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Is this normal for SpO2 to drop this fast during an OA?
#1
Is this normal for SpO2 to drop this fast during an OA?
First, since switching to BIPAP, my AHI has been <1 this past week. But I still have these crazy fast drops in SpO2, during even short events.

Here is a sample. This UA lasted 16sec, and O2 dropped from 93% to 80% within about 40sec. This occured three more times last night.

I had my Contec O2 monitor alarm turned on at 88%, but apparently it didn't wake me up until it was 80%. I'm hesitant now to sleep with the O2 alarm off, because i don't know if the events would be longer and O2 would drop more. My last sleep study, when they switched me to BIPAP, they said I had ZERO events, with NO drop in O2. But the sleep study shows my pressure was set at a higher constant rate on BIPAP. They started me on BIPAP at 14/10, with final titration at 16/12. I guess that means IPAP Max 16, EPAP 12?

If that's the case, I still don't understand why he has me starting a low EPAP. It was EPAP 4 PS4, but I was having major events yet. So I switched it to EPAP 5, PS3, and that took care of almost everything. Except I still have a few O2 drops.

1. Are these O2 drops considered normal during events?
2. Anyone know why BIPAP at lower pressure is working better for me, then my APAP ever did from 7-14 EPR1?
3. This is the 2nd sleep doctor I've been to, and now had 4 sleep studies in two years. Both always say "you are doing great", and only look into the main AHI number with their MyAir/ResMed clinical software. Are all doctors like this, or do any actually go deeper into figuring out what is going on with people?
4. I am feeling much better now, since being on BIPAP IPAP max 16, EPAP5, PS3. But still would like to fix these O2 drops. I'm not sure what to do, or if i just need to live with these minor drops?

[Image: PW6IfpV.jpg][Image: FxE0rD4.png]
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#2
RE: Is this normal for SpO2 to drop this fast during an OA?
You still need to try and sort your leaks, as the therapeutic pressure that will be holding your airway open is escaping somewhere you are in Large Leak for 45% of the night.
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#3
RE: Is this normal for SpO2 to drop this fast during an OA?
(03-10-2018, 11:29 AM)jaswilliams Wrote: You still need to try and sort your leaks, as the therapeutic pressure that will be holding your airway open is escaping somewhere you are in Large Leak for 45% of the night.

Well I went this past week to my DME and showed them the sleepyhead chart leaks. They kept telling me the machine compensates for the leaks and don't have to worry about it. They did order me a new foam liner for my AirTouch mask, so maybe that will help. But I hate when DME and sleep doctor says all is good and still there are some minor issues.
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#4
RE: Is this normal for SpO2 to drop this fast during an OA?
For a 10 second apnea, that seems like an awfully fast desaturation. I guess if we count the reduction in volume ahead of the apena and go through the end of the expiration before recovery breathing, it is nearly 25 seconds. It has the appearance of a central followed by a clear arousal.
Sleeprider
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#5
RE: Is this normal for SpO2 to drop this fast during an OA?
(03-10-2018, 11:55 AM)MyronH Wrote: Well I went this past week to my DME and showed them the sleepyhead chart leaks. They kept telling me the machine compensates for the leaks and don't have to worry about it. 

The machines do compensate for leaks - up to a point.  They did not look very closely as the charts as you are way beyond that point.
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#6
RE: Is this normal for SpO2 to drop this fast during an OA?
Here's a test. Put on your oximeter and turn it on. Let it settle. Let out the air in your lungs and hold it for as long as you can. See what happens to the O2.

To further test, do it with the machine on. Do one where you block your throat with your tongue (obstructive) and one where you leave it open (central/clear airway). Note how the O2 reacts. Give yourself time between each one so you don't get lightheaded. Let the O2 reading get back to normal.
PaulaO

Take a deep breath and count to zen.




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#7
RE: Is this normal for SpO2 to drop this fast during an OA?
That could just be a movement artifact/loss of contact on the pulse oximeter, aka a glitch and not a real saturation dip. The sharpness at which it dips and recovers looks very suspect. And above the graph itself that dark black line for this software indicates artifact as far as I can remember.
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#8
RE: Is this normal for SpO2 to drop this fast during an OA?
(03-10-2018, 06:48 PM)Matt00926 Wrote: That could just be a movement artifact/loss of contact on the pulse oximeter, aka a glitch and not a real saturation dip. The sharpness at which it dips and recovers looks very suspect. And above the graph itself that dark black line for this software indicates artifact as far as I can remember.

I thought the black lines indicate major fluctuations?  I see these black lines when my heart rate fluctuates a lot and not stay steady.
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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#9
RE: Is this normal for SpO2 to drop this fast during an OA?
(03-10-2018, 03:04 PM)PaulaO2 Wrote: Here's a test. Put on your oximeter and turn it on. Let it settle. Let out the air in your lungs and hold it for as long as you can. See what happens to the O2.

To further test, do it with the machine on. Do one where you block your throat with your tongue (obstructive) and one where you leave it open (central/clear airway). Note how the O2 reacts. Give yourself time between each one so you don't get lightheaded. Let the O2 reading get back to normal.

Thanks I'll try that to see what happens. But I just had a thought. Whenever I have large leaks, my O2 is usually stable and doesn't drop. When I have no leaks, that is when my O2 drops.

My bipap was leaking this past month. Turned out to be water chamber. When it leaked I had very minimum O2 drops. 

Is it possible my O2 is more stable due to increases airflow caused by leaks?
ResMed AirCurve 10 vAuto
Pressure EPAP min 4.4, IPAP 8.4, IPAP Max 18, PS 4.

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