I had a head injury 2 years ago and have since been diagnosed with post concussion syndrome (ive posted on the headway site about this a few times). One of the issues I experience to varying degrees is overnight breathing problems - ive often woken up gasping for air, i wake up most mornings with really dry mouth and eyes, plus i often get headaches first thing in the morning and have fatigue issues throughout the day. I know some of this is PCS related, but I believe i may also be experiencing some sleep apnea. Ive spoken to my GP on numerous occasions about this but ive not been able to get a referral for sleep study as yet as 'I dont fit the profile' for sleep apnea!
Taking matters into my own hands (ive learnt you have to do this to get anything done) I recently purchased an overnight oximeter which is worn on the finger, the actual model is a wellvue Wear02 monitor which i bought direct from the US. This monitors oxygen levels and bpm throughout the night, and reports in one minute intervals giving a graphical report for the night on uploading the results to the phone app. I just wondered if anybody knew how to interperet the results correctly? It shows a graph of SP02 levels throughout the night, plus an average SP02 reading over the sleep duration, however I dont think tells the full story - for instance it does not tell me the oxygen desaturation index which I believe is a more important indicator of sleep apnea than the average throughout the night. I can see dips on the graph (i think over 3% dip from baseline is a desaturation event... but i might be wrong!) throughout the night but the average is usually around 96% - 97% so im little confused to say the least. I have tried emailing Wellvue support directly but ive had zero response.
Any help or advice would be welcome, im not sure if its allowed but i do have an output of last nights (i had a lot of drops in 02) which ive included below, if someone would be willing to take look it'd be much appreciated - i know medical advice cant be provided but another pair of eyes on it at least would be appreciated!
Many Thanks
Bb
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Bb1878
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You can't diagnose things that specific from only oximeter readings. Most likely that first dip in the night is enough for a desaturation event but being so early you may have had plenty of oxygen in your body and a dip of bp, heart rate, or oxygen can be normal prior to things leveling out for the night. You also don't appear to have a sharp enough drop at any point for your oxygen saturation to have come anywhere close to completely stopping breathing. It would have to drop 90% below average to meet the criteria for that event. Smaller, less frequent drops in o2 can be related to a variety of other respiratory issues such as bronchitis or if you have a past history of asthma. Chronic bronchitis rather than the version caused by an infectious illness can be caused by severe allergies or an overactive immune system, which is also a common contributor to sleep issues, and mild symptoms may not be so noticeable during the day when cortisol levels are higher and suppressing inflammation. Especially if you are not currently very physically active. To determine sleep apnea you would have to start by calculating the AHI to see if you have enough possible hypopnea events for the cutoff to diagnose sleep apnea. Your pic of the chart lacks any time values to do that and dips that do not go below 90% do not qualify in some criteria while it might be counted as a hypopnea event by other doctors using different criteria. sleepfoundation.org/sleep-a...
This is only a start to confirming whether sleep apnea potentially exists since it has a lot of flaws for determining severity and opinions on what qualifies. ncbi.nlm.nih.gov/pmc/articl...
More measurements are needed and generally visual observation is included in a sleep study to make an accurate diagnoses. Until then it's just a sign of potentially having some low oxygen events with many possible causes. All that really shows is you likely had some mild interruptions to your breathing that could be due to several mild health issues, the position you were sleeping in, sleep aids commonly have a side effect of slightly depressing your breathing, some other medications can cause shallower breathing that may result in brief, usually harmless dips in oxygen levels, or other variables. I had to wear a pulse oxy when I started clonidine er at night for ADHD and it's contributions to my insomnia. I was more concerned about heart rate and did drop briefly below the suggested cut off for too low of heart rate one of the first nights taking it. I never went below 95% o2 values though and my heart rate didn't stay that low long enough to be at much risk considering a cardiologist had looked into my rather unpredictable heart rate changes and could find absolutely nothing wrong with my heart. It appears to be a combination of metabolic effects and signalling issues by the autonomous nervous system.
A company is not going to help you with diagnosing an illness or interpreting results. That would be illegal medical advice. Odds are they also do not know the answer to most of your questions. They are trained to make a device that accurately measures your o2 levels. They are not typically trained in what those levels mean. Doctors are. A device like that is intended to be used with the consultation of a doctor or if it's designed for individuals to keep track of things by themselves then typically software is included that gives a summary and general interpretation of your results. Often along with suggestions of where issues might be that you should further investigate. Generally with a doctor.
My oura ring will do that when any stats go below average. Although it does not say there is a health issue or anything of the sort. It merely says this value is off and you may benefit from rest with links to further info about that particular value, how it's measured, and what it can mean in various situations. Then you can decide if you need medical attention or share their info and study links with your doctor. Info links and studies can be useful in case they happen to be the clueless kind that ask if getting more rem sleep is important after I spend time explaining the issue that while sedatives help me fall asleep sooner so I can maintain a schedule easier it cuts rem sleep time in half. Also I only get 30mins on average and 60mins on occasion. Yes.... 15mins of rem sleep is a problem. 30mins is a problem. Studies show less than around 90mins of rem sleep has a negative impact on cognitive function and mood the next day and long term contributes to the health issues that sleep deprivation can cause even if you get 8hours of sleep. One of those many times I just pause and wonder how in the heck this is the best trained person the US medical system can come up with for prescribing me sleep aids.
Unless you are talking about discussing sleep issues with a sleep specialized neurologist you should probably lower your expectations. Very few doctors including neurologists and psychiatrists can even interpret a sleep study on their own so without bringing in another doctor it would be pointless. Only having oxygen saturation values is unlikely to prove useful for getting taken seriously or receiving any diagnoses or treatment. If you have the option this is one of those situations you go over your doctor's head and find a place that doesn't require a referral to discuss your symptoms and whether you need a sleep study. I've had to do that numerous times. Never wait around on one doctor. Half the time I already have an appointment for a second opinion before getting the first.
Thanks a lot for your very detailed reply - it's very much appreciated.
I understand a diagnosis cannot be made based on sp02 readings alone, I guess I am just trying to find out more about the whole thing myself since my gp won't help me. I haven't felt like I have been breathing properly overnight for some time, it feels like it's more shallow breathing than anything else, I used to snore quite a bit but don't anymore, (my wife is quite happy with this 🤣) however for me I know something has changed and doesnt feel right so im just trying to get to the bottom of it as I understand the long term health implications if there is an issue that goes undiagnosed.
I will look into maybe getting a private consultation as you suggest- thanks for the suggestion.
The graph I included sorry didn't have the duration on it - the total recording time was six hours, so each bold vertical line is 90 minute duration, and each faint vertical line is 15 minute durations.
Manythanks again, I feel like I've learnt more from reading your post than I have done from speaking to my health professionals!
No longer snoring may mean you are no longer resorting to breathing through your mouth at night. If you tend to only breathe through your nose then you can have problems from minor issues there as well and they may not be noticeable during the day. A deviated septum, allergies, etc... can make you move less air when you are breathing more lightly at night.
I actually had that add to my insomnia issues for a few years. I had a problem for awhile of chronic inflammation in my sinuses from a dusty old house and leftover mold from a sewer line issue. Workers didn't clean up properly when they replaced the pipe under the basement concrete. My symptoms very slowly got worse over years so I didn't realize just how bad it was and why I kept getting back up out of bed to sit in my reclining computer chair for awhile before laying down again. My doctor kept giving me steroid nasal sprays and antihistamines. If anything it made it worse. That is common with fungal sinus infections and dang hard to get doctors to diagnose them sometimes.
Finally I bought one of every type of nasal spray I could find and afford off amazon and tried them for a few days to a week each. Using the most useful of the group, which was mainly designed for mold exposure, had the added effect that I suddenly felt less need to keep getting up out of bed when trying to sleep. When I ran out the company had none for sale at the time. I decided to use their nasal rinse that had nearly the same ingredients but in higher concentration and dilute it down to make an equivalent to their usual nasal spray.
The instant I tried using it I knew I screwed up. Stupid homeopathic concentrations and trying to calculate these weird x and c dilutions instead of a simple mg/ml value. I ended up hanging over the side of my chair in misery while I felt like I'd just given myself the worst head cold ever but the odd thing was despite the massively increased pressure in my face and head I was breathing easier. After an hour of feeling like my head and face would explode lots of mucus with various stuff in it started emptying out of my nose and I could breathe properly out of one side for the first time in years. So of course being me I repeated it again the next few day despite the amount of temporary misery it put me in and black lumps started to come out. I had been seeing my doctor every few months with numerous exams and they kept saying it was allergies and nothing else.
The 3rd day I was breathing so much better the muscles over my ribs actually started to ache. I also hadn't realized I'd been breathing so shallow for so long my body was no longer used to fully expanding my lungs. All my breaths when not exerting effort had apparently been been shallow for years but unnoticed because I could force enough air through or open my mouth when awake. My breathing when I tried to lay down and relax was probably insufficient for sleep. All because I had some sinus pressure that during the day was mostly only somewhat annoying compared to other things I was dealing with and doctors kept writing it off as unimportant and treating as allergies. I asked for a referral twice.
Turns out there was probably fungal balls and certainly various debris in my sinus cavities. My oopsy extra concentrated spray cleared things out so well by the time I managed to find an ENT specialist that didn't require referral that they didn't find anything on scans or more detailed examination of my sinuses to determine what really had been the main problem. After discussing my past few years of increasing respiratory problems with the ENT she started trying to suggest ways to reduce irritants in the house. I stopped her to point out it's an 1800s farmhouse that probably has more mouse poop in the walls than insulation. It would be easier to move than tear apart the old plaster and lathe walls and ceilings or to attempt to seal every single gap in the walls and floors. We moved into my husband's grandma's house because she had just moved into an assisted living facility. For one of the few times in my life I spent the first several months falling asleep even when I didn't want to and my oura ring had to be re-calibrated to define a new average for me because it was constantly saying my respiration, heart rate, sleep quality and timing, etc... were all abnormal for me. A few weeks ago a doctor actually measured my blood oxygen level at 100%. Probably the first time since respiratory and cardiac symptoms started.
Discovering contributions like that to sleep issues throughout my life is why I keep trying to point out to people that you often have to look at things that seem minor; sometimes to the point you don't even bother treating the symptoms, and completely unrelated to figure out why you aren't sleeping well and improve it. It takes very little interruption to certain functions or systems of the body to cause sleep problems or changes. Doctors look for big things and we tend to follow their example by looking for some major health issue or easily observed problem when many people don't get any help and remain on sedatives with no known cause for their sleep disturbances because of all the little things instead. When something changes like suddenly not snoring it may be a clue of what is contributing to your symptoms. However, people developing sleep apnea tend to snore an increasing amount instead of less. A person who is not overweight and doesn't snore may be immediately ruled out as having sleep apnea by many doctors because of how uncommon it is in someone that doesn't have those contributors or warning signs. Not that it's impossible for people in good shape with no snoring to have sleep apnea but it would make it much harder to argue for a sleep study based on possible sleep apnea.
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Help!!!!!!!!!!!!!!!!!!!!!
low oxygen reading same time as waking in night? 
Sleep apnea
Atypical Sleep Disorder?
New diagnosis
