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SP02 During Sleep Study
#1
I am concerned because my SP02 was low all during my sleep study and it dropped to 88% at pressure 14; 85% at pressure 15 and 16. It was 92% at 12 and 13. Is this a reason for concern or am I panicking over nothing.

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#2
No, this is nothing to worry about unless your doctor feels it is - these numbers alone are not enough to indicate anything beyond the scope of the study. If there are suspected respiratory problems, this will show up in other ways and the O2 sats alone are not enough to go on - but it does indicate that you react to different levels of pressure in different ways. Without seeing any other numbers, this may indicate that your "sweet spot" is around 12, and above may be bringing on some distress, but without the chart there is no way to glean this - the chart, on the other hand, will clearly state if there are Central or Obstructive events, and show other factors as well, so this is something you need to discuss with your doc. The information you gave here is not enough to go on, other than to say that there is no reason at all to panic. Generally, even in "healthy" people, O2 sats will drop during different phases of sleep, and it is only when it crosses the threshold of 88% that there is reason to have concern, and that is what the CPAP machine tries to address by keeping the air passage open. Getting the right titration is the main thing, and since you are being tested at pressure, I assume that you have already been diagnosed with SA and are now going through the next phase, titration, or finding the right pressure for you. Don't panic, this isn't something to get overly concerned about yet. Let your doc guide you on this.
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#3
(10-23-2013, 04:44 AM)DocWils Wrote: No, this is nothing to worry about unless your doctor feels it is - these numbers alone are not enough to indicate anything beyond the scope of the study. If there are suspected respiratory problems, this will show up in other ways and the O2 sats alone are not enough to go on - but it does indicate that you react to different levels of pressure in different ways. Without seeing any other numbers, this may indicate that your "sweet spot" is around 12, and above may be bringing on some distress, but without the chart there is no way to glean this - the chart, on the other hand, will clearly state if there are Central or Obstructive events, and show other factors as well, so this is something you need to discuss with your doc. The information you gave here is not enough to go on, other than to say that there is no reason at all to panic. Generally, even in "healthy" people, O2 sats will drop during different phases of sleep, and it is only when it crosses the threshold of 88% that there is reason to have concern, and that is what the CPAP machine tries to address by keeping the air passage open. Getting the right titration is the main thing, and since you are being tested at pressure, I assume that you have already been diagnosed with SA and are now going through the next phase, titration, or finding the right pressure for you. Don't panic, this isn't something to get overly concerned about yet. Let your doc guide you on this.

this is my 2nd sleep study. I have been on cpap since 2011. I tried to figure out how to post the data from my sleep study but I can't figure out how to do it without including my personal information (I got it in PDF format) and they told me pressure 16 is optimal but my data in SH and ResScan say otherwise.

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#4
2011 titration results

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#5
Well, actually you seem to have a few good pressure ranges, and as you have an Auto Pap machine that senses and adjusts the pressure accordingly within a given minimum to maximum range, you're all right. The problem is that titration studies don't reflect real world usage 1:1, so there can be some drift from what really works for you, especially if you are using another type of machine or mask from the one in the study, and of course, you sleep differently in the lab then at home. Still, 12 - 16 seems you ideal range, with 16 pegging the main benefit.

Do you have a recording pulse oxymeter at home, to monitor your O2sats during real world usage? If so, do it for a week, entering it into sleepyhead daily with a daily entry of your CPAP card data as well, and you can build up a good picture of how you are doing.
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#6
(10-23-2013, 01:58 AM)me50 Wrote: I am concerned because my SP02 was low all during my sleep study and it dropped to 88% at pressure 14; 85% at pressure 15 and 16. It was 92% at 12 and 13. Is this a reason for concern or am I panicking over nothing.

I'm jealous of your O2 stats. Really, you have nothing to be concerned with even at 85%.


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#7
I did a search on this forum and found this post; I didn't write this or post this

that's a good question about O2 levels exceeding 100%.
This is from one website I found.
Measuring Oxygen Saturation

Kathy Lawrence, MSN, RNBC
Clinical Educator II
Educational Resource Center

Sue Simpson Johnson, BS, RRT
Manager, Pulmonary Care Services

Basically, a saturation of 97% of the total amount of hemoglobin in the body is filled with oxygen molecules. A range of 96% to 100% is generally considered normal. Anything below 90% could quickly lead to life-threatening complications. The margin between "healthy" saturation levels (95-98%) and respiratory failure (usually 85-90%) is narrow. If oxyhemoglobin is low (below 90%) inadequate amounts of oxygen will reach body cells!

Note: UTMB Pulmonary Care Services Oxygen Protocol requires titrating oxygen to maintain an SPO2 of 94% for most patients, and 92% for those who are CO2 retainers.

Pulse oximeters are used to monitor patients who have actual or potential respiratory problems. Although 100% saturation is not normal when breathing air, it can be achieved when supplementary oxygen is given. Oxygen, like any drug, can have toxic effects. So if oximetry consistently shows 100% saturation, patients may be receiving unnecessarily high levels of oxygen. However, 100% saturation may compensate for other problems of oxygen carriage, for example anemia, and you should consult medical staff to establish whether any change in oxygen therapy is appropriate.

As a rule of thumb, respiratory failure usually occurs when saturation (SpO2) falls to 90%, although some patients with chronic respiratory disease may tolerate lower saturations. Nurses should consider the patient's normal respiratory function and clarify the point at which medical staff needs to be informed of any changes. Alarm limits should be set at a level that identifies any significant change in saturation. Setting lower alarm limits of 90% may be appropriate when saturation is 95%, but inappropriate if saturation is fluctuating at 90-91%. If setting alarm limits below 90%, nurses should be cautious about the very narrow margin remaining before respiratory failure. Setting a lower alarm limit of 85% or less should always be avoided! Oxygen delivery to tissues, including vital organs, is likely to be inadequate at this level, and such low saturations usually require urgent medical intervention (intubation and artificial ventilation).

Oximetry may be used for 'spot checks' or a continuous measurement. Measurements should always be considered in the context of the whole person. A 'spot check' or single measurement of hemoglobin saturation might suggest respiratory problems. Example: a patient with no history of chronic respiratory disease who has a saturation of 90% may have an acute problem, such as a chest infection. But the value of isolated measurements is limited and trends are more important than absolute figures. Changes in saturation identify deterioration or improvement, caused either by changes in pathology, response to treatment, or both.







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#8
My question is this: If I have better SPO2 at lower pressures, why would CPAP therapy at a higher pressure drop my O2 to 85%?
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#9
My appointment got moved from Nov to next Monday with the sleep doc. I will give him a chance and if he doesn't make me feel safer about his choices then I will make an appointment with a pulmonologist.

I/WE are our own best advocate
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#10
(10-23-2013, 06:29 PM)me50 Wrote: My question is this: If I have better SPO2 at lower pressures, why would CPAP therapy at a higher pressure drop my O2 to 85%?

I agree to not panic, but talk to your doctor.

Speculation: Higher pressure may reduce the urge to breathe. Partly this is because of deeper breathing lowering your CO2 level. CO2 in the blood is the main impetus to make you breathe. There are also some neurological effects from stretching out your lung tissues when your lungs get filled more deeply with air.

These are part of the explanations of why some people develop central apnea on higher pressure.

Maybe these effects will lower your O2 saturation without causing central apneas due to you breathing less.

You may also be having central apenas. That probably needs to be fixed.

I agree to not panic too much over the 85%. Talk to your doctor. It may be that 85% is not too much of a problem if there's an explanation for why that happens. It might also correct itself as your body adjusts to CPAP.

You might want to get a recording pulseox and do your own testing at home. Be sure to get one of the recording pulseoxen like the CMS-50D+. (Note the plus). A non-recording pulseox doesn't do much for sleep apnea testing.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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