Where is the common sense?

[1102TC]

I suffer from obstructive sleep apnea and panic disorder. I was treated successfully with an Phillips Dreamstation for a number of years now for the apnea. I did not think much about it, just clean it, change the filers, and use it. I do have a collection of SPO2 monitors not because of my apnea but because of my panic attacks. It helps me get through the panic attack suffocation feeling to see a good O2 level. I noticed an odd rarity however that when relaxed sometimes my SPO2 drops to very low numbers, when high anxiety I am on at 99 lol. I brought this up to my doctor 2 years ago and he just blew it off as cheap non medical grade equipment even though it matched his during the visit. Anyways he told me that I should not have a SPO2 monitor because he felt it was causing my anxiety and refused to offer any actual test.

Anyways, I bought an overnight SPO2 monitor lately because I read that sometimes panic disorder is related to SPO2 drops. I was collecting my data for proof on my own to force the situation that I wanted oxygen added. Anyways all of a sudden I started to have panic attacks that don't match my norm. I wake up with racing heart rate of about 150 bpm and it lasts for about an hour and a half. Very painful to have them that long.

Getting panic attacks in my sleep is not normal. So I used a security cam to capture them to see why it happens every time I sleep now. I had 8 of them tonight so far and I think that I will stay up now, that's enough. I thought perhaps it was a sleep position or a mask problem when rolling over. I noticed in the videos at first that I would roll over and wake up. However I decided to also include my computer screen linked to my SPO2 monitor in the videos. What I found out is that my heart was taking off like a rocket in my sleep and actually causing me to roll over and wake up. Again another doctor refused to even look at the video I created. I asked them to check my CPAP data at least and as far as I can tell they have not. So I did using Oscar. Turns out I had 4 back to back clear airway events, so at least 40 seconds of no breathing before my heart rate decided to take off and it all matches the time stamp off my cam footage. So yeah I am ready for a showdown with my doctor. I have a few more days to go yet until she will see me.

So here is the common sense questions I do not understand. A CPAP in made for the purpose of making sure you get air. Why don't they have an optional SPO2 device built into the system? Why do they log events of not breathing but don't give the average user access to detailed information? It shows me 4 even'ts but fails to say it was actually one long event. Why can't you at least create an alarm setting to wake you up if you stop breathing for a certain amount of time? I rather be woken up by alarm instead of staying asleep to the point that a panic attack manifest itself.

[Julie]

Cpap is made to keep your airway open better than it stays when not using Cpap... it's not meant to be giving you 'air' but helping the air to pass properly into your system. You're waking up with 'panic' attacks because your body is not letting you breathe well enough to sleep... keeps waking you with big gasps trying to get air into your airway. Forget the video and post Oscar results (according to directions at the top of the page here) and we can help you interpret results.

A few clear airway events are normal when you start to sleep and just before waking, so don't fuss about those, not unless you have lots all night through.

[ChicagoGranny]

So I did using Oscar. Turns out I had 4 back to back clear airway events, so at least 40 seconds of no breathing

Look for the Events tab on the left of the OSCAR Daily Details screen. Click on it. You can find these four events and see how long each of them is.

[1102TC]

Cpap is made to keep your airway open better than it stays when not using Cpap... it's not meant to be giving you 'air' but helping the air to pass properly into your system. You're waking up with 'panic' attacks because your body is not letting you breathe well enough to sleep... keeps waking you with big gasps trying to get air into your airway. Forget the video and post Oscar results (according to directions at the top of the page here) and we can help you interpret results.

A few clear airway events are normal when you start to sleep and just before waking, so don't fuss about those, not unless you have lots all night through.

I am sorry but how do I find the directions to post results. I have to clickable link.

[Miss Emerita]

You want to post a daily chart. Include the left panel, plus these graphs:

Events
Flow rate
Pressure
Leaks
Snores.

Just take a screenshot of the daily chart, save it, and attach it to your next post. Exactly how you do the screenshot will depend on your computer, so you might need to poke around a little to figure it out. For what it's worth, I have a key that says PrtSc, then I go to Paint 3D and paste the screenshot, then do a save in the usual way.

About your questions. I believe many (most?) CPAPs can be used with an oxygen bleed adapter. Like you, I wish we could see a lot more information on the screen of the machine itself, but that would probably make the machines more expensive. Luckily, there is the free Oscar software that we can use to get incredible amounts of information, minute by minute, about what happened during the night. And if you google sleep apnea alarm, you will see there are devices you can use to be awakened if you have apnea events.

I also just want to throw out a thought. Because you have a panic disorder, you naturally think in terms of panic attacks when you have these night-time experiences. But you are describing this sequence, I believe: clear airway events / increased heart rate / roll over and wake up. I'm not seeing any psychological mediation between the CAs and the high heart rate. Is the same sequence occurring for all the episodes of elevated heart rate?

[1102TC]

Sorry I already worked on this one. Wanted it to show my spo2 and heart rate. Will get another of the snore. Sorry again I know you want everything on one pic.

[1102TC]

I threw the cpap mask off as soon as I realized my heart was pounding out of my chest.

[jnk...]

Being awakened by a surge of panic juice during an obstructive apnea is a feature of the human body, not a bug. The solution generally is to optimize pressures to prevent obstruction and further stabilize the airway during sleep, not to add in O2.

You have no information worthy of a showdown with any doctor. And hopefully you can get help here to optimize your own treatment pressure to solve your own sleep issue. Your O2 concerns are likely a red herring, though. Occasional dips are no big deal, not the way sustained low O2 is for the people with constantly very low O2 asleep and awake.

As for common sense: It is easy to fix sustained low O2 during sleep with even a too-low pressure that allows sleep disturbance to continue, so patient monitoring of O2 is not really useful information in the way that other efficacy data are. (Possible exception of showing a need for bilevel for the obese.) But get events as low as possible and O2 takes care of itself for an otherwise healthy patient with no medical indication of continual very low O2, awake and asleep. For most, using a pulse-ox to assure oneself of one's own breathing makes about as much sense as using a stethoscope to assure oneself that one's heart is beating.

And adding an alarm to a OSA-treatment machine designed to help sleep for an OSA patient would just wake the user up needlessly and would cause more panic attack issues for people, not fewer.

So get pressures optimized to keep your airway stable and file the pulse-ox under entertainment for the curious and creation of needless spats with docs. (Other than the one useful use that Mars highlighted in another thread, anyway. That is about sustained low O2 while awake indicating possible COVID-19 deterioration to be reported to one's doc.)

[Cannuck 1]

I think you have a issue with leakage from your mask, Resmed considers anything over 24 l/min as a large leak. You can add a red line as a marker to your graph by on the left of the chart to find the proper marker.(upper leak threshold,click it on)

[palerider]

I think you have a issue with leakage from your mask, Resmed considers anything over 24 l/min as a large leak. You can add a red line as a marker to your graph by on the left of the chart to find the proper marker.(upper leak threshold,click it on)

PLEASE stop posting when you have absolutely no idea what you're talking about.

It wastes peoples time, and confuses them.

LOOK at the OPs chart, they do NOT have a Resmed machine, so the guidelines for a Resmed machine mean *NOTHING*.

To the OP, ignore the post by Cannuk 1, it is completely wrong.

Your leak rate is fine.

[Cannuck 1]

I think you have a issue with leakage from your mask, Resmed considers anything over 24 l/min as a large leak. You can add a red line as a marker to your graph by on the left of the chart to find the proper marker.(upper leak threshold,click it on)

PLEASE stop posting when you have absolutely no idea what you're talking about.

It wastes peoples time, and confuses them.

LOOK at the OPs chart, they do NOT have a Resmed machine, so the guidelines for a Resmed machine mean *NOTHING*.

To the OP, ignore the post by Cannuk 1, it is completely wrong.

Your leak rate is fine.

Seeing you are full of wisdom what is the difference?

[palerider]

To the OP, ignore the post by Cannuk 1, it is completely wrong.

Your leak rate is fine.

Seeing you are full of wisdom what is the difference?

I suggest you do some reading on the forum, it's been explained hundreds of times.

Don't offer comments on things you don't know the answer to, it wastes everyone's time, yours in posting drek, someone else's time correcting you, and most of all, it wastes the time of the OP who's sent off on stupid wild goose chases.

Here, I'll start you out:
https://www.google.com/search?channel=f ... espironics

[Pugsy]

what is the difference?

Difference in what? Leak rate numbers?
There is a huge difference in how Respironics machines report leak and how ResMed machines report leak. Total leak vs excess only leak.

Example...large leak for a ResMed machine starts at anything over 24 L/min.
Large leak for a Respironics machine...it varies with the pressure used and the mask used but a conservative estimate would be 70 L/min total leak.

The OP in this thread....other than the spike when the mask was removed...there weren't any real excess leaks at all to speak of.

When we give advice we need to make note of the machine and how it reports leaks. Leak numbers for ResMed users are meaningless to a Respironics or actually any other brand machine leak numbers. It's all because of the fact that ResMed is the only brand that reports only excess leak numbers.
All other brands report total leak which is the mask's expected vent rate PLUS any excess leak.

When a ResMed user tells a Respironics user they have a leak problem and they really don't....it can create confusion and undue stress.
They can go trying to fix a problem when the problem doesn't exist.

Also the "time over red line" on the statistics....the red line is a ResMed line and it needs to be adjusted to reflect the anticipated Respironics red line. See the LL line on the events graph?? That is Large Leak....per the machine and not the software. It trumps everything else. If there are no LL flags up there.....no large leaks happened. That's actually what I look at when evaluating leaks on a Respironics machine. If the machine doesn't flag a large leak then it didn't happen.

[1102TC]

Thanks everybody so far. According to my machine I have a 100% mask fit. Sometimes a leak is because I adjust it or pull it away. I have another days I can post. But most are horrible looking because things got ugly quick and my sleep erratic. I picked one that had some actual consistent hours of sleep thinking it would be easier to look at. Others have a much higher AHI. I got bloated and thought that I had food poisoning because it was hard to breath, full of pressure. But that passed and these waking up events persisted. In fact it got to the point that I was so rattled from adrenaline from staying awake or waking up this way that I could not eat or drink and ended up going to the ER for dehydration and an IV. LOL that's another first for me. This is going on now for two weeks and I only got two days to make it to the Doc. Perhaps this is just my anxiety finding a new way of manifesting itself. But even before CPAP treatment I never had it this bad. All I know is my heart rate climbs drastically in my sleep and wakes me up in that order. Perhaps it's some other thing going on that needs diagnosed by a professional.

[Cannuck 1]

what is the difference?

Difference in what? Leak rate numbers?
There is a huge difference in how Respironics machines report leak and how ResMed machines report leak. Total leak vs excess only leak.

Example...large leak for a ResMed machine starts at anything over 24 L/min.
Large leak for a Respironics machine...it varies with the pressure used and the mask used but a conservative estimate would be 70 L/min total leak.

The OP in this thread....other than the spike when the mask was removed...there weren't any real excess leaks at all to speak of.

When we give advice we need to make note of the machine and how it reports leaks. Leak numbers for ResMed users are meaningless to a Respironics or actually any other brand machine leak numbers. It's all because of the fact that ResMed is the only brand that reports only excess leak numbers.
All other brands report total leak which is the mask's expected vent rate PLUS any excess leak.

When a ResMed user tells a Respironics user they have a leak problem and they really don't....it can create confusion and undue stress.
They can go trying to fix a problem when the problem doesn't exist.

Also the "time over red line" on the statistics....the red line is a ResMed line and it needs to be adjusted to reflect the anticipated Respironics red line. See the LL line on the events graph?? That is Large Leak....per the machine and not the software. It trumps everything else. If there are no LL flags up there.....no large leaks happened. That's actually what I look at when evaluating leaks on a Respironics machine. If the machine doesn't flag a large leak then it didn't happen.

Thanks Pugsy, I used the Respironics Remstar auto/Aflex M series and it was my first Cpap auto for about 5 years, when it came to leaks it was hard to figure the thing out because Respironics is vague and they had their propriety card reader no one could decipher But if it creates confusion >like Palerider some how dramatized, and if a person has to defend every little thing I guess it time to move on. He is still a pain like he was 5 years ago . People do learn when it is presented like you have taken the time to do. Thanks for helping so many folks over the years.