[Diagnosis] Questions about OSCAR data/SpO2/heart rate/flow limitations

[SarcasticDave94]

Pulse oximetry info: Average oximetry 87%, as low as 77 and 111.2 minutes below 88%. This was before CPAP.

During CPAP, it changed up to average 92%, as low as 81%, 19.1 minutes below 88%.

Where's the discussion about supplemental oxygen? There isn't any that I could find. OK these quacks need roasted.

It seems like this Dr. McQuack's answer is run up the PAP pressures. Weren't you at 14-20 already? Fire and replace.

[Geer1]

On the last page (chart page) the apnea are shown in the last row (Resp, sec) but you can see moments of hypoxemia when there are no apnea indicated (for example around 10:30 after first falling asleep) and there is even hypoxemia while on CPAP around 5:00...

Your rem sleep SPO2 was higher than nrem supporting my theory those flow limitation periods may just be rem periods in which case they aren't worth worrying about (although treatment is same with bilevel). I find it interesting that your body has less issue breathing in rem because for most people their breathing and apnea is worse.

I would definitely be asking for a second opinion and treatment with bilevel or supplemental oxygen. Your current sleep doctor must have low standards if he is ok with settling with these sub par results.

[phlamingo]

Thank you, fine people, for giving me so much information! A lot to digest! I'm off to sleepy-land now, and will provide requested screenshots and such tomorrow.

[phlamingo]

Good morning, lovely people! I did not follow up on any posting requests because I was feeling yucky and brain-fogged yesterday (and I forgot to put the SD card back in the CPAP. Grrr...)

So, here's last night's OSCAR snapshot and my SpO2 report. It was a wild and crazy night. I have several areas I want to zoom in and ask about, but will do that a bit later (still trying to wake up).

   

   

[Gideon]

A call to your doc today please.

"I spent nearly an hour, 53+ minutes,under 88% O2 last night, How do we fix that?"

Repeat EVERY day.

BTW nice job on getting your Apneas under control, but this is CRITICAL!

Ask for a referral to a pulmonary specialist. Ask if his staff can expedite that appointment STAT.

[SarcasticDave94]

Agreed. Call continuously until they get you a solution.

[Geer1]

That night of data does a good job of showing a section of apnea related hypoxemia (during the short flurry of central apnea) compared to your usual hypoxemia. During the group of apnea you can see how your SPO2 drops but is very erratic dropping and rising quickly. This is typical with apnea because there is a cessation of breathing followed by recovery breathing. In your case the majority of your hypoxemia isn't apnea/obstruction related because we see no signs apnea or obstruction in the flow rate data but yet you have gradual changes and periods of constant hypoxemia.

I stated that obesity hypoventilation syndrome is most likely but things like COPD can also cause this sort of issue. As Gideon mentioned a good pulmonologist (especially one that focuses on sleep issues) should be able to able to help you out.

[phlamingo]

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.

Here are the requested zoomed in views. Both periods were during REM sleep.

Thanks!

   
   

[phlamingo]

That night of data does a good job of showing a section of apnea related hypoxemia (during the short flurry of central apnea) compared to your usual hypoxemia. During the group of apnea you can see how your SPO2 drops but is very erratic dropping and rising quickly. This is typical with apnea because there is a cessation of breathing followed by recovery breathing. In your case the majority of your hypoxemia isn't apnea/obstruction related because we see no signs apnea or obstruction in the flow rate data but yet you have gradual changes and periods of constant hypoxemia.

I stated that obesity hypoventilation syndrome is most likely but things like COPD can also cause this sort of issue. As Gideon mentioned a good pulmonologist (especially one that focuses on sleep issues) should be able to able to help you out.

Obesity hypoventilation syndrome makes a lot of sense. I just had a pulmonary function test two weeks ago which did not show any lung disease.

[Geer1]

Those examples may or may not correlate with rem. I believe they do because of the agreement with your sleep study data but the breaths aren't erratic rem breaths like I thought they might be (which often falsely flag as flow limitations). Those breaths actually look like fairly normal with mild flow limitation present. I don't consider those flow limitations to be an issue though since they also correlate with high SPO2 and low HR.

Your main issue appears to be the small fast breathing that occurs and it isn't easy to view or quantify that in OSCAR (other than reported tidal volume and respiration rate values). As a test you can try laying down and taking long slow breaths from your belly and then taking faster small breaths using mostly your chest. You will probably find the long slow breaths is more comfortable and relaxing but because it takes more muscle coordination and effort your body likely defaults to the latter during sleep when breathing effort is reduced.  

As an example where a bilevel would come in handy is providing extra pressure support which helps force more air into your lungs helping expand both the chest and diaphragm. In OSCAR it will make the inhalation peaks higher and more round/full increasing your tidal volume and allowing respiration rate to drop. Imo a bilevel has two benefits as the extra air provided will not only increase oxygen levels but will also reduce your effort levels. Supplemental oxygen to my knowledge will only treat the oxygen levels and not the breathing effort. I assume some of your symptoms are caused by periods of hypoxemia but I can't help but wonder if some are due to effort as well and my untested hypothesis is that a bilevel to treat both would be the most effective and then supplemental oxygen can still be added if necessary (I personally don't think it would).

One important thing to note if this is indeed obesity hypoventilation syndrome is that neither a bilevel or supplement oxygen should be considered long term treatment (although some might use them as such). They are crutches to help overcome the symptoms and difficulties associated with this weight issue and the advantages gained from their use (reduced symptoms) should be used to try and reduce your weight to a level that the crutches are no longer required. I personally don't know the reasons for your weight but I personally know I became obese myself and in my case it was due to poor eating habits because of a medical issue that made me feel like crap and eat for comfort. In my case I had to use multiple crutches (CPAP, nasal spray, diet changes, exercise and counselling) to get control and stop weight from continuing to spiral but I wasn't able to lose the weight and keep it off until I figured out I had a dairy intolerance (and SIBO) that was causing me significant medical issues (reflux, nasal congestion, bloating, poor sleep, anxiety and more). After that I lost 40 lbs and have been able to keep most of it off and no longer need most of my crutches to do so. As mentioned I don't know your situation but what I do know is that you can overcome it with some help and dedication and hope that we will get to see you succeed in doing so.