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0 AHI, o2 still dropping.
#1
0 AHI, o2 still dropping.
Hey guys. As the title suggests, i'm still having problems with o2 levels, despite being on CPAP consistently with a 0-0.5 AHI. While on CPAP, i've still been waking up at times gasping for breath and in panic mode. This prompted me to get myself an o2/HR meter. Sure enough, it showed an o2 drop right around the period of time when I usually have the attack (1-4 hours into sleep). The rest of the time after that, i usually sleep fine, and the data seems to match that. o2 levels remain relatively normal after that. Seems I only ever have one attack in the early AM. Though I didn't have an attack during this recording but when I do have them, I suspect o2 is probably dropping into the 80's, causing my body to panic. 
  I'll post all the relevant data. The o2 readings are in 2 separate pics because I took off the monitor briefly to check results. So any ideas what could be causing these drops in o2? I'm 37 years old, 6'2'', 185 lbs, very active and waking o2/HR are always normal. I really thought I'd be done with all this after paying close to $2k for the sleep study, mask and CPAP.  Sad

BTW, the times don't seem to synch up for some reason, but the time before the first big gap in the CPAP data is when you'll see the o2 desat events in the first o2 graph. The rest of the night coincides with the 2nd o2 pic.


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#2
RE: 0 AHI, o2 still dropping.
Your SpO2 levels are just fine, but I think you should be adding some EPR (exhale pressure relief) to help improve your flow limitations and this might further improve ventilation and oxygen. Your Oscar chart should be modified to get rid of the monthly calendar so we can see settings. It appears you are currently using a fixed pressure of 8.0 and no EPR. Assuming this is an Autoset, I would be tempted to try Autoset mode with Minimum pressure 8.0, maximum pressure 11.0 and EPR full time at 3. That will make the therapy more comfortable and may improve the downward dips in SpO2.
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#3
RE: 0 AHI, o2 still dropping.
I have tried EPR, as suggested by Gideon in another thread, but even an EPR of 1 gave me central apneas. Nothing crazy but it would bring my AHI up to 0.40 at times. I'll definitely switch things up if necessary. Here's another screenshot with my settings. Reached my image limit so I had to crop the pic a bit lol. Any other info needed, let me know. So as far as o2 variations, what should I be watching out for?


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#4
RE: 0 AHI, o2 still dropping.
An EPR of 1, did not give you centrals.

0.4 is really nothing. In fact, new CPAP users are often expected to have a few false positives and a higher AHI (often with centrals) because they aren't sleeping well and their erratic more volatile breathing is interpreted as centrals.
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#5
RE: 0 AHI, o2 still dropping.
Your O2 numbers are similar to what I get which I consider good. Over the years I've been on CPAP and monitoring my O2 levels with an Wellue O2Ring I've observed that if I do have an uptick in pulse rate at night, which occasionally wakes me and feeling anxious, it's usually when I've had one or two alcoholic beverages or a sugary snack later in the evening. Alcohol will help you get to sleep quickly, but can have an affect as it later hits your system. The sugars do seem to have a delayed reaction for me about 1-2 hours after I fall asleep. I've pretty much given up drinking since I started CPAP.  Any chance that you may be snacking/drinking in the evening or taking a med that could possibly disrupt your sleep?

I got my O2Ring prior to CPAP. If you want to see some scary O2 levels, try a night without CPAP.
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#6
RE: 0 AHI, o2 still dropping.
StratCat thanks for your post. It's really informative.
DaveL
Toronto
DaveL
compliant for 35 years /// Still learning!



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#7
RE: 0 AHI, o2 still dropping.
(05-11-2022, 08:41 AM)Dog Slobber Wrote: An EPR of 1, did not give you centrals.

0.4 is really nothing. In fact, new CPAP users are often expected to have a few false positives and a higher AHI (often with centrals) because they aren't sleeping well and their erratic more volatile breathing is interpreted as centrals.

Ok I WILL definitely try EPR 3, along with the other settings suggested above tonight. 
(05-11-2022, 09:29 AM)StratCat48 Wrote: Your O2 numbers are similar to what I get which I consider good. Over the years I've been on CPAP and monitoring my O2 levels with an Wellue O2Ring I've observed that if I do have an uptick in pulse rate at night, which occasionally wakes me and feeling anxious, it's usually when I've had one or two alcoholic beverages or a sugary snack later in the evening. Alcohol will help you get to sleep quickly, but can have an affect as it later hits your system. The sugars do seem to have a delayed reaction for me about 1-2 hours after I fall asleep. I've pretty much given up drinking since I started CPAP.  Any chance that you may be snacking/drinking in the evening or taking a med that could possibly disrupt your sleep?

I got my O2Ring prior to CPAP. If you want to see some scary O2 levels, try a night without CPAP.

I don't drink at all except for water, the occasional drink of OJ, or a tiny bit of coffee (1/4 cup or less) in the AM. As far as eating, I do sometimes have to eat dinner between 8-9 pm due to my work schedule. I have heard eating before bed is bad for apnea, so I never eat anything past 9. I'm usually in bed by 12 am. I do sometimes have a dessert after dinner, so maybe i'l stop that and see what happens.

 And as far as my o2 readings, I suspect they're worse than last night's reading. Last night I feel like I barely slept and I didn't wake up with one of those panic episodes. I bet they have something to do with an o2 crash. But I just got this o2 meter, so only time will tell. I'll keep you guys posted and thank you all so much for the help!
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#8
RE: 0 AHI, o2 still dropping.
(05-11-2022, 07:44 AM)Tcp84 Wrote: Hey guys. As the title suggests, i'm still having problems with o2 levels, despite being on CPAP consistently with a 0-0.5 AHI. While on CPAP, i've still been waking up at times gasping for breath and in panic mode. This prompted me to get myself an o2/HR meter. Sure enough, it showed an o2 drop right around the period of time when I usually have the attack (1-4 hours into sleep). The rest of the time after that, i usually sleep fine, and the data seems to match that. o2 levels remain relatively normal after that. Seems I only ever have one attack in the early AM. Though I didn't have an attack during this recording but when I do have them, I suspect o2 is probably dropping into the 80's, causing my body to panic. 
  I'll post all the relevant data. The o2 readings are in 2 separate pics because I took off the monitor briefly to check results. So any ideas what could be causing these drops in o2? I'm 37 years old, 6'2'', 185 lbs, very active and waking o2/HR are always normal. I really thought I'd be done with all this after paying close to $2k for the sleep study, mask and CPAP.  Sad

You haven't told us how long you've been using a CPAP. If are only few days, your panic attacks may be driven by from the fact that you are not used to therapy. I don't say that your symptoms are not real, but only that your mind is rejecting CPAP use even if it works well. How about your AHI before CPAP? Mine was 80.2 and after one month and half is pratically zero.
I don't see SpO2 drops: it's normal some desaturation during sleeping hour. Look at my SpO2 drops before BiLevel use: I didn't have painful gasps because brain slows methabolism to balance the low oxygen supply. Anyway, mine was a very dangerous situation and luckily has got better now with BiLevel.
I think your problems are psychological only.

Bye!
Paolo


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#9
RE: 0 AHI, o2 still dropping.
(05-11-2022, 10:54 AM)nikonomikon Wrote: You haven't told us how long you've been using a CPAP. If are only few days, your panic attacks may be driven by from the fact that you are not used to therapy. I don't say that your symptoms are not real, but only that your mind is rejecting CPAP use even if it works well. How about your AHI before CPAP? Mine was 80.2 and after one month and half is pratically zero.
I don't see SpO2 drops: it's normal some desaturation during sleeping hour. Look at my SpO2 drops before BiLevel use: I didn't have painful gasps because brain slows methabolism to balance the low oxygen supply. Anyway, mine was a very dangerous situation and luckily has got better now with BiLevel.
I think your problems are psychological only.

Bye!
Paolo

Yeah guess I should've added those details. It all started with me walking up every single night with what felt like panic attacks. Always around 3-4 am and it would never be more than once. I'd wake up suddenly, gasping for air, full of adrenaline. Those would sometimes last for 10-15 min . HR jacked up to 160+. I'd sometimes feel absolutely drained the entire day after. Meanwhile, panic attacks during the day were non existent. I felt like something more than just anxiety was at play here. After googling a bit, I decided to get a sleep study with Lofta. Sure enough, it came back with an AHI of 5.8 and a low o2 of 90%. Got the cpap, mask etc... and I thought I was finally done with it all. My AHI since I started about a month ago has been a steady 0-0.5. Which seems a bit odd to me. Starting to wonder if I was misdiagnosed. Any other questions, please ask. Trying to keep posts shorts since I'm at work lol. Thanks!
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#10
RE: 0 AHI, o2 still dropping.
You weren't misdiagnosed, you were diagnosed at the very low edge of mild sleep apnea.

The generally accepted classificaion is:
AHI:
 5-15, Mild
 15-30, Moderate
 > 30, Severe

I believe you are desperate to solve your night time panic attacks, including pursuing avenues that aren't the cause and seeing patterns that aren't there. 

A little more pressure and perhaps higher EPR would likely clean up your flow limits, but I don't think that will help with your panic attacks. At least not immediately. I'm not suggesting you abandon CPAP, at 37 with a mild diagnosis there's a good chance Apnea will worsen as you get older. I don't know what minge was at 37, but i can say with confidence it was a lot less than when I was diagosed. (59 AHI)

It takes a while to get used to sleeping with it, and that may go a long way to better sleep.

But, there likely is no perfect pressure setting that will solve your panic attack problems. 

Continue to try to optimise your pressure, continue getting used to your machine, but persue other causes including CBT, good sleep hygiene and other medical causes.
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