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Unread post  Post subject: Oximeter alarm advice  |  Posted: Tue Apr 02, 2019 1:21 pm

Joined: Tue Apr 02, 2019 12:39 pm
Posts: 1

Hi all - new guy here. I've posted some of this to another board - hope that's OK. My wife has been using her new Philips Dreamstation for 4 months now (APAP, pressure 7-15, have requested 9-20). She had NO complaints about sleep quality, and gets subjectively POORER sleep with the machine. I told her she occasionally stops breathing, so got PSG (AHI 30), and the journey began. Latest 30 day AHI is 8.2 (with 100% compliance). Her SOLE reason for putting up with the machine is strong fear of future stroke/heart problems.

Trying to understand better, we've been using a CMS-50E oximeter for a couple of months now. Our first question is about [ab]using that device.

The main thing the oximeter has shown is O2 desaturation events into the mid 70%s, lasting 8-20 minutes, 2-4 times a night (with the machine). (Suspect it's during REM, but no EEG to prove sleep stage.) The pic below was with the machine maxed out at pressure of 15 - that's why we're trying to get back to 20.

DesatAtMaxPressure.jpg [ 229.92 KiB | Viewed 1289 times ]

Oximeter shows obvious heart rate increase during these episodes. Our understanding is between the reduced O2 levels and the stress response kicking the heart rate up, these episodes are precisely the prime contributors to long term health problems, so they are our main concern.

To reduce the time she spends in these events, she's taken to using the audible alarm on the oximeter. We've played with alarm threshold values; it's at 79% right now. Of course this goes off several times a night, waking her enough to breathe deeply for 30 seconds or so until the noise stops. This of course reduces even her perceived sleep quality.

The question is: Are the arousals caused by the alarms doing more harm than good? The flow + O2 data show pretty clearly it's having the desired effect of less time in heavy desat: several spikey descents punctuated by alarm/breathing/rapid O2 rise instead of dwelling at low O2. (Pic below.) But is that worth the arousals? Any insights would be greatly appreciated!

DesatsWithAlarm.JPG [ 94.85 KiB | Viewed 1289 times ]

(If the Dr doesn't respond in a couple more days, we'll set the pressure ourselves. Thank to LL for getting us into the clinician menus! Also, the leaks shown are almost completely resolved with Somnifix strips, which she can accept.)



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