Confused about sleep study results

[ppca]

1. My first sleep study was done in October of 2013. The short overview of the results:

Sleep time - 2 hours (only)
AHI - 15.3 (36 in REM)
REM sleep - 4% (only)
I don't have any data about oxygen desaturation from this study (the report only says that minor desaturation was noted).

2. Couple of weeks later that same year, my titration study showed:

Sleep time (with a sleeping pill) - 6.25 hours
AHI - 0 (at 9 cmH2O)
REM sleep - 7.6%
Mean SaO2 - 94%

That year I got my ResMed 9 Elite, extra heated humidifier, heated hose and AirFit P10 nasal pillows mask. As I mentioned in my very first post on this forum, I was really struggling, trying to get used to it. I used it initially for a month or two, and then tried a few more times within the last 3 years, but never became fully used to it.

3. So now 3 years later, I decided to give it another try and went for a new sleep study (basic, no titration). These results are quite confusing to me:

Sleep time (with a sleeping pill) - 3.8 hours
AHI - 5.2 - unbelievably low!!! (REM AHI - 30)
REM sleep - 4.4%
Oxygen desaturation was below 90% during 96.7% of total sleep time (mean at 88%)

Two weeks later I went for a titration study, which was a complete fiasco. I could not fall asleep at all, and therefore no results available. I am guessing that the results could have been similar to my 2013 titration study.

As I mentioned in my other posts, determined more than ever to get this to work, while I was still waiting on these latest results, I started using my CPAP again. It has now been just over two weeks, and as my other posts here show, my AHI is consistently below 1 (using it on the average for about 4.5 - 5 hours per night). I am running it at 7 cmH20.

I'd like to see the doctor again, but the way things are here, it may easily be another 7-8 months before I'll be able to do so.

Should I just carry on with my therapy the way it is now (7 cmH2O)? I am a bit concerned about these lower oxygen levels from the latest study. Is 88% mean desaturation acceptable? Would it be a good idea to get an oximeter maybe ?

Thank you all for the amazing posts on this great forum!

[ppca]

I tried to edit my message, but unfortunately the 30 mins time limit has expired.

I just wanted to add that the 88% mean oxygen numbers were from the study without CPAP. Hopefully, these numbers are higher when I'm using my machine. Still the question remains: is it a good idea to get an oximeter, and how good are they, without having a spend a fortune?

Thanks!

[Beej]

Do you sleep on your side? For some individuals, that may greatly increase the apneas.

[Sleeprider]

An untreated SpO2 below 92% is a concern, 88% is pretty bad desaturation, especially as a mean. The minimum SpO2 would have been lower than the average, so that's not good news. Oximeters come in all cost ranges from less tan $20, with a good wrist sensor that provides recording data for around $100, and you can spend a lot more. If you can afford it a Contec CMS50I is a wrist worn model that will record multple sessions and works with Sleepyhead. The CMS50F is a step up and is worn like a wrist watch. Finger clip types like the CMS50D+ / CMS50E / CMS50H, are cheaper and less comfortable. All work with the software. IMO if you just adapt to the machine, the oximeter will be optional, and you will be able to tell if treatment is adequate.

It would help if you would add the CPAP model to your profile. The S9 had Escape, Escape Auto, Elite, and Autoset. You have enough posts now to post data, so we can help you to evaluate any screenshots you want to post.

[ppca]

I probably should have been a bit more specific what the confusing part for me in this latest sleep study was. It is the fact that it shows AHI of only 5.2. Keep in mind this was a study with no CPAP machine attached. That number would mean that either I have no sleep apnea, or a very, very mild case, none of which makes any sense. My first study, 3 years ago, reported AHI of 15.3. Is this last report just bogus, at least with regards to AHI number?

As for oxygen, again since the 88% mean desaturation was measured without CPAP machine attached, now that I'm using it at my home, and consistently showing AHI < 1, would it be right to assume that the oxygen desaturation numbers should be better, with the therapy going on?

I was looking into CMS50E oximeter, and the best price I found so far was around $90 CAD (around $70 US). The question is, like you said Sleeprider, do I need it? Can I assume, if everything else looks good in SleepyHead, that the oxygen levels are good too?

I have already posted a few of my reports in the last few days, and here is the one from last night. It is very typical, pretty much this is what I'm seeing on a daily basis.

http://imgur.com/a/EWJdN

Would it be wrong to assume that my oxygen numbers should be good too, based on reports like this? Or do I just get an oximeter?

As for changing my profile, when I go into it, I do not see any edit option. I can only read what I put in there originally, when I registered.

The machine is ResMed S9 Elite.

[srlevine1]

Would it be wrong to assume that my oxygen numbers should be good too, based on reports like this? Or do I just get an oximeter?

You cannot assume that your oxygen numbers will be good if you get a good SleepyHead report.  I have found that Kevin Cooper of Cooper Medical Supplier #19 is a great source of information about pulse oximeters. He is an expert on the subject and gives great advice.  It is well worth purchasing from a known supplier rather than risking being sold a Chinese knock-off and being unable to return it. Best of luck.

[ppca]

You cannot not assume that your oxygen numbers will be good if you get a good SleepyHead report.

The double negative is fine , but just to be clear: if my SH reports are good, I should expect my oxygen numbers to be good too?

If I decide to go for an oximeter, what do you folks think about CMS50F? It appears that it might be more comfortable to wear than the finger clip types. Is it worth spending a few extra bucks on it, as opposed to CMS50E?

Also, aren't they all made in China, regardless of who the supplier is? I am under the impression that all of these Contec models originally come from China, and may be sold under slightly changed names, depending on who the supplier is. I found a Canadian supplier selling these and one of their models is obviously Contec CMS50F, except they gave it a different name. Their price is considerably lower compared to most US online sites (around $80 US).

[ppca]

With regards to CMS50F, I found a few comments on the web about how it may not be accurate enough.

Any input from people who are using this one is highly appreciated.

[srlevine1]

You cannot not assume that your oxygen numbers will be good if you get a good SleepyHead report.

The double negative is fine , but just to be clear: if my SH reports are good, I should expect my oxygen numbers to be good too?

If I decide to go for an oximeter, what do you folks think about CMS50F? It appears that it might be more comfortable to wear than the finger clip types. Is it worth spending a few extra bucks on it, as opposed to CMS50E?

Also, aren't they all made in China, regardless of who the supplier is? I am under the impression that all of these Contec models originally come from China, and may be sold under slightly changed names, depending on who the supplier is. I found a Canadian supplier selling these and one of their models is obviously Contec CMS50F, except they gave it a different name. Their price is considerably lower compared to most US online sites (around $80 US).

Sorry about the double negative -- fat fingers work faster than the mind sometimes. To be clear -- GOOD SLEEPYHEAD REPORTS SAY NOTHING ABOUT YOUR OXYGEN LEVELS OR DESATURATION.

BTW: a second method for spotting symptoms of desaturation is to check your hemoglobin, hematocrit, and red blood cell count. When you have consistent desaturation, your body may compensate by producing more red blood cells to carry oxygen. (Polycythemia).

I am using a CMS-50F and the only problem I have found with accuracy (checked against a professional pulse oximeter) is when I am in arrhythmia (PACs, PVCs) and the pulse is inaccurate and bouncing. Over a period of a year or more, the higher price of a quality unit will seem insignificant, especially if measured against the time, effort, and money involved in returns. Pretty much why I use Kevin Supplier #19 for advice and as a supplier of my pulse-ox.

Yes, they all seem to be made in China -- along with knockoffs -- pretty much why I caution against purchasing from a foreign supplier. By using a reputable vendor, not only are you assured that the unit is authentic, you have some level of recourse and customer service. Some of the cheaper units --- and even some of those offered by reputable manufacturers are not FDA-approved or certificated. Personally, I like my medical devices to be FDA-certified which holds the manufacturer to certain quality control standards.

[ppca]

Thanks a lot, srlevine1.

Just recently I did my complete annual lab, and the blood work was okay. I have some other minor issues, but hemoglobin and RBC's were within limits.

The low oxygen numbers only came from this latest sleep study (no CPAP attached). I am kinda guessing that, while attached to my ResMed at night, the oxygen numbers may be okay, as was the case during my titration study 3 years ago.

Still, to be sure, it is probably a good idea to get an oximeter, capable of recording data. My question about the accuracy of CMS50F was related to a few comments that I found on the web (some may have been here on this forum). I remember reading that someone claimed that it reports 7-8% lower oxygen numbers, than what they really are. That would be a lot, I certainly hope that is not your experience.

I found a Canadian supplier who sells this unit for $105 CAD. That would be about $80 US. I'm still hesitant, but maybe I should give it a try.