oxygen desaturation levels.

Pugsy · Post by **Pugsy** » Mon Apr 17, 2023 11:59 am

If someone just wants a one time verification that when on CPAP that the prior O2 level desats are no longer a problem and don't really want or need a recording pulse oximeter for repeated use....just call up your doctor or DME and ask them for a recording pulse ox from the DME and have them check it.

FWIW....pre cpap and my diagnostic sleep study showed me going down to 73% and that's what I did to verify that I was no longer having desats because cpap fixed the problem causing the desats.

Now if you think you might want to check it more often for whatever reason that's okay too and you might be happier buying one of your own.

Dwep60 · Post by **Dwep60** » Mon Apr 17, 2023 1:32 pm

I just wanted to thank everyone for taking the time to offer your input to my inquiry regarding a oxygen monitor. It's very obvious that there is a lot of information to be learned from many of you. I must say, I got a lot of food for thought, and an education from the dialog that took place. I think that in my case, I will discuss with my sleep doctor when I see her about the O2 levels and see if there was anything to be concerned with. And many of you were right that I was mainly looking for a monitor for peace of mind. I guess I allowed myself to get a little rattled about how low the O2 levels got, but I never took into consideration that the amount of time spent at a certain level was important to bring into the equation. I look forward to following this forum for the insight it offers to someone like me who doesn't have a clue. Again, thank you.

Ray4852 · Post by **Ray4852** » Mon Apr 17, 2023 4:06 pm

robysue1 wrote: ↑
Mon Apr 17, 2023 8:39 am

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
70 percent is very serious. your blood is loosing oxygen. have your doctor check your Hemoglobin and Hematocrit with a blood test.
The OP's O2 dropped to 70% on the diagnostic sleep test. OP does not have any hard evidence of significant O2 desats while using her APAP, particularly since the OP has no history of other conditions other than sleep apnea that would explain the nighttime O2 desats.

It's still worth getting an oximeter to measure things given her worries about whether her O2 might still be dropping at night.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
my sleep doctor wanted me to get another sleep study where they put the mask on and see what pressure works for me. I already had 3 sleep test. I turned down his sleep test.
In my opinion you were a fool to turn down that sleep test for titrating the device. It would have provided you with a lot of additional very useful data. Not only would you have come out of the test with an idea of the minimum pressure needed to actually control your apnea, you would also have gotten real data gathered in the lab about your continuing O2 desats. In particular, you would have information about whether the desats continued in the absence of OAs and Hs. And if that is indeed happening, that points to a problem that you have in addition to common OSA.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
my blood levels was a low. primary doctor was getting nervous because my blood was to thick. I could have a heart attack or stroke if I don't take care of it. what I did. bought myself the Lookee 02 ring. it cost 150 dollars. I'm on Apap with pressure 4 to 20. events 1 to 3. my ring found my problem. my oxygen was drooping down to 70 for the lowest reading and stayed up in the middle 80s during the night.
Sounds to me like you may still be having clusters of events.

But if your O2 is in the mid 80s for extended periods of time in the middle of the night AND you are not having clusters of OAs & Hs that are causing the O2 destats, you need some additional testing to find out what is wrong.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
I told my doctor about this. he sent me to see the oxygen doctor.
Do you mean a pulmonologist---i.e. a doctor who specializes in treating problems with the lungs and respiratory system? If so, what specific tests did the pulmonologist order? And did the pulmonologist suggest possible causes for the O2 desats in addition to OSA? If so, what are the other possible causes the pulmonologist wants to rule out?

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
he gave me a home study test. that test came back on boarder line. another problem.
What kind of a home study? Another sleep test? Or a lung test? Have you had any testing to rule out things like COPD? (In the early stages of COPD, some people have significantly more problems maintaining O2 at night than they have in the daytime.)

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
medicare will not approve this. I'm not going to play politics with the insurance company. write me out a prescription for a concentrator.
I hope that you actually listen to the doc rather than demanding a script for the O2 concentrator.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
I will pay out of my pocket. total cost for 2 concentrators home and portable 3 grand. money well spent. I only need this while I sleep.
Now you have really lost me: If you only need supplemental O2 when you are sleeping, then why do you need 2 concentrators PLUS a portable O2 concentrator? That set up only makes sense if you need O2 pretty much round the clock. And you would only need O2 round the clock if there's something other than OSA that is causing your low O2 levels.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
we want our blood oxygen to stay up in the 90s most of the night. when it drops below 90. you start to loosen oxygen. when it goes down to 70. it time to take action about it.
Granted. But the OP has taken action: They got themselves a sleep test which showed moderate OSA (based on RDI = 17) combined with significant O2 desats. And they then got themselves an APAP and started using it. And it's reasonable to believe that the O2 desats are no longer occurring, but getting an oximeter may help ease the OP's mind.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
I don't see any doctors no more. I manage my problem myself. if I have a problem. I will let him take care of it.
Good luck with "managing your problem" all by yourself. Out of curiosity: Has a doctor actually prescribed supplemental O2? If so, how much O2 is your concentrator set to add? Or are you just "guessing" about the settings based on your oximeter ring's readings? Too much O2 can be as dangerous as the O2 desats you want to prevent.

Ray4852 wrote: ↑
Mon Apr 17, 2023 6:13 am
get work now. you want to try another sleep study. that's up to you. you have the same problem I had too.
There is no evidence the OP has continued to have O2 desats while on APAP. You claim you are still having O2 desats down to the 70s, along with substantial time spent with O2 levels in 80s while on APAP. That's a whole different kettle of fish.

ChicagoGranny is right: Your post is unnecessarily alarming to the OP, rather than being helpful.

I'll go further: You seem to be implying that you can manage using supplemental O2 without some professional involvement beyond writing a script for an O2 concentrator and that others, including the OP, should do the same. In my opinion this is potentially dangerous advice.

I see you are from buffalo NY. I'm 40 miles south of you. I did my sleep study with Dent, orchard park. terrible outfit to deal with. my oxygen doctor don't like their sleep study. I'm on 2 leter of oxygen now with .5 to 1.5 apnea every night. I made the right decision turning down the 4th study.

robysue1 · Post by **robysue1** » Mon Apr 17, 2023 5:16 pm

Ray4852 wrote: ↑
Mon Apr 17, 2023 4:06 pm
I see you are from buffalo NY. I'm 40 miles south of you. I did my sleep study with Dent, orchard park. terrible outfit to deal with.

I am sorry that you didn't like Dent. I personally have found the sleep doctors at Dent to be far superior to the others that I have been to in the Buffalo metro area. The two sleep docs at Dent (one retired and one my current one) have been far, far better at dealing with my particular problems than the first 3 sleep docs I consulted, including the one who diagnosed me back in 2010. They've been far more knowledgeable and far more open about dealing with a well educated patient than my first 3 sleep docs. The sleep doc who retired was critical in getting me over a severe hump of major insomnia that set in as I started CPAP, which the first 3 doctors essentially wanted to ignore. The retired Dent doctor was also the only one that I've gone to that did more than a cursory look at my CPAP's actual data when I was still fighting the insomnia. As a bonus (to me), that doc was also the only sleep doc I ever went to that had OSA and used a CPAP himself. So he didn't look at me like I was some kind of a weird monster when I was describing the problems I was dealing with during my first 3 years or so on PAP therapy.

my oxygen doctor don't like their sleep study. I'm on 2 leter of oxygen now with .5 to 1.5 apnea every night. I made the right decision turning down the 4th study.

My question is still: What medical condition was the 2 liters of O2 prescribed for? And how was that rate of O2 determined?

Julie · Post by **Julie** » Tue Apr 18, 2023 6:39 pm

What is an OXYGEN DOCTOR??

Dwep60 · Post by **Dwep60** » Fri Apr 21, 2023 1:41 pm

I wanted to ask about the CPAP machine it self. I have noticed that during position changes in bed, I tend to hold my breath. When I do so, I have come to notice that I can sense what can only be explained as small gentle pressure pulses in the mask. When I inhale this goes away, but I have also noticed that the display on the machine indicates a pressure increase when I inhale. Can someone explain what this maybe?

robysue1 · Post by **robysue1** » Fri Apr 21, 2023 2:13 pm

Dwep60 wrote: ↑
Fri Apr 21, 2023 1:41 pm
I wanted to ask about the CPAP machine it self. I have noticed that during position changes in bed, I tend to hold my breath. When I do so, I have come to notice that I can sense what can only be explained as small gentle pressure pulses in the mask. When I inhale this goes away, but I have also noticed that the display on the machine indicates a pressure increase when I inhale. Can someone explain what this maybe?

Holding your breath when you change position is perfectly normal wake breathing. But your APAP doesn't know that you are awake and changing position. When you hold your breath, it thinks you might be having an apnea. So, because you are using a Resmed APAP, the small gentle pressure pulses that you are feeling are most likely the forced oscillation technique (FOT) algorithm that Resmed uses to classify an apnea as an OA or CA. The FOT algorithm typically kicks in about 4-6 seconds after the machine detects no airflow into/out of the lungs and continues until an inhalation starts. The FOT oscillations are pretty subtle and not everyone can feel them---the variation from the minimum to maximum pressure in the oscillations is less than 1 cm. Since the pressure increases after you start to inhale, the machine is most likely thinking that you either just had an OA or some flow limited breaths when you were holding your breath while changing position in bed.

It's important to remember that how we hold our breath varies a bit from individual to individual. In my case, I'm pretty sure that when I hold my breath while awake, I tend to use my. epiglottis to block my windpipe in a way that is similar to what happens when I swallow. The fact that the epiglottis is blocking my wind pipe means that if I hold my breath for at least 10 seconds while I'm awake and using my machine, almost always I'll see an OA scored in the data.

palerider · Post by **palerider** » Fri Apr 21, 2023 10:13 pm

Dwep60 wrote: ↑
Fri Apr 21, 2023 1:41 pm
I wanted to ask about the CPAP machine it self. I have noticed that during position changes in bed, I tend to hold my breath. When I do so, I have come to notice that I can sense what can only be explained as small gentle pressure pulses in the mask. When I inhale this goes away, but I have also noticed that the display on the machine indicates a pressure increase when I inhale. Can someone explain what this maybe?

Here's a video that explains the gentle vibration: https://www.youtube.com/watch?v=4GW97Xk06N8

Dwep60 · Post by **Dwep60** » Wed May 03, 2023 8:35 am

I am curious, I have down loaded OSCAR and have discussed with my primary doctor. But the trend that I am noticing is that neither my doctor nor the DME appears to know of or heard of OSCAR. It amazes me that such a useful tool isn't better known. I will be seeing my sleep tech week after next, and I am interested in what I will find out with them. What I am really interested in seeing is if the sleep study I underwent is displayed as well as OSCAR. I would love to see a before and after comparison of the flow rate, and flagged events. So I guess my question is; Is this normal that the medical professionals are not familiar with these types of programs such as OSCAR, that patients have the opportunity to use?

Pugsy · Post by **Pugsy** » Wed May 03, 2023 8:40 am

Dwep60 wrote: ↑
Wed May 03, 2023 8:35 am
So I guess my question is; Is this normal that the medical professionals are not familiar with these types of programs such as OSCAR, that patients have the opportunity to use?

DMEs and doctors will be using the manufacture's software and in the case of a Resmed machine it will be ResScan software.

ChicagoGranny · Post by **ChicagoGranny** » Wed May 03, 2023 11:33 am

Dwep60 wrote: ↑
Wed May 03, 2023 8:35 am
this normal that the medical professionals are not familiar with these types of programs such as OSCAR, that patients have the opportunity to use?

OSCAR is an excellent tool developed by users for users. If a doctor were using OSCAR and something went wrong with the patient, the doctor would be subject to lawsuits he couldn't defend. This is because OSCAR has not been approved by the FDA for marketing.

ResScan and the software of other manufacturers do have FDA approval for marketing.

Dwep60 · Post by **Dwep60** » Wed May 10, 2023 4:59 am

When looking at OSCAR, on the graph that indicates pressure, I have come to notice that occasionally the green line becomes red for a small segment. What does the red segment indicate?

Dog Slobber · Post by **Dog Slobber** » Wed May 10, 2023 8:18 am

Depending on your EPR, and display settings there may be two visible pressure traces, inhale (red) and exhale (green).

You will only see one red line when they are the same, or when your display limits aren't showing the green one.

If you want a more accurate explanation, you really should be posting your graph instead of describing what you see.

Gen99 · Post by **Gen99** » Wed Apr 24, 2024 2:48 pm

Just jumping in here to give people some info.

Standards for needing O2 with your cpap (cpap working effectively so AHIs down), has been a handful of minutes below 88 (e.g. 4, 5 - it changes over time).

Many things can lower O2 that a cpap can't fix, thing people may not know they have. Such as pulminary hypertension (cardiologists can diagnose this, I have no idea if pulmonologists can).

Having just run into a situation where O2 was boarderline qualifying for O2 concentrator treatment at night (depended on if it was tested on a good night or not), and over time it dropping to more severe (e.g. 30-60 minutes under 88), I suggest everyone check their O2 overnight on a regular basis (maybe yearly). This crept up because it looked ok and do wasn't tested for many years, all of a sudden it is severe (with good CPAP treatment).
Diseases creep up slowly.... catch them early for best results.

ChicagoGranny · Post by **ChicagoGranny** » Thu Apr 25, 2024 11:28 am

Gen99 wrote: ↑
Wed Apr 24, 2024 2:48 pm
boarderline

Do you keep tight reins on your tenants?

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