New Sleep Study - MORE Confused

[cmpman1974]

Well, I just spin in circles.  I heard back from my new sleep medicine doctor's office today via telephone.  After asking so many questions about BPAP ST-A units, O2 levels, CO2 levels, etc., someone who is not my doc calls and tells me I have severe sleep apnea waking up 37 times an hour without a machine.  I said tell me something I don't know as I've been on therapy 15+ years.

My current pressure is 16/8 on BPAP-S titrated 3 years ago approx.   When I left the sleep study, the tech told me my ideal pressure was 18/14.  Strangely, this new person calls to tell me my new titrated pressure will be 17/9 (same one tried many times over the years).  The person said it got my AHI all the way down to 4.5.  My average AHI per my machine at 16/8 has been 0.5 - 2.5 for two weeks.  I'm sure AHI is understated on the machine relative to a lab setting.  My SPO2 was wonderful with a low of only 86% 2% of the time I was titrated (65 min at that pressure supposedly).   I said hold on a second.  I got no feedback on mean O2 levels.  I said aren't O2 levels supposed to be in the mid 90s ideally?  I asked for a copy of my sleep study, but I have to go through the hoops of reaching out to medical records. SMH.   

I asked about CO2 retention - zero feedback.  Asked her if she believed the head of Neurology of an entire hospital system accidentally miscalced my low O2 levels for 8+ years on all previous sleep studies and how this new pressure was the miracle one that makes me not need supplemental O2.  I know I came across very cynical, but damn a story needs to make sense.  I asked what would possibly make a doctor go through the effort of titrating ST-A, sending a patient to get a PFT, running Arterial Blood Gases and fighting the insurance to get a machine approved if the issue didn't exist?  I'm not saying ST-A is the answer, but wouldn't all that make you think there's some major history there that needs to really be thought of?

So thousands of dollars of testing later, I still have a ST-A machine sitting in a closet, no titration results to review yet, and moving to a pressure the same as I had a couple years ago.  They say I don't need supplemental O2.   All this really shouldn't be so hard.  So I guess I just send the ST-A unit back to my DME and try to get a new ResMed Air Curve 10 VAuto since the unit I am using is 7 1/2 years old. : At some point, that old machine will go out and most likely it'll be at the worst time. 

I just don't know how to proceed anymore.  My wife thinks I am playing doctor.  I truly am not trying to.  I look at facts in front of me and try to understand what's going on. Nothing more, nothing less.  I know at the end of the day, no one cares more about my stuff than me.  65 min of titration is not the same as taking a bit of time daily to see the big picture each night after sleep.

So 18+ months ago a re-titration showed I had 42 min under 88% O2 within a 101 min block of time at a 16/8 pressure.  That is 41.6% of the time.  Nadir was 82% for that same period.  However with no major improvement in health (i.e., weight loss or other huge changes), I am now down to 2% of a 65 min block under 88%?   Seem rational?

One more re-titration from 4 years ago.  Note similar pressures and note the time under 88% on each.  Again, how is this possible?

If there truly is a way I may be missing something and the situation may have changed, I'm completely open to suggestions.

[cmpman1974]

Then you read publications such as this and question if nocturnal O2 has benefit? This makes it sounds like supplemental O2 comes with plenty of risk as well. In the end, it sounds like insufficient studies have been performed to fully answer these questions. At least that's the conclusion I got from the Q&A section at the end of this.

https://rc.rcjournal.com/content/58/1/32