Replies to This Discussion

Permalink Reply by Jackie S. on February 26, 2010 at 8:45pm

I've seen pts in there 30's with no stage 3 but on the same note I've seen pts in there 40's-50's with significant amount of stage 3. Sometimes there isn't an exact science to the human brain. I always joke around when there is a much older individual with stage 3 and say they must be immature. Just a joke. From my understanding stage 4 is no longer scored as per the new scoring rules. Which is silly to score it as 3 when it's always been 4. Rules, rules? =]

Rock Hinkle said:

Your to young to have no stage 3. We should still see at least a somewhat normal sleep architecture at this age. Are you taking any meds?

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Permalink Reply by Jackie S. on February 26, 2010 at 8:49pm

Nice thing about Cpap is it's just humidified air. Not another drug. Doctors are always so fast to hand out meds these days. Forever treating symptoms without treating the problem.

amith ram said:

No medications other than some type of low dose tri-cyclines the Sleep med dr. prescribed to me a few days ago. I need to have a physical done with full labs to be sure there are no definciencies. However, my last full set of labs was a little over 2 years ago with no issues.

Rock Hinkle said:

Your to young to have no stage 3. We should still see at least a somewhat normal sleep architecture at this age. Are you taking any meds?

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Permalink Reply by Judy on February 26, 2010 at 9:07pm

I was told Medicare rules required below 88% for more than 5 minutes before qualifying for 02 supplementation. And once when I was hospitalized they also cited 88%. Every time they found my levels below 90% they would tell me to take a deep breath. Sheesh!

And a BIG AMEN to "Nice thing about Cpap is it's just humidified air. Not another drug."

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

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Permalink Reply by Margaret Parker on February 26, 2010 at 10:34pm

when they did my sleep study I was told I stopped breathing 285 times in eight hours and then I didn't go into stage 3 or 4 at night. I never could get out of stage 2. I'm always aware of what is going on around me at night. I can't have any tv or radio or any thing on that is making noise at night or it comes into and becomes part of my dreams. Since being on the CPAP it hasn't been as bad. It just takes time to get use to all the things that go and come with sleep apnea good luck all

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Permalink Reply by Jackie S. on February 28, 2010 at 3:37am

thats true about the 02. Usually cpap/bipap is enough to take care of the low o2 levels (caused by apnea). My job has a pulmonary rehab here so we see a lot of patients with chronic lung disease who tend to require added 02.

Judy said:

I was told Medicare rules required below 88% for more than 5 minutes before qualifying for 02 supplementation. And once when I was hospitalized they also cited 88%. Every time they found my levels below 90% they would tell me to take a deep breath. Sheesh!

And a BIG AMEN to "Nice thing about Cpap is it's just humidified air. Not another drug."

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

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Permalink Reply by RockRpsgt on February 28, 2010 at 7:05am

It is normal with apnea for o2 to drop below 90%. Typically once the apnea is corrected this type of behavior stops.

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

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Permalink Reply by Jackie S. on February 28, 2010 at 3:00pm

Absolutely! that's what i said on the previous comment above. Normally not below 90% in general.

Rock Hinkle said:

It is normal with apnea for o2 to drop below 90%. Typically once the apnea is corrected this type of behavior stops.

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

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Permalink Reply by amith ram on February 28, 2010 at 3:21pm

So...it seems like from the different opinions, I should see another sleep med physician who will order a titration. I have tried sleeping on my side the past week..with only minimal benefits. Those too may be just my imagination!

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Permalink Reply by sleepsurfer on February 28, 2010 at 9:10pm

last than 20 arousals per hour is normal????? for who? this looks like classic upper airwayway resistance syndrome to me. very similar to my sleep study results. you need to find a sleep doctor that is operating in this millenium!!!!! they won't all acknowledge UARS, but believe me, it is real. be an advocate for yourself and don't count on doctors to always be correct. research everything they prescribe! YOU NEED A NEW SLEEP DOCTOR. you will also need and ENT that can examine your airway and determine were your resistance(or obstruction) is occurring. that way you don't waste 5 months using a dental appliance when your resistance is in your nose and not behind your tongue(like me). when and if you get prescribed a CPAP, make sure you get one that is data capable and preferably an apap. not everyone can handle a straight cpap(leaf blower).....good luck to you!

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Permalink Reply by Randal on March 1, 2010 at 12:28pm

This is the first reference I see to xPAP and Oxygen levels on these boards. Let me give you a brief history and then maybe a few questions. This all started in Oct 2009. I was being prepped for a caterack operation. They put one of those pulse ox meters on my finger. I cann't remember if it was 84 or 88. Anastgeoligic (sp- the doctor that keeps you under) had me take a whole bunch of deep breathes and talked to me about my sleeping habits. We got it up to 90% and went ahead with the surgery. Made me promise to talk with my primary care doctor.. Talk to my Doctor in December and she suggested a Sleep Study. Study got scheduled for end of January. Mean while I'm feeling pretty bad. If I sat still for more then 20 minutes I was sleeping. January was a real bad month. Mother in Law passed away on the 7th and I feel asleep during the mass. Next week co workers got very concerned about me at work. I was falling asleep at my desk and sluring my speech. They told me to go home. Wife then took me to ugent Care and they sent me to hospital. I had respitory failure and Knee-Moan-Ya. Bad shape. After 6 days in hosiptal with heavy duty meds they rreleased me. They sent me home 2% oxygen and a auto BiPAP machine.w/oxy bleed. They based the BiPAP on my blood O2 and CO2 levels. ! week after the hospital I went for sleep test. You guessed Moderate Sleep Apnea. Come back in a week for titration. Remember, all this time I'm using a BiPAP set on auto with a range from 8 to 12. Went in for titration. They never looked at data from my machine. Jumping ahead the Sleep Doctor Rx a CPAP C-flex set at 10 with a 1.5 Ox feed. Only been on the CPAP for 4 days now but don't seem to be as rested. Is this in my head? If I'm not having Apneas why does my O2 levels drop. I pass the 6min walking test. Having moderate COPD is there a difference between BiPAP and CPAP? Would one help my O2 levels more? Sorry for the long letter but maybe I can get some direction. Thanks . .

Jackie S. said:

thats true about the 02. Usually cpap/bipap is enough to take care of the low o2 levels (caused by apnea). My job has a pulmonary rehab here so we see a lot of patients with chronic lung disease who tend to require added 02.

Judy said:

I was told Medicare rules required below 88% for more than 5 minutes before qualifying for 02 supplementation. And once when I was hospitalized they also cited 88%. Every time they found my levels below 90% they would tell me to take a deep breath. Sheesh!

And a BIG AMEN to "Nice thing about Cpap is it's just humidified air. Not another drug."

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

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Permalink Reply by Judy on March 1, 2010 at 1:11pm

I'm surprised at 1.2% 02 supplementation. I've never heard less than 2% before. Live and learn, I guess. I have COPD, and am on 2L of 02 supplementation w/my bi-level auto, currently IPAP 17, EPAP 8, Pressure Support 5 TRYING to find the actual pressure settings I need.

I have the Resmed VPAP Auto which I LOVE - BUT I suspect that Respironic's bi-level auto Pressure Support is the better method - at least for me and I'm going to look into renting one for a month for an at-home titration.

Its a bit hard to explain but: with a Resmed auto bi-level the pressures can only vary by the exact amount of the PS setting. The IPAP and EPAP can never get closer or further apart than the PS.

With the Respironics auto bi-level method of Pressure Support IPAP and EPAP can roam anywhere between their settings but never CLOSER than the PS setting.

For instance:

Resmed IPAP 14, EPAP 8, PS 2; EPAP can go as high as 10 and IPAP can go as low as 12, but IPAP and EPAP pressures can never be closer OR FURTHER apart than 2 cms.

Respironics IPAP 14, EPAP 8, PS 2; IPAP and EPAP can roam anywhere between 14 and 8 but never CLOSER than 2 cms apart. So IPAP could range anywhere from 14 to 10 and EPAP could range anywhere from 8 to 12 so long as they never got closer together than 2 cms between them.

Is that clear as mud?

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Permalink Reply by Jackie S. on March 1, 2010 at 1:43pm

In some cases we automatically put a pt. with pulmonary disease such as COPD on a Bipap. Because it makes it easier for them to breath against the pressure (its a lower pressure when u exhale). But there are times when Cpap (which is one continuous pressure) is fine and can be tolerated even if u have COPD. It depends on the pt and the situation. If I put a Cpap on you and you c/o difficulty breathing I would switch u to Bipap. If u were ok initially in the lab with a CPAP i would leave you on CPAP. I would only change to Bipap later if I saw CPAP wasn't helping you. Being that u were on Bipap previously you may just not be used to the CPAP yet. If you continue to have a problem let the doctor know. How do u know ur O2 levels are still dipping? Is this during sleep or during the day? Are you on O2 24hrs or just for sleep?
I don't know where u live but if in NY that would be great b/c i have a pulmonary rehab at my job that u could really benefit from. We are the only non-hospital based rehab in the state of NY. It's really a great program.


Maybe they saw CPAP was enough to treat your Apnea. You can always ask the sleep dr. why ur no longer on BIPAP.
Randal said:

This is the first reference I see to xPAP and Oxygen levels on these boards. Let me give you a brief history and then maybe a few questions. This all started in Oct 2009. I was being prepped for a caterack operation. They put one of those pulse ox meters on my finger. I cann't remember if it was 84 or 88. Anastgeoligic (sp- the doctor that keeps you under) had me take a whole bunch of deep breathes and talked to me about my sleeping habits. We got it up to 90% and went ahead with the surgery. Made me promise to talk with my primary care doctor.. Talk to my Doctor in December and she suggested a Sleep Study. Study got scheduled for end of January. Mean while I'm feeling pretty bad. If I sat still for more then 20 minutes I was sleeping. January was a real bad month. Mother in Law passed away on the 7th and I feel asleep during the mass. Next week co workers got very concerned about me at work. I was falling asleep at my desk and sluring my speech. They told me to go home. Wife then took me to ugent Care and they sent me to hospital. I had respitory failure and Knee-Moan-Ya. Bad shape. After 6 days in hosiptal with heavy duty meds they rreleased me. They sent me home 2% oxygen and a auto BiPAP machine.w/oxy bleed. They based the BiPAP on my blood O2 and CO2 levels. ! week after the hospital I went for sleep test. You guessed Moderate Sleep Apnea. Come back in a week for titration. Remember, all this time I'm using a BiPAP set on auto with a range from 8 to 12. Went in for titration. They never looked at data from my machine. Jumping ahead the Sleep Doctor Rx a CPAP C-flex set at 10 with a 1.5 Ox feed. Only been on the CPAP for 4 days now but don't seem to be as rested. Is this in my head? If I'm not having Apneas why does my O2 levels drop. I pass the 6min walking test. Having moderate COPD is there a difference between BiPAP and CPAP? Would one help my O2 levels more? Sorry for the long letter but maybe I can get some direction. Thanks . .

Jackie S. said:

thats true about the 02. Usually cpap/bipap is enough to take care of the low o2 levels (caused by apnea). My job has a pulmonary rehab here so we see a lot of patients with chronic lung disease who tend to require added 02.

Judy said:

I was told Medicare rules required below 88% for more than 5 minutes before qualifying for 02 supplementation. And once when I was hospitalized they also cited 88%. Every time they found my levels below 90% they would tell me to take a deep breath. Sheesh!

And a BIG AMEN to "Nice thing about Cpap is it's just humidified air. Not another drug."

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

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