AHI staying below 4, but desats below 90 most nights

[WildMtnHoney]

I wouldn't worry about it, your leaks are under control according to the summary on the left.

LOL too late. At least now you can see a nice flat leak line most of the time

[Strict Compliance]

the greater tidal volume of the extra pressure support

Why do you call EPR "pressure support" when it reduces the pressure?

[WildMtnHoney]

One more, from today, this one doesn't show a rise in heart rate:


I'll be contacting my dr soon to talk with them about all of this, but I'm not sure now if the desats are "real" if there is no rise in heart rate -- although at least one article suggests it can happen w/Central Apnea and a few suggest it can happen with worsening heart disease (according to wikipedia - I know, not the best source - it can be due to cor pulomonale, which can show right bundle branch block on ecg, which was an incidental finding that they thought was a false reading on a recent ecg I had due to a fainting episode).

wiki link: https://en.wikipedia.org/wiki/Hypoxia_( ... ite_note-9

CA and low HR: http://circ.ahajournals.org/content/107/13/1822.full

[tedburnsIII]

So way back 2ish years ago, I was first diagnosed with sleep disorder NOS, and put on nocturnal oxygen, 2L/min because that study showed desats only. However that didn't solve everything, so several sleep studies later I was put on CPAP with a steady pressure of 11cm and they took the O2 away.

I realize I'm not even 4 months into therapy, and that I have confounding issues (my thyroid is freaking out on me - high to low and now possibly over medicated), but I'm not sleeping well, exhausted all day, still falling asleep during the day when reading (without CPAP, not good I know) and still morning headaches.

Awhile ago I bought a cheap pulse oximeter that works with sleepyhead. It is showing desats every night. Some nights pretty severe, other nights not so much -- like I can go down to 72 repeatedly one night, but then have a night like last where I only get as low as 88 a couple of times. According to Sleephead, my "last 6 months" % of time in desat is 4.65% -- would that be "enough" to put me back on O2, in theory? Of course last night was only like 0.25% of the night, and I didn't go below 88, with a baseline of 95.

What would you do in my shoes?

OP-

You've had desat issues before CPAP and with use of CPAP. Before, they placed you on 02 and more recently they added CPAP to the mix and dropped the O2 and you still are having desat issues.

Don't have the knowledge to read and understand SH tidal volume, flow all that other stuff in part because my machine is not compatible with SH. So I do not feel competent to comment re those issues.

Looking at your summary chart which I understand better, it is clear that with such low desats repeatedly appearing that in a lab titration you would not pass, IOW, you would not have an optimal pressure, or even a good or 'adequate' recommended pressure for straight CPAP, which is your current therapy. Why? Because minimum Sp02 must be 90% or above.

That said, and assuming that CPAP is the correct therapy, which it may not be, considering your 'clear airway events' which I still don't understand other than what I've been told by tech support for my machine- can not definitively state that CAI represents central apneas at all, only that airway was apparently clear at the time and may be indicative of the same.

FYI, in my lab titration RDI was below 5 as low as 7cm, but minimum Sp02 were in the mid to high 80's until I was titrated up to 12cm. They were able to get me up there to minimum 90% without use of supplemental oxygen- and so far, so good. Do note that sleep specialist doctor, in light of the study and titration, however, stated in narrative report that in my case, and due to the foregoing, that supplemental 02 might be considered.

So, it seems that CPAP for you at least, at 11cm is not doing the job without supplemental 02, so what would I do?

I'd post a thread like you have and consult with the pulmonologist and sleep specialists.

Perhaps you might embed your titration study/chart because it would be informative as to how they arrived at 11cm, assuming you had such a lab titration? If not, and you self-titrated, one might be more inclined to suggest a pressure increase, but wary of CAI.

It does appear from your OP that you are desirous of 02 again, and with CPAP or other. Seems to make sense, but I am not competent to know what may be required for insurance coverage purposes.

Cheers,

[palerider]

the greater tidal volume of the extra pressure support

Why do you call EPR "pressure support" when it reduces the pressure?

because, that's what it is. pressure support is a difference between inhale and exhale pressure. (ipap and epap)

epr creates an ipap epap situation, and the difference between them is pressure support.



the delivered pressure there went from 13 to 13/10, EPR is a limited bilevel.

[tedburnsIII]

PR or anyone-

In other than bilevel, A-flex, etc, is EPR but I don't think it's referred to as 'pressure support' because it's not added to epap pressure to determine inhalation pressure.

Or, can one assume that at an EPR of '0' there is an exhalation pressure equal to that of the set inhalation pressure, for instance, cpap set to 9 cm, epr to '0', exhalation pressure required on part of patient equals amount of incoming pressure (9 cm)?

Please explain.

Thanks,

[WildMtnHoney]

Perhaps you might embed your titration study/chart because it would be informative as to how they arrived at 11cm, assuming you had such a lab titration? If not, and you self-titrated, one might be more inclined to suggest a pressure increase, but wary of CAI.

It does appear from your OP that you are desirous of 02 again, and with CPAP or other. Seems to make sense, but I am not competent to know what may be required for insurance coverage purposes.

Cheers,

I looked and I don't seem to have that hanging around (thought I had a copy at one point) as I did an in-lab full night titration.

I'm not sure I *want* oxygen, but I know I'm not feeling well, and if it would help, sure I'd like to try it again.

I have an appt today to discuss this and other things, so we'll see what comes of that.

[tedburnsIII]

Eagerly await your update, OP!

I can say that if you feel lousy, like I did, with low desats, that that may be a contributory factor.

Your average sats look great! But apparently the minimum desats are controlling. If rare occurrence, that is one thing. But in your case,
it seems to me imperative to address.

Best wishes,

[palerider]

.

[tedburnsIII]

Oh, come on, PR, let bygones be bygones.

Or, don't think of assisting me, think of assisting others!

Cheers,

[palerider]

.

[tedburnsIII]

.

[Guest1]

PR or anyone-

In other than bilevel, A-flex, etc, is EPR but I don't think it's referred to as 'pressure support' because it's not added to epap pressure to determine inhalation pressure.

Or, can one assume that at an EPR of '0' there is an exhalation pressure equal to that of the set inhalation pressure, for instance, cpap set to 9 cm, epr to '0', exhalation pressure required on part of patient equals amount of incoming pressure (9 cm)?

Please explain.

Thanks,

Ted: for resmed cpap/APAP machines, with a set pressure of 'x', and EPR set to 'y', your numbers are as follows:
IPAP = x, EPAP = x - y

For respironics machines, 'y' is always equal to 2.

[palerider]

.

[BleepingBeauty]

C'mon, you two. Up against the wall and whip 'em out. I've got the ruler.

Please don't derail the OP's thread with more of this.