TechieHippie's story: "mild" apnea but clusters of SpO2 drops

[TechieHippie]

As a recap, I have mostly good nights and then whenever I have exposures to everyday chemicals, things tank; extra thyroid helps but not consistently enough. Last night was one of those (choir practice in a new building). I increased my afternoon dose of thyroid both the good day in the reply above and for this day, for consistency. It helped in that the issues didn't start until later i the night so I got some good sleep first.

   

I don't know why it was missing the section from 1-2; I don't remember anything happening but I think from how I feel, everything was stable. It could have been "Auto stop" which has been erratic (someone on another thread) at altitude. The increased pressure woke me just before 5 (though I didn't know that at the time) and I got up and fed the cats and had some hot tea to clear my throat.  Earlier we talked about wearing a SSC - I wore it for that last section and it didn't seem to help. I thought (perceptually) it was making things worse, but it looks like the "worse" started just before the first wakeup I remember.  I'll keep trying the collar, but I suspect my "positional" issue is tongue related since I'm still retraining it a couple years after major tongue-tie release surgery.

I just have the sense that something hormonal or nutritional is going on but I don't know what. I did look and I'm pretty sure my (cheap) machine can't detect CAs so that's something to keep in mind. Otherwise this machine has been great though for the price point.

Here are two closeups. I notice there was a lot of time where the pressure waveform was erratic.
         

Thanks for all your help and insights.

Lisa

[TechieHippie]

I've made definite progress by using the collar. I had it a little too tight last night and my neck was sore. You can see the big differences after I took it off. I was still sleeping on my side. I tried switching to another mask which didn't help, you can see the results. I've been getting AHI of < .25 earlier, but this is still not an awful night.

[TechieHippie]

I wonder if you all can help me with a puzzle (or how to address it even if we don't know the cause).  I have most nights AHI < 2.  Then, on days that I am stressed and exposed to regular household chemicals/mold, I have poor results, like last night, which was the worst it's been in a while even though yesterday was not an unusual day.  (However, I did forget the nasal rinse the last couple nights; I'll be careful from now on).

My oxygen dropped to < 77 once, just seconds after I had been awake and aware of my mask and body positioning. Subjectively, when this happens, my breathe is a little faster and I can't relax into belly breathing, but airflow seems ok. It's like everything is tight all the way down my abdomen and as soon as I stop paying attention (without even fully falling asleep) it goes haywire - but ONLY on those nights.





I know my clusters are obstructive, but they don't feel positional, they feel like something relaxes internally (I do have a small airway and have only recently been able to fully use my tongue after surgery 2 years ago). I was wearing the collar last night in the exact same sleep position I get the <2 AHI.  I have a thin pillow (though another on order) and my husband took pictures to make sure I was aligned well.  I did put a sheet on the bed that was slightly musty and I'm sensitive to mold but since the air goes through the cpap I thought that would be ok; it might have been "the straw."

I was semi- awake for most of the time after 2:15. Get up, go to the bathroom, get some water, lay down, and boom, as soon as I relax my breathing, bzzzzt. Oxygen drops. Try a few more times, making sure chin isn't tucking, body isn't curled, properly on my side...bzzzt.  Get up, feed the cats, drink tea, back to bed...same thing, the moment I fully relax and let myself head toward sleep.

I think my machine is working and just can't push through whatever closes in my throat?  Sometimes it feels like the machine is not letting me breathe (those oscillations perhaps-- are they normal - I have a cheap machine?) I'm beginning to suspect something similar to intermittent nocturnal asthma but I've never had asthma before. 

Thanks, all.

[TechieHippie]

Another question!! I've been wanting to get a second machine and keep one as backup and for a trip I'm taking this summer (it may pick up hotel room fresheners and I don't want to bring those straight to my bedroom), and I'd like to compare a Resmed to my Resvent and see what difference it makes.

A person near me has an almost new Aircurve Vauto 10 with humidifer for $400 and an Autoset 10 for $250 with 900 hours and maybe no hose. I'm thinking of getting the Aircurve since it's newer.

On another thread, someone said that many CPAP users could benefit from a BiPap, esp with high flow limits, and I figure I can start with the same settings as my APAP and then slowly adjust PS. Is this a reasonable strategy even though I've not been on APAP long at all and don't have any CAs? (It would also give us more data about my Resvent).

Any thoughts?

[BoxcarPete]

900 hours is not that many. I have been 62% compliant since Black Friday 2023, for a variety of reasons, and my machine has 300 hours on it already.

If you want more nerd knobs and geek gadgets, the aircurve is the better machine, but in your charts I don't see a compelling reason to get that one if the extra $150 is going to make a significant difference to your finances. Either will almost certainly be a significant upgrade to the machine you are using now. It's hard to say if the FL tags you are seeing are artifacts of the machine's data logging, real breathing abnormalities, or some combination of both. As an example, your machine flags an FL right in the middle of an apnea in your chart above for some reason.

[TechieHippie]

Thank you, BoxcarPete, for the quick reply. Interesting about that data anomaly. I think a lot of them are real but who knows with this machine.

[TechieHippie]

Hi folks. I'd love your advice on a video consult with my PCP next week. Summary:

- I showed PCP a year of results from my SleepU, showing mild apnea most nights and moderate-severe on others. She suggested sleep test (level 3 Philips NightOne) and said she would manage care based on the results (yeay! I don't trust the sleep center after my son went there) but I postponed it and haven't done it yet. 

- Instead of doing the sleep test right away, I bought an APAP w/o script 12/24 and used every night since. I wanted to see if it helped and if I tolerated the chemicals in the materials (yes and yes). No centrals have been detected. I'm still struggling with high flow limits and erratic nights but it's much improved. AHI 0.14 to <4 usually, with outliers to 12.4 with similar settings and setup.  Mornings are awful still (e.g. when rest of night is excluded, AHI as high as 38. !!)   I suspect I may have intermittent airway resistance/inflammation.  

- My cost for Philips NightOne would be $608 and won't tell me all that much new compared to combination of CPAP and SleepU data.  Philips website says they are discontinued, but sleep center is still using them. Measures body positioning, pressure flow and snoring through cannula, respiratory effort, SpO2, Pleth, and heart rate, some of which we already know through APAP and SleepU.

- AXG has $800 level 2 test with EEG and sleep staging, which I think would be worth the night of oxygen drops so I have a baseline. Measures EEG, EOG, ECG/heart rate, EMG, Airflow, Respiratory effort, SpO2, and body position. It includes manual Sleep Staging of EEG and Respiratory Scoring (Airflow and Respiratory Analysis) by an RPSGT and Interpretation by a Board Certified Sleep Specialist.

My feeling is that I should probably get the level 2 test for a baseline going forward (and sleep on my back part of the night, after a stressful day with chemical exposure, just to make sure it shows my "poor night" issues.) It just feels weird to manipulate the test so I can reliably fail it and get treatment.  But I don't want it to come back < 5 AHI; I want it to show the bad nights, and so I have to create one.

I hope to convince my doc to prescribe a bi-pap, for higher PS and trigger sensitivity. I'd probably purchase out-of-pocket because I have a huge deductible. I've only been on CPAP < 2 months though so I don't know if she will go for that, especially without centrals.

If she won't go with AXG should I do the overpriced Philips one at all? I would estimate that a "bad night" might result in 75% of the night under 94% and 30 min-1 hour < 90%, probably a bunch of drops in the high seventies and low eighties, and likely 1-3 weeks of vertigo...just to add "respiratory effort" and snoring to my stats. Other options are to postpone the sleep test and stay with my APAP longer, or to buy a BiPap without script and manage it myself.

What would you suggest I argue for, and when?  What documentation will be most helpful?  I meet with her in a week over video.

Thanks in advance! I really appreciate the knowledge and focused info here.

Lisa

[BoxcarPete]

For the $200 extra, that's a no brainer if you have any concerns about sleep architecture. The EEG is really the best way to tell sleep stages with proper reliability. I believe AXG will work with you to take any kind of order for a sleep study, though maybe it was only persons with certain occupations where dozing off is considered extra-risky that they'll take a generic letter of medical necessity for the test.