New CPAP user - various questions

1. Using a professional at-home sleep apnea test for one night, I was diagnosed by a medical specialist with servere sleep apnea (55 episodes per hour). I had previously used the Wellue O2-ring pulse oximeter for several nights. According to the O2-ring, I had about 2-3 drops per hour, measured as drops over 4 % in the blood oxygen level. What could explain these very different results?

2. I have now used the Resmed Airsense 10 CPAP for about 2 months. According to the Resmed sleep report, my average AHI for the last 30 days is 1.4 drops per hour. Is such a large reduction from 55 drops per hour to 1.4 drop per hour common when starting using CPAP?

3. I felt tired during the day before starting using CPAP, and after about two months of daily use, I still haven't noticed any difference. Shouldn't a reduction in the AHI from 55 to 1.4 be noticeable after several months of using CPAP?

4. I have been told by a nurse that using CPAP is good for the health for people with servere sleep apnea even if they do not notice any difference in the daytime sleepiness. Is that correct?

Welcome!

Not all apnea events cause a drop of 4% or more in the blood oxygen level. Do you have a copy of your sleep study? It probably also includes information about O2 levels. It will also include valuable information about the kinds of events you had (obstructive apnea, central apnea, hypopnea) and possibly arousals.

A reduction in AHI from 55 to 1.4 shows the PAP treatment is working. It is not at all unusual to see such dramatic improvement. And the nurse is right: this is good for your long-term health even if you are not feeling better during the day.

It can take a while to start feeling daily benefits, so that may yet happen on its own. But people here could give you a lot more help if you would let us know what kind of machine, mask, and settings you have. Ideally your machine is compatible with the Oscar software; taking a look at a chart or two would be very helpful.

Thank you for your reply. Unfortunately, I didn't get a copy of the sleep study from the medical specialist. I use a ResMed AirSense 10 machine with a nasal pillow mask (P30i) and the auto-adjusting settings. The average pressure has been 10.9 for the last 30 days.

Not everyone will have significant desats with their OSA.
I have a friend who had an in lab sleep study and AHI of over 60 and she never really had any significant desats at all.
Her baseline O2 was around 96% and the lowest she ever got to was 93%,
So oxygen levels themselves don't always tell the whole story.

If you live in the U.S., you have a right to have a copy of your sleep study. You can simply request it from the clinic or the doctor's office. It'd be good to have it.

Is your machine an Airsense 10 Autoset? I'm guessing it is. Great machine!

Is there an SD card in the little slot on the left side of the machine? If not, you can get one to stick in there -- anything 32 GB or less. Then you can download the Oscar software to your laptop or desktop computer. You'll need a way for the software to read the SD card. If your computer doesn't have a slot, get an SD card reader. (They're cheap.)

This will give you (and us) a ton of information about what's going on in your treatment. (See below for the link to the software site.)

Pugsy wrote: ↑

Sat Feb 12, 2022 1:22 pm

Not everyone will have significant desats with their OSA.
I have a friend who had an in lab sleep study and AHI of over 60 and she never really had any significant desats at all.
Her baseline O2 was around 96% and the lowest she ever got to was 93%,
So oxygen levels themselves don't always tell the whole story.

I wear a Wellue O2 ring every night and noticed that sometimes I have an OA with no desat (and sometimes I have desats with no OSA or CSA). And so I've been wondering: If someone has apneas (even a very high AHI) but no desats and no waking up due to their apneas, then do their apneas matter? In the case of your friend, would she even need to be on CPAP if she wasn't being woken up by her apneas?

Or would one argue that even though she may not be aware that her non-desaturating apneas are waking her up, they are, and it's damaging? Or would one argue that even an oxygen dip to just 93% is damaging?

Chris33022 wrote: ↑

Mon May 23, 2022 8:55 pm

Pugsy wrote: ↑

Sat Feb 12, 2022 1:22 pm

Not everyone will have significant desats with their OSA.
I have a friend who had an in lab sleep study and AHI of over 60 and she never really had any significant desats at all.
Her baseline O2 was around 96% and the lowest she ever got to was 93%,
So oxygen levels themselves don't always tell the whole story.

I wear a Wellue O2 ring every night and noticed that sometimes I have an OA with no desat (and sometimes I have desats with no OSA or CSA). And so I've been wondering: If someone has apneas (even a very high AHI) but no desats and no waking up due to their apneas, then do their apneas matter? In the case of your friend, would she even need to be on CPAP if she wasn't being woken up by her apneas?

Or would one argue that even though she may not be aware that her non-desaturating apneas are waking her up, they are, and it's damaging? Or would one argue that even an oxygen dip to just 93% is damaging?

She was put on a cpap machine and actually ended up needing pressures in the high teens to get the the OSA under control.
There's a lot more to the body damage that OSA can do besides low oxygen level level damage.

A drop from 96% awake baseline O2 to 93% is actually considered a normal drop for when someone falls asleep.
It's normal to see a 3 to 4 % drop from awake to asleep.

Chris33022 wrote: ↑

Mon May 23, 2022 8:55 pm

And so I've been wondering: If someone has apneas (even a very high AHI) but no desats and no waking up due to their apneas

You assumption of "no waking up due to their apneas" in incorrect.
There's a major distinction between "waking up" and being conscious of it, and being aroused from sleep, having the sleep stages disrupted, without being conscious of it. You want to avoid sleep disruption by arousals.

In my last sleep study (home sleep study) the doctor said "and your AHI and desats would probably have been much worse if you didn't have so may arousals".

A 4% oxygen desaturation may be and indication that a person need supplemental oxygen when awake, but that doesn't mean your brain doesn't respond to a 2%, 3% or for that matter 3.25% when you're asleep.

ozij wrote: ↑

Mon May 23, 2022 9:10 pm

You assumption of "no waking up due to their apneas" in incorrect.
There's a major distinction between "waking up" and being conscious of it, and being aroused from sleep, having the sleep stages disrupted, without being conscious of it. You want to avoid sleep disruption by arousals.

sorry to disrupt the thread, but i just wanted to say that i'm very happy that you are here on the forum. i don't know why you've decided to come back, but i like the way you express yourself. you're always very helpful.

now back to the regularly scheduled topic, already in progress.

Thank you very much, Zonker.

ozij wrote: ↑

Mon May 23, 2022 9:10 pm

In my last sleep study (home sleep study) the doctor said "and your AHI and desats would probably have been much worse if you didn't have so may arousals".
[/quote]

Interesting! Thank you! I, too, am very happy you are back, even though I didn't know you were gone (because I'm new). I really liked an answer you wrote in the thread "Is brain damage due to sleep apnea reversible?" as well.

Pugsy wrote: ↑

Mon May 23, 2022 9:03 pm

She was put on a cpap machine and actually ended up needing pressures in the high teens to get the the OSA under control.
There's a lot more to the body damage that OSA can do besides low oxygen level level damage.

Thanks, Pugsy, for these additional details. And I fear I'm about to ask a dumb question, but since I'm very interested in this topic, I just want to make sure my understanding of what you said is correct. When you say, "There's a lot more to the body damage that OSA can do besides low oxygen level damage," I assume you are referring to sleep disturbances, right? Not some other form of damage I'm not aware of? Or does OSA, in fact, cause some additional form of damage other than the damages caused by low oxygen and disrupted sleep?

Chris33022 wrote: ↑

Tue May 24, 2022 12:33 pm

"There's a lot more to the body damage that OSA can do besides low oxygen level damage," I assume you are referring to sleep disturbances, right? Not some other form of damage I'm not aware of? Or does OSA, in fact, cause some additional form of damage other than the damages caused by low oxygen and disrupted sleep

There's more to OSA damage to the body than just O2 levels or sleep disturbances.
Everything gets sort of intertwined.


Here's a couple of starting points to read

https://www.healthline.com/health/sleep ... ts-on-body

https://my.clevelandclinic.org/health/d ... leep-apnea

What are the effects of sleep apnea?

If left untreated, sleep apnea can result in a number of health problems including hypertension, stroke, arrhythmias, cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes, obesity and heart attacks.

It’s likely that sleep apnea can cause arrhythmias and heart failure because if you have sleep apnea, you tend to have higher blood pressure. In fact, sleep apnea occurs in about 50% of people with heart failure or atrial fibrillation.

This is because sleep apnea can cause:

Repeated episodes of oxygen lowering (what doctors call hypoxia).
Changes in carbon dioxide levels.
Direct effects on the heart due to pressure changes within the chest.
Increased levels of markers of inflammation.

With the high prevalence of sleep apnea in cardiac arrhythmias and heart failure (essentially a coin flip as to whether the patient has it), experts recommend that you don’t delay in seeking the advice of your physician.