CPAPtalk.com

Posted: **Thu Jun 25, 2015 5:21 pm**

Oh, I thought that you already had been doing overnight pulse oximeter studies! My 'bad'...sorry.

Suggest at least 3-5 days overnight recording studies at your current pressure, without changing it.

My lowest desat was 83% during the diagnostic study without CPAP. The dx was severe obstructive apnea in spite of RDI of 27.9.

Following is an example of a really good night. Please note that for 48.3% of the time that particular night sats >95%.
You will learn a lot by doing your overnight oximetry studies.

I have found the lower my AHI numbers, the higher the sats, the lower the desat events
and with a given of sufficient hours of sleep, I usually feel very good or even great the entire day with not even a yawn the entire day, or a
feeling of sleepiness, fatigue, etc., despite a BMI of nearly 32.

And in my case, the sleep doctor's written report cautioned that due to my lung condition supplemental nighttime 02 might be considered. So far, it seems that is not necessary, and it wasn't prescribed.

Posted: **Fri Jun 26, 2015 12:05 pm**

CardiacProtest wrote:So, I saw my doctor. He wants me to try things I've already tried now for months... neck pillow, change my breathing (wtf?), etc. Its not enough. I need to have energy NOW. I'm sick to death of being tired when I wake up. I'm missing out on life. The doctor wants me to have nasal surgery, then if that doesn't work, adjust my jaw, then if that doesn't work, throat surgery, on and on. He'd rather me do all that than try oxygen.

I know I'm kind of ignoring your advice, but it is helpful, thanks

I don't know what KIND of doctor you have, but maybe you need a different one? At the very least, (and you'll hate me for saying so), another sleep study could be in order. Even with CPAP, I top out at 91% oxygen - that's because I have bradycardia which would not have been discovered before the sleep study if I hadn't ended up in the hospital overnight on IV antibiotics. It could simply be that you have another medical issue that is hidden. My bradycardia doesn't show up in the doctor's office - it shows up when I've been laying down for 5 minutes (yes, so I'm awake and 43 beats a minute). Here's one of the problems - Medicare (and most insurance) will not pay for oxygen unless you can't be corrected above 88% some other way. So, unless you are a really wealthy person, I don't think you have an option there without proof that your levels are below 88%.

Posted: **Fri Jun 26, 2015 1:35 pm**

I've spoken numerous times with sleep techs at my sleep study center post-study, and have also researched the issue of oxygen sats.

I was told so long as you are at or above 90%, not to be concerned about it.

I am less concerned about my lowest desat during a given night than the average low Sp02 for the night. If that is less than 90% I start looking into it
more- where the average low Sp02 is <90% (luckily rare for me), it's usually some type of anomaly having to do with the pulse oximeter or the CPAP. YMMV.

I am quite happy with the average low Sp02 of 92.5 that night.

(CMS50D+ pulse oximeter has an accuracy tolerance somewhere in range of -2 to +2).

Hope this helps, though it is not medical advice.

Look forward to your posting overnight PO reports.

Posted: **Sun Jun 28, 2015 6:47 pm**

Oxygen saturation didn't go below 94. Guess I don't need oxygen.

I do have a lot of apnea/hypopnia some nights. Will keep monitoring and hold off on oxygen.

Posted: **Sun Jun 28, 2015 7:00 pm**

CardiacProtest wrote:I had severe apnea, 80 events an hour. Treated with AutoBipap for a few years.

About a year ago, I started sleeping 10+ hours and feeling terrible when I wake up... generally not until 11AM if I can get away with it. We've upped the pressure, adjusted pillows and now I'm supposed to train myself to breathe differently, which seems ridiculous to me. Nothing has helped, yet My doctor is against adding oxygen to the bipap.

I've read studies where oxygen was somewhat effective for apnea, albeit less effective than CPAP/bipap.

So, for $200 I can get a used respironics oxygen concentrator. I'm going to do an experiment... I'll start low, and if the oxygen makes a big difference well great! If not, I'll sell it for $200.

Am I crazy? Anyone done this?

You are correct about those studies:

CPAP Tops Oxygen for Sleep Apnea.

http://www.medpagetoday.com/Cardiology/Prevention/46279

Posted: **Tue Jun 30, 2015 12:25 am**

Wearing my oximeter around and... It hits 85 while laying down or standing. This is what is happening at night.

Posted: **Tue Jun 30, 2015 2:53 am**

Don't use it when awake - it's designed to read asleep events - your whole breathing pattern changes when you sleep. Of course you can get readings when you're awake, but they won't be valid for results of sleeping with it on.

Posted: **Tue Jun 30, 2015 2:06 pm**

CardiacProtest wrote:Oxygen saturation didn't go below 94. Guess I don't need oxygen.

I do have a lot of apnea/hypopnia some nights. Will keep monitoring and hold off on oxygen.

CardiacProtest wrote:Wearing my oximeter around and... It hits 85 while laying down or standing. This is what is happening at night.

Sorry, but I just don’t understand you.

Posted: **Tue Jun 30, 2015 2:33 pm**

Julie wrote:Don't use it when awake - it's designed to read asleep events - your whole breathing pattern changes when you sleep. Of course you can get readings when you're awake, but they won't be valid for results of sleeping with it on.

the oximeter?

Posted: **Tue Jun 30, 2015 3:19 pm**

Yes, was it unclear?

Posted: **Tue Jun 30, 2015 3:58 pm**

Julie wrote:Yes, was it unclear?

well, yes, because oximeter use during the day is often useful... not for what's happening during sleep, of course, and your "don't use it when you're awake, it's designed to read asleep events"... that didn't strike me as relating to an oximeter... sorry for the confusion.

Posted: **Tue Jun 30, 2015 5:57 pm**

I now understand this guy. I got confused. But if his 02 awake at night time is 85%, that does not sound good at all. Maybe that is his heartbeat.

If not, one might think his 02 while asleep would be lower than even that 85%, but he has said it's 94% while asleep.

Whatever... I am out of this thread.

Posted: **Tue Jun 30, 2015 7:22 pm**

CardiacProtest wrote:So, I saw my doctor. He wants me to try things I've already tried now for months... neck pillow, change my breathing (wtf?), etc. Its not enough. I need to have energy NOW. I'm sick to death of being tired when I wake up. I'm missing out on life. The doctor wants me to have nasal surgery, then if that doesn't work, adjust my jaw, then if that doesn't work, throat surgery, on and on. He'd rather me do all that than try oxygen.

Basically... I still have a lot of apnea from leaks, heart problems too. As to data, I have a pulse oximeter and I have a halter monitor on the way. In my sleep study, my ox went down to 90 and not lower at the current pressure. My problem is with leaks. I leak out my mouth, so I still have plenty of apneas/hypopneas most nights. I tried a full face mask, but I aspirate once or twice a week, and I just couldn't make it work. Also, I have trouble with higher pressures going into my belly, although a pillow does help. My pulse ox has an alarm set at 90, and it hasn't gone off two nights I've set it that way. To mix this in, I have arrythmias... and they tend to happen shortly before sleep (thus the halter monitor). Recently during arrhythmias, my O2 hit 90 or less. So it does happen sometimes.

I know O2 does help apnea (albeit less than bipap), so I want to add it into the mix. Just to see. I need improvement, fast. I need more energy. If I get GREAT sleep with it, I'll own up to my doctor that I borrowed a unit and tried it. Its worth a $200 experiment, and I can resell the unit for $200 anyway so its not costing me anything.

I know I'm kind of ignoring your advice, but it is helpful, thanks

You need a different doctor. Get on the phone and make an appointment with someone else. Anybody who keeps repeatedly doing what their doing expecting different results is not really helping you. The doctor cannot order oxygen for you and expect insurance to pay for it unless your sats are dropping below 88%.

Posted: **Sun Aug 02, 2015 8:23 pm**

So, I ended up getting oximetry levels and even a home halter monitor reading while sleeping and while having an episode and it was all normal most of the time (aside from my pulse hitting 130). But once my oxygen levels crashed while standing in the kitchen... it hit 43 and I almost hit the floor. So I kept bugging doctors.

Anyway, it turns out that the problem wasn't oxygen. It was CO2. I was having respiratory acidosis, and developed central apnea (as opposed to obstructive, which I had before). We added a third pain medication... Tramadol, some time ago, and the combination was depressing my respiration enough that CO2 was building up in my blood. Oxygen wouldn't have helped. Glad I thought it through and involved the doctor. Removing Tramadol and decreasing doses has resolved the issue.

Thanks for your help!

Posted: **Sun Aug 02, 2015 8:49 pm**

Great news! Good for you.

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