[Diagnosis] nocturnal hypoxemia with hypoventilation, Moderate OSA

[gainerfull]

There may be an opportunity to improve your situation while you wait for your doctor if you're open to it. This would require downloading OSCAR and sharing screenshots of a couple nights of your sleep data so that the more experienced members can make some suggestions. At minimum you should consider turning off ramp and lowering your max pressure to 16cmH20 based upon the screenshot you shared.

I also was experiencing blood oxygen problems and I've been able to make a considerable improvement in my vitals after picking up a wedge pillow, switching over and titrating myself to a constant pressure, and building a night routine that includes washing my mask seal, clearing out my sinuses with a rinse, etc. Good luck

Given the edema - are you sure you're using the right mask size for your face? A lot of durable medical equipment providers can set you up with a "fit pack" that include small, medium and large pillows so you can see which one works the best.

[vgrando]

Hellow again,

With help, I Downloaded OSCAR and imported my data. I am trying to share with you, but i do not know how to do. C you help?

[Jay51]

Attaching Files

If this doesn't work, just let us know.

[vgrando]

This is my first upload to OSCAR[attachment=51186]

[vgrando]

Do you just take screenshots like this?

[attachment=51194][attachment=51193][attachment=51192]

[Jay51]

Thank you for posting those charts Victoria.  I see a few things.  Your spontaneous respiratory rate is about average to above average.  Your tidal volume and minute ventilation look a little low (unless you are a very petite person).    

You have a few CA's during the night, but I would not call them excessive.  With the 1 or so AHI, that is very good.  

Nightly SPO2 may hold some answers.  You said that you hover around 90 most of the night.  And have some drops below that.  Usually that indicates a positional aspect to sleep apnea (chin tucking is kinking your airway); but your charts are very clean from any OA's and H's.  

Raising your tidal volume (and subsequent minute ventilation) may improve SPO2 #'s.  The current machine that you have does not have the capability to do this.  Ventilating type machines can increase these ST (A), ASV, and VAPS.  Since your spontaneous respiratory rate is very good, a volume assured type of machine might benefit you the most (ivaps or avaps).  ASV might not work for you because you do hypoventilate (and that is contraindicated to use it).  

The only other thing I can think of is a V/Q mismatch type of situation (which would only apply here if you are very petite and you normally have low tidal volume and minute vent. #'s.  But you already said that these are low, so it is not V/Q mismatch.  

Showing appropriate people this (RT, Sleep Dr.) and educating them could help you get to a better machine.

[vgrando]

Thank you so much. My doctors have been less than helpful. I found a new sleep doctor who I see in July.

This is my oxygen stats for the charts that I posted. I have an 02 ring that I wear while I sleep and I track sleep with my apple watch and an Oura ring.

I was first diagnosed with Nocturnal Hypoxemia from my home sleep study I desaturated for 420 minutes independent of respiratory events and mild Apnea. My in-lab study identified moderate Apnea, hypoventilation (independent of respiratory events), and hypercapnia (a high of 59). During my titration study, I had hypercapnia (a high of 49) and I desaturated to a low of 76% for 90 minutes on a pressure of 10. None of my in-lab studies identified Central apneas. 

My data from the being has shown low tidal volumes from 80 to 220 while sleeping. I awake frequently at night since on the APAP and then my Tidal volumes are higher.  


I just had a chest CT, which confirmed mild bilateral-dependent atelectasis and [attachment=51211]no other heart or lung disease. I have had this identified 2 times on CT scans since 2019. It is interesting that atelectasis can be caused by shallow breathing, which is the only risk factor I have.

[Jay51]

Atelectasis could be the problem.  Surely all of you Sleep Dr.'s etc. have read this on your medical history and have taken this into account when analyzing your sleep study?  If not, they need to know.

[Bruce Reynolds]

I am unable to open the Oxyring file.  Can you post an image?

Can you post the actual results of the PFT?  I believe there may be a couple values there that will help your case.

Can you tell me what your height and weight is?  I thinking that you're an OHS or Overlap (no offense meant!).

[vgrando]

This is a screen shot[attachment=51252]