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[Pressure] Hypoxic- No Apneas- Pressure Too High?
#1
Hi folks,

I just re-registered, so I am still filling in the details. Please bear with me while I figure this all out.

I am also struggling with a lot of brain fog due to hypoxia. I used to post here about 5+ years ago, but I haven't been here for quite a while.

++++++++++++++++

My basic question is this:

I have been having a massive hypoxic headache in the morning, with a morning Pulse Ox level of 80% or lower upon waking. I am on a non-auto BiPap, with very few events, leaks, etc. Exhalation is set at "10", Inhalation is set at "14".

Can I be having such drastic hypoxia just because of the pressure settings?

I assume that I need to lower the settings? Which is more important for hypoxia?

Exhalation, Inhalation, or both? Details follow below. Thx!


+++++++++++++++++

My BiPap is a ResMed Aircurve 10, Model S. It is set at "10" for exhalation and "14" for inhalation.

I don't have many events during the night. My AHI for the last week is 3.4, Obstructive Index 0.00, Hypopnea Index 0.34, Clear Airway Index 0.00, Average Leak Rate 5.40. (I will figure out how to post my Sleepyhead summary in a bit.)

I used to have a BiPap Auto but it died.


I got a new BiPap though my insurance company 15 months ago, but it isn't an auto device. I have been on CPAP for about 6-7 rears, and I got this ResMed AirCurve 10 Model S about 15 months ago.

I have had some massive hypoxic headaches whne i wake up recently. I am dizzy, weak, confused, no energy, and now I now have a high red blood cell count (Polycythemia), which can be a result of hypoxia.

I tested my morning Pulse Ox levels with a Pulse Oximeter. Yesterday it was pretty persistent at 78 to 80 for a good 20 minutes after I woke up. I have been trying to get an overnight recording, but I am having trouble with my older CMS50E. I can hardly see the screen.

I just made an appointment with my sleep doctor- for February- so I need some help figuring this out on my own.

My numbers with the ResMed Aircurve 10 all look pretty decent in Sleepyhead, with only a few exceptions. I have the data going back to June 2015. My AHI for the last week is 4.0, and my Hypopnea Index is 0.34. Mask leaks and everything else look good. It doesn't look like I have any Central events.

+++

Last night I switched back to an older machine that I have here, a Respironics BiPap Auto. It uses those older, big, flat cards, and I can't find a reader here. It doesn't have any useful on screen reporting. I believe the settings are at 8 and 14, with a "rise" of 6.

When I checked last night, it seemed to be running at 8.0 for exhale, and 11.0 for inhale. That is significantly lower than the 10 and 14 settings on my newer ResMed BiPap.

I tried to record the Oximeter readings directly to my laptop in Sleepyhead, but it only captured about 1 hour of data. I am not sure why. The first time I tried it, the laptop shut down after 20 minutes on battery. I plugged it in and tried to set it so that it wouldn't sleep on AC. I am not 100% sure what is going on.

Thanks for the help! The medical system may help me in 4+ months.

Best,
Michael


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#2
The truth is in the data on your new machine. Download SleepyHead. Load up your SD card and post the information. These tutorials show how to organize and post the data:

https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

I think the problem will be pretty quickly identified by any number of members that see a lot of this data. It would help if you also clarified if there are any complicating conditions like COPD, asthma, or prescription drug use that might affect the results. An AHI of 4.0 is relatively high, and apparently hypopnea is a very small contributor. What type of events are making up that index? What kind of tidal volume are you recording? We can drill down into the details and try to find a good solution for you. You indicate the majority of events are obstructive, so that suggests a higher EPAP pressure. Your PRS1 Auto machine had variable pressure support, so it may be the fixed pressure support of 4 is just too much. It would help to know what the settings on the old machine were.
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#3
Thanks! I was trying to find the information on how to post the Sleepyhead chart data. Smile

I am working on getting it organized now, but the dogs are agitating for dinner.

The data I shared was the summary for the past week. Here is data for Tuesday, November 1. I woke and had a massive hypoxic headache, as I have had lately. I had 0 events that night, with 7+ hours of sleep. My Pulse Ox was 68% for at least 10 minutes after I woke up. I verified it with 2 different pulse oximeters. (One was recording overnight, but I wasn't able to recover the file.)

I took no sleep medications. (I take Mobic and Suboxone for pain, and have been taking those for 8+ years.) I have chronic pain due to 7 bad disks (4 cervical, 3 lumbar), and a torn right shoulder.

Okay, the forum won't let me post clickable links yet- this is only my 2nd post. I will try to get an attachment under 200K for now. Temporary:

Summary Information for Tuesday, November 1:

[attachment=2958]
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#4
We need to see the detailed daily data for a typical night, not the summary statistical data.

You also write:
Quote:Here is data for Tuesday, November 1. I woke and had a massive hypoxic headache, as I have had lately. I had 0 events that night, with 7+ hours of sleep. My Pulse Ox was 68% for at least 10 minutes after I woke up. I verified it with 2 different pulse oximeters. (One was recording overnight, but I wasn't able to recover the file.)
If your O2 is at 68% while you are AWAKE, you need to get in touch with both your sleep doctor and your primary care doctor. With untreated or under treated sleep disordered breathing, the O2 level usually bounces back to normal before you wake up in the morning.

There may very well be something that is NOT directly related to your OSA and your CPAP therapy going on here.
Questions about SleepyHead?
See my Guide to SleepyHead
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#5
Thanks! I am working on posting my Sleephead data. Here is a smallish summary, to stay under my 200K limit. Better images soon, once I get past this board restriction:


   


My Pulse Ox was 95% when I woke this morning, after using my older Respironics BiPap Auto. It tried to record the Pulse Oximeter data in Sleepyhead, but I only got the 1st hour. Not sure why yet, still have to work on that.

I don't have a card reader for the old, flat, thin cards that the old BiPap Auto machine uses. So I can't access that data.


(The board won't let me post external links yet, until I have more posts. I am also having trouble with Sleepyhead and my laptop function keys (in F12 mode, but can't activate F11-Snapshot. Or exit F12?) Sad
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#6
My 4th post... to get past limit for external links. Sad
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#7
The image file was fine.

There is nothing in that image file that would explain your symptoms.

If the pressure were "too high" we'd expect to see at least a few CAs. There are NO events scored on this whole night. So I don't think your hypoxia problem is caused by under treated sleep disordered breathing OR too much pressure from your current machine.

The fact that your O2 level remained very low for 10 minutes after waking up is a serious issue and it needs to be reported to your doctors---both the sleep doctor AND your primary care physician.

My suggestion is that you call both offices tomorrow morning and report the problem. I would try to get an appointment with the PCP as soon as possible. Significant daytime O2 desats need to be investigated.[/i]
Questions about SleepyHead?
See my Guide to SleepyHead
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#8
Hi beardog,
WELCOME BACK! to the forum.!
I hope you figure out what is causing your health problems and good luck to you as you continue your CPAP therapy, hang in there for more responses to your post.
trish6hundred
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#9
Thank you so much! I will talk to my primary care doctor tomorrow.

I **really** appreciate the help. My brain has been so scrambled, I can't function too well. This is all a struggle.

+++

Can I ask quickly- Sleepyhead only saved about 1 hour of data from my Pulse Oximeter last night, the first 57+ minutes.

I "Stopped Recording" when I woke up, and "Synced" the time to my computer time, because I didn't have any CPAP data.

The laptop and Pulse Oximeter both seemed to be running fine when I woke. Sleepyhead was still showing my breathing graph.

Did I do something wrong, or did my laptop "go to sleep" until I woke it up?

+++

One of the reasons I have been looking at my Pulse Ox levels is because I have a high red blood cell count- Polycythemia.

I saw my PCP for that last Friday. He gave me a referral to an Endocrinologist, but they haven't called yet, so I'm not sure when I will get in.

One of the causes of Secondary Polycythemia is Sleep Apnea, or Hypoxia in general. My doctor didn't think I had any COPD or heart issues, and I had a stress test about 6 years ago.

Here is a snapshot of the Pulse Oximeter from Tuesday morning. I have 3 different ones and they all indicated about the same levels, on different fingers. It went up to 70, then eventually up to 80, and up into the 90's within about 1/2 hour. My hypoxic headache started to get better by then.

I know this is all way beyond your area of expertise! I am only sharing in case this makes sense to anyone else, or someone has a suggestion. I will try to get some attention from my doctor and will hopefully get some help.

Thanks again so much! This is a classic Catch 22- trying to "diagnose" myself with a brain that isn't functioning. So dizzy, tired, weak, and confused. (It took me a minute on Google to find "endocrinologist", I couldn't remember what it was called.)

Cheers! Thanks

[Image: RImKXHJ.jpg]

[Image: B3INlV1.jpg]



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#10
(11-03-2016, 07:48 PM)trish6hundred Wrote: Hi beardog,
WELCOME BACK! to the forum.!
I hope you figure out what is causing your health problems and good luck to you as you continue your CPAP therapy, hang in there for more responses to your post.

Thank you so much for the "welcome back." This is such a great place. Smile

I was here almost daily for about 1.5-2 years, before I got my first machine and after. Based on the age of the current machine that was replaced after more than 5 years, I would guess that was between 2008 & 2010? I will have to try to find my medical records to be sure. I also can't find my old login. I think I probably don't have the same email account any more.

These boards are amazing. I really appreciate all the sharing here in teh past, and the help today. I have been trying to figure this out for a few days. Cheers!

Best,
Michael

+++

ETA: From a question above. I have the older BiPap Auto set at "8" and "14", with a rise of "6". My little sticky note on the machine indicated I had it set at "8.5" and "14.5" previously. If I can find that old, old card reader, I may be able to get some data off of that machine.

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