[Symptoms] Things are better, but not good enough. Help?

[notausername]

Hello again, esteemed board members 

Things improved a lot since the folks here looked at my graphs and correctly diagnosed positional apnea - I have been working on neck brace choices, still trying a couple Valpeaus

But what's going on is shown in the graph - adding O2 data from O2-Ring Model 3163


At about 06:14 my flow (respiration) stops for 7 seconds, not enough to register as an apnea event.
At 06:17 there's a sudden drop in O2; I have my O2 alarm set to 91%
My HR spikes to 80 in response to the hypoxia, presumably because I have an occluded vertebral artery?
Then at 6:23 there's another spike - I assume because the bump to 80 BPM then drop back to 60 wasn't enough for my brain.
With my HR at 100, I'm jolted awake.

This is serious sh*t; over enough time this kind of thing is sure to screw me up, even if it's not an immediate emergency. This needs to be managed but neuro and sleep doc have been totally unresponsive. It's been going on since March '23

Any ideas? I don't see any event flags other than the O2/HR. C-collar still not working well enough, maybe?

Thanks in advance for any thoughts!

Side note:
I'm really aggravated that sleep docs took a bunch of stats from a healthy population to derive acceptable standards. I should be able to flag 5-second interruptions as apnea if they're going to make my brain hypoxic.


Anyone interested in some advocacy and activism???

[Jay51]

Overall, your chart doesn't look that bad based on flow limitations, respiratory rate, tidal volume, etc.  

Notice how the spo2 drop lags behind in time by seconds after the large event you had in the 1st half of this chart.  It takes time for blood to circulate through the body.  

I cannot see any reason why your pulse jumps close to 100 at the end of this chart:  your tidal volume is steady, no major event in flow rate, steady spo2, etc.  Puzzled here.

[notausername]

Hi - thanks for the note. This is what I gather so far:
The flow limit of 7 seconds is what starts the cascade. Note it doesn't show up as apnea, since it's < 10 sec
Then the O2 drop happens, a small spike in HR, then a big spike.

The spikes are a result of brain hypoxia. The O2 drop triggers an autonomic nervous system response from the brain to "dammit hurry up and get some oxygen in here!"

A little scary.

I'm attaching my full sleep session from 3AM to 7AM, in case someone sees something in the overall pattern.

Thanks again for looking! Any ideas welcome.

ugh.

[Jay51]

Great analysis IMO.  The obvious fix would be to stop all of the flow limitations, but you are at 0.00 95th percentile flow limitations.  

Have you tried lowering pillow height, side sleeping instead of back sleeping, and even using a soft cervical collar?  These might help, but they may not help you either.  Just thoughts.

[notausername]

Hi thanks for your note - and yes I’m doing all those things and they have helped a lot.

That said, seems the last couple of comments suggest what I experience is not typical of an apnea event.

Anyone know of a home continuous BP monitor ?

??

[Dormeo]

A few things.

It isn't possible to diagnose hypoxia from the kinds of data you have available to you. Your O2 monitor can give you information about hypoxemia, but aside from a few seconds, you O2 levels are just fine.

What I'm interested in, however, is what's going on in your flow rate below the zero line after the arousal at 6:14. Could you provide a 2-minute snippet starting at 6:20:15?

[staceyburke]

I have been on Oxygen at 4 liters for 20+ years and have been told no problems unless my reading is <88 for a longer time.  The DR. never gave me an exact number of seconds but a brief period is probably the sensor being moved.

Also you need to know that we all hold our breath for several seconds each night when we roll over in bed or reach down to pull up a blanket or take a sip of water.  That is what your lack of breath could have been.

[notausername]

Hi Stacey, and thanks for your note.

I read those figures in the literature and that's what the Dr's go by but all the research behind those numbers was done 30 years ago and nobody has done tests on stroke patients to arrive at updates. The clinicians know they need an update but until there's some money or fame to be made by researching it, this will remain something the survivors have to sort through on their own.

It's well known that apnea will make cardio/cerebro-vascular conditions worse - from my experience it's because doc's keep using values for O2 levels and AHI that are only characterized for healthy populations.

My own lived experience says that if conditions are wrong, I end up in the hospital. At some point I hope to advocate for some awareness of these issues.

[notausername]

Hi Dormeo and thanks -

I've mentioned a couple of places that I have this occluded vertebral artery which could make me more susceptible to low O2 levels, even briefly, than most.The HR spikes always happen when I'm asleep, and only occur if I'm sleeping on me left side. The autonomic nervous system activation is consistent with hypoxia but you're right - it's more complicated to Dx than the data I have available. It's also more complicated than the Dr.'s I have access to - but I know it's wrong and it's a sign of something unwell since my stroke symptoms were identical though much worse.

That said I agree O2 of 95 shouldn't be a problem - unless my BP has dropped too. Cardiac? Pressure on my heart from sleeping on my left side?? The cardio prescribed one night of Zio then threw out the outlier values. Well, that night I didn't have any incidents. Doc says: "you're fine." Sure.

Going back to the chart,


Look at RR up till 4:00 (I got up for 1/2 hr.) 15-20 ish. After I go back to bed, it drops to 10-ish for 1/2 hour until the jolt in BP at 5:06

At 5:30 I took off the O2 in dismay.
Lay back down at 6:13 then gave up and got out of bed at 6:26

I'm confused by : "What I'm interested in, however, is what's going on in your flow rate below the zero line after the arousal at 6:14. Could you provide a 2-minute snippet starting at 6:20:15? " 

I attached charts for 6:20 for 3 mins or so, and also from 1:00AM to the HR spike so you can see the changes in Ti, Te, RR, etc. during a quiet period of sleep, up to the jolt.

Wondering what you can see and glean from this, thank you again!