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SPO2 still falling with CPAP
#1
SPO2 still falling with CPAP
Hi All,

I am new to this and last week I was diagnosed with Sleep Apnea. I did at home test through Lofta. I was diagnosed with Moderate sleep Apnea with AHI of 19 and RDI of 26. Since last friday I have been using a CPA machine. Therapy is going well and myair and Oscar is telling me that my AHI is like 0.2/0.3 each night. On myair I am getting constant scores of 99. But I am still getting my SPO2 dropped to 80s or low 90s and my continuous SPO2 monitor is still showing almost the same ODI3% and ODI4% as it was before CPAP therapy. I am using emay SleepO2 and my apple watch and both are showing same dips so accuracy might not be an issue. For reference my CPAP machine (airsense 11)  is set for 4-20cm pressure with autoset on. most of the time max pressure goes to 9 but ocassionaly it has gone to 11cm as well.   Shouldn't these ODI events be solved with this CPAP therapy? Are those ODI events not because of apnea because myair and oscar is telling me that my events and AHI is under control? I am lost. I am at work right now but can post the oscar and emay charts later for view
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#2
RE: SPO2 still falling with CPAP
Freedom, If you can post some detailed charts from Oscar, ideally with SpO2 results, we can probably help. Your device is on default settings, and even though your AHI is now acceptable, that doen't mean optimized. We're likely to suggest a higher minimum pressure and the use of EPR (exhale pressure relief) to introduce some bilevel pressure into your therapy. Your Airsense 11 is capable of providing inhale and exhale pressure with a difference up to 3-cm. This can greatly improve ventilation, reduce flow limits, and improve oxygenation, especially with a higher minimum exhale (EPAP) pressure.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: SPO2 still falling with CPAP
Perfect. I will post my charts later today and will adjust the pressure accordingly. right now my EPR is turned off.
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#4
RE: SPO2 still falling with CPAP
(03-05-2024, 12:19 PM)Sleeprider Wrote: Freedom, If you can post some detailed charts from Oscar, ideally with SpO2 results, we can probably help. Your device is on default settings, and even though your AHI is now acceptable, that doen't mean optimized.  We're likely to suggest a higher minimum pressure and the use of EPR (exhale pressure relief) to introduce some bilevel pressure into your therapy.  Your Airsense 11 is capable of providing inhale and exhale pressure with a difference up to 3-cm. This can greatly improve ventilation, reduce flow limits, and improve oxygenation, especially with a higher minimum exhale (EPAP) pressure.

I am attaching my Oscar as well as data from Emay app for reference. what should be my set pressure and EPR based on this data? I also do not know why my SPO2 is fluctuating so much.


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#5
RE: SPO2 still falling with CPAP
We can't correlate your CPAP results with SpO2, but I know how tho help you. Increase minimum pressure to 6.0, and set EPR on, full-time at setting 2.This will continue to provide a minimum pressure of 4.0, but will greatly stabilize the pressure changes and improve ventilation. My preference would actually be a minimum pressure of 7.0 with EPR full-time at 2. Higher exhale pressure (aka PEEP) can improve oxygenation by recruiting lung volume. It's up to you. I know the EPR feature will help, and I'd prefer to see a minimum pressure of 7.0 vs 6.0, or the 4.0 you're using now. I think you will find this much more comfortable, and your SpO2 results should reflect an improvement. Your SpO2 chart shows on 3/3/24 your oxygen sagged at about 2:00 AM. This coincides with a significant increase of flow limitation that EPR can address. Even though your AHI was zero, addressing your upper airway resistance and flow limitation should resolve this problem.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: SPO2 still falling with CPAP
(03-05-2024, 06:39 PM)Sleeprider Wrote: We can't correlate your CPAP results with SpO2, but I know how tho help you.  Increase minimum pressure to 6.0, and set EPR on, full-time at setting 2.This will continue to provide a minimum pressure of 4.0, but will greatly stabilize the pressure changes and improve ventilation.  My preference would actually be a minimum pressure of 7.0 with EPR full-time at 2.  Higher exhale pressure (aka PEEP) can improve oxygenation by recruiting lung volume.  It's up to you.  I know the EPR feature will help, and I'd prefer to see a minimum pressure of 7.0 vs 6.0, or the 4.0 you're using now. I think you will find this much more comfortable, and your SpO2 results should reflect an improvement. Your SpO2 chart shows on 3/3/24 your oxygen sagged at about 2:00 AM. This coincides with a significant increase of flow limitation that EPR can address.  Even though your AHI was zero, addressing your upper airway resistance and flow limitation should resolve this problem.

Hi Sleeprider. Thanks for your help. So I changed the min pressure to 7 with EPR at full time at 2. Attached is the Oscar for the night. I think flow limit is better now for sure. I am still having ODI events as per EMAY SPO2 device,. I have ordered Wellue Check me and will compare it with Emay SPO2 results. Accuracy might be an issue. I dont know. Can you please check Oscar and any recommendation relating to settings on my Resemd?


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#7
RE: SPO2 still falling with CPAP
Your SpO2 improved as well as AHI an your desaturation now bottoms out at 90%. The 95% flow limit dropped from 0.06 to 0.01 and a slight increase in tidal volume. You had a total of 3 obstructive apnea, so we can't really call that a trend or even significant. If you found the use of EPR comfortable and the pressure was okay, we can go another night at these settings, or move to a minimum pressure of 8.0, maximum pressure 12. 0 and EPR 3. Your qualitative feedback of how it feels and if your sleep is better or worse helps us as much or more than the data.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: SPO2 still falling with CPAP
(03-06-2024, 12:44 PM)Sleeprider Wrote: Your SpO2 improved as well as AHI an your desaturation now bottoms out at 90%.  The 95% flow limit dropped from 0.06 to 0.01 and a slight increase in tidal volume.  You had a total of 3 obstructive apnea, so we can't really call that a trend or even significant. If you found the use of EPR comfortable and the pressure was okay, we can go another night at these settings, or move to a minimum pressure of 8.0, maximum pressure 12. 0 and EPR 3.  Your qualitative feedback of how it feels and if your sleep is better or worse helps us as much or more than the data.

I did not find the pressure to be bothering. It was comfortable. I will try min 8 and max 12 with EPR tonight. Thanks for the support
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#9
RE: SPO2 still falling with CPAP
(03-06-2024, 12:44 PM)Sleeprider Wrote: Your SpO2 improved as well as AHI an your desaturation now bottoms out at 90%.  The 95% flow limit dropped from 0.06 to 0.01 and a slight increase in tidal volume.  You had a total of 3 obstructive apnea, so we can't really call that a trend or even significant. If you found the use of EPR comfortable and the pressure was okay, we can go another night at these settings, or move to a minimum pressure of 8.0, maximum pressure 12. 0 and EPR 3.  Your qualitative feedback of how it feels and if your sleep is better or worse helps us as much or more than the data.

Last night's OSCAR with Min 8 Max 12 pressure with EPR3. Flow limit is at 95% is 0. I had 3 OSA. I slept well and without any disturbance. Woke up only once. Oxygen is still dipping but average saturation is higher. 2 of the OSA are almost at the time when I was about to get up. I do not know what it was like that. I did check time at around 6:25.


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#10
RE: SPO2 still falling with CPAP
Excellent. this looks good, and you seem to feel good. At this point, we have a choice to continue at this setting, or to increase pressure slowly and see if that have a positive impact on oxygen. The principle behind a higher EPAP pressure is used in mechanical ventilation to increase "positive end expiratory pressure" (PEEP). This improves lung recruitment and increases partial pressure for oxygen to transfer to the blood stream. In theory it may help, and my only reluctance is that you're already achieving what we would want from CPAP therapy. So I'll put it out there and let you make the decision.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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