse-Inc · Post by **Muse-Inc** » Sun Apr 25, 2010 7:57 pm

echo wrote:...have you ever run in straight CPAP mode?

Oh yeah, first 17-18 months slept great with SLOW recovery, then became intolerant of straight pressure. I sleep much much better using APAP, no more ribcage pain/ache.

echo wrote:...(hyper) sensitivity and frequent arousals/awakenings...

I'm one of those princess & the pea types...breaking in new shoes takes months. I waken easily from noise, light (all digital LEDs covered in bedroom), AC or fan currents will wake me up, so do temp changes...it sucks. Skin has always been touchy...runs in family.

echo wrote:...You're reading blizzardboy's thread, right?

Yup. Doing some reading on hypo & apnea connection for our local group of forum members. My T3 is in the lower third of the range...some say that is too low. Still gathering data to present to my docs.

echo · Post by **echo** » Mon Apr 26, 2010 6:38 am

Muse-Inc wrote:
echo wrote:...You're reading blizzardboy's thread, right?
Yup. Doing some reading on hypo & apnea connection for our local group of forum members. My T3 is in the lower third of the range...some say that is too low. Still gathering data to present to my docs.

That's right, you even posted there. Good luck with meeting, and the hypo research. Let us know if you find anything more interesting tidbits.

Nightly Hypops with Desats

Nightly Hypops with Desats

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