Should I be considering an oxygen concentrator?

[gainerfull]

Despite using CPAP for nearly 10 years I've started to experience some memory issues which I'm investigating and currently looking to optimize my sleep where possible. I recently ordered a Wellue o2 ring and have been collating the data w/ my cpap to look for any clues. What I've found is that on my worst nights my blood oxygen drops below 90% and I spent over 20 minutes that night during different periods below the 90% threshold. Granted, this was fragmented sleep but an interesting data point nonetheless. I've read several threads here and implemented some recommendations in order to hopefully increase sp02 overnight including:

• Increasing EPR
  
• Solving mask leaks
  
• Mouth Tape
  
• Trying a larger mask / pillow
  
• Breathe Right Strips
  

I'd appreciate any feedback on the screenshots I've attached. The first screenshot is from my worst night and the second one includes the first portion of sleep with a larger mask with thicker pillow and EPR at 2 followed by my normal mask with the same settings. I also lifted my minimum pressure to account for the EPR drop.

I've decided to start working with a new sleep doctor and he was open to ordering a new sleep study considering I've only had one and it was a long time ago. Should I be pursuing an oxygen concentrator? Should I consider using a static pressure to eliminate more CA's? All the sleep docs so far just marvel at my sleep data saying I'm doing great but I think I've found that despite my great AHI score considering how severe my sleep apnea is, I'm still sleeping in hypoxia at least infrequently which is a concern for me.

Even with the higher AHI in the 5's I feel well rested today.

[gainerfull]

Bump, have a new sleep study coming up in the beginning of May - how do I make sure I maximize the opportunity? Does anyone have experience with oxygen desaturation overnight and what it takes to get tested / prescribed?

[Apnea23]

Aren't sleep doctors great?

Your nights look absolutely dreadful in all respects. There's no wonder your o2 levels are all over the place with such a variable flow rate, which may or may not be inducing centrals.

Leaks seem to start pressure rises. Are these mouth leaks due to too much pressure, which then causes the machine to misread the data, increasing pressure and causing variable breathing and CA events?

Who knows.

As like many of us, you have been let down.

To reduce centrals the advice given is always less EPR. But is there a possibility you're primarily getting too much pressure causing all of this and the machine is tasked with the impossible?

Perhaps as you suggest it's worth attempting to titrate yourself on a fixed pressure first with a main view of getting more stable o2 levels, and no centrals to start with.

If there's obstructions, you can increase until you overcome them.

You may have to forget your current settings (they clearly aren't working) and start lower.

I hate giving advice, as I'm only just experimenting myself but it wouldn't take many nights starting on 7cm fixed with no EPR and increasing the pressure by 1cm each night to see if things are looking much better or not.

It wouldn't surprise me one bit if your REM sleep is being totally trashed and disrupted. This would certainly account for your memory/cognitive issues from what I understand and from my own experience.

[staceyburke]

I have been on O2 for at least 25 years.  When I went on it the Dr would not prescribe it until my level was LOWER than 88% for a period of time, not just spikes but several minutes lower. 

That has been a long time ago and I have no idea if this is still what is needed for a Rx.

[Jeff8356]

The general Medicare requirements for supplemental O2 are: <=88% for 5 minutes
Many insurance companies follow the same guidelines.

See this POST

If you can show your Dr that your O2 consistently drops close these levels he/she would likely order an overnight (or multi night) oximetry test. He may also order the test if you have signs/symptoms of Hypoxia or Hypoxemia. Or possibly based on other health issues you may have (COPD, Emphysema, Heart Disease, etc.).

Some people are very sensitive to lower O2 levels (<91%) and may have symptoms before dropping to 88%. It's worth having a conversation with your Dr and bring up your concerns with him/her. Be specific about your symptoms during the discussion.

If you are having a new PSG performed then that will also have your O2 levels and desats listed in the report.

[gainerfull]

Thanks for the help - here's some testing I did last night. Both portions of sleep were set on CPAP with the first section at 11cmH2o w/ EPR set to 1 because I was finding it hard to fall asleep. The second section is 12cmH2o w/ EPR turned off - pretty interesting results. Given the residual hypopneas I'm considering trying 13cmH2o tonight to see if I can solve them. Thoughts? I still had oxygen desaturation periods but nothing below 90% and not as frequent.



upload pic

[Gideon]

Your fixed pressure showed no appreciable difference in CA from EPR=1.

I'd set EPR=2 and see if your CA increases and your flow limits decrease.

[gainerfull]

Your fixed pressure showed no appreciable difference in CA from EPR=1.

I'd set EPR=2 and see if your CA increases and your flow limits decrease.

CA increased but flow limits decreased to best ever numbers. Sp02 data was all over the map last night. Where to next?

Since I'm still seeing hypopneas and obstructive events it makes sense to me to try either a higher pressure like 15 with EPR 2 or same pressure with EPR 1 - thoughts?

[gainerfull]

Here's last night, CPAP @ 15cmH20 and EPR 1.

Flow limits look even better than they did at 13cmH20 and EPR 2.

I've also been working on forcing myself to sleep on my side and I actually dreamed for what seemed like a long time last night which is rare.

Tonight I'm going to try 16cmH20 and EPR 1 unless anyone has more feedback to share. I'm also curious how well I'd do on auto setting with a higher minimum than the 9-13 I was running on my Resmed Airsense 10 Autoset. (Just got a Resmed Airsense 11 Auto).

[Sleeprider]

I don't see a need for higher minimum pressure with only one single OA event. If anything I would try a lower minimum pressure at 13 with auto pressure that has a maximum at 16. There just isn't obstruction here to justify higher pressure.