OSCAR Data vs Lookee O2 Ring

[cmpman1974]

I'm glad you're determined to come away from tomorrow's appointment with a plan for the next steps.  You probably don't need any of this, but just in case, here are some pointers for a productive appointment with a doctor:

Write down your observations and questions ahead of time.

Consider typing them up, printing them, and giving them to the doctor.  Remember, the time with the doctor will be limited, and you want to use it productively.  

If you have additional written materials, bring copies with you to give to the doctor.  For you, that would include representative O2 data from your current oximeter.

Bring a family member or friend with you, to be a second pair of ears and a note-taker.  This person can also remind you during the appointment if any of your observations/questions haven't yet been acknowledged/answered.

Find ways to express your respect for the doctor's specialized experience and knowledge while at the same time being ready to ask informed questions and request help beyond what is being offered.

I have all this ready to go already. : No family members understands this stuff like I do so my wife won't be of any help there unfortunately.   I don't think my spouse fully understands how important getting this stuff figured out truly is.  She doesn't have any sleep issues or fatigue.  I will do my best to be my best advocate as always.

[cmpman1974]

Sadly I deal with Doctor issues far too often than I should ever have to.  Too many arent staying current, and just go by the book.  One time was so bad I came that close to filing a Board Complaint of what he did with someone.

In the end, I always urge that YOU are your best health advocate, no one else.  If a Dr isnt doing it, find another.  I think you will far ahead with another from the minimal data I see.

BTW< I require supplemental O2.  I treated my hypopneas with increasing O2, but once I started seeing bradycardia, that was the shot across the bow to get going on CPAP.

Ironically, I just saw my cardiologist a couple weeks ago for - yep you guessed it - brachycardia.  Daytime pulse rates hitting high 40s and believe me I am in absolutely no physical shape to ever be reaching a pulse rate that low. He cut back on my beta blocker.  So far still seeing pretty low heart rates at times during the day.  Night pulse rates drop to high 30s at times.   This is all with BPAP treatment for 15+ years.  Not sure what to make of it all.

[jeffpack1957]

What is your o2 doing?  I'll bet you are having hypopnea events

[cmpman1974]

What is your o2 doing?  I'll bet you are having hypopnea events

I switched back to my ResMed Air Curve 10 ST-A machine last night.   Here are the results including a summary of distribution of O2 levels every 4 seconds based on Lookee O2 ring monitor. AHI of 0.4...still feel groggy, yawning endlessly, head fuzzy, etc.

Oxygen level numbers are simply a count of all times that my figure was in the range (90, 86, 95, etc.). The Lookee monitors captures O2 levels and pulse every 4 seconds.

[Jay51]

Jeff, you stated that, "BTW< I require supplemental O2.  I treated my hypopneas with increasing O2, but once I started seeing bradycardia, that was the shot across the bow to get going on CPAP."

Do you mind explaining why this happened for cmpman?  The exact mechanism that is occurring?  

Would the higher spo2 from the O2 cause more central apneas (which in turn would slow the heart rate down?)  I am sorry that I do not understand this, but it could be something important for cmpman when he sees his Dr.'s, etc. 

[jeffpack1957]

I switched back to my ResMed Air Curve 10 ST-A machine last night.   Here are the results including a summary of distribution of O2 levels every 4 seconds based on Lookee O2 ring monitor. AHI of 0.4...still feel groggy, yawning endlessly, head fuzzy, etc.

Oxygen level numbers are simply a count of all times that my figure was in the range (90, 86, 95, etc.).  The Lookee monitors captures O2 levels and pulse every 4 seconds.

you spent 6m under 90% which is substantial, and low point of 84.  So either your pressures are not correct and you are getting hypopneas, or you need supplemental O2. My expertise isnt in this area to determine which is needed.  Others can analyze Oscar data.  But you really need times of the hypoxic events, to match into Oscar data and see if they coincide.  In my case I only look at the following

1> O2 levels above 90% and only want above 90%. 
2> Time spent under 90% (the smaller the better)
3> Actual O2 events (when, clusters etc)
4> I also look at HR to make sure it remains stable.

Thats the problem with CPAP and not tracking O2 and HR. Trust but verify.

Example, last nights O2 data.

Time under 90% was under 1m.
I had a cluster of lower o2 events, culminating to 1 mild hyopnea to 88%
HR confirms the cluster with smaller spikes. One mild bradycardia  cluster though that didnt correspond with  any O2 events.
AHI was .3

so everything matches up.

Now with that said, I'm pulmonary compromised with lung damage from Covid Pneumonia and am on supplemental O2 overnight, and only during heavier exertion during the day

[jeffpack1957]

Jeff, you stated that, "BTW< I require supplemental O2.  I treated my hypopneas with increasing O2, but once I started seeing bradycardia, that was the shot across the bow to get going on CPAP."

Do you mind explaining why this happened for cmpman?  The exact mechanism that is occurring?  

Would the higher spo2 from the O2 cause more central apneas (which in turn would slow the heart rate down?)  I am sorry that I do not understand this, but it could be something important for cmpman when he sees his Dr.'s, etc. 

Raising my O2 levels just meant the untreated apnea events that were actually hypoxic were less often, and less severe.  Dropping from 95>90 isnt as bad as 93-88.

Too many people just go by events reported by a machine with not verify  O2 oximetry.  You may only get a few events, but they may be severe and for how long?  Thats where OSCAR data becomes more valueable, but I dont have the time to download off of SD card, and match everything.  So I just take a more simplistic approach as I posted above.  If my O2 levels are good, HR is good, AHI is low, thats all I need to know.  And I can do all of that in less than a minute with the app on my phone after it downloads my overnight info from my Wellue O2 monitor

 In my case I know how to manage O2 and what to look for.  in cmpmans case  its still unclear if Supplemental O2 is required, or just needs to adjust pressures.  I dont have enough data, but what I do know is he's getting hypoxic events that need to be treated.  

Does this answer your question?

[Jay51]

Yes.  Thank you Jeff.  Much appreciation for explaining that.

[cmpman1974]

I had my appt today.  I'm not sure what to think.  I guess it's early to say, but I am a bit perplexed why the sleep doc wants to do a new titration test when I had one five months ago approximately.  Also,  I have been on BPAP for 15 YEARS and they said they need to do 1/2 the sleep test with me not on a machine to show I have sleep apnea.  I absolutely guarantee anyone I have it. lol.  I am the picture person for the illness.  It makes me a bit disappointed to think 1/2 my time will be wasted proving a guarantee instead of nailing down more important stuff.

The doc didn't seem impressed by any Lookee O2 data, but did say it's important to be at 90% O2 saturation or greater.  At the same time, the doc made a comment saying no need to 'track' O2 nightly as that's going too far.  I was told a capnometry is not possible to do while using a BPAP machine and again not real necessary. They said the only real option is an Arterial Blood Gas test in the morning to assess CO2 / O2 post-sleep levels. I was told they could order an overnight O2 test, but it's rare and most likely not needed. It seemed they viewed the Lookee and other similar devices as unreliable at best, especially when on sleep apnea treatment.

The practice said many times sleep apnea causes irreversable damage and some patients just never get back to a pre-apnea level of energy.  They said some  people fully recover, others only 50% recovery in energy and others no improvement due to permanent brain damage from the O2 loss during all the years.

They wanted to start off the titration on regular CPAP.  I said no way on Earth.  I know that's a failure up front.  Been there, done that.  They said always better to keep treatment simple than less variables to dial in. 

They agreed large leaks were bad, but also said really a DME is the one to address that.  Not sure I agree with that.  I'm glad I'm getting that under control more on my own using the chinstrap.  Most DMEs don't care that much in my experience.  I get the impression patients doing their own data mining with their treatment is not really cared about too much.  If the whole point of treatment is to stop/minimize O2 desaturations / events, why is this not a focal point when evaluating one's treatment?  I truly don't grasp that concept. 

In the end, I don't know they are convinced the ST-A and IVAPS are the needed treatment.  I'm not sure I am either, but I am sure a 16/8 BPAP pressure isn't right either based on the number of OSAs.  It feels like groundhog day sometimes.  Same path over and over again with no concrete way of knowing treatment is working.  Toss in the caveat people can be permanently damaged and it really makes progress hard to assess. At some point, the increased BPAP pressures get to be too much. One suggestion from my previous doc was 24/14 (IPAP/EPAP). That's a lot to handle.

I also found a way to monitor my sleep via a video feed using a Wyze camera. It worked out well and I could see just how much I toss and turn and my positional habits. It definitely puts more perspective as to what happens during a night of sleep. Those cameras are a great tool for a very reasonable cost. I'm pretty impressed.

[jeffpack1957]

I was going to wait to comment when you got back.  I'm not impressed with the result.  Your over night sats were well below normal.  And thats important.  For most of that data collection period you spent it between 93 and 88, with 6m under 90. You dont even want to be at 88% for longer than a minute as it stresses heart and lungs. Overnight O2 is very important to collect along with CPAP data.  Thats why its collected in a sleep study.  In this case, It also confirms if your treatment is working and its not.

More could be analyzed if you gave me the raw data so I could graph it.  The data you provided is very limited to just O2 ranges you were overnight, not how it overall looks, clusters etc.Also give me your AHI for that data range.

I dont have extensive experience with CPAP treatment and sleep machine data like others here do, and whether CPAP titration would solve your lousy O2 sats.  I do know O2 very well, and those numbers are lousy.  With healthy lungs, you should be at least 95% overnight, at least that, and you werent above 93% much at all.  If I had numbers like that, I'd be upping my own O2 levels, but then I did just that going from 2L > 4L to make those hypopneas not so bad.  Note I'm not suggesting that, just giving what I did, and why.  Prior to the apneas showing up, I used 2L overnight and maintained a rock steady 95% in O2 oximetry.  Again noting I have fibrosis from covid pneumonia, but the scarring is reversing from CHinese herbals.

I'd be curious to hear from the sleep experts here whether titration would solve this.  Personally, I'm dubious, but then I've havent seen it graphed yet either.  Thats the decision maker from me.

Best of everything to you.  I hope it gets solved because those arent good numbers and most likely why you feel like crap in the morning.

Also note I have damaged lungs, am running 10/4 BiPAP and my numbers are way better than yours.
BTW 2L is considered a therapeutic dosage. Just say'in.,