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+--- Thread: Low SPO2 despite CPAP use (/Thread-Low-SPO2-despite-CPAP-use)
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Low SPO2 despite CPAP use - leifurh - 07-22-2024
I use a ResMed Airsense 10 with my pressures set to 16 and 14 (EPAP). Before I started using CPAP I would have episodes every night where my SPO2 (as measured by one of the wrist oximeters connected to a sensor ring) would drop below 80%, frequently going below 75%.
My problem is that DESPITE using the Airsense 10 full time (every night/all night) I am still seeing drops every single night - albeit rarely to values below 80% I often see these in two "surges", one early (around midnight), one late (around 5 in the morning). Being a side sleeper who rarely snores (according to OSCAR) I don't know what to do. According to OSCAR logs, the machine doesn't even detect these SPO2 drops ...
I would attached an OSCAR log if I knew how - but here is an image showing both some of the OSCAR data and the imported fields from the oximeter.
[attachment=67295]
RE: Low SPO2 despite CPAP use - Narcil - 07-22-2024
can you post a "normal" oscar screenshot too please? we need to see the settings and the flow limit graphs. instructions here
you mean it's set to APAP at 4-16 EPR 2?
it looks like you need to raise the minimum pressure quite a bit. i would start at 7 or 8 and try EPR 3 hopefully it helps deal with the remaining hypopneas. the SpO2 drops correlate pretty well with the hypopneas event so fewer events should help your oxygen levels.
RE: Low SPO2 despite CPAP use - Nightynite - 07-22-2024
Apap/Cpap stents your airway. You may be wise to seek out a pulmonologist and get to the bottom of this.
RE: Low SPO2 despite CPAP use - leifurh - 07-22-2024
So - here's the "standard" screenshot as requested. My machine spends most of its time at 16 as shown in the screenshot. the EPAP is then 14. It does have a 20-minute ramp up period, stating at 6 but goes up to 14-16 pretty quickly.
[attachment=67299]
RE: Low SPO2 despite CPAP use - Narcil - 07-22-2024
that's quite significant flow limits. i think it's "interesting" how FLs seem to increase significantly as soon as the machine starts increasing pressure but i'm not too sure how to explain it. do you sleep exclusively on your back maybe?
i would try epr 3 and min pressure 8, as you said the machine rapidly increase pressure anyways.
are you sure the ramp is still on? Oscar says it's off but it's possible it is incorrect.
RE: Low SPO2 despite CPAP use - leifurh - 07-22-2024
Part of the reason why I posted was my nagging suspicion that maybe CPAP wasn't the right way to address this issue. Still, comparing my SPO2 from 2 months ago with the situation now seems to indicate SOME improvement, only not a complete cure.
[attachment=67300]
[attachment=67301]
RE: Low SPO2 despite CPAP use - Narcil - 07-22-2024
i think it is much better and if you can optimize the settings to reduce the remaining hypopneas as much as possible it would improve more. but if in doubt ask a pulmonologist as nightly said. ideally i believe it should stay above 90%.
RE: Low SPO2 despite CPAP use - leifurh - 07-22-2024
Like many here I have no idea how to interpret OSCAR data - I guess I need to at least find out what "flow limit" means (that's what you mean by "FL" right?). As for "ramp", all I know is that before falling asleep I hardly feel any pressure. I thought that was "ramp" in action.
As for sleeping positions, I never sleep on my back, I alternate between the two sides.
Regards,
Leifur
RE: Low SPO2 despite CPAP use - UnicornRider - 07-22-2024
Leifurh, Did you happen to have a respiratory illness this last winter/spring? There are some respiratory illness that results in loss/reduction of respiratory drive that can last from a few months up to a year.
From your left hand panel Statistics area, your Median Pressure is 13.52cm H2O, you also bump up against the Pressure Maximum of 16 cmH2O. As indicated by your 99.5% as well as your Pressure Graph. EPR is utilized to reduce the Flow Limitations. Your Minute Volume is on the high side and Respiration Rate is at the upper end of what is considered the normal range, yet your Tidal Volume is not excessive.
I would suggest you try settings of:
Pressure Minimum 14 cmH2O
Pressure Maximum 18 cmH2O
EPR 3 cmH2O
My brother has SpO2 graphs from O2 Insight Pro similar to your more recent SpO2 graphs, From his Apple watch the SpO2 Drops he experiences correlate to REM sleep. He has improved significantly since last winter when his SpO2 Graphs were more similar to your graph from two months ago. Our family was hit with a nasty respiratory illness last September. We are just the last couple of months show signs of improved respiratory drive.
Give the setting a try and post back with OSCAR Reports. try grabbing the right border of your Left Hand Panel and moving it to the right just a little so your parameter titles only take one line.
Besides your normal screenshot, try to submit a secondary OSCAR Report with Pulse/Oximeter information that includes Events Graph, Flow Rate, Motion Graph, Spo2 Graph and Pulse Rate Graph. From that we can have you zoom into areas of interest.
Any questions, concerns or doubts please post back.
RE: Low SPO2 despite CPAP use - leifurh - 07-22-2024
I've actually had TWO cases of viral (RS of all things!) infections that affected my respiration. The first was in the spring of 2022 and was first thought to be COVID until they found that it was in fact RS. That time I ended up in intensive care on supplemental oxygen for a couple of days. The second infection (which I think was also RS but which was never diagnosed beyond "not bacterial, so it must be viral") happened last winter. No hospitalisation this time but pretty gnarly all the same.
After the first bout I experienced a very dramatic decrease in my athletic ability - before I had climbed a 2400 foot mountain 4 times a week all year round - my time up that mountain DOUBLED overnight and this had a major effect on my ability (making my way up those 2400 feet went from 1:20 to 2:40). It was basically as if I had aged 10 years in that one week.
The second bout added asthma to the mix - and led my doctor to prescribe Seretide inhalation. She figured that since I smoked until 20 years ago the infection might have started some form of emphysema. For unrelated reasons I have since changed doctors, the new one sent me to a sleep study which ended with me getting a CPAP machine and a sleep apnea diagnosis. By then I had become 20 pounds heavier than I was two years ago. I am trying to claw my way back to my former self :-)
The only good thing to say about ageing is that it beats the alternative :-)