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SpO2 and blood-gas arterial test?
#1
Has anyone had this test done? 

Ive been having issues with fragmented sleep and O2 dropping at night, and general unwell feeling. Feeling like my respiratory drive is depressed but my CPAP machine still shows my average breathing of around 13-15 breaths, except for during central episodes.

My cardiologist said they didn't think this test would be beneficial to me, since it would need to be done during an episode. I'm not sure what that means. Would need to draw blood at night while I have the O2 drop? I thought this test would show results even if drawn the next day.
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Pressure EPAP min 5.6, IPAP Max 16, PS 3.

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#2
The test you mentioned is usually used to see what the CO2 levels are. They can see tell your O2 levels well enough with a finger Oximeter. If your Doctor wants to check your O2 levels during the night they usually will have you wear a recording device on your wrist with a sleeve that fits over your finger.
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#3
I've had an arterial blood test done.  It was actually quite painful because they jabbed a needle into my wrist.  It essentially gives an instantaneous measure of current gas levels in your blood, which can change quickly.  The doctor explained to me that breathing in deeply during the blood draw can skew the numbers a lot.
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#4
(06-13-2018, 01:55 PM)Walla Walla Wrote: The test you mentioned is usually used to see what the CO2 levels are. They can see tell your O2 levels well enough with a finger Oximeter. If your Doctor wants to check your O2 levels during the night they usually will have you wear a recording device on your wrist with a sleeve that fits over your finger.

Right. I wear an oximeter with sleeve on my finger already. It records and shows me the graph showing my oxygen dropping on these nights where I quit breathing. 

My doctor told me transitional CA's are normal. That is fine. But it is not normal for my respiratory drive to feel depressed on certain days and nights causing these issues. 

I am at a loss for an answer from any of my doctors. 

I'm okay with transitional CA but not okay with it happening during the night when I wake up and try to go to sleep again and immediately my oxygen drops. 

Doctor says I don't qualify for any backup rate device and thst my other days are fine. I've lost two days of sleep now and tonight will probably be the same. 

I may need to go to ER tonight. Although they may send me home again telling me my oxygen is fine awake, and that they can't help me with sleep issues. They previously referred me to sleep doctor.
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Pressure EPAP min 5.6, IPAP Max 16, PS 3.

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#5
Don't have an answer for that. Probably getting a second opinion would be the way to go.
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#6
Hi,

It sounds like you're really having issues here more with anxiety than with the O2 dropping. There is a certain range where your O2 will drop and there are a series of things that could play into this, but your anxiety - not your O2, is causing you to not sleep. First, unless you were told to wear the pulse oximeter, I would ditch it. There is such a thing as having too much information and not understanding the information contextually, is going to do you more harm than benefit (as is happening here). The second thing is that your O2 levels are not really telling you or anyone anything as the devices are notoriously unreliable. They are, after all, doing a measurement through the skin and not of the blood itself. These serve more as points of reference for a clinician to quickly assess how bad you are in the event of cyanosis or an asthma attack etc. What is not able to be measured is the levels of CO2 and the fact your body has compensatory mechanisms built in to restore proper homeostasis. If you aren't turning blue and you aren't dropping into a danger zone for an extended period, then you are worrying over nothing.

If you have discussed this with your doctor and they can see your data via the modem in your device, which I would hope they could. Then they can see the important things and/or red flags in your presentation. If your doctor has looked at the data, said you are fine, then I wouldn't obsess over it. There are also things that happen like your respiration rate changes when you sleep, heart rate and even core temperature change. This isn't indicative that you are necessarily in any kind of danger.

You definitely should be trusting your doctor over a pulseox. If you don't trust your doctor than you should find a new one. You also can find another one to bring in on a consultation with your data. That would take a few weeks so that means you would need to sleep and not go to the ER over an anxiety/panic attack. I have been there and it's tempting when we have anxiety but at the end of the day it's just a waste of time, money and a period when you could be sleeping as the ER is for stabilizing someone in the event of a crisis - not a chronic condition.

There maybe a clinical reason but not everything that we go through is dangerous or indicative of something terrible. Maybe stay away from the data for a few weeks and then meet with your doctor to let a professional go over things. In the interim, you're hurting yourself more with the anxiety than you are with whatever you are interpreting from the data. Trust me, we can really mess ourselves up quickly over things that truly aren't clinically significant.

J
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#7
Yep, seems that a visit to a pulmonologist or certified sleep doctor is appropriate and necessary.
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#8
(06-13-2018, 07:27 PM)ShaunBlake Wrote: Yep, seems that a visit to a pulmonologist or certified sleep doctor is appropriate and necessary.

(06-13-2018, 07:27 PM)ShaunBlake Wrote: Yep, seems that a visit to a pulmonologist or certified sleep doctor is appropriate and necessary.

I've been to a pulmononologist a month ago, they did a breathing machine test, where you force your breath into. That was okay.

My sleep doctor's office contacted me today and said they don't see anything wrong with my apnea numbers. Of course they only look at the summary, like a 30-day report. They NEVER look at individual days where I had this issue. They did say they don't trust my Oximeter either, and said they are going to get one through their DME to have me use overnight.

johnathonm, Yes, it could be anxiety too. I don't like going to sleep lately since these symptoms started. I take Multaq, Bystolic for AFIB. My cardiologist and EP said that neither should depress my respiratory system. Now, I do take a very small dose sometimes of "Klonopin" which in large doses could depress system. I use it for anxiety at night.

I used to be on Zoloft for a long time, but had to get off of it, due to starting Multaq. I'm also on Xarelto, since I had a DVT/PE less then a month ago. This issue though started way before me being in the hospital.

Here is a worse-case scenario, when I was in Hospital with DVT/PE. During this night my O2 definitely kept dropping. The hospital nurses didnt believe me either, so they got a professional Oximeter, and the alarm did go off a couple times on it. But they still didn't do anything for me, and wasn't concerned it seems.
   

And here is last night, which appears good except for CA's at very beginning and a 38 second OA at 4:30am.

   
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Pressure EPAP min 5.6, IPAP Max 16, PS 3.

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#9
You want Blood markers for Hypoxia :


Quote:HIF1 (HIF-1α and HIF-1β) and HIF-2 proteins are a more reliable blood hypoxia markers that will be present for up to 24h(HIF1) and 2-3 days(HIF-2) after hypoxia

If you do these and they are fine, you can start working on some anti-anxiety, thought I'd avoid any antidepressant. Maybe some diazepam for short treatment of insomnia like lorazepam or lormetazepam for 2-3 weeks depending on the package size.

I took lormetazepam 1mg 1/4 dose each night for a month and a half. so if you never took sleep drugs you might not need the full dose.

Also you have a leak issue.
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#10
(06-14-2018, 03:24 AM)crowtor Wrote: You want Blood markers for Hypoxia :


Quote:HIF1 (HIF-1α and HIF-1β) and HIF-2 proteins are a more reliable blood hypoxia markers that will be present for up to 24h(HIF1) and 2-3 days(HIF-2) after hypoxia

If you do these and they are fine, you can start working on some anti-anxiety, thought I'd avoid any antidepressant. Maybe some diazepam for short treatment of insomnia like lorazepam or lormetazepam for 2-3 weeks depending on the package size.

I took lormetazepam 1mg 1/4 dose each night for a month and a half. so if you never took sleep drugs you might not need the full dose.

Also you have a leak issue.

thanks. I sent a message to my doctors about that Hypoxia test. Don't know if they will approve it or not. They've pretty much given up on me, and said to transfer my records to Mayo Clinic for more detailed study.

Unfortunately, I can't take any SSRI antidepressant or Diazepam, as those interact with Multaq, which is for my AFIB. My doctors had me stop my Zoloft and other one I was on last year.

The only thing I do have to take for anxiety and help sleep, is Klonopin(Clonazepam). It is a very small dose I only occasionally take as needed. Unfortunately it can cause Central Nervous System Depression in larger doses. And I found out recently it has a long half-life 19+ hours. Not sure if that would be an issue with it building up in my body since I was taking it every night.
ResMed AirCurve 10 vAuto
Pressure EPAP min 5.6, IPAP Max 16, PS 3.

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