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ResScan says doing great, pulse oximeter says not so good!!
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Don in Austin Offline

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Post: #1
ResScan says doing great, pulse oximeter says not so good!!
I use a dental device, but recently decided it was not quite cutting it so went back for round two of CPAP http://www.apneaboard.com/forums/Thread-ROUND-TWO-APPRECIATE-INPUT I am still using the dental device which can only help and with which I have no compliance problems at all. I think I will be able to live with the Quattro FX full face mask.

Here is what ResScan said about last night:

Apnea index .2
Obstructive .1
Central .1
Hypopnea .3
AHI .5
Leaks under 20 the whole night.

So outstanding, right?

No so fast.....

Pulse oximeter said

Event index of 11.3

(Event is defined as a drop in O2 of at least 4% for at least ten seconds.)

There were 66 events 94-90% range. 11 events 89-85% range.

Oxygen below 88% .3 minutes.

Graphs show one dip to about 85% O2 with a simultaneous pulse surge to 100. I believe this was what woke me up about 4:00 AM.

It had been suggested by my sleep doctor and sleep dentist that the pulse oximeter gives false readings due to moving your hand. I tested this by recording a few minutes of waving my hand around as hard as I could. The pulse oximeter works much better than it was given credit for. No matter how hard I sling my hand, it does not corrupt O2 readings, it does not show heart rate spikes, it DROPS a few pulse beats of pulse.

I wonder how common is a false sense that all is hunky-dory based on the CPAP reporting alone?

I am running the CPAP at very conservative pressures right now with compliance my primary goal, but it looks like I will be ramping it up based on the pulse oximeter, and the goal of no awakenings.

I did have one night that the pulse oximeter was much happier with -- reporting 2.3 events.

Don in Austin
07-10-2014 10:22 AM
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diamaunt Offline

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Post: #2
RE: ResScan says doing great, pulse oximeter says not so good!!
(07-10-2014 10:22 AM)Don in Austin Wrote:  Pulse oximeter said Event index of 11.3
(Event is defined as a drop in O2 of at least 4% for at least ten seconds.)

There were 66 events 94-90% range. 11 events 89-85% range.

Oxygen below 88% .3 minutes.

Graphs show one dip to about 85% O2 with a simultaneous pulse surge to 100. I believe this was what woke me up about 4:00 AM.

spending only .3 minutes below 88% really is doing good enough.

correlate the oximeter report with sleepyhead, bearing in mind that o2 dips will be half to a minute later. you'll probably see an apnea and a corresponding dip.

xpap isn't perfect, but it's keeping you in a good enough range.

my friend with congestive heart failure spent an hour and a half under 88%, even with his ASV. so now he's also got 2lpm of o2 supplementation, because his heart isn't pumping enough blood at night to keep everything going, even with the breathing.

consider yourself lucky and doing well enough Smile
07-10-2014 11:16 AM
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Don in Austin Offline

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Post: #3
RE: ResScan says doing great, pulse oximeter says not so good!!
(07-10-2014 11:16 AM)diamaunt Wrote:  
(07-10-2014 10:22 AM)Don in Austin Wrote:  Pulse oximeter said Event index of 11.3
(Event is defined as a drop in O2 of at least 4% for at least ten seconds.)

There were 66 events 94-90% range. 11 events 89-85% range.

Oxygen below 88% .3 minutes.

Graphs show one dip to about 85% O2 with a simultaneous pulse surge to 100. I believe this was what woke me up about 4:00 AM.

spending only .3 minutes below 88% really is doing good enough.

correlate the oximeter report with sleepyhead, bearing in mind that o2 dips will be half to a minute later. you'll probably see an apnea and a corresponding dip.

xpap isn't perfect, but it's keeping you in a good enough range.

my friend with congestive heart failure spent an hour and a half under 88%, even with his ASV. so now he's also got 2lpm of o2 supplementation, because his heart isn't pumping enough blood at night to keep everything going, even with the breathing.

consider yourself lucky and doing well enough Smile

Things could certainly be much worse. But it would be nice not to wake up in the middle of the night, and I still have some daytime sleepiness. Just as an academic issue, there does seem to be a conflict between ResScan says near perfect, the reality is not too bad but could be better. I was at only 8 for max inhale pressure, (thanks to assistance of dental device) so there is room for improvement.

Don in Austin
07-10-2014 11:28 AM
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robysue Offline
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Post: #4
RE: ResScan says doing great, pulse oximeter says not so good!!
(07-10-2014 11:28 AM)Don in Austin Wrote:  
(07-10-2014 11:16 AM)diamaunt Wrote:  
(07-10-2014 10:22 AM)Don in Austin Wrote:  Pulse oximeter said Event index of 11.3
(Event is defined as a drop in O2 of at least 4% for at least ten seconds.)

There were 66 events 94-90% range. 11 events 89-85% range.

Oxygen below 88% .3 minutes.

Graphs show one dip to about 85% O2 with a simultaneous pulse surge to 100. I believe this was what woke me up about 4:00 AM.

spending only .3 minutes below 88% really is doing good enough.

correlate the oximeter report with sleepyhead, bearing in mind that o2 dips will be half to a minute later. you'll probably see an apnea and a corresponding dip.

xpap isn't perfect, but it's keeping you in a good enough range.

my friend with congestive heart failure spent an hour and a half under 88%, even with his ASV. so now he's also got 2lpm of o2 supplementation, because his heart isn't pumping enough blood at night to keep everything going, even with the breathing.

consider yourself lucky and doing well enough Smile

Things could certainly be much worse. But it would be nice not to wake up in the middle of the night, and I still have some daytime sleepiness. Just as an academic issue, there does seem to be a conflict between ResScan says near perfect, the reality is not too bad but could be better. I was at only 8 for max inhale pressure, (thanks to assistance of dental device) so there is room for improvement.

Don in Austin

I would suggest that you simultaneously scroll through the flow rate and flow limitation graphs when the flow rate is zoomed in enough where you can see individual breaths (about a 10 minute window). Look for high spots in the flow limitation graph and FLAT spots in the flow rate graph that are roughly correlated to the times of the O2 desats if you know them.

You may be having respiratory events that are just a bit too short to show up as "flagged" events in ResScan, but are still long enough to cause you problems with the O2 levels. You might also see some serious flow limitations, which occur when the airway is compromised, but not compromised enough to be scored as an OA or an H. But some people do have O2 desats with prolonged flow limitations.

If you can't figure out a way to zoom in on the appropriate curves in ResScan, you might want to try SleepyHead instead and read through my Sleepy Head Guide

Questions about SleepyHead?
See my Guide to SleepyHead
07-10-2014 12:39 PM
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diamaunt Offline

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Post: #5
RE: ResScan says doing great, pulse oximeter says not so good!!
sadly, the human body is a deeply flawed conglomeration of evolutionary results.

unfortunately, (evolutionarily speaking) sleep apnea tends to hit *after* genes have already been passed on, else it would likely have died out way back when.
07-10-2014 12:43 PM
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justMongo Offline

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Post: #6
RE: ResScan says doing great, pulse oximeter says not so good!!
I've worn my CMS50F some nights. It appears to overstate events.
I find that under the 4% drop criterion, I have more events than reported by my APAP.
Further, most do not seem to correlate with events recorded by my APAP.
I tend to run at a low baseline O2 wise. Likely Pickwickian Syndrome; as I have never smoked.

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07-10-2014 01:25 PM
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Don in Austin Offline

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Post: #7
RE: ResScan says doing great, pulse oximeter says not so good!!
(07-10-2014 01:25 PM)justMongo Wrote:  I've worn my CMS50F some nights. It appears to overstate events.
I find that under the 4% drop criterion, I have more events than reported by my APAP.
Further, most do not seem to correlate with events recorded by my APAP.
I tend to run at a low baseline O2 wise. Likely Pickwickian Syndrome; as I have never smoked.

I am most concerned with the O2 drops accompanied by heart rate surge and awakening.

Don in Austin
07-10-2014 01:55 PM
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diamaunt Offline

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Post: #8
RE: ResScan says doing great, pulse oximeter says not so good!!
(07-10-2014 01:55 PM)Don in Austin Wrote:  I am most concerned with the O2 drops accompanied by heart rate surge and awakening.

Don in Austin

did you have an apnea at that time, perhaps something else precipitated the awakening.
07-10-2014 01:58 PM
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Peter_C Offline

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Post: #9
RE: ResScan says doing great, pulse oximeter says not so good!!
The magic number I watch is the time below 88%. Due to lung scarring, my nighttime average hovers very close to the 89-91% area, and I score any night that my 88% time is under 3 minutes (lately, it has stayed under 1 minute).

I completely ignore what the Oximeter calls an 'event', but rather watch the graph itself, and the nightly totals.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
07-10-2014 03:09 PM
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diamaunt Offline

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Post: #10
RE: ResScan says doing great, pulse oximeter says not so good!!
(07-10-2014 03:09 PM)Peter_C Wrote:  The magic number I watch is the time below 88%. Due to lung scarring, my nighttime average hovers very close to the 89-91% area, and I score any night that my 88% time is under 3 minutes (lately, it has stayed under 1 minute).

I completely ignore what the Oximeter calls an 'event', but rather watch the graph itself, and the nightly totals.

that's how I read 'em too... Smile
07-10-2014 04:00 PM
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