Stopping CPAP with low O2 high CO2

[marxxx]

Hello all,

I am relatively new here and having a problem - hoping all the experts can help out a bit.

Long story short, I have several issues contributing to on going fatigue and lack of quality sleep. I was diagnosed with mild sleep apnea (exacerbated to severe in REM sleep) last year, AHI was 10.6 in non rem sleep, 41.7 in rem sleep.

The big area of concern to me is the respiratory data -
The mean oxygen saturation during the study was 92.0%, with a minimum oxygen saturation of 73.0%. The patient spent 5.7% of sleep time with an oxygen saturation below 90%. The maximum end-tidal CO2 was 59 mmHg and the minimum EtCO2 was 30 mmHg. The patient spent 72.3% of
sleep time with an EtCO2 above 45 mmHg and 23.0% above 50 mmHg.

To expand on this my study was 344 minutes of sleep
I was at 45-49mmHg EtCO2 for 170 minutes
50-54 for 74.5 minutes
55-59 for 5 minutes.

As for the O2, (again 344 minutes total)
at 91-100% for 296.7 minutes
81-90 for 22.7 minutes (19 of these minutes occurred in REM sleep)
71-80 for 1.05 minutes.

I went to a new sleep dr this week seeking advice for leaks, arousal throughout the night, and waking up between 3 & 4 am. He wants me to discontinue the use of the cpap and see how I feel. He says I am a mild case and the CPAP is likely irritating me (and waking me up) more than it is doing good.
I questioned him on the data that I posted above and he feels the oximetry numbers are transient and don't really show anything to be concerned about. I did get them to agree to order an oximetry test in home (yes I know I can buy a meter, but not sure EXACTLY sure how to interpret the data or convince them of treatment based on that). Before doing the oximetry test he wants me to go a few days without the cpap to see how I feel - then get the test.

I'm sure he knows what he is talking about, my concern is that doctors can be in such a hurry they miss info or misinterpret info.

What does everyone think? Should I be concerned with the respiratory data from my study? Should I stop using the CPAP as suggested?
I have had one other overnight oximetry test and also showed me desat to 75% for about 17 seconds. 80-88% for 3 min 5 seconds and the rest above 88%

Thanks in advance for all the advice!

[justMongo]

Way over my head there.

[TheManseHen]

Hey Mark,
Also over my head, hang in there, someone will have good advice surely on the board.

One question, How long have you been using your c-pap? Days, and avg hours per day?

The Manse Hen.

[OpalRose]

Hello all,

I am relatively new here and having a problem - hoping all the experts can help out a bit.

Long story short, I have several issues contributing to on going fatigue and lack of quality sleep. I was diagnosed with mild sleep apnea (exacerbated to severe in REM sleep) last year, AHI was 10.6 in non rem sleep, 41.7 in rem sleep.

The big area of concern to me is the respiratory data -
The mean oxygen saturation during the study was 92.0%, with a minimum oxygen saturation of 73.0%. The patient spent 5.7% of sleep time with an oxygen saturation below 90%. The maximum end-tidal CO2 was 59 mmHg and the minimum EtCO2 was 30 mmHg. The patient spent 72.3% of
sleep time with an EtCO2 above 45 mmHg and 23.0% above 50 mmHg.

To expand on this my study was 344 minutes of sleep
I was at 45-49mmHg EtCO2 for 170 minutes
50-54 for 74.5 minutes
55-59 for 5 minutes.

As for the O2, (again 344 minutes total)
at 91-100% for 296.7 minutes
81-90 for 22.7 minutes (19 of these minutes occurred in REM sleep)
71-80 for 1.05 minutes.

I went to a new sleep dr this week seeking advice for leaks, arousal throughout the night, and waking up between 3 & 4 am. He wants me to discontinue the use of the cpap and see how I feel. He says I am a mild case and the CPAP is likely irritating me (and waking me up) more than it is doing good.
I questioned him on the data that I posted above and he feels the oximetry numbers are transient and don't really show anything to be concerned about. I did get them to agree to order an oximetry test in home (yes I know I can buy a meter, but not sure EXACTLY sure how to interpret the data or convince them of treatment based on that). Before doing the oximetry test he wants me to go a few days without the cpap to see how I feel - then get the test.

I'm sure he knows what he is talking about, my concern is that doctors can be in such a hurry they miss info or misinterpret info.

What does everyone think? Should I be concerned with the respiratory data from my study? Should I stop using the CPAP as suggested?
I have had one other overnight oximetry test and also showed me desat to 75% for about 17 seconds. 80-88% for 3 min 5 seconds and the rest above 88%

Thanks in advance for all the advice!

Hi marxxx,
I am very new to this also, but one thing I don't understand is your dr saying you have a mild case. In my sleep study, I was diagnosed with severe apnea with an AHI of 38 per hour. My oxygen level dropped to 69%.
Have you been to a Pulmonogist? He should be running lung function tests.
I see you are using an auto CPAP. What pressure were you titrated at?
Your pressure may be too high that you are waking up that much while on therapy.
I personally wouldn't stop CPAP use until your doctor looks at all your oximetry results.
There are a lot of very knowledgable people here who I'm sure will have answers for you.
Best of luck
,

[marxxx]

I have been using the cpap for about year. All night every night. I try to get 8+ hours of sleep, but often wake up around 3-4 am.
I had a single night in clinic study without cpap treatment. The Dr ordered the cpap at 4-20 auto and didn't feel I needed another study. After several months and some issues with this setting, I did some research and narrowed the range to try and avoid having the apneas (since the cpap can't actually open them, the positive pressure just helps the throat from closing). I have reverted back to 4-20 recently to see if that would help.... not so much.
I got good results with each of the changes for a while, then slid back to not sleeping as well. I also got good results changing masks - for a few weeks. It just seems that after a while my ahi climbs back up and I start waking more. At one point I was sleeping through the night!

The new dr said I have a mild case as my overall AHI is 10.6 per hour. In REM sleep it is 41.7 (I was only in rem for 22.7 minutes).
I have not been to a pulmonologist as I am not aware of any breathing issues aside from sleep apnea. \

[TheManseHen]

Do you use the EPR on your machine, (if it has it)? Not sure it would help but just wondering.

[OpalRose]

Marxxx,
Its probably is not a good idea to leave your range open at 4 to 20. Whether you use a perscribed range, set range, or use 4 to 20, you should be able to look at your results on Sleepyhead. Check to see what your pressure goes up to when you have apneas. This should give you a good picture of where you should set your pressure range. Your doc should be looking at these numbers and advising you, although I know firsthand, like you said, they are busy and dont look at everything.

[marxxx]

I have tried EPR on and off, doesn't seem to have much of an effect.

Opal - I tried adjusting my range up. Seems like 12-14 is the highest it usually got. I tried it a couple different levels but settled on 11-17. It seemed to be working for a few weeks then the leaks started waking me up and what not. The most frustrating is waking up between 3 & 4 because I can't always go back to sleep. I was hoping they would give me something to help me sleep, instead he wants to take me off cpap. I almost fell out of my chair I was so shocked

[quiescence at last]

you have visited us from time to time, and say you have sleepyhead. pictures are so much better to explain your progress, changes you've made, and the kinds of things you encounter.

and yet, you have not shared this with us, and I wonder why.

I asked for some info by PM and got no response.

you really have left us in the dark. isn't there any way you will share this with us. it sure seems like a lot of caring folks are just waiting to help.

personally, I would like to see the following:

one whole night all in a single plot, on a night where you have moderately interesting action, or you felt most disturbed. or just any night if it is too hard to decide.

Myself, I am particularly interested in these things being shown:
1. flow (y axis at -60 to +60 if possible)
2. pressure
3. respiration (y axis at 0 to +25 if possible)
4. tidal volume (y axis at +200 to +800 if possible)

like this:



Others may also want an overview like this:



Here to serve you -
QAL

[marxxx]

QAL,
I apologize for missing your pm. I just didn't notice it sitting there. I did reply this evening.

Here are a couple sleepyhead shots





Thanks in advance!

---

I often have low AHI. I seem to have felt my best when getting down around 1 or. Much over 2 and I don't feel nearly as well.
My main complaint lately has been waking up with air blowing in my eyes and waking too early (between 3 & 4). I usually try to go back to sleep (and keep the mask on). Even if I do it's rarely restful.