Newbie with ?s and overnight oximetry results

Hi everyone,

I am new to all of this and I just joined this site. I have been waking with severe headaches for a very long time and now that I am so tired during the day (yawning every minute or so with eyes watering), I am finally seeking help. I have had an overnight oximetry recently which has prompted my doctor to do a home sleep study followed by a cpap titration and I am waiting on that to be scheduled. He hopes I will only need cpap but thinks I will need additional oxygen since I tend to drop to the mid 80's and stay there for 20-30 minutes at a time which don't register as events. I have no insurance and no job as I am in school full-time. Since I have no money I was given a GoodKnight 420s with heated humidifier by a friend who hated cpap, to use once I have the titration done. How safe is it to go ahead and start using it at a low pressure before I have the titration done? And from results below what can you tell me? Also I am allergic to latex so are there any mask recommendations?

Here are my results from the overnight oximetry:

Event Data Spo2
Total record time 478.1 minutes
Total events 168
Total Time in events 60.3 minutes
index (1/hr) 25.6
artifact 0.1
Basal SpO2 88.7
Time (min) <89% 199.2
Events <89% 151
Minimum SpO2 79%
Avg low SpO2 85.8
Avg low SpO2 <90% 85.4
Percentage 0f time <90% 73%
Average pulse rate 81.6
Low pulse rate 62

Thank you for your time,
Cr1kk1t

I'm always a little hesitant for people to try CPAP without going through a traditional route (trialling it somewhere with support).
I've just known many bad experiences patients have been put off CPAP and not wanting to try it again because they have had a bad experience to begin with. That is, they weren't given proper education and they did not have feedback and support when things weren't going right.

You really need an automatic titrating machine to find what pressure you need to keep your airway open. Starting at just a "low pressure" might do you no good at all - you may even sleep better without the machine. The *right* pressure needs to be found - otherwise your sleep apnea isn't being controlled and it's likely you'll be put off it for good if everything isn't perfect to start with! Unfortunately it can take weeks even months to get used to CPAP. Being able to try different masks, try different comfort settings etc are in my opinion all essential to have proper (and long lasting!!!) CPAP treatment.

Just my two cents

Why not take your machine to an emergency dept. in a non-private hospital and ask the physicians there to help you?

I think the other 2 have more experience with all of this than I have but I can speak to the latex issue, I'm also allergic. I don't think most masks have latex in them. The company Resmed states that none of their masks have latex as a selling point so you might look at their stuff. If you're worried about it look to see if you can get info fro their websites. Best of luck to you. In all honesty your ahi is bad but not near as bad as some others (mine was 67 when I became a hose head). I would wait for the study as previously suggested. As afr as paying for it, see if they'll take payments, I had to set up a plan with my DME as there's a 3000 dollar gap in my insurance after the first 2000.

Sleeping with the mask on won't be a big deal for me. I am used to wearing masks as I am in the medical field. The cpap machine came with 2 masks and I tried them both on and only the mask with nasal pillows fit and was comfortable, it is a resmed I believe. The reason I want to go ahead and starting using the cpap before the sleep study is that I am so tired that it is affecting my schooling and my life. Sleep is a big problem for me as I get up 3-4 times a night to use the bathroom and I am very restless. I take zolpidem just to help me go to sleep.

Going to the er wouldn't be practical. The expense alone would be too much and they wouldn't help anyways.

I just need some relief from all this yawning and brain fog so I can function. And I am willing to try the machine if It won't hurt me to do so.

Hi,

Welcome to the forum. Sleepstar is right about ideally using an autopap to do the titration if you can't afford a sleep study. See this thread regarding an FP icon auto for $100

viewtopic.php?f=1&t=83637&st=0&sk=t&sd= ... 15#p797554

However, if you feel you can't afford $100, finding an ideal pressure with a cpap machine wouldn't be impossible although it would be alot of trial and error. There is also this caveat. It would have to work with Sleepyhead or another software so you can see all the relevant information for titration and unfortunately, I am not sure if it does. If it doesn't, you really are operating blindly.

The other issue I am concerned about regarding self titration is your possible oxygen needs. I am not sure how that would work in conjunction with finding the right pressure. Not having a medical background, I may be worried for no reason but I did want to express that concern out of caution.

As one who also doesn't have insurance, I greatly appreciate your concerns and if you do need to have a titration, hopefully, the sleep lab will take that into consideration and greatly discount the fee since you don't have health insurance.

49er

PS - See this thread regarding mask allergy solutions:

viewtopic.php?f=1&t=80604&hilit=latex+allergies

While I am not a medical professional I do have some opinions...

73% of your sleep was spent at an oxygen saturation level below 90% seems to indicate that something is lacking... like Oxygen!

There are a couple of threads around where people have shared their pressures that they are using. If I were starting out blindly I would consider a pressure of 10 - 12 as a good starting point. Watch your data and adjust until you "bounce off the walls with energy."

Thank you 49er and hosecrusher.

My doctor is hoping the cpap will resolve the low oxygen issue due to my money issues but he thinks I will ultimately require oxygen along with the cpap. A local company said they would give the oxygen for under $100 a month if the doctor decides I need it. I will be having a home sleep study hopefully next week. Although due to the effect this is having on my life I think I will go ahead and try the cpap tonight. I have been researching the machine given to me by a family friend and although it is not auto or data capable, until I can afford to get one this will have to do. It is actually quite frustrating not being able to get what is truly needed but I know I will survive and eventually the need will be met.

I do have a pulse oximeter that records so I will wear that tonight to help track if the cpap is helping or not. I will post the results tomorrow and you wonderful people can help determine if it helped or not.

Do you have the provider/clinical manual for the Goodknight machine so that you know how to change the pressures, etc?

Puritan Bennett GoodKnight 420 Series: Make sure the CPAP machine is plugged in, then find the secret button beneath the "Go" in the word GoodKnight which appears just above the LCD screen. Press the secret button and the Information Access button simultaneously for 2 or 3 seconds. The CPAP machine will now be in the provider setup mode. Press the Information Access button to cycle through the list of adjustable settings, and use the arrow buttons to make adjustments.

I have a link for the pdf download. I will send that to you in a private message in just a couple of minutes.

Starting out with pressure of 10 or 12 might be a bit overwhelming. I would suggest 8 or 9 as a starting point.
Without any data available you have to go by how you feel. You might get lucky and 8 does the trick and you feel pretty good.

Hi Pugsy,

Thanks for the information. It was set at 8 for my friend with a ramp up from 4 over 25 minutes. I have been playing around with it, thanks to you, and I can breathe comfortably at 10 and actually like it better than at 8 (barely noticed it at . At 10 I felt like I might actually get benefit from it, I guess I will find out tomorrow morning. My friend gave me 2 masks to use, one of which is too big. But the other one, a ResMed Mirage Liberty, feels great and as far as I can tell it didn't leak at least with me sitting up testing it.

I am not a mouth breather but I do occasionally talk in my sleep. What will happen if I start talking my sleep? Will I even notice or will it wake me up from the pressure through my mouth?

Also I noticed in a lot of posts that most new users usually can only make it a few hours a night at first and have to work up to the full night. Does that brief few hours provide some relief from the exhaustion or will it take wearing it all night to start feeling better?

Thank you,
Cr1kk1t

If you open your mouth wide enough to start talking there's a good chance that the rush of air exiting the mouth will wake you up. The air going up the nose and down the airway likes to take the easy way out if the mouth is open.

How much sleep and how long before you feel any difference. We don't have any real way to know even when all the other stuff is known and we have data to back us up.
Sometimes people feel amazing after a couple of nights with maybe 4 or 5 hours and others can sleep 8 hours and the data on the reports looks good on paper but a person might still feel crappy.

Often there are other factors involved that affect the quality of our sleep. Other factors unrelated to cpap therapy and the machine doesn't do such a good job fixing stuff that isn't related to sleep apnea.
So we don't know which way you will go...and we don't have data available to see if leaks are an issue or whatever.

Main goal right now...get used to the mask and machine. If 10 cm feels good then use it. We took a survey a while back asking what pressure do you use...the majority was 10 cm...so its a good place to start.

Things to watch for that we know will affect how you feel the next day.
If you wake up often during the night...that's going to mess with how you feel and it doesn't matter what the reason.
Leaks may wake you up...I always tell people if a leak wakes you up, even if tiny leak, then it needs to be fixed because first and foremost it is messing with the sleep cycles that the body has to go through for the restorative powers of sleep to work their magic.
Short hours of sleep...of course that messes with how you feel.
Sleeping for 3 hours on the machine and 3 hours off the machine you will likely feel horrible because the body remembers the last bad 3 hours and not the first 3 hours.

How many hours is your body going to need? Unknown. I need almost 8 hours of optimal therapy to feel my best but others do very well with much less.
You will probably find yourself waking up a few times in the night for no apparent reason. The brain sometimes takes a while to accept the fact that the alien mask stuck on your face is an okay alien to have attached.

Some people take to this therapy like a duck to water and some people struggle a lot even if they really want this to work.
Sounds like you really want it to work and while attitude isn't everything and it doesn't guarantee immediate success...it sure doesn't hurt to try to have a positive attitude.

You will have bumps in the road. I promise you that fact. We all have them from time to time...even seasoned cpap veterans. I also promise that things do get better with time and experience. Unfortunately I can't tell you how much time will be needed. Wish I could but we just never know.

The mask fit and leaks and comfort is the hardest part to all this therapy.

Other things that impact how we might feel that the cpap can't fix...we can talk about those things should the need come up.
Right now what we tell you is give it time and work on leaks. Leaks are something we never totally conquer. Some nights we win and some nights the mask wins.

Don't be afraid to try different masks. There are ways to obtain masks that don't cost an arm and a leg.

Good morning,

So I slept with the cpap at 10 ramping up from 4 over 15 minutes. Not sure I like the ramp up but it may just take a few days to get used to. I had to stop the machine once to adjust the mask due to a major leak. Overall I wore the mask for 8 hours which I think is great. And I must say I never sleep for 10 hours so this is huge for me and I only went to the bathroom once and that was when I was fixing the leaking mask. Normally I get up 4 or 5 times a night. I will have to see how I feel overall today. I am very excited that I may finally get relief from all this exhaustion.

By the looks of the numbers my O2 saturation has improved (still needs improvement) but I am still having a ton of apnea events. I am wondering how much of this apnea is CA versus OSA? What is everyones opinion? Also, should I keep it at 10 or go up to say 11 since there is still so many apnea events?

Event Data Spo2
Total record time 609.2 minutes
Total events 182
Total Time in events 82.4 minutes
index (1/hr) 17.9
artifact 0.1
Basal SpO2 91
Time (min) <89% 55.1
Events <89% 110
Minimum SpO2 79%
Avg low SpO2 87.7
Avg low SpO2 <90% 86
Percentage 0f time <90% 20.1
Average pulse rate 75.3
Low pulse rate 56

Thank you,
Cr1kk1t

Pulse ox "events" don't necessarily mean sleep apnea events when evaluating number of events. The pulse ox has a different set of criteria for "events" than a cpap machine has.

Without data from a cpap machine that differentiates between centrals and OAs we can't tell if a pressure change will help or hurt or do nothing. So there's no way to know for sure which type of event is occurring to cause the desats.

Your baseline 02 is on the low side. Do you live at a higher altitude or have some sort health problem that goes along with a lower than normal O2 baseline?
Have you checked your O2 while awake during the day at rest? What is it?

Could you please add your cpap equipment to your profile so we can see at a glance what you are using?

Pressure needs are better evaluated with cpap machine data and not pulse ox data. In the absence of any cpap machine data and/or any way to tell if whatever the events are, it's hard to tell what is going on. About all we could do is change the pressure and see if the pulse ox results are better or worse. See if we feel better or not.

Unfortunately my machine is a "brick" (GoodKnight 420S) so I don't have any data to go by. I am hoping to get a fully data capable auto cpap by this fall. Sooner if I can find the resources.

[quote="Pugsy]

Your baseline 02 is on the low side. Do you live at a higher altitude or have some sort health problem that goes along with a lower than normal O2 baseline?
Have you checked your O2 while awake during the day at rest? What is it?

Could you please add your cpap equipment to your profile so we can see at a glance what you are using?[/quote]

I live at about 4600 ft above sea level. I do have very well controlled asthma and my doctor says it doesn't affect my apnea. My daytime O2 is usually between 94 - 98 unless I take a nap then it drops below 90 and stays there.

Usually when I first go to bed and put the pulse ox on my O2 is 97-98, once I start falling asleep it usually drops quickly to below 90 and stay there for the most part. I know the basal with cpap was only 91 but that is an improvement from 88. Right?

Oh, I tried to add my equipment but it didn't like it so I wil create a signature with the information.

Ahh, now I remember the situation. You will have to forgive me. I can't remember each individual situation unless I have something to jar my memory.

Did you have a formal sleep study with or without a machine to get you pointed in the right direction?
If so, do you have copies of the reports so you can see what your O2 was then and did you have any centrals.

Yes, 91% is better than 88% but not by much. It is normal for most of use to have a slight drop in O2 levels at night when comparing to daytime awake O2 levels.

If there is no history of a large number of centrals then trying a little more pressure is unlikely to cause any problems.

Since all you have to go on is the pulse ox and how you feel and you just started using the machine then if it were me I would stick with 10 cm for a week...watch your O2 results and see if they change much. If they don't seem to change much then try 11 cm. Watch the results for about a week. Watch how you feel as best you can.

The first few nights that we start cpap therapy are often filled with awakenings due to just the equipment's presence.
Add in the fact that we simply don't sleep the same way night after night and even those of us with full data machines where we can see the nightly details will often see a fairly wide range of results.

When we don't have any data available we have to take things slowly and make changes slowly. Even when we do have full data available we don't recommend changing pressures daily based on the previous night's reports. Instead we look for general trends. We never know...last night might have been a fluke and if we keep changing things then we don't know if what might have caused a change. Was it just a fluke night or was it a change in settings that gave us a markedly different report.

Now if a change produces markedly worse general feelings then of course we wouldn't want to continue the change. Go backwards instead of forwards.