[Treatment] Low O2 After Almost a Month of Therapy

[somewherein413]

           
My energy and alertness has improved greatly from when I started a month ago. But my O2 levels are still averaging slightly under 90% (89.93%). I have improved slightly but not to where I think I should be. I am 36% of the time in an O2 drop. I range from low O2 of 76 to 86 on my best night. I have averaged at 42% of the time under 90 with my best night being 9 % under 90 and my worst night 86% under 90. I have 10 days of O2 data. So I am curious of  what the suggestions are. I have been using CPAP for almost a month.  My average AHI is 2.67. I had an AHI on home test of 63.8, with average O2 of 89%, with a low of 63% and 59% under 90%.  Any suggestions to improve 02 levels? I am currently using an Airsense 11 on Auto with err of 3, low pressure of 8, high of 18. Dreamwear Nasal Pillows and a Wellvue Checkme O2 Max for Oximeter. 

[somewherein413]

    I am adding the home sleep study O2 graph as well.

[staceyburke]

I would ask the Dr for a test of your night time o2 levels. If they are as low as your oxygen measurement device shows you may need extra o2 supplied with an oxygen concentrator.  I have one hooked up to my Cpap for 15 years now.

[TechieHippie]

That's a reliable oxygen monitor and I agree with the previous poster that your oxygen levels aren't at all sufficient, but I don't think you need further testing. You should already qualify for external oxygen just from your existing sleep test. Unless you have COPD or other factors you probably want an average of at least 94 with little under 90. I don't think settings adjustments are going to get you there... Bite the bullet and get a concentrator and bleed o2 into your CPAP s soon as you can. Going down to 60s you are risking heart attack and heart damage.

[staceyburke]

The reason to ask a Dr is to have insurance pay for it. I have been on o2 therapy for years with no cost to me.

[somewherein413]

I wrote an email to my sleep med practice. Their recommendation is to go to a fixed pressure of 16. I have my doubts it will work but will try it. I feel like they don't listen to their patients. My pressure rarely needs to be that high, normally if I have broken my mask seal.

[TechieHippie]

You can google indications for the need for external oxygen in pap therapy and use them as leverage. I don't think they are following standard of practice.

Going to a fixed pressure with no pressure support would make me very nervous. I do see that higher pressure may be indicated but to jump to an epap of 16 after being 5-9, I would be afraid I would just not breathe out against that pressure.

Now raising and fixing ipap a bit higher than you have been getting would make sense to me, keeping the PS the same. Both the increased pressure and the lack of variability could be helpful. I wouldn't raise it a few cm at once though, or you will be resisting the pressure and tension never helps oxygen saturation in my experience. Maybe a smoother transition would be to 14.5 ipap max, PS 4, min epap 10.

[somewherein413]

I tried the 16 with the ERR at 3 and I couldn't take it this afternoon for a nap (as I slept like crap last night). I very well may switch, if I can to a pulmonologist, because I am not being heard and the sleep med practice wants to go by their static data from the titration and haven't looked at my O2 data that I offered to send them. When I talked with the PA today at the Sleep med place, she was adamant that I need a pressure of 16 because they titrated me at 16. Well when I compare timing of the 16 in the lab study, I was awakened 3 times and fought the 16 as even awake I couldn't keep my mouth shut concentrating on it. Also, the O2 levels were pretty flat all night but slightly higher at that time. When I look at my O2 levels that I have recorded, they tend to go up the later part of the night as well so the timing coincides with what I see in my OSCAR data. I will try again tonight. I put the ramp back on as I can't do 16 and fall asleep it is just to damn uncomfortable. My guess is this is why so many people can't do CPAP as I really do not think high fixed pressures works for many people.  Sorry for the rant. I am attaching the graph part of the titration. I swear i have better analytical skills than the PA, I am an engineer by education and did analysis for the last 8 years of my professional life. 
   

[Expat31]

@Somewhere413
Hi, I just came across your thread concerning low O2. 

I think there may be a missing element here, a full set of graphs.

You have only sent pressure, flow rate and Spo2. May be useful to see these all together:-

1. Events
   
2. Flow rate
   
3. Pressure
   
4. Leak rate
   
5. Flow limitations
   
6. SpO2 
   
7. Pulse 
   

Often one can find explanations by searching for interrelationships amongest them. You just never know...

[somewherein413]

These are the graphs you mentioned. I gave you movement as well as they noted leg movement in  my trituration study and I had a extra space for a graph.