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Pulse Oximeter readings How to interpret?
#1
My doctor requested an oximeter reading each night for a week. Last night was first. It is an oximeter that was recommended by some users on here. The readings are a little confusing: for example it reports there were two events between 70 and 74 (oxygen) but it also says minimum SPO2 was 66.
The total events were 147 and the time in minutes was
190.4. (For all night for the events. But I slept for 10 hrs total.) The basal SPO2 percent was 94.2. The average duration of events was 77.7 seconds. The time (minutes) below 88 percent was 27.5. The average low is 88.8. The average low below 88 percent is 83.2.
What the machine considers as an event is 90 to 94 percent which I have 78 in that range; 85 to 89 percent, 46 events. 80 to 84 percent , 18 events, 75 to 79, 3 events and 70 to 74, 2 events. The percentage of time below 95 percent is 53.9, the percentage of time below 90 is 10 percent. The percentage of time below 85 is 2.6, and below 80 is .6, below 75 is .2. I am not sure how the machine(oximeter) calculates these Percentages. Is it for the entire night?

What I can't figure out is how long I am in the 3 lowest oxygen events? I see the graph and it dips down to about 70 in 3 places.
I tried to compare with Sleepyhead data for same night.

I also examined the Sleepyhead data for last night and looked at the flow rate for the central apneas during that time. It looks like 10 seconds or less. On Sleepyhead I zoomed into the screen that allows me to see detailed flow rates for 1 minute 7 seconds. When I saw the flow rate for those
centrals (apneas)they occurred between the 10 second intervals. At least that is how I interpreted it, because after 10 seconds the waves were going up and down again.
It's so complicated because I have quite a few central apnea every night. last night the central apneas were 17 per hour. (But my obstructive apneas are only 1 or less than 1)
And I feel rested!

I wonder if my sleep doctor will suggest another machine for the centrals.( i
It is hard to adjust to a new type machine. I love the BiPap that I have and I trust it.)

(My regular doctor--not the sleep doctor--said she sees patients with COPD who walk around everyday with oxygen levels of 70 and 72.)

Any advice?
Thank you
Kim
Kimberly from HonoluluSleep-well
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#2
First download the new version of SleepyHead 0.9.8-1

SleepyHead v0.9.8-1 Testing builds
I just uploaded some Windows "Testing" builds for anyone game to help test them.

64bit and 32bit Windows versions are available, each comes with both BrokenGL and OpenGL binaries, so you don't have to go hunting for one that suits your computers graphics card.

I updated the mac ones too, which fixes a several silly mistakes.

You can find the download links here:
http://sleepfiles.com/SH/index.html?TestingVersions

Please BACK UP your SleepyHeadData folder before even attempting to upgrade...
Once you upgrade SleepyHead's data folder, you can't use it in an older version without causing corruption.

Then download the oximeter data into Sleepyhead It displays it more clearly in my oppinion and you can place the SPO2 graph where you want it next to your events or flow rate or ??

Which Oximeter did you get?

If you post the new SH Data here someone willbe able to help you.
If you are having that many centrals while on BiPap you may need to join us big boys with the ASV machines. You might want to talk to your sleep doc about that.
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#3
(10-05-2014, 08:25 PM)kfujioka Wrote: My doctor requested an oximeter reading each night for a week. Last night was first. It is an oximeter that was recommended by some users on here. The readings are a little confusing: for example it reports there were two events between 70 and 74 (oxygen) but it also says minimum SPO2 was 66.

Hi Kim,

Somewhere in the SpO2 report I think it will say what is considered an event. Often an "SpO2 event" means there was a drop of 4% in SpO2. There might also be a minimum time limit, perhaps that the drop must last at least as long as 10 seconds.

For example, it sounds like during the night there were two drops of SpO2 of at least 4% each, causing the SpO2 to drop to a percentage between 70% and 74%.

And the worst desat seen during the night was an event which reached as low as 66%.

(10-05-2014, 08:25 PM)kfujioka Wrote: The total events were 147 and the time in minutes was
190.4. (For all night for the events. But I slept for 10 hrs total.)

Kim, it is great that you are able to sleep 10 hrs!

147 total SpO2 events in about 10 hrs means your Oxygen Desaturation Index (ODI) was about 14.7 per hr.

(10-05-2014, 08:25 PM)kfujioka Wrote: The basal SPO2 percent was 94.2.
I think this is a good number to have.

(10-05-2014, 08:25 PM)kfujioka Wrote: The average duration of events was 77.7 seconds.
I am not sure how significant this statistic is. You can ask your doctor whether he would pay much attention to it.

(10-05-2014, 08:25 PM)kfujioka Wrote: The time (minutes) below 88 percent was 27.5.
I think this is significant and I think means your treatment needs to be upgraded in order to lower this number. For example, perhaps supplemental O2 (Home O2 Therapy) may be needed, or (much better, I think) an ASV bilevel machine may be needed.

(10-05-2014, 08:25 PM)kfujioka Wrote: The average low is 88.8. The average low below 88 percent is 83.2.
Again, I think this is significant and I think means your treatment needs to be upgraded in order to improve these numbers. For example, perhaps supplemental O2 (Home O2 Therapy) may be needed, or (much better, I think) an ASV bilevel machine may be needed.

(10-05-2014, 08:25 PM)kfujioka Wrote: What the machine considers as an event is 90 to 94 percent which I have 78 in that range;
I think this means there were 78 times during the night that the SpO2 decreased by at least 4%, reaching as low as 90% to 94%.

(10-05-2014, 08:25 PM)kfujioka Wrote: 85 to 89 percent, 46 events.
I think this means there were 46 times during the night that the SpO2 decreased by at least 4%, reaching as low as 85% to 89%.

(10-05-2014, 08:25 PM)kfujioka Wrote: 80 to 84 percent , 18 events,
I think this means there were 18 times during the night that the SpO2 decreased by at least 4%, reaching as low as 80% to 84%.

(10-05-2014, 08:25 PM)kfujioka Wrote: 75 to 79, 3 events
I think this means there were 3 times during the night that the SpO2 decreased by at least 4%, reaching as low as 75% to 79%.

(10-05-2014, 08:25 PM)kfujioka Wrote: and 70 to 74, 2 events.
I think this means there were 2 times during the night that the SpO2 decreased by at least 4%, reaching as low as 70% to 74%.

(10-05-2014, 08:25 PM)kfujioka Wrote: The percentage of time below 95 percent is 53.9,
I think this is a good number to have. It means 46.1 percent of the time your SpO2 was 95% or higher.

(10-05-2014, 08:25 PM)kfujioka Wrote: the percentage of time below 90 is 10 percent.
Again, I think this is significant and I think means your treatment needs to be upgraded in order to improve this number. For example, perhaps supplemental O2 (Home O2 Therapy) may be needed, or (much better, I think) an ASV bilevel machine may be needed.

(10-05-2014, 08:25 PM)kfujioka Wrote: The percentage of time below 85 is 2.6, and below 80 is .6, below 75 is .2. I am not sure how the machine(oximeter) calculates these Percentages. Is it for the entire night?

Yes, I think the percentage would be for entire session, between when Pulse Oximeter was turned ON until it was turned OFF.

(10-05-2014, 08:25 PM)kfujioka Wrote: What I can't figure out is how long I am in the 3 lowest oxygen events? I see the graph and it dips down to about 70 in 3 places.
I tried to compare with Sleepyhead data for same night.

I also examined the Sleepyhead data for last night and looked at the flow rate for the central apneas during that time. It looks like 10 seconds or less. On Sleepyhead I zoomed into the screen that allows me to see detailed flow rates for 1 minute 7 seconds. When I saw the flow rate for those centrals (apneas) they occurred between the 10 second intervals. At least that is how I interpreted it, because after 10 seconds the waves were going up and down again.

Yes, from what you describe it sounds like the central apneas you looked at were lasting perhaps less than 10 seconds, in which cases these would not even be counted as apneas by your machine and by SleepyHead because an apnea must last at least 10 seconds to be called an "event" and be counted in your AHI.

(10-05-2014, 08:25 PM)kfujioka Wrote: It's so complicated because I have quite a few central apnea every night. last night the central apneas were 17 per hour. (But my obstructive apneas are only 1 or less than 1)
That is really good news that your obstructive apneas are so few. There are things you and your doctor can do to decrease the central apneas, which I will suggest below.

(10-05-2014, 08:25 PM)kfujioka Wrote: And I feel rested!

Kim, it is super great that you feel rested!

(10-05-2014, 08:25 PM)kfujioka Wrote: I wonder if my sleep doctor will suggest another machine for the centrals. (It is hard to adjust to a new type machine. I love the BiPap that I have and I trust it.)

I suggest two things.

The first is to work with your doctor in lowering your Pressure Support, while monitoring your AHI and SpO2, because for a few patients lowering the Pressure Support will significantly decrease the number of central apneas.

Pressure Suport is the pressure difference between inhalation (IPAP) and exhalation (EPAP). Lowering PS means keeping EPAP unchanged and lowering IPAP.

From your user profile next to your posts, it looks like your IPAP is 12 and your EPAP is 7, which would make your PS equal to 5. This is not an unusually high level for PS, but it may be causing many of the central apneas. Won't know unless you and your doctor try slowly lowering PS, perhaps lowering PS 1 cm H2O per week for example, and monitoring your AHI and SpO2 to see if lower PS solves the problem.

Pressure Support makes breathing under pressure much easier, so as PS is lowered eventually you may find it harder to breathe if using very low PS (such as 0 or 1), and at some point you may find sleep becomes less restful when using very low or no PS. If that turns out to be the case, then I think perhaps ASV therapy might work better for you.

Here is a link to discussion of an article reporting that bilevel therapy causes a few patients to have too many central apneas:
http://www.apneaboard.com/forums/Thread-...9#pid14389

If the first approach (above) does not help, the second thing I would recommend would be to have an ASV titration and to see how you do when using an ASV machine.

(10-05-2014, 08:25 PM)kfujioka Wrote: (My regular doctor--not the sleep doctor--said she sees patients with COPD who walk around everyday with oxygen levels of 70 and 72.)

Well, did your doctor also say whether these patients were walking zombies, unable to mentally focus, foggy-headed and unemployable? Or were these patients merely unable to climb a short flight of stairs? Or what?

Here is a link to a tutorial which I think thoroughly explains SpO2 in plain language:
http://windward.hawaii.edu/facstaff/mili...imetry.pdf

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#4
Vaughn: Thank you so much for your detailed explanation. What a great help!
Yes, I understand a lot better now.
I'll see my sleep doctor on the 10th so I can discuss with him. I'll have my data on Sleepyhead and the Oximeter reports.
I read that link that explains how people,using bilevel,can have more central apneas.
When I started out on my machine Sept. 13th the central apneas were 27 and last nigh they were 19 but for a few days they were only 13 so they are coming down. But it might not always be coming down.
Thank you for your help!
Kim
Kimberly from HonoluluSleep-well
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#5
Have you ever had a test called a Spirometry Test ? It would show what your lung capacity is. My doctor also did a 5 minute walking test with me wearing a oximeter and that determined my O2 level dropped below 88%, which is a magic number of sort. It is where insurance and Medicare start paying for the needed O2 . It was determined that I needed O2 during exertion (exercising) at 2 liters a minute. You could ask your doctor about both of these tests. from there they may do CAT scan of your lungs to see if there are blockages and/or other problems .

I have asthma which falls under that COPD umbrella .. I only use O2 when I walk or am exerting myself some how! At rest my O2 is usually around 94-95% . and have found my CPAP raises my O2 levels at night to 97-98% except when an apnea is occurring !
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#6
I have an SpO2 reader that can download and display a wave form. my SpO2 is jagged saw tooth when I am having a string of apneas. I rarely drop below 90% when on my APAP. I also try once every couple weeks to do a run of about 3 to 4 hours without the APAP. I see similar jagged tooth waveforms during this period, often more severe than while on the APAP, but that is to be expected.

Time under 88% is usually 0 while on APAP, with median of 96-97%.
Time under 88% is often between 0.2 and 0.8 minutes without PAP therapy. In 3 hours, expressed in percentage would be 0.11 percent to 0.44 percent of the time.

It is good that you know what your scores are. That's how you'll get the best help.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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