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[Diagnosis] Questions about OSCAR data/SpO2/heart rate/flow limitations
#1
Questions about OSCAR data/SpO2/heart rate/flow limitations
Greetings!

I have been using my CPAP nightly since August. Prior to that, my OSA was untreated for over a decade. I could immediately feel the improvement in sleep quality, fewer wake-ups, and longer nights of sleep. I am, however, still very sleepy during the day and I do not wake up feeling refreshed. Then in October, I started feeling very low in energy, walking to the kitchen felt like running down the block (elevated heart rate and shortness of breath), and I would have periods of exhaustion where my limbs felt like they were filled with sand. In the pursuit of a diagnosis for these new symptoms (so far been to ER, Hospital, general practitioner, pulmonologist, sleep doctor, chiropractor, psychiatrist, and psychologist with no answers), I started reviewing my sleep data for anything that stood out. I've been learning by watching videos and reading the guides, but would like a more experienced eye to tell me what (if anything) I'm seeing.

Yesterday I noticed two things in conjunction with the data from my wearable pulse oximeter (Emay SleepO2 wrist unit with fingertip sensor): 

1. From about 2:40 to 3:40, my flow rate increased on both inhalation and exhalation. This corresponds to a drop in oxygen saturation for the same time period (around 87% average) with it barely reaching 90% for that hour. See the red circles in the attached reports.

2. From about 4:20 to 5:30, I was having flow limitations. This corresponds with a drop in heart rate that occurred from 4:55 to 5:30 with values between 55 and 60 for that time. See the blue circles in the attached reports.

Any insight into my observations is greatly appreciated. I can provide more detailed screenshots if needed.

Thank you!


   

   
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#2
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
Welcome to Apneaboard.

SpO2 80-87% 47:51, nearly 48 minutes, IMHO you NEED to be on supplemental O2

Your flow limits are clustered and you did make a correlation between Flow Limits and Low O2, nice.

Action: Go down to your neighborhood pharmacy and buy a soft cervical collar TONIGHT.  This is to keep your chin from tucking which I think is the source of your flow limits which are significantly lowering your SpO2 readings.  Read the soft cervical collar in my signature and get this TONIGHT, it is that important.

Also seeing this you need to purchase a recording pulse oximeter, preferably one compatible with OSCAR to routinely monitor your O2 levels, until this is under control this means EVERY NIGHT.

If I'm wrong I'd like you to try a BiLevel such as the VAuto for the increased Pressure Support, greater than EPR's 5 cmw.
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#3
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
Thanks, Gideon!

I also sent this info to my sleep doctor, who HOPEFULLY THIS TIME will listen to me and look at what I give her. I brought up the low SpO2 three weeks ago and she dismissed my concerns, saying that as long as the night-long average is 90 or above, it's fine. *sigh*

Regarding my flow limits, I do want to provide some additional information. I am morbidly obese. Along with an extra chin or two, I have an ample bosom. If I lay on my back, both excesses make it difficult to breathe, so I wonder if that may have contributed to the problem. I read your information on the cervical collar, and that make a lot of sense. I just hate having things around my neck, so I'm open to other solutions. :-) I plan on setting up my camera tonight to see if I sleep on my back part of the time.

The pulse oximeter I have creates a .csv file, and I'm following another thread that discusses potential modifications to the file to be able to import it into OSCAR. I'm living on disability, so have no funds to purchase a more compatible one at this time. I've been wearing it every night and can continue to carefully monitor my SpO2 readings until I get some resolution.

I really appreciate your help!

Best,
Luci
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#4
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
Luci, I hate recommending users to add something else to their sleep regime, especially around the neck. A collar works! Also realize that your doctor will not recognize the significance of the clusters. And they will see no reason for a collar and could recommend increasing pressure instead. Increasing pressure does not resolve this. You can try pillow mods. Thinner, flatter, 1 vs 2 pillows. Less firm, buckwheat vs foam. Things like that. Basically positioning your head for rescue breathing. As you know, weight loss will help you long term but you have a serious immediate need.

Medicare says 8 minutes under 88,% requires supplemental oxygen overnight. Normally a CPAP resolves that. Yours isn't.
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#5
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
Good morning!

I had one hour-long period of flow limitations last night and I was sleeping on my side. So, cervical collar ordered! I will let you know how it works.

Got a message back from my doctor... 

"I do not feel that this is a significant contributor to your ongoing fatigue. You sleep apnea is very well controlled on current settings and your oxygen levels are overall good.
 
"If you would like, we could increase the minimum pressure on your CPAP to 16cmH2O and see if you notice any differences in your readings. However, I would not expect a significant change in your fatigue with this."

I don't quite know what to do. Why isn't she concerned about my oxygen being that low for that long of a time? My GP thought I should be on oxygen at night, too, but deferred to my sleep doctor.

I guess all I can do is gather more data, and now I'm thinking I should find a way to buy a better pulse oximeter to make that process easier. :-) 

Thanks!
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#6
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
You have an oximeter, that is good enough. I expect your. Pre-CPAP sats we're horrible in comparison to your current overnight numbers.

As far as your apnea is concerned that is resolved IAW medical standards. And your sleep doc is correct in that a higher pressure is not likely to resolve the issue.

Collect the oximeter history, 2 numbers and date.

Date
Low value (typically means look deeper)
Duration under 88%

Also post one full night with screenshots of both standard and advanced charts.

@Sleeprider, do you see anything I missed?
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#7
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
The periods where your SPO2 is dropping doesn't correlate with obvious breathing issues like apnea (or even the flow limitations). It isn't dropping horribly low but 47 minutes hypoxemia is not good and for example another recent member got prescribed oxygen after a test with 7 minute hypoxemia. The drop in SPO2 not correlating with obvious apnea etc is called hypoventilation and based on your "morbid obesity" comment the best explanation is probably obesity hypoventilation syndrome. Your tidal volume (breath size) is quite small for a person your size (don't know how large you are but your breathing correlates roughly with a 100 lb person) and your respiratory rate is elevated (almost 20 bpm) to try and make up for the small breath size. In short your body has to work hard to maintain this breathing rate/effort and that is why you also have periods of high heart rate. This extra effort being expended to maintain adequate breathing could be causing the fatigue you are noticing.

The treatments for this are higher pressure support with a bilevel (provides ventilatory assistance making it easier to breath), supplemental oxygen and losing weight. Your first step should be to fire your inadequate sleep doctor (you can try bringing up the hypoxemia and that you believe you need a bilevel or oxygen but it sounds like you have already done so) then bring up these concerns to your GP to see if he will take the next step or refer you to someone more knowledgeable. If you want to try and improve this on your own my recommendation is to buy a Resmed vauto bilevel and we can help you titrate it. A recording oximeter is key for titration in your case as it is the oxygen levels and heart rate that appear to be the issue more so than apnea/ahi.

Interestingly the periods of flow limitation correlate with decent SPO2 and your lowest heart rate. Normally one would expect an elevated heart rate to try and overcome the restricted breathing. I wonder if these are true flow limitations or just odd breathing correlating with say rem sleep. I would like to see a couple zoomed in views of 3-4 minute duration starting at 4:40 and 10:15 to confirm.
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#8
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
I would be complaining loud and long. Wake up doc. I'm not doing well! Would doc accept this SpO2 drop for themselves? They're taking the data as the only thing that counts, some good numbers MUST mean you're doing well. Except you aren't. Similar to my own dilemma, they're not actually listening to the patient. OK fine, either call daily till they act on your complaints or in short order fire them and replace.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
can you post cop[ies (redacted) of your sleep studies? Let us see what it looks like without CPAP.
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#10
RE: Questions about OSCAR data/SpO2/heart rate/flow limitations
Thank you all!

Here's the first three pages of my most recent sleep study...            

            And the next three...

The last page!

   
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