Interpretation request - Pulse Ox Report

I talked a friend into wearing my CMS-50F for a night. I've told him what I think about the report but I would be interested in other interpretations.

STL Mark wrote:I talked a friend into wearing my CMS-50F for a night. I've told him what I think about the report but I would be interested in other interpretations.

Wow Mark, that's sobering. Average event duration = 43.5 seconds and some really deep desats. This is one of those times when the hourly index doesn't really tell the whole story of the severity of the condition.

What did he say when you gave him your feedback?

Thank you Kaiasgram for the input. I will provide more input in a later response. I would like more thoughts. If anyone else has time to provide their review I would appreciate it.

Without knowing all the particulars and assuming you had good reason to suspect a problem in the first place...if there aren't any lung or heart issues in the history that we could blame all that ugliness on... then I would think you would be packaging up one of your machines for your friend.
I would also do a follow up pulse ox with the machine...just in case it isn't something simple.
That's too ugly to mess around with much DIYing unless improvements are fairly significant immediately.

Pugsy wrote:Without knowing all the particulars and assuming you had good reason to suspect a problem in the first place...if there aren't any lung or heart issues in the history that we could blame all that ugliness on... then I would think you would be packaging up one of your machines for your friend.
I would also do a follow up pulse ox with the machine...just in case it isn't something simple.
That's too ugly to mess around with much DIYing unless improvements are fairly significant immediately.

After discussions with a room mate I learned of his snoring issues. He typically sleeps in a recliner. The idea of something on his face while he sleeps is creating some anxiety.

I am doing some searches using healthgrades.com to attempt to locate a sleep medicine physician in his area that accepts his insurance. The combined specialities of neurology/sleep medicine only show three options. One unrated, one rated poorly and one with a 3+ out of 5. I may have to go with pulmonology/sleep medicine to get 5 star ratings. Finding one affiliated with a lab that uses recliners may be a challenge.

I have convinced him to provide the above report to his PCP's office via email.

My guess is due to pain medications he is taking for other issues he will probably have central in addition to obstructive apnea. It is an interesting challenge to handle long distance. I visited 3 sleep doctors before I found one that I could work with for myself. I may ask for lab/doctor references in a new thread. I am not sure that the task will get accomplished if I don't handle it.

Mark, you are a true friend.

That is one ugly chart...

Not only do you have desaturations but the hear rate spikes are almost off the chart.

It looks like the person had difficulty falling asleep and then finally got into a deeper sleep stage at around 5 am. After about 1.5 hours of that deeper stage the restlessness started back up again.

I think some of the big spikes may have been caused by finger movement but the % Artifact number isn't large.

My suggestion would be to monitor a couple of additional nights to see if a trend emerges. Was this just a bad night or is this "normal" for that person...

Looking at the chart, a couple of technical comments:

1) the chart doesn't show the actaul max's and min's. Reset the parameters so that max heart rate is 130, min is 40, and min SpO2 is 40. Then the total data is shown.

It appears as if your friend stopped breathing for durations of about one minute or so. That may be central apnea not obstructive apnea for the really dramatic desats. OTOH, his only sleeping in a recliner is suggestive of OSA. Put them together and you are likely looking at severe complex sleep apnea. I'd guess an AHI somewhat greater than 40.

I'd give him the same advice I got from a neurologist at Mayo in Rochester, "Untreated, sleep apnea will kill you."

I hope he gets to a good sleep doc and then starts treatment.

I have been asked several times about what happened on this individual. I was able to convince him of the necessity for a sleep study. And coordinated it with his insurance and it actually was 100% covered. Less than one week ago he had his PSG.

Untreated AHI was 92, Obstructive 60, Central 32. Low O2 was 69%. They processed him through CPAP and BiPAP that night and we are coordinating another visit for an ASV titration. While he is not thrilled with the process and the tech he was assigned the first night, he does finally understand what my concerns are after meeting with the sleep doctor. He hated the mask and CPAP/BiPAP therapy during the study but I have worked with the lab to have a different Tech handle his ASV titration who is more compassionate. I am excited at the possibility of getting him the therapy that he so desperately needs.

It has been interesting trying to coordinate all of this from a distant location...

Hello everyone, I'm the friend that Mark was speaking about in this Thread. I want to first tell you all, that Mark is an individual that I respect immensely and someone I admire for what he does not just for me, but for others. When Mark first came to me with the idea about wearing this thing on my finger while I slept, I was a bit hesitant, but with Mark and my Fiance explaining why they wanted me to do this, I relented.

When Mark told me about the results of this, I was shocked, at least on the inside, and I knew what the next step of the process would have to be. I have this problem with Doctors in general, at least for me, the Doctors I had visited over the past 10 years, and there were MANY of them, I had only found 3 that I actually felt they cared about me as a person. I won't go into the details of my situation, I'll save that for a new Topic for everyone, but I will say that in the past 10 years I'd seen at least 15 different Doctors. So when Mark wanted me to do a Sleep Study, I wasn't too thrilled about having another Doctor look down his nose at me and pass judgement without knowing anything about my History. Still, with Mark and my Fiances urging, I went ahead and did the Sleep Study. The appointment with the Doctor went fine, and the Sleep Study that evening was marginal, mostly because the attendant that was caring for me didn't really want to be working that evening, and made it clear when he said, "I promise my attitude will get better as Morning draws near". Anyway, I did the Study and was happy to leave that place. After that, I went back to do one more night and Mark made certain that I had someone that wasn't going to bring their problems to work and visit them on me. Actually, Mark setup everything for me, as I'm not always able to remember things and I would bet without Mark helping me along, I wouldn't have seen a Sleep Specialist for quite some time. When I returned to do the next Study, I took a Mask that Mark had given me to use, it was much like a Mouth-Guard you would use when playing Football or Hockey. To my surprise, I actually slept 6 straight hours with the new "mask" and felt amazing that morning.

Without Mark I would probably have never had anything done for my Sleep disorder, I wasn't even aware I had one until Mark and my Fiance started talking to me about it. Mark is an amazing person and an incredible friend and I'm so glad he calls me a friend. I also know that Mark buys/sells machines and I can tell everyone that Mark would never mess anyone over. Mark is truly the Friend everyone wishes they had, because he not only has empathy for his friends, he does what he can to help them out. I am one of those Friends and I can never thank Mark enough for all he's done in my life.

I also want to thank each of you that took the time to ready Mark's thread and give input. You too helped get me to the Sleep Study and for that I'm grateful.


Bob

Hello Bob - welcome to the site- I am also new around here. For an example for you, my untreated O2 had a low of 82 with over 30 minutes under 88% over a 5 hour study. My AHI was 41.4. In my second sleep study my O2 had a low of 85 with only 0.6 minutes under 88%. I use an SPO2 device every night, more curiosity than anything, and my typical is only 0.1 - 0.5 minutes under 88% over a 7 hour night. So,,, it does get better and I feel much better with treatment than without for sure.. Keep the faith. We can all use some good friends like you have with Mark.
Paul

Welcome Bob, it's great that you've come on board here. And Congrats on your engagement.

Welcome. I totally agree about Mark. He is a great friend to have.

Hey B9b, Glad to here you are getting a good nights sleep.