Worried - Severe Desaturation- Mild Apnea

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Harmonyhill
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Worried - Severe Desaturation- Mild Apnea

Post by Harmonyhill » Wed Jan 12, 2022 3:53 pm

I just got my sleep study results and am new to understanding desaturation problems and very concerned. I am a 63 year old female.
For 89% of my sleep time, my SpO2 was 80-89% and it even dipped as low as 78%. Impression: severe arterial O2 desaturation but mild obstructive apnea according to the report. My family doctor referred me to a pulmonologist to see why I have such shallow breaths. My day time saturations are always 95-97 and I have no allergies or lung issues, I breathe easily through my nose, not a mouth breather. I sleep “like a log” as we say. Quick to fall asleep and wake up in the morning really tired with no memory of sleep disturbances. I’m plump, not obese, I realize that can be a factor, and I have controlled high blood pressure. My mom had a stroke this summer and that of course was scary for her and me.
I had a one prior sleep study in 2017 where 74% of my sleep time was at 80-89% SpO2 and I was prescribed nasal cannula night oxygen but no one really explained how to use it or the importance in light of my desaturations. I sent the oxygen concentrator back after two months.
My sister in law gave me her ResMed AirSense10 Autoset which she tried out and gave up on. She says she sterilized it throughly a year ago before she packed it up. Nasal cushion headset.
I looked up how to change the pressure on her machine. Can I try using it while I wait a month until seeing a pulmonologist and then wait longer for a CPAP trial study? I don’t want to be getting worse in the meantime.
I have other numbers from my report(s) if they help clarify. Now that I have a little more understanding of the impact of my type of sleep disorder, I’m spooked. Thank you for any insights.

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Julie
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Julie » Wed Jan 12, 2022 5:15 pm

Really didn't see anything awful there, but if you post Oscar (see Stickies top of threads) results of tonight's sleep you'll get help with interpretation and suggestions if any are needed (also help changing pressures if needed). Oh, and tell your sister if she comes here (separate thread plse) we'll help her with her stuff... too often MDs don't know zip about the machines and their PA's, nurses, techs know less, so don't advise properly. I hope she didn't 'sterilize' with SoClean - it's a total scam and Cpap mfgr's void warranties if it was used. There's no need to steriilze the machines anyhow = only certain parts are cleaned and those are with hot water and soap.

Harmonyhill
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Harmonyhill » Wed Jan 12, 2022 7:43 pm

Really…I shouldn’t be terrified about my numbers? That would be a relief and would be helpful to my frame of mind about proceeding.

I found bottles of Control III in the kit. It’s a benzoyl ammonium chloride germicide.

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Julie
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Julie » Wed Jan 12, 2022 9:36 pm

Hi again... glad in a way you didn't use the 02 - unless you had med. help to do it. Also glad your sister didn't use SC, but in any case hopefully the machine did OK with what she did. Don't get hung up on sterilizing anything - it's in your house (hopefully with the filter in) just as you are, and sharing the same air, etc. so chances it will be any dirtier are pretty slim. The mask needs cleaning depending on the type (there are many) maybe weekly, some do it daily, others less. The machine can just be wiped from outside and the hoses really never need washing unless you're aware of something living in them - normally only air passes through.

It really would be most helpful if you can set up Oscar (it'll tell you what's needed and not) you get going so people here can decide what's what and work with you.

Please stay in this thread btw so we don't have to chase around looking for info.

MMcG
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Re: Worried - Severe Desaturation- Mild Apnea

Post by MMcG » Thu Jan 13, 2022 4:25 am

Just sharing my own experience which might be helpful, because I got feedback from my sleep/pulmology consultant. I was diagnosed with moderate sleep apnea five months ago and with very low O2 saturation for long periods at night. My mean saturation was 87% and I dipped as low as 63% at one stage. For context, anything less than 88%, and you would be given oxygen, if in hospital. It's normal for the blood oxygen saturation to drop a little while sleeping but not into the mid-80's. I'm guessing that you frequently wake with a dull headache. If you can get it, have a look at your detailed sleep study and get the mean duration of apneas and hypopneas. The simple AHI number can mask the severity of the problem, because while you may have averaged less than 15 events per hour, the mean duration might be quite long, i.e. whether an event lasts for 10 seconds or a minute or more (I managed 1 min 12 sec at one stage!), the AHI score still just counts it as one event. I can only share my personal experience - I'm definitely no expert. So, hopefully, you get additional feedback from the more expert contributors here.

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Julie
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Julie » Thu Jan 13, 2022 6:07 am

While having a level of less than 88 is considered to be desatting, a few points below that for a few times a night is not a disaster, but a call to keep an eye on things. Many people have much, much lower events (into the 60's etc) and survive well once everything is addressed. Certainly here in the US and Canada doctors don't rush to 02 immediately when individual events show up on testing, but address them (if deemed necessary) by adjustment of pressures, etc. I do wonder if your pulmonologist didn't go off the deep end a bit and scare you because of a few isolated events - though we obviously have no way to know what else was involved and why he worried you - and there is more to it all than those.

Hopefully e.g. Pugsy and others who are experts on everything here will come in with more specifics so keep watching for more help.

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Pugsy
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Pugsy » Thu Jan 13, 2022 10:53 am

Julie wrote:
Thu Jan 13, 2022 6:07 am
Hopefully e.g. Pugsy and others who are experts on everything here will come in with more specifics so keep watching for more help.
Need more specifics to be able to offer any ideas in addition to those that have already been mentioned.
....those detailed OSCAR reports.

I do think that one thing that might be done to help relieve worry is an overnight recording pulse oximeter test while on cpap to make sure that the desat problem is no longer a problem once someone is actually on cpap...and assuming the settings are effective.
I did this when I went on cpap....BTW with desats to 73% during my sleep study and they were prolonged...I just asked my DME to get in touch with the doctor and get an order for the overnight pulse oximeter recorder thing just for my own peace of mind. Often the cost is either free or covered by insurance.

To the OP....don't let the term "mild" lead you to believe your rather low category of severity isn't important.
Severity of OSA is set by the number of apnea events we have on a per hour basis. It unfortunately doesn't take into account for duration of those events and the duration of events is what likely causes the desats.
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Harmonyhill
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Harmonyhill » Thu Jan 13, 2022 12:23 pm

I know this format is not ideal but I somehow deleted the overview screen that you prefer. I will do better next time.
And I hope these photos are not too huge.
The last photo is my sleep study report from a couple weeks ago, Dec 28th, 2021.
Is there anything else I should provide? I really appreciate all the time you folks have put into this endeavor.
A heartfelt thanks.


https://www.cpaptalk.com/download/file. ... ed99b02607
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Pugsy
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Pugsy » Thu Jan 13, 2022 12:34 pm

Read this for when you post additional images.
viewtopic/t158560/How-to-post-images-for-review.html

Don't worry about the overview stuff....not all that useful anyway

Your OSA is composed of mainly hyponeas and also primarily in REM stage sleep which is fairly common. My own OSA is mild in non REM at 12 per hour and kick ass bad in REM with 53 per hour.

You are having a lot of large leaks. How bad they are we can't tell because you have omitted what is needed for leak evaluation....but very likely at a minimum that amount of leak can very well cause wake ups....so it needs to be worked on.

Your OSA....while mild overall due to averaging of numbers....in REM it is quite severe.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

Harmonyhill
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Harmonyhill » Thu Jan 13, 2022 1:46 pm

So until my pulmonology appointment and overnight CPAP trial, am I ok using a steady CPAP pressure of around 14 just to get the hang of things or can I increase it a little every night? What happens if the pressure is too high?

I made the EPR setting a full time 3 so I don't feel like I'm blowing out birthday candles with every exhale, and I used some kinesiology tape to keep my mouth shut at night. I have enjoyed the feeling of inhaling so easily with the device and will tighten the head strap to prevent leaks tonight.

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Pugsy
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Pugsy » Thu Jan 13, 2022 2:02 pm

Not much happens when the pressure gets higher and there's really not a "too high" thing when using auto adjusting pressures.
I can't tell what your settings are or what the pressure is doing because you omitted that information on the daily detailed page.

In general the machine won't go higher than it needs to go to get the job done. So if it goes higher.....it's got a good reason.
Higher pressures won't hurt you.

The worst that might happen is just a side effect from pressures in general (could be high or low) and the most common issues are.....
1..Aerophagia issues....belly pain from air in the gut and not everyone has that problem...and if you do you will know it.
2..Sometimes the pressures can cause central apneas to pop up....easily seen on the detailed reports if that happens and not really all that common but if it does happen we can usually deal with it fairly easily.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
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I may have to RISE but I refuse to SHINE.

Harmonyhill
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Harmonyhill » Fri Jan 14, 2022 8:39 am

I slept well last night Should I continue with these settings? Min 9 and Max 20
screenshot-20220114-093438.png
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Pugsy
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Re: Worried - Severe Desaturation- Mild Apnea

Post by Pugsy » Fri Jan 14, 2022 8:41 am

Harmonyhill wrote:
Fri Jan 14, 2022 8:39 am
I slept well last night Should I continue with these settings? Min 9 and Max 20
Looking good on paper and you report you slept well....doesn't get much better than that.
I see no reason to go changing things at this time.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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zonker
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Re: Worried - Severe Desaturation- Mild Apnea

Post by zonker » Fri Jan 14, 2022 11:52 am

Harmonyhill wrote:
Fri Jan 14, 2022 8:39 am
I slept well last night Should I continue with these settings? Min 9 and Max 20

screenshot-20220114-093438.png
Image

most excellent!

let us know if anything changes, but if this one graph holds, you've got it made.
resmed airsense 10 autosense for her
p10
"nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.” -mlk jr

MMcG
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Re: Worried - Severe Desaturation- Mild Apnea

Post by MMcG » Fri Jan 14, 2022 12:16 pm

Julie wrote:
Thu Jan 13, 2022 6:07 am
While having a level of less than 88 is considered to be desatting, a few points below that for a few times a night is not a disaster, but a call to keep an eye on things. Many people have much, much lower events (into the 60's etc) and survive well once everything is addressed. Certainly here in the US and Canada doctors don't rush to 02 immediately when individual events show up on testing, but address them (if deemed necessary) by adjustment of pressures, etc. I do wonder if your pulmonologist didn't go off the deep end a bit and scare you because of a few isolated events - though we obviously have no way to know what else was involved and why he worried you - and there is more to it all than those.

Hopefully e.g. Pugsy and others who are experts on everything here will come in with more specifics so keep watching for more help.
Just for clarity, she did say between 80-89% for 89% of the sleep time. That's not "a few times a night". That sort of desaturation for nearly all the night is something that needs to be addressed urgently.