Feel faint/nervous/wrong in morning when slept on left side.

[MyronH]

I thought all my problems were resolved. Haven't had any issues in awhile. AHI <=1 every night. Male 47yo 260lbs 6'1. Had two DVT and PE in past and one afib incident in 2017. Now on blood thinners. All past blood tests negati e. Echocardiogram Stress test normal with no afib. Heart checked OK. 

I usually been sleeping on my right side and have little issues when waking up. Last night I tried left side again. I woke up in middle of night with my SpO2 alarm going off at 85%.

I haven't looked at my bilevel charts yet to see what they show. But this whole morning so far I had this unnerving feeling that something was wrong. Very odd feeling. I take medicine for anxiety and panic disorder which works. This feeling was a feeling like something is wrong. Like I was going to pass out whenever I stood up.

Can this be vasovagal issue when laying on left side? 
Low blood sugar? 

I went to work and felt weak going in. and so far when I stand up the feeling is still slightly there. Like I didn't get enough sleep and that something is a little wrong

[Sleeprider]

There are limits to what we can help you with on the forum. If you feel you are having a medical emergency or issue, asking here is just delaying the care you may need. It is impossible for us to distinguish between anxiety and a real medical condition, so my suggestion is to err on the side of caution and go to the ER or consult with your doctor's office.

[MyronH]

I am consulting now with my doctor.

[MyronH]

There are limits to what we can help you with on the forum.  If you feel you are having a medical emergency or issue, asking here is just delaying the care you may need.  It is impossible for us to distinguish between anxiety and a real medical condition, so my suggestion is to err on the side of caution and go to the ER or consult with your doctor's office.

Yeah I tried it yet again sleeping on my left side. I keep telling my doctors something is wrong when i sleep on left side. This morning I woke up and rolled over to left side. Fell asleep again for an hour, and my SpO2 alarm went off, when it dropped to 85%. No apnea reported, but it does look like Tidal Volume goes up double for some reason. I'm not sure if I should get my cardiologist involved again or not, since they told me multiple times my heart was good.

If I send this to my sleep doctor, he won't be of any help. He looks at AHI only and will see I got low AHI and tell me to walk out the door. As you can see though my O2 drops significantly laying on my left side. And this causes me to have those weird feelings during the day.

   
       

[Sleeprider]

These are brief episodes, but you seem to be reacting to a low O2 in the normal way, with increased pulse and recovery breathing. The event at 06:01 is a hypopnea but for some reason the machine did not flag it.

[WillSleep]

There are limits to what we can help you with on the forum.  If you feel you are having a medical emergency or issue, asking here is just delaying the care you may need.  It is impossible for us to distinguish between anxiety and a real medical condition, so my suggestion is to err on the side of caution and go to the ER or consult with your doctor's office.

Yea, what Sleeprider said.  Definitely issues to bulldog through with your Docs.  

"I keep telling my doctors something is wrong when i sleep on left side." 

I am definitely the opposite of what you call an expert on this topics.  

"Left side"  Somewhere in my perpetual learning travels I have seen a med team continuing education presentation and some research papers on the alternative positive and negative aspects of cardio <> pulmonary, chest wall pressure and sometimes NIV / CPAP / BiPAP interactions.

These documents focus mostly on positive aspects to research and show where NIV and xPAP are good for cardiac patients because of reduced heart workload in certain situations.    Some also go into great depth on many other +/- interactions in far more cardiac and pulmonary areas than I knew exist.   At least one or two docs talked about left side / right side of the heart differences.    

Taxpayer funded PubMed is a great place to start a search for info because it seems to be the best source for free view-able documents https://www.ncbi.nlm.nih.gov/pmc/    

Include one of the following keywords in the search to find xPAP related documents (Ventilation, Positive Pressure, BiPAP and CPAP).     One example search of hundreds of possible searches  https://www.ncbi.nlm.nih.gov/pubmed/?ter...ous+return   

Let me know if you want me to try and find a reference or two.    

///////////////////////////////////

On the the charts.  

If the 5:59 - 6:01 sequence happens often, would a Backup Rate help?   

I noticed from 5:59 - 6:01 what may be a flow limitation with a shorter Peak Inspiration Height and much shorter inspiration than expiration legs of the breath.   

From 5:59 - 6:01 (through the time of the SpO2 desaturation) EPAP remained about 5 cmH2O.    In this one instance if PIP (Peak Inspiration Pressure) was higher you might have seen a higher inspiration peak height, more inspiration and therefore lower desaturation.

EPAP (PEEP) drives Oxygenation. At this time (5:59 - 6:01) EPAP was pretty low (5 cmH2O) so unless it is a mis-match with what you already know and what the rest of the chart is telling us I would recommend raising EPAP Min slightly.
  
Currently your EPAP Min is current set to 4.4.  Might consider increasing EPAP min to 5.0 or 5.4 and see if you like the resulting changes.   

Last two thoughts:  

• Love the fact you are using an alarm to monitor and awake you when SpO2 gets too low.  This is gold.
  
• In my mind Sleeprider is hands down my go-to person for all topics related to the VAuto so when he contradicts me go with what he says.
  

Happy Snoozing!

WillSleep

[WillSleep]

One more quick one.. 

If you think it is right..  add a Pulmonologist to the list of Docs you are going to visit.  An infection or edema inside the lung or chest greater on one side would explain a difference when sleep on your left side vs your right.  

WillSleep

[MyronH]

These are brief episodes, but you seem to be reacting to a low O2 in the normal way, with increased pulse and recovery breathing. The event at 06:01 is a hypopnea but for some reason the machine did not flag it.

Why would such a brief episode cause a dramatic drop in SpO2? 
It appears I'm still breathing according to the flow rate, although erratically. I would suspect a CA to cause a drop, but not such a brief episode.

On the the charts.  
If the 5:59 - 6:01 sequence happens often, would a Backup Rate help?   
 
Currently your EPAP Min is current set to 4.4.  Might consider increasing EPAP min to 5.0 or 5.4 and see if you like the resulting changes.   

I don't think I'd qualify for any backup rate. That's for people with severe CA issues. Also my EPAP Min is 5 as seen below the big AHI number. (5-18). The reason it shows lower like 4.4, is probably due to my 5min ramp time which starts at EPAP 4. After numerous sleep studies with my doctor, he always puts me at EPAP 4 for some reason. I felt starved for air so raised it to 5.

My doctor has a good practice going in his city, but he doesn't dig deep into issues. It took multiple appointments until he tried a BILEVEL on me. I had to complain to him that I still felt like crap on CPAP even when my AHI <=7. 

One more quick one.. 

If you think it is right..  add a Pulmonologist to the list of Docs you are going to visit.  An infection or edema inside the lung or chest greater on one side would explain a difference when sleep on your left side vs your right.  

WillSleep

I have a pulmonologist and they did multiple tests too. I'm actually on blood thinner due to two past DVT/PE's . A few years ago, during my first PE, they found some slight scarring on base of my left lung. They think maybe I had an infection or something at some point in my life that caused it. So I do have reduced lung capacity but not very much. Pulmonologist did tests to have me blow in a tube and measure capacity and it was normal. Cardiologist ruled out any problems with my heart too, even though I had an AFIB incident in 2017, due to sleep apnea. My AFIB-free for two years now.

TODAY...my pulmonologist had me come in to do blood test to see if I'm producing clots. Should get results Monday.

[WillSleep]

Why would such a brief episode cause a dramatic drop in SpO2? 

I would just keep hammering your Docs with that question and the picture to show the big drop.
Not at all taking away the energy to pursue that question with your Docs ... any chance part of the size of that fast big drop might be from sensor position faltering a little by a physical response to an arousal?  I have occasionally visually seen my SpO2 sensor a wee bit out of place in the middle of the night. 
WillSleep

[holden4th]

I've got to agree with Willsleep about seeing a pulmonologist.