Just got diagnosed, need some advice

[Gideon]

That time <= 90% is important, keep it and associate it with the OSCAR charts (there is no date that you showed us)
Can you also report the same thing for 88%? Different doctors use different criteria.

For the foreseeable future please report this stat along with your OSCAR report.
Dave has a good point. Start talking to your pulmonary doctor about getting an overnight oximeter test. The doc will not accept your rings as fact, but that's ok, he just needs to see that it doesn't look right and he needs to investigate.

I do want to see the results of the 10/7 night.

Your severe apnea is well managed. That we hit right off the bat, but your O2 levels are a trainwreck. I'm thinking that you may need a BiLevel to help manage your desats. Sleeprider?

[Sleeprider]

Well, this is bilevel. This one does not record flow limits so we don't know how functional respiration is without getting some zoomed views in the 3-minute range that shows whether the respiratory wave is normal. We may want more pressure support. Just using basics, oxygenation is dependent on more positive end expiratory pressure or EPAP, so that's why I suggested a 3-cm bump to 7.0 cm. I look forward to seeing if this improves oximeter results and is more comfortable. We will have to ask for some zoomed views to make other conclusions.

[tedlongford]

I tried 10/7 last night. I slept really well and woke up feeling great. My AHI was higher that the previous night, but my O2 numbers were significantly better. I spent much less time under 90%. I wasn't able to get the software to read out for the 88% level. But I was able to get another view that has a different chart. I ordered a more sophisticated spO2 monitor with better resolution, should be here in a few days.

   
   
   

[tedlongford]

   
   

[Sleeprider]

The fact the higher pressure makes you feel better is very encouraging. SpO2 was low from 02:30 to 03:15, but the extent and duration of desaturation is significantly improved compared to the lower pressure. Hypopnea is somewhat clustered and this corresponds to periods of pronounced snores, so we may want to look at positional issues. Take a look at our positional apnea and soft cervical collar articles. I suspect that during periods of low SpO2 and snores you are tucking your chin. This may be cause by a pillow that is too tall or multiple pillows, or may be simply flexion in the neck that partially obstructs the airway. I'm not going to rush to a recommendation of a soft cervical collar, but it may be a solution if this pattern continues.

Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

Your SpO2 chart would be improved by adding a dotted line at 90%. Just right click near the SpO2 title on the Y-axis and select Dotted line to set the threshold.

[tedlongford]

Excellent, thanks for your help and review. I will run with the same setup tonight and see if I have similar results.

[tedlongford]

Woke up feeling pretty good again. Looks like I had a few episodes last night. O2 still looks better than it was. I must have been right on the edge of 90% during the dips because one ring recorded 2min below 90% and the other 50min.

   

   

   

---

   

   

[Sleeprider]

I think the events are all obstructive based on the clusters of both CA and OA, and most likely are the result of chin-tucking that I have discussed before. If we can stabilize your neck to prevent these events, I think everything else will resolve as well. The mechanism by which CA can be registered is obstruction caused by positional occlusion of the airway, and the only way to really know CA from OA in these cases is to measure respiratory effort. CA seems unlikely since it is only one single cluster, and the remaining OA events come mostly in closely timed pairs. We can increase pressure by 1-cm to 11/9 and see if it has any effects, but pay attention to the potential for the neck flexing. Overall, your SpO2 is remarkably better.

[tedlongford]

Thanks. I will try with +1 on the pressure and report back. I have been trying to be mindful of my pillow and neck position when falling asleep. After a night with pressure +1 I will try a night with a soft cervical collar.

[tedlongford]

I tried last night on a pressure of 11/8. I unfortunately got called in to work at 5:45 which cut my sleep short, but other than that I feel good. I think my apneas and spO2 look a bit better as well. I felt like it leaked a bit more on the higher pressure so need to snug up the mask a little bit. I am also going to go buy a soft cervical collar to trial if I can find one locally.

   

   

   

---