A not so profound oximeter discovery.

After a month of recording my nights with an oximeter, I have discovered something. It is trivial, but I thought it was worth sharing.

In general my oxygen saturation is in the 90-98% range. So I wonder why I feel like garbage so often. I've spent time reviewing the nightly saturation history each morning, and there is a pattern.

There are periods of several hours when the saturation is like a straight line. But there are equal periods where the saturation is like a roller coaster.

Looking at the photo, that dip in saturation is about one minute in duration. What I did was to turn on the oximeter and attempt to replicate that wave. And I discovered something interesting.

The only way I could replicate that wave was by EXHALING and then not inhaling for thirty seconds. If I inhaled, the wave would take longer than I could hold my breath before dipping. So this shows the mechanism of what is happening at night.

I am exhaling and holding my breath for a half minute, over and over each night.

I think it's central apnea. But that is stepping out on a limb. I believe this is a mild form of apnea where the saturation isn't dropping significantly, but my days are horrible.

It's nothing a sleep study won't uncover. And that is something I'm slowly getting closer to as I go on.

But I just wanted to share this. Perhaps someone recognizes something or can aim me in a direction, or just tell me to go away.

Gregg



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I couldn't tell how far it's dipping to and you didn't say.....but generally, if it doesn't go below 88% they don't consider it a problem.

Den

I think it says:

You are in REM sleep if it happens in the early morning hours or roughly every 90 minutes, a typical sleep-cycle. That is when most SDB events are likely to occur.

But those dips could also mean:

Your airway is blocked due to a apnea or you have stopped breathing preventing oxygenated blood from reaching your vital organs (reason for the dips).

apnea type can be obstructive or central, both can impact your ability to deliver oxygen to your vital organs like the brain.

Did you know brain cells can start to die in as little as 10seconds without blood or oxygen? When they do they don't grow back. That is why it is so easy for people to have a stroke, yes a brain fart it is. How long does a Hypopnea last? or a apnea? Not unusual to have several hundred per night.
Try going under water in a pool and holding your breath as long as you can. Then try doing that several hundred times per night you get the idea.

I'd say time for a PSG so you know which.

Question: That machine appears to have a pulse Heart monitor function? Does it record your pulse rate as well? If so you may be able to correlate those two to provide you with more info. For example, if your SPO2 level drops, your heart pulse rate could go up at the same time suggesting extra workload for your heart.

I mainly posted this in the hopes that someone will come along and say, aha that's what my oxygen sats looked like.

I agree with the PSG. I'm getting to where I have to do something about this. But it IS interesting to just observe what is going on. Without an eeg, it's really limited. But at least I KNOW what is going on.


The saturation is right there on the photo. No, they are not dipping that low. I have had some in the 88% range. I just used the photo for an example.


The only reason I'm doing any of this "self diagnosis" stuff is that I live in nowhere. There isn't a place where I would go for sleep analysis within a large distance. It's just not convenient right now. But it may be once I'm out of here. Which hopefully won't be much longer.

Is there anything that can be done for central apnea?

My understanding of central is it is brain related, not physical. Do I understand right?

Gregg wrote:I mainly posted this in the hopes that someone will come along and say, aha that's what my oxygen sats looked like.

I agree with the PSG. I'm getting to where I have to do something about this. But it IS interesting to just observe what is going on. Without an eeg, it's really limited. But at least I KNOW what is going on.


The saturation is right there on the photo. No, they are not dipping that low. I have had some in the 88% range. I just used the photo for an example.


The only reason I'm doing any of this "self diagnosis" stuff is that I live in nowhere. There isn't a place where I would go for sleep analysis within a large distance. It's just not convenient right now. But it may be once I'm out of here. Which hopefully won't be much longer.

what is your base line level? If you are sitting there awake breathing normally you have a baseline value. For example that may be 94% or higher. So if during sleep it shows you are dropping to 92% that is nothing to worry about unless it is dipping to <89% then it becomes medically significant where you should do something about it.

I've had 4 PSG/titrations one my level dropped as low as the mid-high 60% but on the other 3 it stayed above 80%. All were below <89%. I was not overweight, 45yrs old had my first stroke, most likely cause untreated OSA. I also smoked for 30 years which contributed to the problem, I'd go all night long with several hundred untreated OSA's not getting any oxygen, get up in the morning have some coffee and 3-4 smokes reading the paper before work. The caffeine from coffee restricted blood vessels, the nicotine would enter the blood stream directly from the lungs which also constricts blood vessels in addition to adding other chemicals to the blood like carbon monoxide which impedes the ability of the blood to carry oxygen.

I'd spend all night in a hypoxia condition, then get up and do things that kept me there all day long. Eventually it caught up with me and left a nice divot to the caudate head of my basal ganglia. The other option is your heart, if you don't have a stroke first you end up with CHF from the heart being overworked. I was lucky, it only kept me down from walking for about an hour where I had to learn how to walk all over again, but during that hour you are thinking to yourself will I ever walk again? You can't ask anyone that because you probably can't talk either.

I was 45, 6' 1" and weighed less than 180lbs. I was active and in pretty good shape I thought.

gregg,

Thanks for this info - has set me thinking - am not sure what conclusions to draw, but I may try some experiments to see if I can match your experience.

Thanks

DSM

Thanks guys.

My baseline is 98%.

I only posted this here to get feedback. Otherwise, this discovery leads to nothing.

What I do see when I scan the entire nightly sats is around 5% of my time spent below my baseline.

The only thing I can say is that I know I'm holding my breath. Whether it's obstructive or not most likely won't be discovered without a sleep test.

But the one thing that baffles me is how horrible I can feel for the oxygen saturations I'm seeing.

My only explanation is that even though this isn't serious oxygen deprivation it may be triggering migraines. That is how it has felt over the last ten years.

JeffH wrote:Is there anything that can be done for central apnea?

My understanding of central is it is brain related, not physical. Do I understand right?

Central apnea is thought to be neurological related (i.e. the signal traveling to/from the brain that triggers respiratory drive is somehow interrupted).

With that said, the human body seems to have/be redundant with vital functions like respiration. So my theory (and this is all theory) is I see centrals as our body "limiting" respiration for some reason assuming that all neurological pathways are functioning correctly.

Is it a malfunction of the signal that causes them as thought? Could be, but is it the neurological side that is actually the problem or is it elsewhere in one of the redundant pathways?

That they don't know, for example you have other sensors and receptors which make up and triggers your respiratory drive. For example you have stretch receptors in the lungs that are there for a purpose. It is thought they are there to limit how far your lungs can expand/inflate. If your lung over inflates what is to stop them from completely bursting (if there was enough pressure)?

So if the stretch receptors are there to prevent the lung from over inflating, what happens if those stretch receptors are damaged or malfunctioning? You would think that the stretch receptor if it got to its limit it would send the signal to the brain to stop inhaling.

Then you have other receptors like the Peripheral chemoreceptors which perform a similar function or contribute to that same respiratory drive. Is it that receptor malfunctioning? Again, they don't know.

During that Harvard CSDB study they manipulated CO2 levels that the mask retained including blocking off all the exhaust holes and using a mask that had larger dead space like a UMFF.

What I think was found was that if you retained more CO2 in the mask vs. exhausting it all out so you rebreathe more CO2 that this also forced your respiratory drive to take a breath. The bipap S/T can sometimes trigger a breath by flipping IPAP/EPAP this can sometimes trigger a person to breathe again.

So in simple terms the theory is if you are having central events as seen in CSDB that if you used a mask that had better CO2 retention that it could possibly trigger your respiratory drive to take a breath. All in all very promising research. With CSDB you have both OSA and central apnea, many times at the same time. So how do you treat both events with a machine? Centrals for the most part don't respond to machine pressure increases. Then the trick became how do you treat the OSA along with the Central since one responds to pressure and the other doesn't? Well it takes a more sophisticated machine that responds only to the OSA and not the central events such as in Resmed's ASV machine now being tested. Then you add CO2 manipulation tactics like using a mask with higher CO2 retention levels (basically a non-vented mask or one with lower exhaust rate).

That is how I understand it and SWS understands it a whole lot better than I and can probably give a much better explanation of it.

If you think about it, CO2 manipulation really makes sense, the human body is redundant in nearly all its vital functions including respiration.

Is there any such thing as "non-sleep apnea"?
I find myself holding my breath during the day; more frequently when stressed, but have also found it to be true when doing something relaxing.
This "condition" has been happening for years. I TRY to be conscious of it (for awhile, after noticing it happening), but of course that doesn't last long.

Is there a known reason for a person doing this routinely?
Is this a trait of a "shallow breather"? ...and why to both of those...

I feel like my body/brain is "attacking" me by doing this, and worry about any damage that's being done. I know it's not as severe as what happens during sleep w/o treatment, but still scary just the same.

Due to above posting, I wonder that since I have scoliosis, if, due to compromised size of lungs, there is a miscommunication somewhere - as if the brain doesn't know it, and fails to send correct signals to compensate? that's just an afterthought, probably unrelated to first subject/problem. (??)

Snoredog: I too "lived on" coffee and cigarettes. Ashamedly, still do on some days. Depends on stress level, especially if I don't keep it in check, and run out of "tomorrows", in which to worry about or handle certain things.

Kathleen

Gregg wrote:I mainly posted this in the hopes that someone will come along and say, aha that's what my oxygen sats looked like.

When I posted my first response, I wasn't sure if the 92% showing on your image file was the lowest level......or if there was more to it.

Like Snoredog, I was told my desats dropped into the 60's during my sleep study.

It seems to me like I recall some who have posted here being diagnosed with apnea but didn't have desats below the 88% level.

Den

Gregg.....Have you by chance taken your blood pressure at various times during the day and night?

What caused me to go for a sleep test was BP systolic pressure doing a number of spikes over 200 at night. I kept detailed records of BP taken about 8-times per day.....and found that my BP was getting out of control at night.

During the day, the BP would drop....but, at night and in the mornings it was out of sight! My lady was concerned because she noticed that I would stop breathing at various times during the night.

Purchase one of those battery-powered BP machines and gather some data.
What you learn might help give you another piece of the puzzle.

Gerald

Gregg......One more thought. DSM posted an interesting series of messages on October 16th concerning "complex" apnea......something Mayo Clinic thought was significant. I suggest you take a look at some of the articles DSM mentioned in his post. One of them is the following:

http://www.medicalnewstoday.com/medical ... wsid=51105

DSM's posts are really worthwhile reading. Check them out.....

Gerald

Yes I did see that complex apnea study. And I honestly believe there's more to apnea than we know. I mean, central types.



As for my blood pressure, I'm basically an athlete. My weight is the same now as it was in 1975. And so is my blood pressure.

My resting heart rate is 45. That's a one sign of cardiac fitness.

Gregg wrote:
My resting heart rate is 45. That's a one sign of cardiac fitness.

It is if you are Lance Armstrong

Question: That machine appears to also have a pulse/heart monitor function?

Does it record your pulse rate as well? If so, you may be able to correlate those two to provide you with more info. For example, if your SPO2 level drops (due to apnea), your heart pulse rate could go up at the same time suggesting extra workload for your heart.