Low O2 and Snoring

[Bigdonpaul]

For the past few weeks, I've been waking up multiple times, snoring lightly and I've had low O2 numbers. I've just started using the Wellue O2 ring for my O2 readings. MyAir has been coming back with perfect scores but I know that's not the complete story.

For context, I'm a 37M who is morbidly obese. I use a wedge pillow as well. Any help or recommendations are greatly appreciated. I have an appointment with a new sleep doctor on March 27.

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[srlevine1]

Looking at your charts, I see that your pressure is at 17.66 for 95% of the time. Have you considered re-setting the top end at the max range of 20.00 to see if that changes anything?
Also, have you checked your bloodwork with your doctor to see if the oxygen-carrying ability of your blood is low? And if you have any symptoms of polycythemia?

Nocturnal Mean Oxygen Saturation Is Associated with Secondary Polycythemia in Young Adults with Obstructive Sleep Apnea, Especially in Men (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901050/)

"Nocturnal mean SpO2 was an independent predictor of polycythemia in young adults. Mean SpO2, compared with the AHI, was more associated with polycythemia. Men were more prone to suffer from polycythemia compared with women. Hemoglobin and hematocrit values might have diagnostic utility for assessing nocturnal hypoxia severity of OSA patients, especially in men."

[Bigdonpaul]

This is from last night. I bumped up the min pressure to 13 and the max to 20. I also changed my pillow setup as well. Let me know what you think.

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[cmpman1974]

Seems like you have seriously low Tidal Volumes.  I see no stats on your O2 / pulse levels from the Wellue product.  Any chance it is Obesity Hyperventilation Syndrome?  I have not seen median Tidal Volumes so low, but I'm not expert.  Something seems off, especially for those high pressures. When you say low O2, that's not clear enough. What's your lowest O2 level each night? Mean O2 for the night? How many minutes under 88% O2 saturation per night?

Does your blood CO2 levels run high? Have you had Arterial Blood Gas testing to determine PACO2/PAO2 and Ph levels? Just some general thoughts. I don't know how extensive of a work-up you've had so far.

You also have very high flow limits too.

If you're not currently on BPAP, I'm guessing good chance you'll need to be soon with those levels. You're at the limits of a CPAP machine.

[Bigdonpaul]

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My last sleep study was done October 2021. I'm expecting to have to do another one after my appointment on March 27. I have that data from the sleep study pre-CPAP if that helps.

[cmpman1974]

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My last sleep study was done October 2021. I'm expecting to have to do another one after my appointment on March 27. I have that data from the sleep study pre-CPAP if that helps.

Scary part is your O2 numbers look better than mine.   Your mean is 95%.  Mine is usually 90-91%.  It could be better, but not as bad as I expected.  Those minutes under 88% aren't good, but they are less than I thought I'd see based on the original comment.    I would  consider exploring my other testing questions with your new sleep doctor to see if they are relevant for you.   Best of luck.

Other questions are how are you wearing the ring? On what finger? Being large myself, I understand the hassle of trying to fit these absurdly small silicone rings on a thumb or pointer finger. They are not made for anyone larger and I outright told the company they are severely missing a key market. I don't think they'll care, but it doesn't hurt to ask. Until I cross-check my stats with a medical-grade device ordered by a physician, I won't be 100% convinced. I feel that's the smartest route.

It certainly may be helpful to post the last sleep study with de-identified information. If it shows O2 stats, it'll provide some perspective for everyone. Do you have any other comorbid beathing issues like COPD, asthma, etc. that could generate lower Tidal Volumes? Any pulmonary function testing showing low values from expected? As you can probably tell, I've been down this road.

One thing that throws me off is the inspiration to expiration ratio you have It's almost 1:1. Mine is more like 1:2. I don't know what that means.

[Bigdonpaul]

Thank you. Based on this and other responses, I'm thinking a BiPAP may be in my future.

[Bigdonpaul]

No other comorbidities besides the obvious morbid obesity. I recently had some blood work done and my Troponin levels were elevated indicating heart damage. Chest X-ray, 3 EKGS and Troponin levels in the ER were all normal. I have a heart stress test on April 3 just in case.


I wear the ring on my right pointer finger. The band is tight like yours so it might affect accuracy. I tried the oximeters you can use overnight on the tip of your finger but it fell off repeatedly.


Attached is the October 2021 sleep study before I started on CPAP.

[cmpman1974]

No other comorbidities besides the obvious morbid obesity. I recently had some blood work done and my Troponin levels were elevated indicating heart damage. Chest X-ray, 3 EKGS and Troponin levels in the ER were all normal. I have a heart stress test on April 3 just in case.


I wear the ring on my right pointer finger. The band is tight like yours so it might affect accuracy. I tried the oximeters you can use overnight on the tip of your finger but it fell off repeatedly.


Attached is the October 2021 sleep study before I started on CPAP.

Somehow the attachment didn't make it on here.  You may want to check again.  Were your CO2 levels normal range (27 or < on a Comprehensive Metabolic Panel)?  That's usually a starting screening test for OHS.  It's not the end all be all by any means, but many docs look there first.

Regarding a sleep study, the upcoming one should be telling. No doubt you probably had low O2 saturations with no CPAP therapy if a split study. I'm most curious how low desaturations go according to a lab with 'optimal' CPAP/BPAP titration levels. That's an important aspect and may let you know if something more has to be considered moving forward. As you've said, the stats look good otherwise such as AHI, leak rates, etc. That is not the final story though in many cases.

[Bigdonpaul]

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