Home Sleep Study - Low AHI but significant desat

[ArcherNeedsSleep]

I changed the trigger to very high for two nights.  The centrals definitely reduced, but my SpO2 dropped.  I then changed it back to high last night to compare, and the centrals came back with a vengeance.  Flow limits seem similar between the two.  Both settings felt fine to me, so I'll default to very high for now since it produces better results.

I'm still seeing around 2 hours of SpO2 below 90%.  That's an improvement, but I'm hoping to get even better, if anyone has recommendations for improved settings.

I'm adding Oscar charts for one of the nights with the trigger set at very high, to compare to the ones with a high trigger from the previous night.

       

[Jay51]

These charts look pretty good.  Sleeprider has mentioned supplemental oxygen several times already.  I agree with his suggestion.  With your charts looking this good, there must be some other reason that you are trending so low in SPO2.  It looks like you average around 90 or even a little lower during the entire night.  

If you get on supplemental oxygen and hate it, you can always get off of it.  I briefly glanced at your entire thread (I know you live at 7300 feet elevation also).  And you had your heart checked out as Steve (srlevine1) recommended.  I am kind of leaning toward something going on in your lungs.  Just a guess.  Have you seen a Pulmonologist?  Dave has made some great suggestions also. 

It would be interesting to see what your SPO2 would be at sea level or so with this same set up with the VAUTO, but since you live where you live in Colorado Springs, it may be time to try supplemental oxygen.  Just my opinion to try to help you.  An oxygen bleed can be set up to your mask using your VAUTO and adjusted as needed.

[ArcherNeedsSleep]

Sigh. Thanks for your comments. I've been fighting it, but I'm coming around to the opinion that I'll be getting supplemental oxygen in the near future.

I did see a pulmonologist right after I started on CPAP, and he said that my lungs are fine and that the nighttime oxygen issues must be caused by Apnea (even though my sleep study didn't technically show apnea in it).  Of course, with the help of the folks on this board, we've done a reasonable job of treating the "nonexistent" apnea, without fixing the oxygen, so he was apparently a bit too cavalier in his opinion.  He was also a straight-up jerk, so if I had to see another pulmonologist, I would be starting over with a new one.  

But honestly, I'm very active, doing cardio and strength work multiple times a week, with no shortness of breath.  I can hike in the mountains above 8,000 feet all day without breathing issues, either.  So, it doesn't look like a "lung thing" in general.  My body just works wrong at night, I guess.  

[ArcherNeedsSleep]

Good news – I finally navigated the oxygen concentrator maze and have one on the way.  Hopefully it will provide the last piece of the puzzle to this elusive “good night’s sleep” thing.

In the meantime, I’m back to dealing with some wicked aerophagia in the middle of the night.  It has come and gone over the past year or so, and I can’t figure out what brings it on, or how to truly eliminate it.

The setup is typically like this:
I sleep great, with no apneas or swallowed air, for the first full sleep cycle (~3 hours).  Then, after a brief wakeup and reposition, I end up waking up to full swallows of air over and over again for hours.  No matter what position I get into, it continues to happen - just as I fall back to sleep, I swallow a bunch of air and wake up.  There aren’t any marked apneas during that timeframe, but it does look like I do a mini central apnea prior to each instance. 
 
I’ve attached an overall view of last night, along with a zoom in to one of the time periods where I believe I was in the aerophagia stage.  I’m hoping that someone can see something in the charts that gives some ideas about adjustments that I can make to minimize this type of situation.  

As always, thanks for any insight that you can provide.  

       

[ArcherNeedsSleep]

Here’s a quick update and thanks to everyone who continued to recommend the addition of supplemental oxygen at night.  After a few nights with added O2, I can tell the difference in my sleep and overall wellness.  My SpO2 stays above 90% all night, and mornings are better.  I’m sure that it will take some time to undo whatever damage I accumulated after years of low oxygen at night, but I’m looking forward to the improvements.

The O2 also made my AHI drop to nearly zero, and effectively eliminated the centrals.  That surprised me, since I figured it would flush out the CO2 and make me more likely to have central events.  So, it’s a nice surprise to eliminate the centrals along with the other events.

I did some additional research on low nighttime SpO2 before talking to my doctor, and it’s worth noting a few things for anyone who is searching for info on this board.  I found that most of the research and articles related to nighttime SpO2 and supplemental oxygen are focused on people with COPD and other lung and heart diseases.  They commonly use “survival” and “death” as their measurement criteria.  And the results are split - about half say that O2 reduces death in the short term, and the other half say there's no statistical difference.  None of these studies were helpful for me, since I’m not dealing with any lung/heart issues and am certainly not willing to accept alive/dead as my personal success criteria.  Plus, my doctor was inclined to quote those studies rather than deal with my issue as a different situation.

Eventually, however, I stumbled upon a high-altitude medical blog where they discussed small-scale studies on oxygen as it relates to a variety of activities at altitude (i.e. hiking, skiing, drinking, and sleeping!).  Although they have small sample sizes, they do present some interesting cases related to high altitude living, and one of their articles presented a summary of opinions from multiple ER, primary care, and cardiology doctors that provided the last push for me.  Here’s the quote they used that finally spoke to me:  “…if you’re 50 and you’ve lived here [at high altitude] 10 years and you want to live here for another 10 years you should be sleeping on oxygen.”

Boom!  Regardless of the inconclusiveness of so many studies related to nighttime oxygen for people with lung and heart diseases, these doctors all make the case that living at altitude is a sufficient cause for low SpO2 at night in healthy individuals, and they strongly recommend supplemental oxygen to combat the impact to the body.  This argument helped in my discussion with my doctor, and hopefully it helps anyone else who’s in the same conundrum as I was.

In case you want to peruse the articles, they are located at the High Altitude Health website - here's the interview article that helped me:  https://highaltitudehealth.com/2021/02/

[Sleeprider]

Good article. Back when I was an administrator at Epic Ski, we had medical doctors from Colorado that spoke extensively on altitude sickness, HAPE the benefits of everything from Dimox to oxygen. There is even a company in Summit County that provides oxygen bottles for skier and other affected by high altitude. A previous member from Colorado fully resolved sleep apnea by using supplemental oxygen and was able to quit CPAP.

[ArcherNeedsSleep]

Yep, I was wondering if oxygen alone would work.  But...I know that I still struggle with sleeping without my CPAP, even if I'm at sea level.  So there's something apnea-related going on, even if it didn't show up on the sleep study the first time around.

I'm content with things as they are.  I'll continue to monitor my SpO2 and if it stays in the mid 90's, I might try with oxygen alone.  But it won't be anytime soon.  For now, I'm just going to enjoy the new experience of waking up feeling refreshed.



Thanks again for all the help.  

[AndyB]

Archer -- thank you for sharing the results of your research, and especially the link to HighAltitudeHealth.com. As a VAuto-using senior who spends several weeks each year living, skiing and hiking at altitude in the mountains of SW Colorado, I appreciate the information you provided. Makes me think I will wear a pulse oximeter when sleeping there and -- possibly -- consider adding oxygen to my therapy. Thanks again.

[ZacharySimon]

Wow. A long and challenging journey. But also emphasizes that this board is far more helpful than the professionals we deal with. I know you mentioned it, but what O2 ring do you use? TIA