Pulse ox report help....UK user

Hi I've started tracking my Oxygen levels at night due to suspected breathing problems and getting no refreshing sleep.

Are dips to 88-90% anything to worry about?

I'd worry only if I saw drops below 88%.

There are two things to look for on SPO2 data.

a) Oxygen desaturation events, the index for this (ODI) is the number of events per hour. ODI does not correlate exactly with AHI but the two are often similar. In your case ODI was 9.6, potentially indicating mild sleep apnea.

b) SPO2 dropping below 88-90%. This is the level that is usually flagged as abnormal during sleep. Your levels only dropped below 90% briefly which isn't a big deal but it does support potentially mild sleep apnea. SPO2 dropping below 80% especially for any significant amount of time indicates more severe desaturation.

Your graph acts up in a somewhat cyclical manner(00:00, 1:45, 3:15, 5:00) which might mean you are mostly affected during REM sleep. This is not uncommon and it can lead to non refreshing sleep.

Based on the limited data available I would say that you may have mild sleep apnea (might be moderate level during REM). I would get tested especially because of your claim of suspected breathing issue and non refreshing sleep.

The lack of significant ugly desats doesn't necessarily mean no sleep apnea.
I have a friend who had an in lab sleep study and her oxygen levels never dropped below 94% but she ended up with an OSA diagnosis with an AHI of 60. Pretty severe.

While overnight pulse oximetry results can often point to sleep apnea....the lack of significant changes in oxygen levels doesn't always mean we are home free.

Also bear in mind that there's often more to sleep disordered breathing than just sleep apnea. Sleep apnea is but one item on a very long list of potential sleep disordered breathing issues that can mess with our sleep quality and how we feel during the day.

It is normal for our oxygen levels to drop 3 to 4% once we go to sleep....so that part is probably normal.
So a not really very remarkable overnight pulse ox report but that doesn't guarantee no apnea or other potential issue causing non restorative sleep.

You spent .2% of the night below 90% (assuming the events are real as well) so nothing to worry about in terms of oxygenation. Unfortunately a normal pulse ox isn't very helpful for anything else. You can still have sleep apnea, so maybe ask if you can do a at-home sleep study and start from there.

Thanks for the feedback, very much appreciated.

Can I please just ask one further question, have I got the report set-up correct, just checking is it 3% or 4% desaturation?

I think I need to investigate further because my sleep just isn't refreshing and I'm getting morning headaches with day time fatigue.

My lifestyle is really healthy and this is starting to really bother me, I need to try and bottom this out asap.

You have it set for 4 % now.
You can change it if you wish to 3 % and while it might show more "changes" or "events"....it shouldn't affect overall drop.
A momentary loss of contact will also show as a drop and an "event" but aren't real drops.

Pugsy wrote: ↑

Mon Dec 09, 2019 5:17 am

You have it set for 4 % now.
You can change it if you wish to 3 % and while it might show more "changes" or "events"....it shouldn't affect overall drop.
A momentary loss of contact will also show as a drop and an "event" but aren't real drops.

Thanks for reply

I changed it to 3% and it says 19 events per hour, what causes the oxygen levels to drop in the night, could it be sleep apnea or just struggling to breath properly?

My partner says that I'm constantly moving/turning over all night, could this lead to the unrefreshing sleep and tiredness?

It's normal for our oxygen levels to drop during the night because we are breathing more shallowly and our respiration rate normally slows down also. So not as deep breaths along with fewer breaths.
So it might not be sleep apnea or even related to the airway closing off.
19 events just means 19 changes and it's normal for it to change....and it also might be from some sort of airway issue.
That's the problem with trying to use just a pulse ox report to quantify anything. Your data is limited and there are multiple reasons for it doing anything and not all the reasons mean something bad is or isn't happening.

The tossing and turning could be an indicator of poor sleep quality...maybe not getting the needed sleep cycles in the normal percentages for the restorative powers of sleep to work their magic. I would be wondering why the tossing and turning is happening.
It's possible that the tossing and turning is just a symptom of some other problem and not the cause of the poor sleep in itself.

Are you taking any medications? Medication side effects often either mess with our sleep architecture and cause poor sleep or make us feel like we are tired all the time from non restorative sleep.

There could be any number of reasons why you don't feel like your sleep is optimal. Sleep apnea is but one of those reasons and the first step is to have a chat with your doctor about how you feel.
Low oxygen levels is but one of those reasons as well but based on your pulse ox reports...I doubt that is the reason.

You can still have crappy sleep quality and not have significant desats. Now why the crappy sleep quality might be happening is another question and often one that is very difficult to answer.
To get any real answers you have to start with a sleep study though. Can't evaluate sleep without a sleep study and one that measures actual sleep stages and not just breathing.

If you are taking any medications at all though....start looking at the potential side effects as a possible culprit for not feeling so great.
Often it is that simple.

Thanks for the reply, much appreciated.

I'm not currently on any medication, I would class myself as fit and healthy, I don't drink or smoke and exercise regularly.

I'm going to order an home sleep study, but the only ones I can find are nasal breathing cannula and pulse oximeter (I'm in the UK).

I've recently had private blood tests done to rule out any low testosterone or thyroid issues, all came back fine.

I am going to change your topic line to reflect where you are.
We have a forum member here who is in the UK and he can best advise you on how to get a sleep study that measures more than just oxygen levels.

Here in the US there are several types of home sleep studies and they have different levels of the type and amount of data they collect.
http://freecpapadvice.com/home-sleep-tests

Hi there, Just jumping in here as I'm from the UK, also recently got diagnosed with a new sleep disorder from a 2 night pulse oximetry test. I took myself to a private sleep clinic in the end after a disasterous operation where I ended up in the high dependence unit for a few nights with oxygen issues amongst others. My sleep was also terrible and felt awful in the daytime.this has been going on for years.

My OSA was already diagnosed and treated but the machine and mask were old, so they got swapped out for new. Interestingly the pulse oximetry showed regular peaks in my heart rate which pointed to Periodic Limb Movement Disorder, where your legs twitch or kick at night in your sleep. This disturbs sleep architecture and you don't get refreshing sleep.
Do you have the trace of your heart rate from that test?

What I would say about private tests is that unless they are done under a doctor at a private clinic then a consultant sleep physician is unlikely to accept them and want to do their own. That said, it may at least get you the correct referral and pinpoint an issue. A UK charity, Hope2Sleep offers some private tests reasonably priced: https://www.hope2sleep.co.uk/sleep-apno ... ening.html

As a long time sufferer of low energy levels and poor sleep, there are a few vitamins you could look at where optimal levels can improve energy; Vit D3, B12, Ferritin, Magnesium. Get your GP to test you, you can buy supplements over the counter and these levels need to be optimal, not just scraping the bootom of the reference range.

Hi bobbysnuts,

First, some terminology. There are at least three kinds of 'sleep study' – and somewhat confusingly, some people, even the professionals, call two of them by the same name.

1a. The first kind is with the big, fat 'watch' on your wrist and clip on your finger. This measures two things – pulse rate and oxygen saturation – or 'pulse-ox'.

1b. The second kind is the kit a patient uses at home – a harness to put on like a vest, with a pocket to hold a recorder. The recorder being a little plastic box about the size of a pack of cards. Then a clip to go on a finger (pulse-ox), an expandable tube to go round the chest (breathing effort), and a double-ended plastic prong (or 'cannula') to go in the nostrils (to measure airflow, how big and how small – and to distinguish between those times when you're trying to breathe but there's no air-flow, and those times when you're not trying to breathe and there's no air flow).

All three sensors plug into the recorder. And when you take the kit back to the hospital, the recorder plugs into their computer.

This is called 'a three-channel sleep-study' – but some people also call it poly-somno-graph – or PSG.

1c. The third kind is where you spend the night in the hospital's 'sleep lab' and in addition to the above three measurements, the patient is wired up to an ECG for heart activity, an EEG for brain and nervous system activity, motion detectors on the torso and legs, in some cases temperature, and nowadays, usually a 'night-vision' video-recorder.

If you add up the number of sensors, it's at least 16 channels. This kind of study is also called a polysomnograph or PSG.

What this kind of study is especially good for is looking at 'sleep architecture' – the diagram that shows how long in shallow sleep, how long in deep sleep, how long in REM sleep (rapid eye movement) and dreaming, and so on. Plus, what other kinds of arousal? Any 'restless leg syndrome'? And so on.

Fewer than 10 per cent of hospital-ordered sleep studies in the NHS are multi-channel PSGs done in a sleep lab. One reason is because they are labour intensive and thus expensive. There has to be a technician or specialist nurse on duty and in the recording 'booth' for the entirety of the test.

And currently, not every foundation trust hospital in the UK even has a sleep-lab, so when one is needed in that area, the patient has to be sent elsewhere.

2. I agree with the long-term members who have posted above. You don't look like you have a problem with your O2-sats (oxygen-saturations, or oxygen-saturation levels).

But you may have mild sleep apnea. Mild-to-moderate is: the number of breathing restrictions per hour is between 5 and 15.

That number is called 'AHI' and it has to be 15 or above for the sleep apnea to be treated by the NHS. Be that as it may, some people in the UK (and elsewhere) find an AHI of say, 10, is enough to bother them. So they buy their own machines and masks. And if you talk to the machine manufacturers, they will tell you that, in the UK, they sell a fair number of machines direct to the public. And some of those purchasers 'only' have mild-to-moderate sleep apnea.

If you're buying a machine yourself, search on my user-name. You'll find advice on how to best do that.

3. I agree with Pugsy and the other long-term members above – there are a number of reasons for unrefreshing sleep – sleep-apnea is only one of them.

Ideally, with you having done an O2 study and not meeting the AHI-of-15 threshold', and given that you still present with disturbed and unrefreshing sleep, you would be referred to neurology ... or to a specialist in other forms of sleep disorder.

But we're not living in ideal. There aren't many 'other-than-sleep-apnea' specialists in the NHS. To see that kind of specialist, you almost-certainly would have to be referred 'out of area'. And these days, what with the clinical-commisioning group system, that's takes a bit of doing. And that doing starts starts with your GP.

In our country,* it is possible to have an over-night sleep-lab 16-channel PSG done in the private sector. But there aren't a lot of private sleep labs. And a PSG done by them is expensive.

I don't have a list to give you. Yellow pages is your best bet – but you might have to look for an entry in different sections.

4. As well as physical causes of poor sleep, there are also psychological causes. And treatment for these needn't be long or expensive or self-revelatory – digging into the past, and so on. There is a relatively new treatment called Havening which is now available in the UK (but not on the NHS). It is brief, effective, and mostly content free. If you want to pursue that, Google on 'Havening' and 'UK'.

5. You say:

"I'm going to order an home sleep study, but the only ones I can find are nasal breathing cannula and pulse oximeter (I'm in the UK)."

I'm not sure that a three-channel-sleep study would give you much more information that the oxygen study you have already done. But if you feel you have to, there are better at-home sleep-study options than the one JustBreathe234 gives a link to.

If you search on my user-name and look for the replies I gave to MopTop, you'll find the most recent details.

* If you haven't figured by now, I live in, and am posting from, the UK.

rick blaine wrote: ↑

Thu Dec 12, 2019 9:51 am

Hi bobbysnuts,

First, some terminology. There are at least three kinds of 'sleep study' – and somewhat confusingly, some people, even the professionals, call two of them by the same name.

1a. The first kind is with 'the big, fat watch on your wrist'. This measures two things – pulse rate and oxygen saturation – or 'pulse-ox'.

The "the big fat watch on your wrist' may be a WatchPAT, which measures lots more than just pulse and spo2.

rick blaine wrote: ↑

Thu Dec 12, 2019 9:51 am

1b. The second kind is the kit a patient uses at home – a harness to go round the chest with a pocket to hold a recorder. The recorder being a little plastic box about the size of a pack of cards. Then a clip to go on a finger (pulse-ox), an expandable tube to go round the chest (breathing effort), and a double-ended plastic prong (or 'cannula') to go in the nostrils (to measure airflow, how big and how small – and to distinguish between those times when you're trying to breathe but there's no air-flow, and those times when you're not trying to brearhe and there's no air flow).

All three sensors plug into the recorder. And when you take the kit back to the hospital, the recorder plugs into their computer.

This is called 'a three-channel sleep-study' – but some people also call it poly-somno-graph – or PSG.

There are multiple classes of home test, some are much more thorough than others, some of the home tests measure chest and abdominal effort, eye movement, and eeg. Some don't.

Hi palerider,

The three-channel study I mentioned is what is commonly used in the UK.

And yes, I do know what WatchPat can do. But again, not every single-channel sleep-study offered in the UK uses a WatchPat.