Sleep Study Results - Oxygen Level Questions

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Sleep Study Results - Oxygen Level Questions

Postby kitkat » Sun Nov 25, 2007 6:29 pm

I just received the results of my sleep study and would like to understand more about oxygen levels and CPAP. Until recently, I knew very little about sleep apnea, and now I find myself facing the challenges of dealing with this disorder in my own life.

To quote some of the impressions from my study:

1. Mild obstructive apnea syndrome, AHI 19, severe supine and severe in REM sleep, with desaturations to as low as 68%.

2. Low baseline pulse oximetry 85% - 90%, worse during REM sleep, with saturations as low as 75% - 83% at baseline in REM sleep. Overall, 16% of the night was below 80% saturation, with 32% of the entire night in the 80% - 85% range.

3. Inaccurate time for CPAP titration. Optimal CPAP pressure was not obtained. Recommend a repeat full-night polysomnogram with full-night CPAP and oxygen titration to be performed with sedative hypnotic medications such as Ambien of Lunesta. (I slept very little during the CPAP trial portion of the night.)

Is it common to need supplemental oxygen with CPAP? I thought the pressure used to keep the airway open would resolve oxygen issues, but it looks as though my titration will include oxygen. My primary care physician has already ruled out any cardiopulmonary disease and I've never smoked, so I'm a bit bummed out about the oxygen. Seems like an additional hassle to deal with when I'm already feeling overwhelmed with the apnea diagnosis. Is it possible to eliminate the oxygen after a period of time on CPAP? I haven't noticed others on the forum talking about needing oxygen and CPAP. Any information on this subject would be helpful. I have so much to learn about this disorder, and this forum seems to be a wonderful source of information. Thanks!
kitkat
 
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Re: Sleep Study Results - Oxygen Level Questions

Postby CrohnieToo » Sun Nov 25, 2007 7:15 pm

kitkat wrote: ... 1. Mild obstructive apnea syndrome, AHI 19, severe supine and severe in REM sleep, with desaturations to as low as 68%.

2. Low baseline pulse oximetry 85% - 90%, worse during REM sleep, with saturations as low as 75% - 83% at baseline in REM sleep. Overall, 16% of the night was below 80% saturation, with 32% of the entire night in the 80% - 85% range.

3. Inaccurate time for CPAP titration. Optimal CPAP pressure was not obtained. Recommend a repeat full-night polysomnogram with full-night CPAP and oxygen titration to be performed with sedative hypnotic medications such as Ambien of Lunesta. (I slept very little during the CPAP trial portion of the night.)

Is it common to need supplemental oxygen with CPAP? I thought the pressure used to keep the airway open would resolve oxygen issues, but it looks as though my titration will include oxygen. My primary care physician has already ruled out any cardiopulmonary disease and I've never smoked, so I'm a bit bummed out about the oxygen. ...


1] Most of your apnea events occurred whilst sleeping on your back and in REM sleep which is quite common. Especially when sleeping on your back.

2] Anytime our oxygen saturation goes below 90% for any length of time it is a matter of concern. You had some pretty low saturations and for a good length of time you were below the comfort threshold of 90%. They will most likely get you scheduled quite soon for the second titration study.

3] Don't feel too bad about sleeping so little during your split night study. I had a full night sleep evaluation, then the full night titration. Except during the titration I only slept 42 minutes out of 6 hours bedtime so the following week I had to repeat a full night titration study - and only slept 98 minutes out of 6 hours bedtime. *sigh* They didn't suggest to me to use Ambien. *sigh*

4] You have to keep in mind that your report states that you had insufficient sleep time to achieve optimal CPAP pressure. You just didn't spend enough time sleep during the titration part of the night for them to discover the optimum pressure that would eliminate or effectively reduce your apnea events.

Because of your low saturations whilst you were sleeping they want to have oxygen at hand, they might not necessarily start you out w/oxygen supplementation in addition to the CPAP. It is entirely possible that when they determine the pressure you need to stop the apnea events it won't require you to have oxygen supplementation as well. For one thing, this time around they will have an idea of what pressures they were able to reach and thus will start you out at a higher pressure to begin with, thus taking less time to find and reach the pressure that stops your events. They generally start out at 4-5 cms of pressure and work their way up in time increments monitoring all your vital signs during each pressure they achieve.

And if you do need oxygen supplementation in addition to CPAP, its not a big deal. Its simple really. It doesn't mean big steel tanks around the house. You are provided w/an oxygen concentrator which is roughly the size of a nightstand. There is a tube about the size of aquarium tubing that runs from the concentrator to the humidifier on your CPAP. There is a small plastic adapter that fits between the humidifier and the hose for your CPAP mask and the concentrator tubing fits on a nipple on that adapter. That's it. Nothing additional to wear on your head or face.

I have COPD and I have overnight oxygen supplementation w/my CPAP. My CPAP pressure is only 8 cms. I have mild sleep apnea. But - surprisingly some w/severe sleep apnea need only a low CPAP pressure whereas some w/mild sleep apnea need really high pressures. There's no way of knowing w/o that titration.

I really wouldn't get too worked up about this. Hopefully they will get you in for the full night's titration soon. Definitely that should be a priority. If they can't get you in quickly push them to order a loaner autoPAP w/the range set from whatever pressure they did achieve during your titration to 20 cms.

Good luck. I'm glad you found us. We'll be here as needed for you.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
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CrohnieToo
 
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Machine: Resmed S8 VPAP Auto
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Year Diagnosed: 2006

Postby kitkat » Sun Nov 25, 2007 11:26 pm

Thanks for the encouragement and the detailed description of how oxygen works with CPAP. I guess I had imagined much worse. At this point in time, I'm having a hard time getting used to the idea that I may be sleeping with a mask for the rest of my life. I'll be having the titration study this Friday, so I will have more answers then.

Does anyone happen to know if the Ambien could cause my breathing to become more shallow than it already is? I know I will be monitored carefully, but it is a cause of concern for me since I've never taken a sleep aid before.
kitkat
 
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Postby CrohnieToo » Mon Nov 26, 2007 6:05 am

My understanding is that these newer sleep meds, developed specifically for sleep, are less likely to interfere w/or complicate sleep breathing than the older, antidepressant type meds they used to use (and still do at times) at low dose.

The important thing is that the sleep lab is aware of what med(s) you take and the dosage.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
User avatar
CrohnieToo
 
Posts: 7943
Joined: Mon Mar 20, 2006 9:18 pm
Location: Mid-Michigan
Machine: Resmed S8 VPAP Auto
Mask: Resmed Quattro FX Small
Humidifier: Resmed H3i
Year Diagnosed: 2006



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