Suggest Treatment For Chronic Cough And Sleep Apnea

Posted on Mon, 13 Apr 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 13 Apr 2015 Answered on

Wed, 29 Apr 2015 Last reviewed on

Question : when falling asleep, or when very relaxed, like at night when relaxing before falling asleep I have noticed that my oxygen levels will drop into the low 90s. like 92 or 93. sometimes as low as 90%, but after falling asleep they will rise back up to 94-96 and stay there all night. I have a pc based pulse oximiter that records. During the day, my saturations are normally between 96 and 99%. Even when running all out on the tredmill they will be between 95 and 99%. Is this normal? when they do drop that low it is not for a prolonged period of time. I do have a smoking history. probably a half a pack to a pack a day of utralight cigarettes. probably for the past 20 years or so, so I would estimate my packyear to be about 15 to 18 pack years. I have used a friends spirometer who has bad asthma and my fev1 is about 4.2 and my fvc is about 5.25 ( both about 100% expected) and the fev1/fvc ratio is 80%. I do not have a chronic cough, morning cough, etc. I had a home sleep study done and they told me that I have mild obstructive sleep apnea, but my doctor didn't see a need for a cpap. they said my o2 dropped to 89% one time for a very short period of time. it is since then that I have started monitoring it on my own. I do have gerd and have been taking Prilosec for that, and have seasonal allergies. Not sure if that matters. I also have very bad anxiety and often have to take Xanax. basically I am trying to determine if I have copd or if this is normal. I do have high hemoglobin but I am on testosterone replacement therapy.

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
Anxiety and smoking look to be the causes.

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.
Read and understood your concerns.
First of all, let me tell you that the pulse oxymeter is very sensitive and at the same time changes fast to many conditions. Ultimately it is sensor based. It does change even to minimum of the stimuli, temperature variations and atmospheric factors, including the temperature of your room, of your fingers, whether covered with quilt and so many factors.
It is possible that the fall at the time of relaxation or when relaxing before falling asleep have such factors.

To me it looks normal.

History of smoking, spirometer readings, no coughing, home sleep study (mild OSA), no need a CPAP, GERD,Prilosec, seasonal allergies, Xanax for''anxiety'', high Hb and testosterone replacement therapy at the age of 37 noted.

Nothing is suggestive of COPD.
It is possible the root cause is the anxiety, if controlled well and without Xanax, you will be better; and of course no smoking is important that you better than anybody else.

I hope this answer helps you.
Please feel free to ask for more if you need to or if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. T Chandrakant (2 hours later)

Thank you for your reply. I also wanted to add that I monitor my spo2 when I am lifting weights in the gym, and no matter how hard I push myself, my spo2 remains between 96 and 99%. Its only usually when I am relaxed that it drops to low 90s. I am paranoid because I had a GP tell me that it's probably mild copd, and I always thought that with copd, it would be likely higher at rest and lower when exerting myself. not the opposite so I wanted to clarify that. I did quit smoking 6 months ago, and did great with it up until a couple weeks ago when life stresses took me back to 5 a day. I am definitely quitting immediately. I will find another way to deal with life stresses. Also, how low should spo2 typically go when relaxed and falling asleep in a healthy person?

Answered by Dr. T Chandrakant (32 minutes later)

Brief Answer:
Pulmonologist opinion,

Detailed Answer:
Hi. Thanks for your appreciation and feedback.
It would probably be a good idea to consult a Pulmonologist, undergo Pulmonary Function test and other tests as may be advised by him on clinical evaluation and physical examination. This alone can rule out the doubts which you have.?

This is the best way to rule out the possibility of any disease including COPD.

He would also tell you about the spo 2 readings, it's specificity and sensitivity .
Anxiety and stress are one of the worst enemies as is smoking.
Will wait for the reports and your feedback.

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Above answer was peer-reviewed by : Dr. Yogesh D