Looking for advice

[sleepyqueue]

I'll try and keep this as brief as possible, it just seems like there is a lot to go through.  I've been on a CPAP for about 10 years, diagnosed with both obstructive and central sleep apnea.  Around 2017 I had a follow-up sleep study and my doctor was less concerned about the central and switched me to a Dreamstation 1.  I got a small boost from using the CPAP but honestly have continued to be exhausted.  In 2021 I decided I wanted to get better and realized that I was still having an AHI of 10-15 even with the CPAP and I went through a process of taking matters into my own hands and tried a number of different masks and pressure settings until I got my AHI consistently under 5.  I ended up with a full Dreamwear mask and pressure settings of 16-20.  That helped a little as well, but I still feel exhausted 24/7 and often wake up with a headache.  Last year I went through the Dreamstation recall process and got a Dreamstation 2.  I kept all the settings I had from the Dreamstation 1.  The last time I consulted with my sleep doctor after this he basically said there wasn't much more he could do because it looked like the machine was doing it's job and suggested it might be something else.

Last Christmas I got a Garmin smart watch and I occasionally wear it when I sleep and pretty much every night that I do wear it it shows drops in SPO2 below 88, sometimes much lower.  After a bit of research I found that the Garmin's accuracy for oxygen saturation aren't super great so I bought an Oximeter, a CMS50D-BT, and tried to use that to measure oxygen levels.  The problem with that was it kept slipping off my finger in the middle of the night so I'd only get 1-3 hours of readings.  Finally last night, I used, some bandage tape to tape it to my finger and it stayed on for the night, until I woke up a little before my wakeup time and it was really uncomfortable so I took it off and went back to sleep.  It too shows drops, but I realized I have no idea how to interpret these numbers.   I also wore my watch and while the exact numbers are different it shows drops at approximately the same times as the CMS50D-BT.

So my two questions are this.

1) What can I do to help my overall feelings of exhaustion?  General and specific advice is very welcome.  I'm happy to get any more screen shots or datat that are needed from Oscar to help with that.
2) Should I care about my SPO2 numbers?  Should I do something else to get more measurements?

I'm pasting screen shots from last night, but there are a couple of caveats.  My AHI was really high for me last night at 8.6.  That's unusual.  2.5-3.5 is much more typical as you can see from the statistics screen shot.  I think it was because I usually sleep on my side and the oximeter made that uncomfortable so I ended up on my back more than usual.  I don't do well with having stuff on me or changes with sleep in general. It took me a long time to acclimate to the CPAP and now that I've done that I can't sleep without it.  Second caveat, is that when I imported the SPO2 numbers into Oscar I got the start time wrong and I can't figure out how to adjust it.  I think it's about 5 minutes off.  Lastly, I did drag the SPO2 graph to near the top of the screen shot because I'm asking about that specifically.

Thanks in advance!

[Jay51]

Welcome to ApneaBoard.  It is kind of tough to interpret your SPO2 data since the sensor came off of your finger so much.  The very long straight drops down are artifacts (when the sensor is not working).  All of those were probably calculated into your SPO2 average, so it might be skewed.  SPO2 numbers are important to me because when they get too low, hypoxia can occur.  Average SPO2 for the night is usually around 95 or 96 or so.  Drops into the low 90's are not that bad.  Below 90 is when a person should start looking at them more closely and possibly talk to Dr. or Sleep Dr. about it.  If a person is below 88% for 5 minutes total time or more during sleep, they qualify for supplemental oxygen according to Medicare.  That is serious.  You have lot of drops, but they could be skewed by your finger sensor.  

If you want to, you can download OSCAR and upload some charts here to try to get your therapy optimized as best that you can.

[mesenteria]

You have a great many events, but the more worrying, given your description of your AHI history, are the 'clear airway' depictions in purple.  Those are centrals, and they need to be dealt with.  I can't advise you about therapy, but I think our more experienced coaches here will suggest that you need an ASV (adaptive servo-ventilator), or quite possibly so.  The CPAP varieties don't seem to be helping you, and your therapist/specialist certainly isn't.

Do you sleep with a cervical collar?  There is a sign of clusters of events, and often those can be attributed to supine sleeping, on your back, with your chin sagging down toward your breastbone. This means a pinched trachea, and naturally this is something any machine will have difficulty controlling for.  Soft foam cervical collars do a fairly good job of retaining good head orientation.

[sleepyqueue]

Thank you!  I don't sleep with a cervical collar, but I will look into that.

I'm going to send my sleep doctor another message and try to focus specifically on the SPO2 and clearway apneas and see if he more helpful this time.  If not I'll see if I can find other providers, but the last time I checked my insurance really limited my options.

[sleepyqueue]

Thank you!

I'm going to try to get a few more nights data and see if I can get cleaner numbers.  Maybe get a better sensor.

I will also follow-up with my sleep doc about it and try and focus the questions initially on that issue and the clearway apneas.