New and Needing Help...

[ranvanman]

Hello, I am asking for some advice regarding my Wellue O2 ring reports....and sleep apnea.  I really appreciate you taking the time to read this and give it some consideration.

And yes, I have a doctor appointment at the end of February.

It all started last September when I dreamed that I could not breathe and then woke up. I may have have had trouble breathing when I awoke but only for a few seconds. I don't remember this ever happening before this. It happened again in November also in a dream. Three weeks ago, it happened again but this time I began breathing normally in my dream. (Now I wear this ring and keep the alarm on so I don't drop below 85).

My RN wife said maybe I had sleep apnea so I purchased a continuous pulse oximeter. It did not have an alarm so I got the Wellue ring.  I love how comfortable it feels and it also has a vibrator that wakes me up if I drop too low. On the other hand, now when I go to sleep, I worry that it will be buzzing me and waking me up.

The Wellue reports have a rating. If I am above 8, then it is green and allegedly I don't need to see my doctor.  The rating is based on the total number of drops and how low the O2 goes and also motion, I think. 

So far I have used the ring for seven nights.

Four reports were 9 or above. Two were 8.6 and 8.4. One was 7.9 with the most drops which was about 10 drops per hour adding the 4% and 3% drops.  Most were much better and were in the 6 to 7 drops per hour.

I am attaching my most recent report which is similar to most of them. As you can see, my SpO2 drops below 90% during the night. It reached 85 but my alarm never buzzed me. (If it did, then there would be a triangle at the bottom).  On a couple of other reports, my alarm did go off one or two times. 

Questions...

Looking at this report, should I see a doctor? (As I said I am anyhow...just wondering what you think he might say). 

From your experienced albeit understandably not from a professional medical opinion, does it look like I may have sleep apnea? (As I stated, I will be getting a professional opinion too. I simply want some idea of what others think).

Can oxygen levels fluctuate for other reasons besides SA and lung diseases...ie anxiety, stress, movement, etc. ?

Here are my symptoms or lack of symptoms...

I never have headaches, and when I say never, I literally mean that I do not remember the last time I had one going back years. I have allergies and even with them, I do not get sinus headaches.

According to my wife I do not snore much and if so, it is quiet. I am a side sleeper most of the time. I never find myself waking up gasping for air or choking (except the above mentioned times). 

I do not get up during the night usually. I did on this report and since I have been using the oximeter I have been getting up once a night once in awhile, but I really think it is from the anxiety of wondering what my report will show in the morning.(Yes, I worry about it).

I do not find myself extra tired during the day after having more O2 drops.  

I do not smoke or drink. 

I do not have high blood pressure.
 
I have a BMI of 26 (ten to twelve pounds overweight). However, I am a male who just reached 60, and while I do lift weights a few times a week, I do not do cardio. Right now my job is a sit down job. In a few weeks, then I will do alot of walking. 

I do wake up occasionally with a dry mouth, and perhaps no coincidence, it happens more on the nights with those lower scores and more drops. 

Like I said, I do have allergies and do have post nasal drip during the night sometimes.

I would appreciate any help or advice you could give. 

Also, if you could calm me down about the severity of this. I have concerns and fears because my father (and his brother and his mother and his grandfather) died from dementia. Looking back, I remember him sleeping while breathing through his mouth at the "nursing home." And my brother (who is obese) has AFib. So, you may understand my concerns.

Again, any advice or help? Thanks for reading this and letting me know your thoughts!

[TechieHippie]

The score also takes hours into account. I don't put much faith in the score.

I don't see an attachment. Make sure you didn't just select the file but also click "add attachment."

In addition to the graphs, I would like to know: average O2, time under 90, time under 94, drops below 3 percent and drops below 4 percent.

[cdplatt]

With the Wellue ring you should not add the 3% and 4% drops together.  Any drop of 3% (or greater) is also counting the 4% drops.  By adding them together you're counting the 4% drops twice. 

The reason the Wellue app shows both is because Medicare uses a 4% threshold to qualify an O2 drop as a desaturation event.  The National Sleep Foundation recommends counting an O2 drop of 3% or greater as a desaturation event.

Your Oxygen Desaturation Index (ODI) is the average number of drops per hour.  That is the number you should be most concerned about.  I agree that the "score" is somewhat meaningless and not very useful.  My Wellue ring consistently keeps me within the green range, but I have still been diagnosed with mild apnea on sleep tests.  I use a CPAP (most of the time) and I sleep more comfortably with it.

There is good correlation between ODI and AHI since any apnea or hypopnea event is likely to be accompanied by a drop in O2 saturation.  If night after night you're getting 3% or 4% scores above 5, that would suggest that you may have at least mild apnea.  There is much professional discussion on whether mild apnea needs to be treated and what treatments might be appropriate.  If you have symptoms of poor sleep (you don't appear to) accompanying ODI numbers of 5 or greater, then a sleep study is certainly warranted.

There are several tests that subjectively assess your sleepiness.  The Epworth Sleepiness Scale is the most common one.  You can find it online and assess your sleepiness.  If you have a sleepiness score above 10 accompanied with and ODI of 5 or greater you might want to pursue a sleep study.  If you have normal sleepiness and your ODI average is low apnea may not be the issue.  In any event, if you're concerned about your night time gasping it doesn't hurt to bring it up with competent medical authority.

You may also want to download and use the OSCAR program. You can import data from your Wellue ring into the OSCAR program. I find that it scores more ODI events than the Wellue app does. They're apparently calculating slightly different baselines from which to measure drops. I trust the OSCAR calculations.

[ranvanman]

The score also takes hours into account. I don't put much faith in the score.

I don't see an attachment. Make sure you didn't just select the file but also click "add attachment."

In addition to the graphs, I would like to know: average O2, time under 90, time under 94, drops below 3 percent and drops below 4 percent.

My attachment was not the right kind. It was a PDF.

Last night's was better. It is the best it has been yet.  I adjusted my pillow so that my neck was as straight as possible. I sleep on my side almost all night long. I read that if your neck is not straight then, you can have more sleep apneas. 

For last night...

The average O2 was 93 with the high being 98 and the low being 86.
The time under 90 was 4 min 16 seconds. (Previously this was about 15 to 20 minutes at worse.
The time between 90 and 94 was 6 hours.
The time above 94 was 49 min 25 seconds.
The total drops for 4% were 7. The drops per hour was 1.01.
The total drops for 3 were 25. The drops per hour was 3.62.

Thanks for your help!

[ranvanman]

With the Wellue ring you should not add the 3% and 4% drops together.  Any drop of 3% (or greater) is also counting the 4% drops.  By adding them together you're counting the 4% drops twice. 


Your Oxygen Desaturation Index (ODI) is the average number of drops per hour.  That is the number you should be most concerned about.  I agree that the "score" is somewhat meaningless and not very useful.  My Wellue ring consistently keeps me within the green range, but I have still been diagnosed with mild apnea on sleep tests.  I use a CPAP (most of the time) and I sleep more comfortably with it.

There is good correlation between ODI and AHI since any apnea or hypopnea event is likely to be accompanied by a drop in O2 saturation.  If night after night you're getting 3% or 4% scores above 5, that would suggest that you may have at least mild apnea.  There is much professional discussion on whether mild apnea needs to be treated and what treatments might be appropriate.  If you have symptoms of poor sleep (you don't appear to) accompanying ODI numbers of 5 or greater, then a sleep study is certainly warranted.

There are several tests that subjectively assess your sleepiness.  The Epworth Sleepiness Scale is the most common one.  You can find it online and assess your sleepiness.  If you have a sleepiness score above 10 accompanied with and ODI of 5 or greater you might want to pursue a sleep study.  If you have normal sleepiness and your ODI average is low apnea may not be the issue.  In any event, if you're concerned about your night time gasping it doesn't hurt to bring it up with competent medical authority.

You may also want to download and use the OSCAR program.  You can import data from your Wellue ring into the OSCAR program.  I find that it scores more ODI events than the Wellue app does.  They're apparently calculating slightly different baselines from which to measure drops.  I trust the OSCAR calculations.

Thank you for all of your information! It is really appreciated.

If I take just the over 3% total per hour, then my ODIs per hour has been usually at a high of 7 or 8 and usually 5 to 6 on the Wellue O2 ring. Last night was the best yet and was 3.62 per hour. The low O2 every night is usually 86. Sometimes it nits 85 and my buzzer goes off. The 86 doesn't happen very much. Usually my O2 ranges between 90 to 94. Last night six hours of my night was in this range. Only about 50 minutes was 95 or above. My total sleep time was around 7 hours.

I will look up the OSCAR and Sleepiness scale. I have an EMay wrist monitor too, and it had more events if I remember correctly. It was clumsier than the ring though so I switched to the ring.

I am going to keep using my ring and see what my reports look like when i finally see the doctor at the end of the month. I will definitely talk to him and get his opinion.

Again, thanks!

[TechieHippie]

I think there is definite room for improvement with all of that time under 94 and an average of 94 or under. If you haven't, see if you can sleep on your side and wear a soft collar to help with any positional issues. I would want to see average 95-96 consistently if you can, with <1/4-1/3 of the time 94 and under, with very little time under 90.

Also, are you using the buzzing alarm? If so you might do a few nights without it and maybe with the display taped over close to your doctor's appointment. Taping the display is to tell your brain to not look at it or worry about it.

[ranvanman]

I think there is definite room for improvement with all of that time under 94 and an average of 94 or under. If you haven't, see if you can sleep on your side and wear a soft collar to help with any positional issues.  I would want to see average 95-96 consistently if you can, with <1/4-1/3 of the time  94 and under, with very little time under 90.

Also, are you using the buzzing alarm? If so you might do a few nights without it and maybe with the display taped over close to your doctor's appointment. Taping the display is to tell your brain to not look at it or worry about it.

Thank you for your advice and help.

My usual sleeping position has always been my side. However, I do wake up and find myself on my back once in awhile. When I do, I often have a dry mouth. I sleep on the couch as my wife is a poor sleeper due to chronic pain. (Ironically she passed a sleeping test with flying colors!) Because I sleep on the couch, my back is always supported by the back of the couch, and I place a pillow in front of me for support. There is not much room to sleep on my back unless I start that way.

I have never tried a soft collar but due to your suggestion, I have been doing some research here and elsewhere. I ordered a few and will try them.  Last night I used a towel under my chin, and it seemed to help my numbers on my O2 graph, but I woke up a few times with it moved so it is not a good test yet. I am hoping that this may solve much of my problems as "chin tucking" or sleeping with my chin down seems to be my position often.

Yes, I use the alarm on my ring. I like the security of  knowing that I will not drop too low. I have set the number for the alarm at 85 so it usually never goes off more than once if at all in a night. During the night I rarely check the O2 while I sleep. Being that the ring has the time on it, I do look at it to check the time though so I see the numbers, but I figure if my alarm is not going off, then I am good. However, I do look forward to seeing my chart in the morning. If I turned off the alarm and covered the display, I know me....I will worry MORE than if I had the alarm set and the display uncovered.

So my question is...do you think that I will see improvement with just a soft collar? And are there people who use only a collar and find that the apnea disappears or almost disappears?

Again, thanks for your help!

[TechieHippie]

I don't know the answer about the collar, but this is kind of a one step at a time process anyway. I look forward to seeing what you learn.

I think I was pretty near where you are a year ago. Most days I was under 5 ODI. I thought I could just manage my sleep issues by laying on my side and monitoring my oxygen, taking supplements, etc. Finally, I concluded it helped but just wasn't enough, I was getting run down.

You might not know how affected you are until you actually treat it. There is a lot of space between 0 and 5 events per hour, room for improvement. The cost of treating it will be saved in health care costs later on.

Have you read the page about the stages of getting treatment for sleep apnea? It's a great guide.

[ranvanman]

I don't know the answer about the collar, but this is kind of a one step at a time process anyway. I look forward to seeing what you learn.

I think I was pretty near where you are a year ago. Most days I was under 5 ODI. I thought I could just manage my sleep issues by laying on my side and monitoring my oxygen, taking supplements, etc. Finally, I concluded it helped but just wasn't enough, I was getting run down.

You might not know how affected you are until you actually treat it. There is a lot of space between 0 and 5 events per hour, room for improvement. The cost of treating it will be saved in health care costs later on.

Have you read the page about the stages of getting treatment for sleep apnea?  It's a great guide.

I have now done two nights with a towel under my neck which held my chin up and one night with the Caldera collar. The results indicate (to me at least) that my chin tucks down and may be the main (if not only) reason for the sleep apnea.

First, I do tend to sway between being a hypochondriac to an optimist. I always start my research assuming the best and most simple or most common reason as the cause of a problem. And yet inside, I admit that I fear that it is the worst. So I first try to solve it with simple means first. Usually the simple reason is the one. 

I have not read all of the sleep apnea guide yet. I did read a post on using collars. That helped.

After using no towel or collar and then using a towel for two nights and a collar (so far) for one night, here is what I have found so far.

On Monday night (which is the last night I did not use any means for my chin), the total 3% ODI drops for the night were 38. I spent a total 9 minutes under 90%. The lows reached 82 even with my alarm going off at 85%.  This night is like most of my nights before using anything for my neck. Some have more drops and more time spent under 90%, but most were around 35 to 40 drops total.

On Tuesday night, I used a towel and tucked it under my chin and around my neck "forcing" my chin to stay up while I slept on my side (which is normal for me). This makeshift collar was due to your post and until a real one arrived. The results were as follows: The total of 3% ODI drops were 12 or 1.77 per hour. I spent only 2 minutes under 90% with the lowest being 88%. 

Wednesday night was almost identical to Tuesday night. I suspect that during both nights the towel shifted out from under my chin. I remember waking up a number of times and automatically pushing it under my chin again.

Last night I used my Caldera collar for the first time. Most of the time I slept on my side, but I did wake up on my back a couple of times. The results were as follows: The total of 3% ODI drops were 9 with the lowest being 88%. I spent twenty seconds under 90% at 88%. My average O2 was 94%. 

Going from a total of 35 to 40 drops in a night to only 9 for the whole night is significant. Going from 9 minutes to 20 seconds under 90% is a good improvement.

I will keep using this collar to see if this continues. I do have some other collars arriving from Amazon, so maybe I will switch to one of them, but my guess is that since this one felt comfortable, it will be my main one.

Anyhow, just an update so far. I appreciate that you mentioned using a collar. I really think it will be a big help. And while I hesitate that it is the solution to my ODI drops, time may show it to be just that...or so I hope.

[TechieHippie]

I'm glad it helped. Yes, do keep us updated on what happens. I always wonder how much the initial treatment using anything will help just by making us more conscious. Not that that's a bad thing, if we can train our bodies to sleep in ways that work better.

Another thing I think about is that sleep apnea probably doesn't just appear out of nowhere, it probably starts a lot earlier than we know and just takes a lot of life to make it to the point it needs treating. So by catching this now, you might slow the progression so to speak, and postpone needing a CPAP, Even if you still eventually do need one. There are two books that I would recommend, Breath by James Nestor and Sleep, Interrupted.