adding oxygen

[app1nag]

I get great AHI results but still feel sleepy. I saw an awesome video on youTube where a sleep tech demonstrated how RESMED doesn't count many events that may cause one to have good #S, but less than optimal sleep. I started analyzing FLOW RATE chart to see how what he was saying might be  impacting my sleep. Sure enough, I am seeing several events that are not being recorded by RESMED. I am wondering if others are experiencing the same thing. I will find the video and post a link if anyone is interested in seeing it. 

Here's one small sample of what I am referring to.     

Regarding the Subject of my post, I've been asking my sleep doc if adding Oxygen might help me achieve better sleep. I have been using an O2 ring for several months and the ODI numbers have not been all that good. Good AHI does not always equal good ODI. His reply was to order a medical grade oximeter overnight test. That test showed the worst instance of oxygen loss was for almost 6 minutes @ less than 88%. That caused me some concern, thus my request to try oxygen supplement, but he didn't think it was cause for concern.

[Jay51]

It sounds like you took an overnight test with a medical grade oximeter.  Correct? 

Per Medicare, 5 or more cumulative minutes below 88% spo2 qualifies a person for supplemental oxygen.  Do you have Medicare?  

You can inform your sleep doc of this.  It can be downloaded from the internet and either uploaded to him or copied on paper and sent to him (that Medicare grants supplemental oxygen for 5 or more cumulative minutes below 88% during sleep). 

You kind of right on the border as well in a sense.  Hopefully you can get the supplemental oxygen.  If not you could possibly try to optimize your therapy a bit more to help in the mean time.  (Maybe bump your epap min up to 13).  (And even try a night or two with epap min at 14).  Actually, increasing epap by 0.2 increments would be better to fit you exactly.  And also turn off ramp.

[app1nag]

Thanks for the info. This was overnight with oximeter from doc’s office.  I do have Medicare and informed the doc about the requirement for oxygen and he still doesn’t think I need it. This was “his” test that showed the desat <88% for almost 6 minutes.

[greatunclebill]

I would get a new doctor. You could request a second opinion. medicare and other insurances pay for it because is medical necessity.

[app1nag]

I am thinking just that. Hoping I don’t need a new sleep study. Thanks

[SarcasticDave94]

You should have these anyway, but get all your detailed test report copies then fire and replace the doc.

Then with the test result in hand, you need not test further for CPAP. The oximeter test might apply too.

[app1nag]

?? Thanks

[Sleeprider]

App1nag, I'd like to offer something more. Your CPAP therapy shows a very high inspiratory flow limitation with a 95% flow limit of 0.16. We could resolve that with your CPAP using the exhale pressure relief (EPR) feature to make your CPAP into a bilevel with up to 3-cm pressure difference between inhale and exhale. This would likely improve tidal vent and perhaps help some of the oxygen desaturation you're experiencing. If you're interested in trying this, just turn EPR on full-time and use EPR setting 3. We could do more with bilevel machine like the Aircurve Vauto, but we have to start somewhere. I would consider it very unusual if your doctor went straight to an oxygen bleed when we have the bilevel tool to exploit instead. We have a number of members that use an oxygen bleed to increase the fraction of inspired oxygen at the mask. We have a wiki on the topic that describes how an oxygen bleed works and some basic titration. https://www.apneaboard.com/wiki/index.ph..._with_CPAP

Give the EPR a try and see if it makes a difference in comfort, respiratory volume and SpO2 results. I think there is a good argument for using a supplemental oxygen bleed, but I think we can improve your respiratory volume and reduce effort using the EPR function.

[app1nag]

Will try EPR. I had it on and prior recommendations were to turn it off. I’m open to anything that will help me feel rested in the morning. Thanks.