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Low O2 Levels During Sleep with Low AHI
#21
RE: Low O2 Levels During Sleep with Low AHI
I looked at the explanations more and I think there are not significant flow limitations based on the shape of the incoming air flows on the graph.   At first I didn't realize the chart examples shown in the OSCAR guidelines / literature were just inspiratory and not both inspiratory and expiratory.  I don't think there is a way just to limit the chart to inspiratory breaths and not both.  If I'm wrong, let me know please.

With no serious flow limitations and low AHI numbers, the odds of low O2 during the night seem kind of low UNLESS in general your O2 is lower than a normal person for other medical reasons even when awake. I often have O2 levels on a spot reading pulse meter of 92-94 and every great once in a while 95-96. My device is not medical grade and costed $15-$20 so accuracy could be quite questionable.
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#22
RE: Low O2 Levels During Sleep with Low AHI
generally the 15-20 dollar devices are really quite good, not to worry, they are pretty accurate.

Hey, I started 9 years ago with full face mask and still use one. I was absolutely unable to breath through my nose, all day all night. talk about flow limitations, yeah!

within about two weeks, I was able to breathe some through one side at a time. Well, walking or exercising, I needed more volume. I needed both nostrils to do this. I gradually figured out how to hold my head to do this, and began getting more and more clear. It took a while, but the apnea was a major cause of my congestion, and that started to change.

When you drop off to sleep (while congested) your sleep brain tries to get you sleeping efficiently. And, dragging air though a mouth is just not the most efficient. As you transition to sleep, this brain decides to shift to the nostrils, made only to breathe and be a good filtration system. As soon as it does, it gets the stuffy resistance or just plain blocked, but will still try. Eventually you gasp through the mouth enough to try again. wow, what a roller coaster.

If you need decongestant to start you off or keep you going, then do it! It will eventually work. I breathe through my nose almost all night. But, also I breathe through my nose often during the day.

This will change your life!

Stick with it.

QAL
Dedicated to QALity sleep.
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#23
RE: Low O2 Levels During Sleep with Low AHI
CMPman, would you please modify your last chart to show mask pressure in place of pressure? http://www.apneaboard.com/forums/attachm...?aid=47846
Sleeprider
Apnea Board Moderator
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____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Low O2 Levels During Sleep with Low AHI
(02-10-2023, 09:49 AM)Sleeprider Wrote: CMPman, would you please modify your last chart to show mask pressure in place of pressure? http://www.apneaboard.com/forums/attachm...?aid=47846

I have attached three new charts from last night's session.  I hope these are what you wanted to see.  If not, let me know how to re-arrange?  I had a time frame last night where I must've struggled with mask leaking starting around 7 AM.  AHI still very low, but I know that's not the end all be all. The average leak rate was 15 L/min even with the real bad short period of leaking. If I didn't have that, all would've been good. That 15-16/10 IPAP/EPAP range seems to be controlling apneas/hypopneas well based on reporting. The only piece I'm in the dark about is what my actual O2 levels are throughout a night.

QAL, that's great to hear you got the congestion under control some.   I have been on BiPAP since '08, but I do feel the machine maybe helped some making it easier to breathe through your nose.  My general instinct as a child was mouth breathing. I think I' am getting better.  I can only assume the mask leaking can cause major issues with eye dryness, eye strain, sinus stuff, etc.  That has been near impossible to fully control so far.  it's a roller coaster as you said!
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#25
RE: Low O2 Levels During Sleep with Low AHI
I wanted to see the pressure delivery with your ST-A before judging the issue of flow limitation.  As you can see in the chart below, without the Easybreathe™ algorithm controlling the delivery of pressure support, your ST-A provides a square-wave during inspiraiton, with a rapid increase to the set IPAP, then a flat delivery at that pressure, and a fast drop to EPAP.  There is some flow limitation indicated in the flow rate, due to a dropping of inspiratory flow after the initial peak, and an occasional secondary peak indicating a Class II flow limitation.  However, the delivery of pressure support as a square wave affects the inspiratory flow wave-form which essentially mirrors the mask pressure being provided by the machine.  I'm not sure EasyBreathe™ is available on the ST-A, and suspect it is not available.  The Vauto, VPAP-S and ASV all have this breath-shaping algorithm which results in a more comfortable pressure transition and natural looking breath form.  I'll post your image and compare it to one using Easybreathe. I think the difference is immediately noticeable. The bottom line is that with the square-wave pressure transitions, I cannot accurately infer the presence or absence of flow limitation. We do see at 03:25:45 that the machine is responding to spontaneous respiration and follows the double breath. We can also see small fluctuations or increases in pressure support at the beginning of this segment and where the double breath reduced the vent rate.

[Image: attachment.php?aid=47868]

[Image: attachment.php?aid=37359]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#26
RE: Low O2 Levels During Sleep with Low AHI
I'm still struggling some to understand your reply, but I think I get some of it.  I just received a copy of my latest polysomnogram.  There is a comment on it that the patient had O2 desaturation below 88% for 120 minutes with significant apneas despite optimal BPAP ST.  It says IVAPS / BPAP ST  was hence needed to treat the hypoventilation  syndrome and found effective.  I'm not sure I understand that language fully either and moreso confused why I was on BiPAP for 14 years beforehand if my O2 levels truly dipped like this w/o further progression to BPAP-ST or other available means.  If the other years showed acceptable O2 drops on regular BPAP therapy at prescribed pressures, I guess that's more cause for concern my health is further deteriorating. Sad

Study showed RERA: 37; OSA: 1; CSA: 0; Mixed Apnea: 1.  Total AHI: 4.9 / hr at desired pressures.  Total REM sleep only 8.7%.
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#27
RE: Low O2 Levels During Sleep with Low AHI
This Youtube video really helped clear some things up regarding IVAPS/AVAPS.  Great, clear info!

https://www.youtube.com/watch?v=49hZ8G_r0IM
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#28
RE: Low O2 Levels During Sleep with Low AHI
If your SpO2 is low for extended periods of time in spite of effective iVAPS where ventilation and pressure targets are being met, then you should be evaluated for an oxygen bleed (supplemental oxygen) to increase the fraction of inspired oxygen (FiO2) at the mask. This is common practice, but you should monitor your oxygen saturation using a recording oximeter while sleeping with the iVAPS. With some oximeters, the oxygen and pulse data can be included in your Oscar charts. Without that SpO2 channel, it is hard to judge whether your needs are being met. You should talk to your doctor about monitoring your oxygen while using the iVAPS to evaluate your need for supplemental oxygen.
Here is our wiki on oxygen bleed. http://www.apneaboard.com/wiki/index.php..._with_CPAP
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#29
RE: Low O2 Levels During Sleep with Low AHI
(02-11-2023, 09:19 AM)Sleeprider Wrote: If your SpO2 is low for extended periods of time in spite of effective iVAPS where ventilation and pressure targets are being met, then you should be evaluated for an oxygen bleed (supplemental oxygen) to increase the fraction of inspired oxygen (FiO2) at the mask. This is common practice, but you should monitor your oxygen saturation using a recording oximeter while sleeping with the iVAPS.  With some oximeters, the oxygen and pulse data can be included in your Oscar charts.  Without that SpO2 channel, it is hard to judge whether your needs are being met.  You should talk to your doctor about monitoring your oxygen while using the iVAPS to evaluate your need for supplemental oxygen.
Here is our wiki on oxygen bleed. http://www.apneaboard.com/wiki/index.php..._with_CPAP

Thanks for all the very helpful advice/comments Sleeprider.  I truly appreciate it.  I surely intend on discussing the O2 monitoring with my doc at the next visit.  I also am pursuing getting my own device to continuously monitor the O2/pulse overnight even if not the most accurate device out there.  i want to see some ballpark figures to reference. Given all the stuff I've read/seen, it seems imperative to know if my O2 is within acceptable levels undergoing BPAP ST therapy with IVAPS.   My O2 when awake usually is in the 93-95 range, but sleep may be a whole different animal.

The part that scares me is if seems likely I'd be dead already without this therapy.  Sad to know I rely on a machine to stay alive basically.  It's hard to believe much else though. You posted a chart showing seven scenarios of Inspiratory breaths for another user. The majority of my breaths when zoomed in fall into Class 4 and some Class 7. It seems even with all this help, I still have a lot of flow limitation.
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#30
RE: Low O2 Levels During Sleep with Low AHI
There is a lot of distortion in your inspiratory wave-form and I can't differentiate it from the mask pressure or airway flow restriction. Do you have nay charts from when you used ASV? That device uses EasyBreqathe and if we can compare some flow rate weve charts from that therapy, we could probably say whether this is unique to the ST-A or was also present with ASV.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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