Low daytime SPO2 and fatigue

[Dormeo]

I am going to guess you were obese and had apnea before March of 2022. If that's so, then I'm very skeptical those two conditions account for your symptoms. Please read this, from a trusted web site:

https://my.clevelandclinic.org/health/sy...42-dyspnea

Your PAP therapy is not optimized, but my main concerns for you lie elsewhere. I hope very much you can get a work-up from a pulmonologist (lung doctor). It will be important for you to explain the timing of the onset of dyspnea relative to your apnea and obesity.

In the meantime, would you post a zoomed in view of the chart above, providing about 12-15 minutes from the period when you had the large number of CA events? I'd like to see how the CAs look in the flow rate graph.

[vpsdub]

I am going to guess you were obese and had apnea before March of 2022.  If that's so, then I'm very skeptical those two conditions account for your symptoms.  Please read this, from a trusted web site:

https://my.clevelandclinic.org/health/sy...42-dyspnea

Your PAP therapy is not optimized, but my main concerns for you lie elsewhere.  I hope very much you can get a work-up from a pulmonologist (lung doctor).  It will be important for you to explain the timing of the onset of  dyspnea relative to your apnea and obesity.

In the meantime, would you post a zoomed in view of  the chart above, providing about 12-15 minutes from the period when you had the large number of CA events?  I'd like to see how the CAs look in the flow rate graph.


Thanks for interesting article!
Here are zoomed CA clusters
   
   
   

[Jay51]

Thank you for posting that.  I have never seen anything like the 1st chart you post with all the CA;s in such a short period of time like that.  Are you still asleep?  Are you trying to wake up?  What is going on with you during this time?  A few CA's when a person falls asleep or wakes up is usually sleep wake junk.  

One chart shows alternating CA's and OA's.  OA's can be helped by a soft cervical collar and usually more pressure.  But, increasing the pressure can increase CA's also.  I would try a soft cervical collar if you can first.  I am not sure how to adjust your pressures.

[Jay51]

Just one more thought:  If you can't get your pressured dialed in good enough and get good enough therapy on your current machine, a ventilating type machine (one that uses a back up rate or similar algorithm) might work for you.  I say might.  This type of machine's "ventilating" action would stop the CA's from occurring (would force you to breathe instead of having CA's).  It can stop OA's also.  Straight bipap would probably make your CA's worse (it did mine).  If anyone else sees any way to better optimize the Autoset, please chime in.

[vpsdub]

Thank you for posting that.  I have never seen anything like the 1st chart you post with all the CA;s in such a short period of time like that.  Are you still asleep?  Are you trying to wake up?  What is going on with you during this time?  A few CA's when a person falls asleep or wakes up is usually sleep wake junk.  

One chart shows alternating CA's and OA's.  OA's can be helped by a soft cervical collar and usually more pressure.  But, increasing the pressure can increase CA's also.  I would try a soft cervical collar if you can first.  I am not sure how to adjust your pressures.

After 4am my sleep is more like drowsing - series of short naps, so maybe it's sleep wake junk. 
Collar - will try that, does it feel hot in summer?

[Dormeo]

The middle chart does look as though you're having some arousal-type breathing, but the other two don't really look that way. You're simply pausing a long time between breaths. Then on two of the charts, for part of the zoomed-in period you seem to be panting.

I don't know what to conclude from these charts, except that this is very disordered breathing. How often do you have spells like this?

Like Jay 51, I tend to think that if this kind of breathing happens a fair amount for you, you would benefit from using an ASV machine (adaptive servo-ventilation machine). So that is certainly something to discuss with your physicians, along with the day-time symptoms of concern and the option of using O2 at night.

One additional question for you: do you feel your doctors are professional and supportive in treating obese patients? I'm not obese myself, but I have friends who are. Some have great doctors, and others have doctors who don't seem able to see beyond the obesity and also seem to regard it as a personal failing on the part of the patient.

[vpsdub]

The middle chart does look as though you're having some arousal-type breathing, but the other two don't really look that way.  You're simply pausing a long time between breaths.  Then on two of the charts, for part of the zoomed-in period you seem to be panting.

I don't know what to conclude from these charts, except that this is very disordered breathing.  How often do you have spells like this?

Like Jay 51, I tend to think that if this kind of breathing happens a fair amount for you, you would benefit from using an ASV machine (adaptive servo-ventilation machine).  So that is certainly something to discuss with your physicians, along with the day-time symptoms of concern and the option of using O2 at night.

One additional question for you: do you feel your doctors are professional and supportive in treating obese patients?  I'm not obese myself, but I have friends who are.  Some have great doctors, and others have doctors who don't seem able to see beyond the obesity and also seem to regard it as a personal failing on the part of the patient.

CA clusters and disordered breathing usually happens after 4am - at this time my sleep is more like naps with frequent awakenings, so I thought maybe it's sleep wake junk. 
Rapid shallow breathing happens a lot - at night and during daytime. 

Most doctors use obesity as universal convenient explanation for any of my health issues. In a way it's true, obesity has huge negative impact on health, but I do my best to lose weight. The only sympathetic doctor was the one who had extra weight herself.

[Dormeo]

OK, some more reading for you:

https://my.clevelandclinic.org/health/sy...-tachypnea

Try counting your breaths per minute when you start shallow, rapid breathing. Also notice what was happening just before the tachypnea started. These are points of information that could be helpful when you talk to a doctor. I hope that will be soon, and I hope the doctor will be able to see beyond obesity while considering what accounts for your symptoms.

[vpsdub]

Quick update on my appointment with respiratory consultant in April and some questions: 

- supplemental oxygen prescribed for use with CPAP machine, contacted supplier to arrange this
- sleep study and arterial gases tests planned for late June 
- new type of machine (Bilevel or ASV) might be necessary to replace CPAP, depending on results of oxygen therapy
- blood test planned in May to investigate root causes of breath shortness, chest tightness, fatigue, suppressed hematocrit/haemoglobin and low daytime SPO2
- chest and lungs CT scan was done in April - no issues found 
Any views on this plan? 

Another question - going to buy new mask to replace my FFM Airfit F20. As I mentioned in earlier post F20 causes some discomfort - warm and humid feeling of exhaled air which it seems I'm inhaling again. Tried nasal pillows, didn't like those, would probably prefer FFM again, but open to suggestions. 
It seems a mask that does not have a built-in diffuser to its exhaust vents would suit me well. Which mask has no diffuser, just holes as exhaust vents? 

Thanks

[Jay51]

You have put a lot of effort into your treatment and it is paying off.  Well done.  Your plan looks good.  

The best sealing (least leaks) FFM I have found is the F & P Vitera.  

Other experts can post about FFM's that have no diffuser; just holes as exhaust vents.