Low Oxygen Level Readings

I met with my DME this morning to get a printout from my card to take to the Dr's next week. I took my SPO 7500 with me to check against his equipment. For the 30 seconds or so that we compared them, they were identical. So at least I am more comfortable knowing that my meter is OK. However, he did say that my O2 was only at 93 while we were sitting there, and he felt it should be closer to 97. So, maybe I am breathing shallowly all the time, not just while I'm sleeping.

I have 8 nights worth of reports now from my oximeter, with all but 2 showing lots of desats. Last night was the best one with only 19 desats for a total of 17 minutes in 8 hrs 19 min. The worst one showing 57 desats for a total of 217 minutes in 6 hrs 43 min! I'm taking all the reports with me when I see the Dr.

Since oxygen deprivation is what apnea is all about - I am concerned.

Do any of you have any experience or knowledge about oxygen levels?

Here are my readings from the first printout 12/31/08 to 2/26/09 since I began cpap. (Every night, all night)
Resmed S8 Elite II - Swift LT Mask - Humidifier i4

Therapy Mode: CPAP
Set Pressure: 10.0 cmH20 EPR Mode: Full Time
Median Pressure - cmH20 7.8 Maximum 10.0
Median Leak 0.0 95th percentile Maximum 20.4
Apnea index: 0.0 AHI: 4.2 HI: 4.2

Everything but my oxygen level seems to be OK, I think. Please let me know if I am overly concerned. Thanks.

One of the responses that I got back from my doctor was that during my sleep study, I had apenea events however, the oxygen levels remained steady. He asked me if I exercise a lot. The answer is yes. There is a correlation of being able to sustain higher oxygen levels for longer periods if your heart is strong.

I started to feel much better after a while of aerobic exercise before I went on CPAP. After CPAP I started to feel even better.

My $0.02 worth.

Sue......

My compliments to you on your rational approach to CPAP therapy. O2 saturation levels are indeed the "bottom line"....and you're right on top of it.

I'm certainly not an expert....and I'm not a doctor. I'm simply a "mechanic" (a person who studies Physics) and an owner of a SPO-7500 who shares your concerns.

For myself, I get a little concerned when my O2 saturation levels are in the 90-93% range.. I get really concerned when my O2 saturation goes down to 89% or lower.

If I was holding at 93% or above while awake, I wouldn't be "overly concerned". I might be "mildly puzzled". After all, the oximeter might be "off" a point or two in its calibration.

What I didn't see in your post was the desaturation levels reached while you were asleep. For myself, I try to make sure that my O2 saturation stays at 93% or above....all night.

If I fall below that, I try to figure out "why".....Am I leaking?.....is there some other reason?....Why?

Hope this helps............

Gerald

CPAPSue - how long have you been on CPAP?

I was finally diagnosed with OSA when my daytime O2 levels were down and could not get up. (I went into the doctor because I said I "had trouble breathing." They checked my lung function and heart, both were fine; I wore a pulseox for 2 days and my O2 levels hovered around 90. The ultimate conclusion, after my sleep study, was that my O2 levels were going so low at night, my body could no longer compensate during the day and get my levels up to normal.)

This is a long way of saying that if you are a CPAP newbie, it may take some time for your 02 levels to return to normal. What do you think?

Linus - I'm hoping that using my treadmill will help.

Gerald- My O2 fell to 84% while sleeping.

MoneyGal - I've been on cpap for 8 weeks. I've been hoping to see an improvement in the 'heavy head' feeling I've got. Since the oxygen level is real and reportable, I hope there will be an relative improvement as the levels improve.

Thanks for your comments.

Sue.....

Ok....I think I'm getting the picture now........

Your AHI is above 4.0....and your O2 levels drop into the mid 80's.

Regardless of what the medical establishment says, I've found that my honey and I must keep our AHI scores below 2.5....in order to keep our O2 saturation levels at 93% or above.

Simply said, your CPAP is not effective. You've got too many leaks....or something. It's probably helping....but, not enough.

The beauty of what you are doing....using (2) machines to check yourself.....is that you can see the contradiction.

The medical establishment says that we're "normal" if our AHI is below 5.0. In my opinion, that's simply horse poop! You've got the measurements to prove it.

I'm betting that if you get your AHI below 2.5, you'll find the same thing we did. Your O2 saturation levels will be OK while sleeping.

You have work to do..........and you can do it.

Gerald

Sue.....

Reading over your posts again....i realized something else.

You're only looking at half the picture. You need a fully data capable CPAP machine with software and a reader. You need a full report from your CPAP machine....every morning.....just as good as the one you're getting from your SPO-7500. You can then compare the two reports....and get a really good idea of what you need to do in order to improve.

Right now, you're flying through a "fog" with only partial instrumentation. Your providers have "short changed" you.....just as they do so many others. The cause is partly incompetence....partly dishonesty. You have to conquer those negatives by taking charge of your own therapy. Because you already have a SPO-7500, you're a long way down that road of "self responsibility".

Now..... you need to obtain the rest of the necessary instrumentation. You shouldn't trust your life to those who've "short changed' you.

Gerald

I've been recording the readings in the morning: Leak, AI, HI, AHI. So I do have something to reference.

I will order the reader; but, how do you get your AHI's lower? The DME said that my leak rate is fine, no need to get a different mask. So, what do I do to get a lower AHI?

Gerald, I think that CPAPSue is listing a full-data machine that gives good data from the screen. (Thus the data she provided.) And I believe that, roughly speaking, an AHI of 4 on a ResMed is approximately equivalent to an AHI of 2 on a Respironics machine.

CPAPSue, as I'm sure you well know, health issues beyond OSA can cause low O2. And what you describe may or may not be a matter of larger concern, depending on a lot of factors that only your doctor with your full history in front of him/her would know. So I think you are being very smart to continue working with your doctor on that.

jeff

Sue.....

Only you can determine what needs to be done in order to lower your AHI. As you read through the various posts on this forum, you'll see what a low opinion most everyone seems to have of DME's. So, to assume your DME is correct when he says that your leak rate or your AHI is OK is not something I'd do.

I want a print-out from my CPAP machine....and a print-out from my Oximeter....so that I can put them side-by-side....to see what happened hour-by-hour while I was asleep. The only way to win the battle is to use the Scientific Method or the OODA Loop.....Observation....Orientation.....Decision.....Action. Gather data from both machines....think up modification or changes.....run experiments to prove or disprove your ideas....then observe the data you collect. Repeat....over and over.....learning as you go. Just like a 2-year old does as he tries to figure out how the world works.

Jeff......Because I'm not familiar with Sue's machine....and how it compares with the "M" series I run....I can't know whether or not the different brands report AHI data in different ways. It would seem to me that they'd have to be similar....and to say that an AHI of 2.0 on one machine is pretty much equivalent to 4.0 on another brand machine....is hard for me to understand. It just doesn't seem like that would be the case......but, I've had no direct experience....and I've run no experiments that would help me understand what you are saying.

Thanks, Gerald - That makes sense.

My husband is using an auto Respironics M Series with A Flex. His AHI was running between 1 and 2, however his oxygen level was still often in the 80's and he had numerous desaturations during the night. The doctor ordered oxygen at night and we finally got it a couple of nights ago and now he is having maybe 1 desaturation at night and his oxygen report looks great. I am hoping as he continues to feel better he will be able to exercise more and maybe at some point he can be off the osygen at night, but not at this point.

Gerald wrote:Jeff......Because I'm not familiar with Sue's machine....and how it compares with the "M" series I run....I can't know whether or not the different brands report AHI data in different ways. It would seem to me that they'd have to be similar....and to say that an AHI of 2.0 on one machine is pretty much equivalent to 4.0 on another brand machine....is hard for me to understand. It just doesn't seem like that would be the case......but, I've had no direct experience....and I've run no experiments that would help me understand what you are saying.

Rested gal explains the reasoning better than I ever could, as seen in the following thread. If I understand things correctly, it would have been more accurate for me to have said that the broad rule of thumb is that an HI (Not AHI) of 4 on a ResMed might be considered roughly equivalent to an HI of 2 (or less) on a Respironics. But with AI below one, that comes to pretty much the same thing. (And cpapsue's AI, as reported above, is 0.0.) Here is one of the threads in which rested gal discusses it:

viewtopic/t39237/viewtopic.php?f=1&t=36 ... 32#p319432

Jeff.....

Thanks for the reference to Rested Gal's ("Mother Superior") work. She always helps me understand things better.

Sue......If a hypopnea is a "pre-apnea"....or one might say...an "apnea-wanna-be"......it might be good for you to try and kill them off with a little more pressure.

About a year and a half ago, I found that if I raised my pressure just a tad, I prevented the hypopneas from ever getting started....and that prevented the apneas from ever developing.

As someone else mentioned a few days ago......I can't remember which thread it was on.....CPAP air pressure is simply a "stint" that pushes against the tissues within our respiratory system....shoving our airways open just enough so that we can breathe more easily.

The trick is to get just enough pressure to do the job....but not so much pressure that it causes discomfort. Conquering "leaks" is the key. Someone used the analogy of a "flat tire"....if more air is going in than is leaking out the hole, the tire will inflate. But if the hole is too large....or if it's variable in size.... the tire can't inflate....thereby remaining a "flat".

Probably the most productive thing you can do is to attack your leaks.....both mask and mouth....thereby providing your system with a constant environment on which to "push". Variable leakage will give you variable results.

Hope this helps......

Gerald

Gerald wrote:Thanks for the reference to Rested Gal's ("Mother Superior") work. She always helps me understand things better.

She is a wise woman, and a blessing to us all.

Another such blessing to us is Ozij. And at the risk of my sounding redundant, I would just like to reiterate her fine advice to Cpapsue in another recent thread, "re: Blood Oxygen Deprivation" (colorization mine):

ozij wrote:

cpapsue wrote:Looking for some additional input on my O2 issues.

Last night, I had 0.0 leaks, AI 0.0, HI 2.4, AHI 2.4 - doesn't sound too bad. However, I used the oximeter and it reported a low of 85%, but 85-89% for most of the night! This has me puzzled and concerned. If there are no leaks, why is my 02 so low.
I had a fit of coughing when I first went to bed and thought that would show up as leaks, but it didn't.

I'm going to change hands tonight - for lack of another idea, to see if something wierd is going on with that hand/finger.

The battery should have been OK, just the 2nd night for it.

Anyone have any other suggestions. Thanks.

I'd contact the doctor.

O.