[CPAP] Low oxygen on CPAP/hearth palpitation and cough + Oscar reading

[merlinakis]

Hi all,

I am a 31-year-old male, normal BMI. I was diagnosed with mild sleep apnea after taking an at-home sleep study (polygraphy).

My AHI was 10.5 sleeping on my back and 5.6 sleeping on my side, predominantly hypopneas and <90% SPO2. I assume the number should be higher since I didn't sleep the whole time. I attached the results for my initial sleep study.

The reason I took the test was because I am always tired and have brain fog during the day and I sometimes wake up with heart palpitations. I was consulted by a cardiologist and there is nothing of concern there. I also have recurring deep cough and back pain that seem to exacerbate the days when having those episodes. I've done a recent Xray and everything looks fine.

I also had a consultation with and ENT and was diagnosed with multilevel obstruction due to craniofacial issues (deviated septum, small jaw, narrow nasopharynx and oropharynx with posteriorly displaced epiglottis). I had surgery to correct my deviated septum and while I can breathe easier during the day it didn't do much for me during night.

In the meantime, I got my hands on an Aircurve 10VAuto and have been using it for the past month. I was getting a lot of Clear Air Events in Oscar in the beginning (20-50/h) (maybe treatment-emergent central sleep apnea) but after a while and after I turned off the PS the events lowered considerable. I also noticed that sleeping on the back is quite a problem, so I tried sleeping with something on my back, although not comfortable the CA lowered once again. I also avoid eating late at night as I had issues before.

Usually I get under 2 events/h on the Auto setting and if I avoid sleeping on my back. Sometimes I even get scores of under 1 AHI. I attached the result from Oscar on a good day.

The problem is sometimes I still wake up with palpitations and have the recurring deep cough and back pain. I also have a pulse oximeter that records the oxygen levels during night.

 

Even though my Oscar results are ok I still get oxygen desaturation according to my device. I can't say for sure that the pulse oximeter device is calibrated correctly but I tried it a few nights on my partner and the device yields higher values in her case. I attached the pulse oximeter results to my Oscar readings. There might be a few second delay when trying to sync the 2 devices.

My question is if people have these symptoms even after using CPAP? I tried a few different settings for my BiPap machine (even tried to use is as a regular CPAP varying the pressure settings).

I was thinking if my oxygen levels are still low, I might need to use a higher setting but then I have issues with my Clear Air events.

I am going to see another sleep consultant in the following weeks, but I want to gather as much info I can in order to best advocate for my own health.

I also have a question in relation to my mask which is an Resmed Airfit F20. I noticed that the elbow has a filter installed. Do I need to change this filter as well after a while? I couldn't find a way to remove this filter.

 

Thanks in advance!

   
   
   

[Sleeprider]

I'd like to suggest you gradually increase PS to reduce the flow limitations and pressure fluctuations. My recommendation is Vauto mode, EPAP min 6.0, PS 1.0 Max pressure 14.0 with Trigger sensitivity on high. Let's take a look at that, and if CA does not seem to be a problem we may elevate PS to 2.0.

I don't think your sleep study is particularly useful if you didn't sleep well, and your OSCAR data is more useful at this point. The AHI is good, but your pressure is all over the place, increasing on flow limits. Those same flow limits have a SIGNIFICANT effect on your SpO2. Getting those back under control will improve your sleep, especially if we work to avoid the CA events you initially had.

[SarcasticDave94]

Welcome to the Apnea Board.

On the question about the F20 elbow, that white packing is to reduce noise and has nothing to do with filtering the air. It is not replaceable on its own, the whole elbow would be replaced routinely.

Your VAuto therapy isn't too bad, but you might need a bit more Min. pressure as it's now at 4. Eventually I'd think the PS needs to come up if you were attempting to avoid CA by this method. Your FL/flow limits are likely affected by the 0 PS.

And the oxygen is showing dangerously low as OSCAR shows a very low 79%. If accurate, you need to address this with the doctor. At 88% for over 5 minutes and doctors are filling a script for supplemental oxygen. So keep a sharp eye on it.

[merlinakis]

I'd like to suggest you gradually increase PS to reduce the flow limitations and pressure fluctuations.  My recommendation is Vauto mode, EPAP min 6.0, PS 1.0 Max pressure 14.0 with Trigger sensitivity on high.  Let's take a look at that, and if CA does not seem to be a problem we may elevate PS to 2.0.

I don't think your sleep study is particularly useful if you didn't sleep well, and your OSCAR data is more useful at this point.  The AHI is good, but your pressure is all over the place, increasing on flow limits. Those same flow limits have a SIGNIFICANT effect on your SpO2. Getting those back under control will improve your sleep, especially if we work to avoid the CA events you initially had.

Hello! Thank you for your reply! How can you change the trigger sensitivity on Aircurve S10 VAuto? I didn't find that parameter.

---

Welcome to the Apnea Board.

On the question about the F20 elbow, that white packing is to reduce noise and has nothing to do with filtering the air. It is not replaceable on its own, the whole elbow would be replaced routinely.

Your VAuto therapy isn't too bad, but you might need a bit more Min. pressure as it's now at 4. Eventually I'd think the PS needs to come up if you were attempting to avoid CA by this method. Your FL/flow limits are likely affected by the 0 PS.

And the oxygen is showing dangerously low as OSCAR shows a very low 79%. If accurate, you need to address this with the doctor. At 88% for over 5 minutes and doctors are filling a script for supplemental oxygen. So keep a sharp eye on it.

Thank you for the reply! I will try changing the limits to see what happens.

[Sleeprider]

The setting is called "Trigger" and is the 7th one down from the top on the clinical menu. It will be set by default at Medium. I assume you know how to access the settings menu by pressing the control knob and home button at the same time? A "high" trigger setting makes the machine switch to inhale pressure a little earlier with less inspiratory effort. This sometimes reduces the incidence of CA events by stimulating a spontaneous inhale.

[merlinakis]

The setting is called "Trigger" and is the 7th one down from the top on the clinical menu. It will be set by default at Medium.  I assume you know how to access the settings menu by pressing the control knob and home button at the same time?  A "high" trigger setting makes the machine switch to inhale pressure a little earlier with less inspiratory effort. This sometimes reduces the incidence of CA events by stimulating a spontaneous inhale.

That is weird. I don't see any settings called "Trigger". This is an Aircurve 10 VAuto. I can set the max pressure, EPAP, PS, type of mask and a few settings related to the humidifier and ramp time.

[Sleeprider]

That is the first I have heard of this machine not having settings for Trigger, Cycle, Ti Min, Ti Max. It is possible that the machine has different settings in some UK or European models.

[hegel]

"I was consulted by a cardiologist and there is nothing of concern there."

well, as an atrial fibrillation patient I would beg to differ.

First,yes, your oxygen levels are very low and may be related to your heart palpitations, so definitely do something about that.

New onset atrial fibrillation often occurs at night during sleep. Apnea is one of the few understood triggers for atrial fibrillation. And yes your palpitations may be entirely benign. Usually in your situation a 24 or 36 or two week long Holter monitor would be prescribed. this measures your heart activity 24/7 for a given period of time. People don't know what their hearts are doing when they're asleep. More, some issues only occur randomly once or twice a month. So a 24 hour Holter monitor will only record what your heart is doing in that period (as anEKG only records what your heart is doing for the minute during which it was recorded.) these Holter type monitors are simple, painless and cheap for a doctor to administer. I really advocate getting a two week monitor, or at least a week, so you have a better sense of what's going on.

Cardiologists are the "plumbers" of the heart; Electrophysiologists (EP's)are the electricians. Irregular heart beats are usually the provenance of EP's. Cardiologists will often not want to acknowledge this.

You may want to press your cardiologist for the Holter/ Zio patch.l You won't even have to go in to see him or her. It can be done by a nurse. Super easy-peasy.

[merlinakis]

That is the first I have heard of this machine not having settings for Trigger, Cycle, Ti Min, Ti Max. It is possible that the machine has different settings in some UK or European models.

I bought it in Europe but it says it's manufactured in Australia. I've found the clinical manual and it's says that: "Note: Not all parameters are available in all regions. The default and range values may differ between modes and regions.". I wonder if there is a way to unlock all parameters. I am currently talking to the seller but I don't think he can help me.

I've saved some results from the last 3 nights. The AHI is low but I am still getting flow limitations and CA events. 

             

"I was consulted by a cardiologist and there is nothing of concern there."

well, as an atrial fibrillation patient I would beg to differ.

First,yes, your oxygen levels are very low and may be related to your heart palpitations, so definitely do something about that.

New onset atrial fibrillation often occurs at night during sleep. Apnea is one of the few understood triggers for atrial fibrillation. And yes your palpitations may be entirely benign. Usually in your situation a 24 or 36 or two week long Holter monitor would be prescribed. this measures your heart activity 24/7 for a given period of time. People don't know what their hearts are doing when they're asleep. More, some issues only occur randomly once or twice a month. So a 24 hour Holter monitor will only record what your heart is doing in that period (as anEKG only records what your heart is doing for the minute during which it was recorded.) these Holter type monitors are simple, painless and cheap for a doctor to administer. I really advocate getting a two week monitor, or at least a week, so you have a better sense of what's going on.

Cardiologists are the "plumbers" of the heart; Electrophysiologists (EP's)are the electricians. Irregular heart beats are usually the provenance of EP's. Cardiologists will often not want to acknowledge this.

You may want to press your cardiologist for the Holter/ Zio patch.l You won't even have to go in to see him or her. It can be done by a nurse. Super easy-peasy.

I've done a few ECG and an ultrasound and everything was normal when the doctors have done the test. I don't always wake up with palpitations and if the episodes are rare and would only show when I'm experience them it might be hit and miss. Most definitely I'm going to ask my healthcare provider for further investigations.

[Sleeprider]

I think your strategy needs to be to slowly increase PS to drive down flow limitation, but not so high as to cause CA. You will find that you will likely adapt as you go up in PS, so don't hesitate to be at the point where CAI is about 1/hour.

With regard to your question about the machine, there is no official way for you to do that kind of modification, however as a member, you can read the COVID-19 forum, and at the top of the page is a restricted thread called "machine modificaitons". If you want to read that, you might find something interesting.