high blood pressure from low oxygen at night

[joesetx]

I have been having issues with my blood pressure lately. My sleep study showed complex sleep apnea with both obstructive sleep apnea and centrals.
My sleep doc has me using a fixed pressure
I have been using a pulse oximeter at night and notice some nights my o2 drops into the low 80's

On the mornings that my o2 has been low my blood pressure is too high, running 150/100 or worse

looking for advice

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here is a screenshot showing the drop in my o2 at night

[sheepless]

sorry I can't help but am curious about this as well. I too have mixed apnea & my bp (after bp meds) is high in the morning & quite low in the evening & wonder if sleep &/or pap has something to do with it. I don't monitor my O2.

idk about your bp question but I will comment generally on your charts.

the terms mixed & complex apnea are often used interchangeably, but my understanding is that complex refers to pressure induced / treatment emergent central apnea and mixed refers to idiopathic ca or ca related to heart failure, certain meds, altitude, maybe others. whatever the terms, it's an important distinction.

if yours is complex, your ca should decline in time. if mixed, it's very possible you're on the wrong machine.

meanwhile, you have a lot of snoring & flow limitations that may be affecting the quality of your sleep. I'll let better informed members comment on specific settings but with apap you might need to raise pressure & experiment with epr. those actions can produce ca which is why your pressure is fixed. otoh, if you feel ok & you don't think snoring & flow limitations are bothering you & aren't related to your bp issue, the industry considers an ahi of 4.x as well treated & you can too.

if your ahi is reasonably consistently like your screenshot, i.e., under 5, you aren't likely to get much help from your provider. many AB members are able achieve lower ahi & reduce snoring & flow limitations to a greater extent than we see in your screenshot.

[Sleeprider]

On your SpO2 chart you can add a dotted line at a critical threshold. I would suggest 89%. Just right click near the Y-axis where it says SpO2 and select dotted line. That will make it easier to spot the frequency and duration of desaturation. O2 appears to be a significant problem worth discussion with your doctor.

With fixed pressure at 5.6 and no EPR your numerical AHI appears acceptable, but combined with your oximetry results, high blood pressure and how you feel, this is not efficacy. In addition to discussing your oximetry and marginal AHI you should ask your doctor to schedule ASV titration as soon as possible along with any health screening he feels is needed. I’m sure your pressure settings are to mitigate high CAI with variable pressure and EPR. It’s simply not working and it’s down to a choice between supplemental oxygen or appropriate ASV therapy. You are going to have to make some noise to prioritize a healthful solution or self-fund ASV. Is insurance good?

[joesetx]

ASV was suggested by the sleep technician during the study but my original diagnosis was moderate (AHI around 25) and the sleep physician’s comment was “good luck having insurance cover ASV with your AHI indicating moderate apnea.

I am not working with the shutdown but I’m almost tempted to buy a Resmed ASV without insurance if it would make a big difference.
I could be going round and round with insurance when a lightly used machine might be close to the copay anyway.



Are there folks here who could guide me on the setup?
Right now I see the sleep doc every six months but he seems satisfied with my compliance and where I am at.

[Sleeprider]

Your doctor is looking for the easy way out, but it is his job to determine what is medically necessary. An ASV titration would evaluate alternative pressure schemes where CPAP and bilevel would fail due to events and low SpO2, but ASV would demonstrate efficacy. Based on that study your doctor should give an honest recommendation and prescription for ASV regardless of the insurance company making approval easy or difficult. Given his awareness of your needs, he may be willing to issue a prescription for ASV, which would allow you to purchase one from Supplier #2 or other outlet and get the therapy you need, with or without insurance approval. Ask your doctor if he works for the insurance company or for you. The answer must be obvious and his prescription for ASV should follow that opinion and any screening he deems necessary.

A Resmed Aircurve 10 ASV sells for $1319 to 2149 (used/new) at Supplier #2. If you can afford it, your health will thank you . Self-funding takes the insurance company out of the decision loop, and once you demonstrate efficacy, your doctor can easily justify this device in future claims. At a much lower cost, you can buy a Resmed VPAP Adapt Model 36007 with 15,000 hours for $240 or one with zero hours for $700 on DotMed. This device is an older generation ASV that would allow you to demonstrate efficacy and move the process forward by providing useful data, allowing you to self titrate and show what works. DotMed is also listing a new Resmed Aircurve 10 ASV model 37043 for $1549. That's as low as I can find for new. DotMed won't ask for a prescription.

It's up to you. We can help you to source the machine that will transform your therapy and how you feel, and eliminate this concern over central apnea and oxygen levels. I think you can get ASV with your current doctor and insurance, but it's going to take time and persistence. You are going to have to push a doctor that doesn't want to fight for you, but I'm sure he will write the script he knows to be the best medical option.