Best way to proceed?

tschultz wrote:I don't like to suggest that simply the oximiter data will allow a diagnosis what you have, or rule out what you don't have. But it can be a valuable tool when combined with other information such as data from the xPAP or sleep study information.

I don't think any of us here would argue that point!

Could you also post a graph of what it looks like now that you are on treatment? It would be neat to compare the two.

jbn3boys wrote:Could you also post a graph of what it looks like now that you are on treatment? It would be neat to compare the two.

Here is data after I started to get my CPAP treatment optimized, you can clearly see the roller coaster is gone.

WOW! Impressive!
Thanks!

mars, the oxygen saturation data will pick up OBSTRUCTIVE events, but is much less sensitive to the other events. The pulse rate data is sensitive to all of the events, but it also has "normal" variations during the different stages of sleep.

There is also the problem of the people reading the data focusing on a single aspect of the study, that being the maximum desaturation value.

On one hand, if the data shows multiple desaturations down to something like 75 - 80%, it is pretty obvious that there is something not quite right. On the other hand if the desaturation is only down to 90%, that does not rule out sleep problems. You have to look further.

Global scoring calls for using a 4% drop in O2 to signal an event. In shallow stages of sleep your body can quickly be aroused to get the heart beating faster and limit the total desaturation, while still scoring a 4% drop. In deeper stages of sleep, the arousal is not as quick and the desaturations swing further to the point where they finally cross the 88 - 90% range. We should also look at pulse event scoring. If you set the criteria to a small fluctuation in hear rate over a short period of time, you will score a large number of events. This is useful for picking up on the things that cause small variations, but if it is set too sensitive you score an event every time you move or roll over. On the other hand setting the criteria to a larger fluctuation in rate over a longer period of time alerts you to more "significant" heart events.

Continuing on with scoring... I have a friend that is on xPAP and had eliminated desaturations below 90%, but was still not waking refreshed. The oximetry data showed that there were still some desaturations going on, and about 2/3 of the way through the desaturation the heart rate would increase. I adjusted the scoring to score an event with a 3% desaturation and we ended up with 75 - 100% desaturation events a night. I was amazed that by increasing the pressure by only 0.4 cm H2O, that the 3% desaturations dropped to 0 - 5 per night, and the heart rate settled down. Most importantly, my friend is now reporting more restful sleep.

I have another friend who was curious about his sleep and I loaned my oximeter out for an overnight "study." There was 1 desaturation down to 85%, but what was most interesting was that while not many "events" were scored, there was a gradual drop in O2 saturation several times during the night and each time the heart responded with an increased pulse. This brought the O2 levels back up and the process would continue. The gradual desaturation tool place over 60 - 90 seconds. I mentioned that sleep apnea can have somewhat of a similar pattern and it might be a good idea to talk to the doctor about having a sleep study done. Since there were no symptoms present, my friend went out and bought a brand new sports car and is using that for general treatment for all things... Since I was given the opportunity to drive it, we decided to do another oximetery study in a year and see how the two studies compare.

Oximetry is limited because it only records two channels of information. However, those two parameters are very important for restful sleep. A sleep study gives a more complete look at what is going on, but oximetry data, when carefully reviewed, can also give insights into more serious problems. Oximetry is not good for mild problems, or when arousal's during sleep are caused by something other than obstructions.

HoseCrusher, well stated. I think you clearly summarized the use of oximeter data and its usefulness with sleep disorders. Like any single piece of information it really needs to be considered with other factors and data to make an real decisions.

I for one am very glad I purchased the oximiter and it helped me to gain valuable insight into my condition. When I was trying to optimize my CPAP settings I was able to correlate the oxygen dips that remained with clusters of obstructive apnea events. As I increased pressure I saw these dip lessen and more importantly the heart rate also being more regular. Now I periodically do still monitor things with my oximiter but this is now just more information that I log for future comparisons.

I have now added blood pressure, taking it just after eating breakfast one morning each week and I log this along with how I feel. I am looking now at Zeo and the possibility of adding the raw data for correlation with sleep stages to my total data. I am hoping to one day have enough data channels to clearly show my sleep and me determine if changes have happened that may require modification to my therapy or perhaps increased involvement from my doctor. Having a technical background and someone that works with instrumentation this whole process comes quite naturally to me and perhaps I don't need to keep as much detail as I am but for now it is helping me understand my condition and the impacts that treatment has on it.

Your comments on improving the detection of desats is valuable and in my case I have been less concerned with the numbers but more the patterns and what is happening overall. I have concentrated on the actual graphs in my case but looking for much the same thing. A few dips over a long period of time are much less concerning that the roller coaster every 3 minutes or so I was seeing originally. Once I started CPAP and was able to see the data from the S9 Autoset the added information put everything into perspective for me and when combined allowed me to quickly optimize my treatment.

I do however have a work colleague that also has sleep apnea and his oximiter data shows no significant changes in his oxygen level or pulse rate so this is of much less value to him to help optimize his treatment.

My opinion; to momma w/ the cuuute baby pic:
Your deductible will be the same whether you spend it on a sleep study (or two), or on a machine.
Whatever your co-pay is, it will kick in after you spend the deductible.
Your local sleep lab is probably in-network (lower co-pays), but online are pretty much all out-of-network but way cheaper anyhow.
If I had it to do over; I would get the sleep test(s); but then get all your equipment from an on-line supplier-unless the local DME is competitive,
(yeah, right!) I highly recommend our host site, CPAP.com; 4 masks and my new S9 Autoset. no problems.

I forgot to say this before but YES I do feel that your husband should have the sleep study. There are many different sleep disorders and clear evidence that not all people that snore have OSA and also that not all people with OSA snore. The PSG data collected during the sleep study provides a great deal of insight into how he actually sleeps and certainly helps with any diagnosis for a sleep disorder. There are many things actually measured, pulse and oxygen being only two of them.

Having said that however I do not feel that the sleep study tells the whole story, he will be sleeping in a strange environment all connected to wires but this is needed to provide even a baseline of what to expect. If it does turn out that be has OSA then I would certainly accept only a fully data capable CPAP machine, and ideally an auto-titrating capable CPAP.