New Bipap - hypoxemia during daytime

[rickyriche]

Wife has been having low blood oxygen during the day at random times.  She has an oxygen concentrator and has it hosed into the bipap for nightly therapy.   She is not on oxygen during the day, as it is mostly good, but sometimes dips down to upper 80's.

Pulmologist test were good
Cardiologist says he things its sleep related - ruled out short circuiting with Echo bubble test.
Was on CPAP and dr upgraded to Bipap 3 weeks ago, and still low blood oxygen at random times
Doctor thinking not releasing all the CO2 from bad sleep.

Downloaded oscar and started looking.   After reading and talking to other seems like first step is for my wife needs to not sleep on her back and try to sleep on her side.   

Also bought her the continuous oximeter from amazon and it is due in this week.  The $200 wellue wrist monitor.

We have an appointment with the sleep doctor on Friday.   I just wanted to get some info and get ideas on what to ask him about her treatment so can can get off of the oxygen treatments.
   

[Sleeprider]

Wow, no wonder! Look at those massive clusters of obstructive apnea! Those apnea are all at least 10 seconds of breathing cessation where her SpO2 would be dropping. Number one priority is to fix her "positional apnea" https://www.apneaboard.com/wiki/index.ph...onal_Apnea She may need something as simple as fewer or thinner pillows, or may need a soft cervical collar to help keep her airway open. https://www.apneaboard.com/wiki/index.ph...cal_Collar You can help by observing her sleep and seeing how she is getting into a chin-tucking position that is obstructing her airway.

She is using a Vauto bilevel at EPAP min 6.0, 12.0 cm max pressure and PS 6.0. These settings result in fixed pressure because EPAP + 6.0 cm PS = 12 cm. Due to the number of obstructive apnea, the maximum pressure should be raised to at least 16.0 to give the machine some room to resolve the obstructive events. We will need to look at a zoomed image of the CA events as they could be obstructive with just enough air movement for the machine to detect air movement or an open airway, but more than 70% flow reduction which is flagged as apnea. There are many recording oximeters that can be worn on the wrist or finger that will track SpO2 and pulse through the night. Here is a list of pulse oximeters that can work with Oscar to show if there is desaturation as she sleeps. https://www.apneaboard.com/wiki/index.ph..._oximeters

It would help to know what the oxygen bleed rate in Liters/Minute that she is getting delivered to her mask. The dilution of oxygen while using CPAP may mean her fraction of inspired oxygen is well below her needs. And again, we have a wiki for that https://www.apneaboard.com/wiki/index.ph..._with_CPAP In my opinion these problems should not be ignored. You can monitor and resolve positional apnea, and the oxygen bleed rate can be increased if needed. You may want to contact the doctor about monitoring at night with a pulse oximeter. The problem here is very obvious and needs to be addressed.

[rickyriche]

Thanks.  she is on 2l/min

Yes, we are getting the wearable pulse oxyimeter

Getting with the Doctor on Friday.   I appreciate the comments.

[Sleeprider]

A 2-L/min bleed rate is minimal and with her pressure and raises FiO2 to about 25% with low leaks. We frequently see users requiring supplemental oxygen using bleed rates of 4 L/min due to this dilution. Please read and discuss the positional apnea wiki. Quick question. Does she sleep reclined or upright in a sitting position?

[rickyriche]

Here is a zoomed CA event

   

[Sleeprider]

A little more zoom than I would like but it looks like CA due to the slow entry. You can change the trigger sensitivity to Very-High, and that will usually significantly reduce CA events.