SPO2???

How relevant is it to monitor O2 saturation?

I have been using an Oxygen Concentrator for the past year since I discovered my OSA.

Recently I convinced my new sleep doctor to provide me with a 4 night SPO2 monitor and report, 2 with and 2 without the O2.

The doc determined I no longer need the O2 concentrator even though there is about a 3% improvement with the O2.

Even with the O2 I seldom get above 95%.

It seems to me I can use all the help I can get.

Has anyone convinced their insurance company to pay for a recoding SPO2 monitor?

Many forum members use their own privately purchased overnight recording pulse oximeter .
Unsure what hoops that insurance companies would put up for you to get insurance reimbursement.

Prices were $90 to $150 or so depending on model. Several threads with lots of discussion about them here.

If you feel the added data will help you evaluate your therapy and it really doesn't cost a huge amount of money then go for it. I used one from my DME one weekend. Nothing of great excitement showed up on it and so I haven't found the need to buy one of my own. Not yet any way. I keep buying machines instead. Maybe later.

Ooopsie!!!

I am assuming your insurance was billed for those 4 nights of recording oximetry???

You may be in for an unpleasant surprise. Your insurance may well now refuse to pay for the concentrator rental any longer.

There's certain criteria that must be met for insurances to pay for 02 concentrator rental and Sp02 consistenly above 90% doesn't even begin to qualify for concentrator rental.

By the way - have you taken a look at your insurance EOB to see just how much they are paying for that concentrator each month?

Good luck!!!

Slinky wrote:I am assuming your insurance was billed for those 4 nights of recording oximetry???

Slinky, my DME let me use their pulse ox over a weekend to check my stats. It was free. Part of their service even though I only use them for mask and machine filters since I bought my machine privately.
Maybe OP DME will be one of those "free" uses and not bother to file insurance and thus the insurance company may not even find out about it.

bwexler wrote:Even with the O2 I seldom get above 95%.

I thought as long as you are over 90, you're ok?

I would say that monitoring your SpO2 is more important than monitoring your CPAP data. The whole reason we're on CPAP in the first place is to keep our apneas from dropping our O2 sat level. When I say this, I'm thinking about people with no problems keeping their sats up.
You on the other hand, should get yourself a recording pulseoximeter today.

http://www.pulseoxstore.com/Downloadable-Pulse-Ox.html

ameriken: The way I understand it, normal resting SpO2 is ~95%. If you are in a hospital, they put you on a ventilator @ 89%.
Apneas is scored with a drop in O2 saturation greater than 3%. That means a person can be diagnosed with severe obstructive sleep apnea and put on CPAP therapy with high AHI's and still never see a O2 level drop below 92%

Berkebang wrote: If you are in a hospital, they put you on a ventilator @ 89%.

I'm going to assume that Berkebank meant that they put you on "oxygen" rather then on a ventilator because if he did mean ventilator...well that's inaccurate to the point of silliness.

Different standards exist for starting someone on oxygen...both night-time and full time O2. I was reading an article about sleep studies and O2 use. Generally if you drop below 88% for at least several hours during the night...then O2 is indicated.

My Pulmonologist also uses 88% to determine of someone needs full-time oxygen. If you can't maintain 88% then O2 is added.

Ameriken wrote: I thought as long as you are over 90, you're ok?

Hi Ken. That's generally a safe assumption...but you still have to look at the norms for the individual. A sudden drop from 98% down to 90% would be cause for alarm and a trip to the ER. But for me, I'm happy if I can maintain 90%.

And getting back to sleep apnea. O2 is certainly important but so is quality of sleep. Having adequate O2 does not guarantee a good un-fragmented night's sleep.
J

jamiswolf wrote:And getting back to sleep apnea. O2 is certainly important but so is quality of sleep. Having adequate O2 does not guarantee a good un-fragmented night's sleep.

Ditto....

When I first started therapy (history of desats to 73% during sleep study) and once I got pressures adjusted so that everything looked good...and had a overnight pulse ox study which showed no significant drops in O2....I still had horribly fragmented sleep and certainly did not feel nearly as good as my numbers said I should. There is more to feeling well rested than just a low AHI and more to feeling well rested than having 98% Oxygen all night.

Burkebang wrote:I would say that monitoring your SpO2 is more important than monitoring your CPAP data. The whole reason we're on CPAP in the first place is to keep our apneas from dropping our O2 sat level.

Arousals are bad for your health, even if there are no SPO2 drops.

I meant O2 of cause, I must have been a bit foggy The important thing is that it is an event that a hospital would take action against immediatly.

The only thing CPAP treatment can affect, is apneas, the problem with apneas is drops in O2. So meassuring O2 saturation is meassuring the effect of the CPAP treatment.

When it comes to quality of sleep, I have started a thread about that:
viewtopic/t72700/viewtopic.php?f=1&t=72 ... 65#p668209

The more data we can meassure, and meassure over time, the better we can understand our sleep and if it is healthy or not.

Great! I came to the right place and the right thread. Good evening! I has a study done in Nov of '10... prescribed CPAP at 9 cm, there was no follow up, no consultation with sleep doc... this is public health.. anyway...

Been having terrible time with sleep recently even with the machine, have gotten used to it but things are no better, worse if anything. I'm awake after three or four hours and from there it's a swooning in and out with a lot of anxiety, laying there. My thinking is getting foggier, getting more and more fatigued. I am missing REM sleep and it's dragging me down.

Going back to pulmo Friday.... I look carefully at the report. Without therapy my sats did not drop below 90 and with a mean of 94, as high as 96.

I can see how having a splinted airway will help with obstruction and failure to breathe, and sats that drop say into 80s even. But if I'm doing ok on the 02 why am I given a CPAP? I notice also a larger percentage of 'central' apneas particularly on my back. Can I look forward to perhaps some other way of treating arousals or is it maybe just being uptight, anxiety related.... some neurological bug... is CPAP really going to help me?

Thanks for any thoughts... Brien

archangle wrote:

Burkebang wrote:I would say that monitoring your SpO2 is more important than monitoring your CPAP data. The whole reason we're on CPAP in the first place is to keep our apneas from dropping our O2 sat level.

Arousals are bad for your health, even if there are no SPO2 drops.

Yes, that makes sense (wow, does it!), but if that's the case how then is CPAP a solution to arousals? Is it about forcing the neurological side of things, the respiratory drive to keep working? If so it's not working in my case. I'm interested to figure this out. I'll lay on my back, even with the nose mask and my piddly 9 cm setting, get into a hypnotic groove and j-u-s-t about lose it, about to go off into dreamland, then awaken, as if part of my brain was sensing a slowdown in breath... ok, but then I'm wearing a pulse ox, and in these cases I'll look at the stupid thing and it's like 95% or 93% maybe, that is not an organ-frying desat. Do I just need some drugs?

Brien wrote:Yes, that makes sense (wow, does it!), but if that's the case how then is CPAP a solution to arousals? Is it about forcing the neurological side of things, the respiratory drive to keep working? If so it's not working in my case. I'm interested to figure this out. I'll lay on my back, even with the nose mask and my piddly 9 cm setting, get into a hypnotic groove and j-u-s-t about lose it, about to go off into dreamland, then awaken, as if part of my brain was sensing a slowdown in breath... ok, but then I'm wearing a pulse ox, and in these cases I'll look at the stupid thing and it's like 95% or 93% maybe, that is not an organ-frying desat. Do I just need some drugs?

We get arousals because our brains have to wake up to get our breathing started again when a serious apnea occurs. CPAP prevents these arousals effectivly by splinting our airways and forcing air into our lungs. This means that CPAP treats obstructive apneas well. If you have central apneas, where the brain itself stops giving the "order" to breath, CPAP is much less effective, ASV (Adaptive Servo-Ventilation) may be the thing for you. That is really a CPAP machine with a buildt in ventilator. The ventilator part will keep your breathing rythm going, even if your brain is not giving the order to breath. As long as your centrals are not that long lasting, as the O2 sat levels you mention infer, such a machine could possibly prevent your arousals. You can talk to your sleep doc about this.

Thanks Burkebang. This is an entirely new world to me and I have researched a little on central apneas and even the adapto servor machine. It is freaky to think my brain is simply forgetting to send the order to breathe. It is also a little strange that I am waking up with the sats still in the low to even mid 90s.

Brien wrote:Arousals are bad for your health, even if there are no SPO2 drops.

Yes, that makes sense (wow, does it!), but if that's the case how then is CPAP a solution to arousals? Is it about forcing the neurological side of things, the respiratory drive to keep working? If so it's not working in my case. I'm interested to figure this out. I'll lay on my back, even with the nose mask and my piddly 9 cm setting, get into a hypnotic groove and j-u-s-t about lose it, about to go off into dreamland, then awaken, as if part of my brain was sensing a slowdown in breath... ok, but then I'm wearing a pulse ox, and in these cases I'll look at the stupid thing and it's like 95% or 93% maybe, that is not an organ-frying desat. Do I just need some drugs?[/quote]

If you have an obstructive apnea, your brain may react to the fact that it's trying to inflate the lungs and nothing's happening, even before your O2/CO2 goes bad. That may cause arousals.

Think of an arousal as having a loud noise in the room, stressing you out and disturbing your sleep, even if it doesn't actually wake you up.

Think of a desat as holding your breath until you start to turn blue.

CPAP mostly works by inflating your airway and keeping it from mechanically collapsing.

If you truly have "brain not trying" central apneas, CPAP will probably not do anything about them, and might make it worse.

Don't panic about centrals. They're not necessarily any more harmful than obstructive apnea, just harder to treat. How many and how severe is what affects your health. What are your AHI numbers?