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SPO2 drops during treatment - dwedward - 09-11-2022
I'm relatively new to using a CPAP; I was diagnosed 2 months ago with an AHI of 65, and about 1/3 of my time at less than 90% saturation with a low drop to 67%. Using first the Airmini (bought by myself as the wait for the test and doctor was long) and then by an Airsense 11 (current machine paid for by insurance) I've reduced my AHI to around about 1 or so on a consistent basis (treatment since beginning of August).
However, when I got the new Samsung Watch 5, I noticed that it was registering O2 drops down to 88% during the night; even if the AHI was 1 or less. I validated those drops and got detailed data from the Wellue ring and correlated all the information into OSCAR (see attachments).
Although reading and learning from y'all has been helpful, it's clear I don't have the collective experience, and when I look at the charts I don't see anything consistent causing the O2 drop. The first one might be caused by the CA, but the 2nd later in the night doesn't look like there's anything significant causing the drop.
I have an appointment in October with a sleep doctor associated with Baptist Cardiovascular (recent triple bypass, so the reason why I'm concerned!) but I thought I'd ask the group if they can derive any insight from the data.
Thanks in advance for any help given!
RE: SPO2 drops during treatment - Jeff8356 - 09-11-2022
dwedward,
Those quick dips (desturations) can sometimes be caused by movement. You may have rolled over and tapped the sensor causing an erroneous reading. Generally they are very short (seconds) and quickly go back up to normal. You can sometimes get a handful of those quick desats just from moving around during the night.
The same goes for the watch. It may just be that it lost good contact for a few seconds. Happens with my FitBit all the time.
If you use the O2 Insight Pro software for your Ring it will give you "<90% time:" in seconds. You can keep an eye on how long the desats were.
Since you recently had bypass surgery it's worth having a discussion with your cardiologist to see what desaturation threshold would be normal for you now.
RE: SPO2 drops during treatment - dwedward - 09-13-2022
Hi Jeff8356,
That's an interesting piece of information. However, I'm not sure whether or not that's what is actually happening. Before CPAP I was a restless side sleeper. Constantly rolling back and forth all night long.
Since CPAP, I have been a motionless back sleeper. I usually wake up in the same position as I went to sleep and sometimes even the hands in the same place. I have to say, I prefer the motionless back sleeper. It feels as though I'm better rested.
Last night, I had quite a few O2 drops; more than 2 minutes below 90%, and one down into the 70s! See the attached charts. This time, it looks as though there are definite apneas occurring around the same time, and one occurring for 39 seconds. That can't be good.
I really would appreciate if someone would review the OSCAR numbers and let me know if they see anything interesting. I know I have a problem with mouth leakage (hence the mask leak numbers). I've been trying all manners of cervical collars, chin straps and mouth taping. My chin apparently wants to drop so low during the night that NOTHING is going to get in it's way!!
Anyway, any help would be greatly appreciated!!
[attachment=44557][attachment=44558]
RE: SPO2 drops during treatment - Sleeprider - 09-13-2022
Overall,your oxygen saturation is very good and relatively steady. In spite of using EPR 3, you have a very high residual flow limitation which, unsurprisingly correlates to the dips in SpO2. Resolve the flow limits and the respiration and oxygen exchange will follow. It's interesting that your inspiration time shows no response to spikes in flow limit. That means when the flow limit occurs it probably shows up most in tidal volume, which you did not include. If you want to get a better look at the impacts of this, let's do a zoomed image of the flow rate between 00:40 and 00:43. This three minute segment will show the flattened inspiration wave which reflects increased effort of getting a complete breath, reduced ventilation and effects on Spo2. There is a similar issue at 23:00 and 04:23
RE: SPO2 drops during treatment - dwedward - 09-13-2022
(09-13-2022, 08:19 AM)Sleeprider Wrote: Resolve the flow limits and the respiration and oxygen exchange will follow. It's interesting that your inspiration time shows no response to spikes in flow limit. That means when the flow limit occurs it probably shows up most in tidal volume, which you did not include. If you want to get a better look at the impacts of this, let's do a zoomed image of the flow rate between 00:40 and 00:43. This three minute segment will show the flattened inspiration wave which reflects increased effort of getting a complete breath, reduced ventilation and effects on Spo2. There is a similar issue at 23:00 and 04:23
See the zoomed in pictures below. I also added the tidal volume as requested.
[attachment=44564][attachment=44563]
Of course, the 64,000 dollar question is what could be causing the flow limitation?
I've thought that I had some sort of positional apnea, e.g. my chin tucking in, so I've tried a cervical collar and it feels better but it doesn't stop it from occurring.
I also bought a curve pillow to better align my back and head (and subsequently throat) and that also feels better but it doesn't stop it from occurring.
I've tried all manner of chin straps, but they either pull my jaw too far back, or are not strong enough to contain my jaw drop.
Although I've always been a mouth breather I'm teaching myself to breathe through my nose, but I still need mouth tape to reduce the mouth leaks.
I'm going to send out some messages to my doctor (Cardiologist and my new sleep doctor) today to get their input, but your help sleeprider is GREATLY appreciated!
RE: SPO2 drops during treatment - dwedward - 09-16-2022
(09-13-2022, 08:19 AM)Sleeprider Wrote: Overall,your oxygen saturation is very good and relatively steady. In spite of using EPR 3, you have a very high residual flow limitation which, unsurprisingly correlates to the dips in SpO2. Resolve the flow limits and the respiration and oxygen exchange will follow.
If anyone is interested, it appears as though the flow limit issue is some type of positional issue. I tried a new collar (Velpeau 4" Comfort) last night and showed some improvement. I have a 3" collar that is more comfortable to wear, but not as effective at stopping the flow limitations apparently. When I slept with the 4" last night although it was slightly uncomfortable, it worked much better. Only 2 CAs, each 14 seconds, with resulting drops in O2, but total time at less than 90% is 8 seconds; less than the > 2 minutes previously.
I also switched back from the P10 mask to the N30 mask. I really want to like the P10 as it's lightweight and easy to fit, but I seem to have more leaks with it than with the N30.
I did reach out to my doctors though they didn't respond to my notes. My (new) sleep doctor's nurse did say they were going to get me in to see the doctor earlier, so that's a win.
In any case, thank you very much to sleeprider and jeff8536 for your help and support!
RE: SPO2 drops during treatment - dwedward - 11-23-2022
I thought I'd check in to post on progress as well as ask a few questions to the forum.
First, my new sleep doctor (associated with the cardiology institute where i had my CABG this year) reviewed my OSCAR results and wanted in-lab studies. However, my insurance bounced the idea, so my doctor prescribed another sleep study like the one I had in August. So, starts the slow march to justify more detailed studies with the insurance company... In the meantime, I had resolved most of my SPO2 issues with the support of the forum here. With a cervical collar (to reduce the positional issues causing flow limitations) and a chin strap (to reduce the mouth leaks), I've been tootling along with AHI of around .5 for the last few months. Just waiting to go through the paces with the new sleep doctor to see if we can find a way to eliminate the cervical collar and possibly the chin strap. Also, to see why my O2 drops still; it does, just not as much as before...
Second, I thought I'd try the P10 mask again. I had used one when I was using my AirMini prior to receiving my AS11. But I switched to the N30 as the pillows hurt my nose. I've been having a low-level problem with leaks with the N30 which would up the pressure and then wake me up as the pressure was too high! So, I thought perhaps the P10 would work better.
Attached are my charts from last night where halfway through the night I switched from the N30 to the P10. Two observations: FIRST, the P10 leaks like a sieve!! It has tiny vents on the frame where the pillows attach and that blows constant air. It was kind of annoying as I could feel the breeze. But I stayed with it as I seemed to be breathing okay. SECOND, those leaks show up as a constant low-level leak rate on the OSCAR charts.
My questions...
1). What's up with the vents and the programmed leaks?? The P10 I used previously was for the AirMini and DID NOT have the vents. Although it did have vents around the HumidX capsule like all AirMini masks. So, I was surprised to see so many vents and what I presume is planned leakage???
2). Despite the leaks, it arguably looks like I have FEWER leaks than when I use the N30 (see chart). It also looks like the N30 is the SOURCE of my flow limitations as they are markedly less than with the P10.
Am I misunderstanding something??? Any insight would be greatly appreciated!!!
RE: SPO2 drops during treatment - Sleeprider - 11-23-2022
All masks have a designed leak rate to ensure full exchange of expiratory air. The normal designed leak is four to five ti mes the average respiratory rate, or 25 to 40 L/min depending on mask type and pressure. Without venting, the rebreathing of expired air would quickly result in hypercapnea.
The leak and flow-limit response to a given mask is going to have an individual response, and what works for you is great, but may or may not work for someone else. I have used the P10 for years and think it is one of the easiest to fit and least restrictive mask options. I try not to let my bias for nasal pillows overly influence my advice, but if the P10 works for you too, it's not a surprise. I don't know why you seem to have a baseline leak of just under 5 L/min, but as long as that is not disruptive to sleep, it certainly is not a problem in your therapy.
RE: SPO2 drops during treatment - withtao - 11-23-2022
(11-23-2022, 09:24 AM)dwedward Wrote: My questions...
1). What's up with the vents and the programmed leaks?? The P10 I used previously was for the AirMini and DID NOT have the vents. Although it did have vents around the HumidX capsule like all AirMini masks. So, I was surprised to see so many vents and what I presume is planned leakage???
2). Despite the leaks, it arguably looks like I have FEWER leaks than when I use the N30 (see chart). It also looks like the N30 is the SOURCE of my flow limitations as they are markedly less than with the P10.
Am I misunderstanding something??? Any insight would be greatly appreciated!!!
I've had a P10 for 7 years (Air Sense 10 and now Air Sense 11). When I recently loaded my results into OSCAR I could see that I had some significant Large Leaks. MyAir doesn't actually show the leaks (when, how often, duration). So I set out to see if I could figure out what was going on. I'm a side sleeper and don't move much. I noticed that my leaks occurred in clusters shortly after I fell asleep. I start on my left side, so I switched to me right side and saw less Leaks. Then I figured it out. When I sleep on me left side I lay closer to the edge of the pillow with the left strut over the edge and on the right side I lay with more support from the pillow. So, on my left side the mask strut would push towards the right causing the right side to open up and leak.
So, I conscientiously made sure the pillow was supporting/cradling the strut that comes out of the side of the mask. This dramatically reduced/eliminated my leaks. In addition, when I occasionally sleep on my back I notice that the struts aren't supported and can leak with a slight movement of my head. BTW, the air coming from the mask is much less than another mask I had (Resmed FX) and is directed away from me eyes and face. So, your issue may be with the struts coming out of the mask not being supported and allowing the mask to open up. I don't believe other masks usually have metal struts attached to the mask and head gear. OMHO.
RE: SPO2 drops during treatment - dwedward - 11-25-2022
As always, sleeprider, I appreciate your insight. Yes, it does seem to work better for me (the sore nose notwithstanding), and last night my AHI was .2.
And, withtao, it took me a couple reads to get what you were saying, but I see what you mean. I'll check that. I have a hose holder that I've used for some time, so haven't had too many problems; I have seen leaks occur with other masks because the hose was somehow obstructed by the pillow.
HOWEVER, can you just please confirm for me?? Do either of you with the P10 have two jets of air constantly coming from the mask? One one either side? It appears to be from the small screen of vents on the frame it self. But I can hear, and feel, those jets of air. I think that accounts for the low-level constant leak. sleeprider, I get that all masks leak to an extent to allow CO2 to expel, but this is a constant stream of air. And it's completely visible on OSCAR, and I even loaded the data into ReScan just to make sure. Same thing...
Now, this is a frame that I bought many months ago (before I got my AS11). I bought only the frame as I had cushions from the AirMini version, as well as straps from the N30 (the same as used on the P10). So, to save a few bucks I only got the replacement frame itself. Never used, just sitting in my closet. Now I wonder if it's defective somehow???
At any rate, I've ordered a whole new P10 mask to see if it's any different.
Don't get me wrong, I DO seem to be sleeping better and I have fewer events and fewer large leaks with the P10, so I think I'll stay with it, even if it blows two hurricanes nightly. It's just weird!