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Diagnosing Hypoxemia - Any doctors actually think about a problem - first principles?

wabi-sabi

Senior Member
Messages
1,458
Location
small town midwest
I guess everyone here has that problem.
Yes. It sure is hard, but at least we're going through it together.

I wonder if music would help? I know I can't really fall asleep unless if listen to something that sort of entrances me in the right way. The on/off switch in my brain seems to be broken, but sometimes the right sort of sound can trigger it. If you could find something to listen to that was soothing enough to help you sleep, but just stimulating enough to keep your heartrate up, maybe that would help.
 
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37
That would be nice but it would take loud rock. Soothing = low heart rate = bummer. It's awful not being able to sleep. I thought fatigue and pain was bad..
 

BrightCandle

Senior Member
Messages
1,147
I was having a discussion elsewhere about the O2 uptake issue and one of the problems is that SPO2 in blood isn't our issue, we ought to have high values for that because the issue is taking the O2 out of the blood. It is the amount of CO2 on the return.
 

Shanti1

Administrator
Messages
3,139
I have been pursuing a similar inquiry myself. My O2 saturation and heart rate are normal throughout the night (pulsox), but I wake feeling as though my brain is starved of oxygen. In my case, the impaired oxygen delivery was confirmed when I took a "hit" off of a can of oxygen (Product: Oxygen Boost) and felt the cloud of fog instantly thin. Here are some of the things this has led me to consider in case they are helpful for you too:
  • I'm currently waiting on delivery of an oxygen concentrator. I know you said you tried supplemental oxygen, but there is a great thread here that discusses how to maximize dissolved plasma oxygen (unbound to hemoglobin) through use of a non-rebreather mask and maximizing both flow and concentration. The thread also discusses mHBOT which relies on the increased dissolution of O2 in plasma for additional cell delivery.
  • As my BP is around 85/73 and my ADH is below the detection limit, and I drink 4-6L H20 per day, I'm also thinking that low blood volume and lack of perfusion to the brain/muscles is part of the prob. I tried an IV of 1L of saline as an experiment, which, although that seems to help others, didn't do much for me. I am also looking at ADH replacement (desmopressin) or some of the other meds to increase blood pressure/ fluid retention (midodrine + fludocortisone).
  • High dose B1 seems to help people, one of the proposed mechanisms is increased blood flow to the brain, along with supporting the citric acid cycle: https://www.healthrising.org/blog/2021/04/15/thiamine-b-1-chronic-fatigue-syndrome-fibromyalgia/. This one I just started about three days ago and I'm having a good response so far with less brain fog and fatigue. I've also been considering myo-inositol as there is some research that it can help with oxygen delivery: https://pubmed.ncbi.nlm.nih.gov/319...rispyrophosphate (ITPP,of oxygen by the blood.
 
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I already use an O2 concentrator. B1 Thiamine seems easy enough to add to my supplements. I have some already. I've been reading about ITPP and it sounds interesting. But it appears its been banned and all previous suppliers are out of stock or they are scams. Is there a legitimate supplier?
 
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37
I was having a discussion elsewhere about the O2 uptake issue and one of the problems is that SPO2 in blood isn't our issue, we ought to have high values for that because the issue is taking the O2 out of the blood. It is the amount of CO2 on the return.

Its difficult to monitor Et CO2 at home. I purchased an End-Tidal CO2 monitor but its difficult to get a good reading while sleeping plus it doesn't record. I tried using a O2 cannula adapted to the EtCO2 with a video camera as the recording for its displayed CO2. But getting a reliable reading while sleeping is quite difficult.

https://contechealth.com/products/c...ograph-respiration-rate-end-tidal-co2-monitor
 

BrightCandle

Senior Member
Messages
1,147
Its difficult to monitor Et CO2 at home. I purchased an End-Tidal CO2 monitor but its difficult to get a good reading while sleeping plus it doesn't record. I tried using a O2 cannula adapted to the EtCO2 with a video camera as the recording for its displayed CO2. But getting a reliable reading while sleeping is quite difficult.

https://contechealth.com/products/c...ograph-respiration-rate-end-tidal-co2-monitor

What about awake, is it a normal reading then?
 
Messages
37
What about awake, is it a normal reading then?
Yes but its a little tricky. Normal is a correct waveform as below with a value at peak in the 35-45 mmHg range. The tricky part is not over or under breathing and getting reading with a soft regular breath. Otherwise the value can be below 35 or exceed 45mmHg.

1632696529376.png
 
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@pgrovetom, where are you now with this situation?

Because it is SO similar to mine that it gave me chills when I read your post. My symptoms seem to be a bit less severe, yet at the same time the insomnia component alone has wrecked my life.

My experience:
  • Bad sleep began in 2019, starting around summer while camping and increasing in severity after taking licorice root. During this time I briefly had a Fitbit which measured dips in O2 at the time of awakening. I no longer have Fitbit or O2 data, as I got the device only while having lost my Oura ring, which I’ve otherwise worn consistently since early 2019. During most of my awakenings, it does show an HR dip, then spike as the body tries to recover. — I also just ordered a pulse oximeter after reading this thread.
  • When my HR dips around 3am / after 4 hours of sleep, I’m often awoken with a racing heart, rapid breathing.
  • I just recently learned to describe it as a “lack of saturation” in my breath, and only this morning (at 3am of course) had the epiphany that it could be lack of blood oxygen saturation, which led me to this thread by way of researching hypoxemia.
  • I typically never have the willpower/energy to get up and walk around to raise HR efficacy, however I have noticed a recurring tendency toward, ahem, masturbation, which I imagine has achieved the same thing. If you have a partner, maybe some 3am sex might be in order?
  • My onset was roughly associated to 1 weak or camping during summer 2019. My current, more open-minded doctor just ordered tests for EBV, lyme, etc.
  • However, my symptoms were severely exacerbated Nov 2019 when I had licorice root tea. Licorice root can cause pseudohyperaldosteronism, which I’m certain I experienced … however that’s an acute phenomenon, and here I am two years later:
  • In the last three months it has gotten worse, proportional to increased physical activity. So I should clarify that I don’t only have an HR dip + awakening, but now my RHR is too high: 80-100 during the day, and 60-68 during the night, sometimes 56-58 at night. But before Nov 2019 it was at 60-75 during day and 52 at night, WITHOUT hypoxemia symptoms. — What is your day RHR like?
  • I have severe lack of physical endurance. Used to be able to take long walks, now half a mile can wipe me out.
  • I tropically have diarrhea during these episodes, not constipation. However, my lower gut/abdomen does typically feel very tight and stressed from these episodes.
  • After these episodes my tongue is usually quite white (the muscle, not the surface) = anemia?
Here are the things I’ve tried with some success, especially within the first 1-6 hours, but the effects don’t “hold”:
  • Magnesium (citrate / Calm brand helped more than Glycinate)
  • Sodium (possible sodium deficiency? I heard in a podcast with Morley Robbins that he thinks serum sodium should be 141 or above, and chloride 105 or above. If this is true, I’ve been sodium deficient much of my life — which could explain exercise intolerance / low endurance. I’ve learned that some of the most common blood tests (serum sodium, serum magnesium, serum potassium) only gauge how well that particularly body system is functioning, not whether there are enough stores for the body to operate smoothly. Plus a week ago I woke up at 3am distinctly dehydrated, and a year ago I craved Pedialyte, which helped a bit at the time.
  • Potassium sometimes helped, especially with physical endurance/exhaustion.
  • Adrenal Cocktail: sodium + potassium + C.
  • Vitamin C seemed to help sometimes
  • Phosphorus. This is the most oddball, out-there supplement I’ve tried, but may have had the most success in mitigating 4-hour awakenings.
    • However the ionic liquid bottle I found on Amazon helped the most, but it became cost-prohibitive since the RDA of 750mg-1g seemed to help the most. I then found Sodium-Potassium-Phosphorus powder packets by Rugby, but the effect has been less. It’s worth noting that with either version of phosphate, taking it sublingual helped more than swallowing it: I have a blood test from last autumn showing my P levels right at the threshold for being low. Unfortunately, there’s no “RBC phosphorus” test to gauge storage levels like with magnesium, potassium, and zinc. However a hair mineral test may achieve this; I had one before licorice which showed it low; I also had an OAT before licorice showing P very low.
    • Note that I began researching P based on a theory of hypoparsthyroidism, as during licorice I was mega-dosing vitamin D to try to heal a different issue, and my PTH levels now come back quite low.
    • Another reason I explored P is because in Aug 2019, before the insomnia/hypoxemia really took hold, I did a 7 or 10 day fast. I did not manage electrolytes well since I was rather ignorant of the consequences of fasting/keto, and only later did I learn or refeeding syndrome, which can deplete P and vitamin B1! — I briefly explored B1 last week but may need to try even higher doses.
  • Lithium/B2/B9-MTHF. Still experimenting with this. My B12 levels were though the roof in January, but then I experimented with lithium and had a blood test last week, so I’m curious to see if B12 levels lowered due to increased usage by lithium, as I definitely felt lithium kicking in, and taking MTHF post-lithium led to overmethylation symptoms at way lower doses (2.5mg vs 12mg).
  • Biotin. Started taking larger doses in November and it distinctly induced sleepiness and at least getting me back to sleep after waking up.
  • Vitamin A. Began larger doses in January and it had a similar effect as biotin: great sleepiness. I suspect I’ve been deficient a while, especially after my vitamin D explorations. Vitamin A also resolved chronic eye tingling/prickliness … which has since returned, and is worsened by MTHF and lithium.
  • Serotonin and dopamine. I was deficient in both. Serotonin has not secured sleep / prevented hypoxemia, and dopamine merely helps me fall back asleep sometimes and feel refreshed, but it might be worth exploring neurotransmitters OP, at least to improve quality of life. Even in spite the insomnia, beginning 5HTP (and somewhat lithium) has greatly improved mood abs daily living. The questionnaire at bravermantest.com can help you gauge neurotransmitters; bebrainfit.com also links to two more quizzes in their article Serotonin Deficiency; also look into the bullet points from the book Mood Cure / take the quiz on the author’s website.
  • Vitamin B5. Sometimes this helped, sometimes not.
  • NAC for RHR, energy, brain fog.
  • Beets/arginine/citrulline for RHE and endurance.
  • Sometimes a snack before bed helped, under the theory of adrenal fatigue / hypoglycemia … but again, not dependably.
  • Calcium?? Either calcium helps improve my sleep/mood/RHR/stress, or it directly induces the 3am attacks. Unfortunately it might be both, so I’m unsure how to test it. The last time I took some during the day in January, it led to my worst 3am attack in ages, after which I explored cortisol/ashwaghanda, which helped a bit.
  • Copper: TBD. My RBC zinc levels are at the very high end of the normal range, after high intake over the last few months, and I’m confident I have a copper deficiency, which a 2020 serum+Ceruloplasmin test confirmed but I never addressed. Waiting on new results. The hypoxemia could relate to anemia?
And here’s a special shout-out to things that at one point or another helped me sleep through the night even with a hypoxemia awakening, rather than preventing it:
  • Ashwaghanda, maybe paired with theanine. This helped big time after a severe crash, but may have worn off.
    • Adrenal fatigue has been on my radar since 2019. I do sense these hypoxemia attacks correlate to low cortisol; before serotonin and ashwaghanda, my mood, energy, and brain-state was horrendous, with easy irritability and rage. Now, I’m still waking up, but my mind and mood are adequately functional, if not “great” considering the circumstances.
  • Methylation/MTHF/B2.
  • Serotonin.
Those are all of the things that have helped 1) sometimes lower my HR to normal and 2) get through the night. But again, not consistently or dependably. However I was not exploring hypoxemia with those tests, which I will now prioritize.

FWIW my approach to health has been 1) replenishing deficiencies and 2) balancing imbalances. Addressing deficiencies alone has been a big help. I’m also operating from the place of basic physiology. What could we be deficient in that is inducing hypoxemia? Is it only at night or also throughout the day? (I’m inclined to the latter, with that 3am HR dip just being a “weak spot”.)

Could we/I be low in nitric oxide? Supporting NO has helped my RHR in the past: arginine, citrulline, beets. I want to experiment further.

In my case, I suspect I have NO issues related to urea cycle / ammonia issues. One of my personal tests is soda, which induces fatigue and cognitive impairment / brain fog, which I think is ammonia. I’ll be doing a urine amino acid test after drinking soda to confirm. This possibly-ammonia symptom set began for me in Jan 2017 alongside molybdenum deficiency (since resolved) and would explain so much of my situation, since NAC helps brain fog and RHR sometimes, and the urea cycle uses arginine/citrulline/ornithine as much as NO production.

Oh, and the real kicker after reading your story: I track all of my supplements/symptoms/sleep quality in the app Bearable, which automatically computes correlations between these things. Earlier I was reviewing what helped sleep, and I found it so peculiar that caffeine showed up! Twice in January I meant to drink decaf but got normal coffee, and both times my mood and energy felt amazing/normal, and one time I even had caffeine too late in the day and did sleep through sleep wasn’t spectacular, I did sleep through to 6 hours without a post-4-hour awakening.

I may tentatively explore nightly caffeine… Like you OP, I don’t think this is optimal; but if you explore neurotransmitter support you may find it easier to mitigate the fallout of insomnia … until we discover what is causing acute hypoxemia… I thought my issue was chronically high RHR, however that only began with licorice, whereas hypoxemia began before and worsened after fasting + licorice. I wonder if 50mg caffeine to keep my HR really going paired with serotonin/ashwaghanda for mood support could be a winning combo unti hypoxemia is figured out.

I know my post has a couple of redundancies, some disorganization, and maybe typos, but that’s what four hours of sleep gets us. 🤷🏼‍♂️

If I get any updates from my doctor or experiments I’ll be sure to share. I currently have a NutrEval in the works and am eager to get it. Next: urine essential elements + amino acids, and more experimentation with B1 and nitric oxide.
 
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37
Hi.... I believe I have uncovered the reason for my problems - for real. Most of my problems vary with my circadian rhythm. There are secondary symptoms that ate not as clear but are themselves downstream effects. That means the symptoms trigger and then occur on a schedule during the day. I've done everything you have done and probably more. I've been to the Rochester Mayo Clinic, Columbia, John's Hopkins, Stanford, UCSF and a myriad of local or nearby clinics and doctors. I've been both the traditional Western rigid ( cookbook style) and a variety of functional or integrative doctors.

I've seen somewhere between 2 and 10 socialists and quite frankly think most are lazy unimaginative people who were lucky enough to get a medical degree but don't give a rat's butt about their patients. They use what amounts to a lookup process trying to match symptoms to a condition but rarely use their brain or creativity in the diagnosis process - even if they try a little. There are some notable exceptions to all this but they are few and far between. I applaud the few good ones and am disgusted by the 99% that are glorified technicians that failed their creativity tests.

Ok, so what have I discovered. Since many if not most of my symptoms can be easily tied to something happening during my sleep, I've exhaustively monitored my sleep and I had 2 formal Stanford sleep studies that showed exactly what I knew, I have very mild controllable obstructive sleep apnea. Mild sleep Apnea causes almost no problems - period. As things during my sleep became so severe upon awakening, I had to try anything less risky. By using an overnight pulse oximeter recorder ( downloaded to my PC the next morning plus a video camera with audio. It looked like my heart rate was dipping as low as 38 in the early morning (4-7AM) but I could tell I was getting ill in the high 40's. Very grossly it appeared as my heart rate dropped below 50 and circulation slowed, my body was in trouble but without any outward signs ( snoring, breathing, sounds, O2 sat etc..). - downright mystery.

So I decided I would use coffee, then caffeine and lastly theophyline to speed up my heart a little and it made a big difference. That clued me that the slow heart rate and controlling it might control my symptoms by upping my nightly heart rate - think circadian rhythm . That alone would be a miracle. But sleeping on these drugs which wear off in a few hours was awful. In Zooming with a UCSF muscle neurologist, one of his comments was that caffeine and similar drugs influence the critical adenosine pathway/cycle plus a few other pathways. He thought I shouldn't be to quick to think about a pacemaker just on the basis of a slow heart and the complexity of the adenosine and how something like caffeine helped. Like the other doctors, he didn't want to be involved but his comment led to a miracle.

Three of my easiest problems to trigger led me back to PubMed trying to see if adenosine could tied to my symptoms/problems. The three areas I investigated were heart rate, extreme full body restless legs and my myriad of GI issue.

Sure enough adenosine which is at the basis of sleep, heart rate, GI and restless legs were easily tied to everything in an uncanny way. High adensosine regulates sleepiness and sleep. High adenosine cause restless legs - not dopamine, High adenosine cause extreme stomach acid which 2 endoscopes had shown my duodenum was badly burned - my GI leaky gut/IBS/constipation etc.... But over the counter acid reduces did nothing.

The next day ( 4 days before a Stanford full blown sleep study), I stopped caffeine in all forms. My circadian rhythm oriented and downstream symptoms stopped. Of course I passed the sleep study - duh. After stopping caffeine or anything that effects the adenosine receptor subtypes (A1, A2A, A2B, and A3).

Its now been 6 weeks and my symptoms ( related to all my posts) and all these issues are GONE. I am sensitive to caffeine or any drug that effects its functions. I did not drink a lot of coffee ( 1-3 cups daily) and now won't go anywhere near it in any form . So far so good. I can eat anything, no lung issues, no GI. no neurological etc...

So it turns out my problems are all tied to the interference in my adenosine pathways and its circadian cycles . Adenosine cycles daily in concert with melatonin. If too high, it will override any attempt by the autonomic nervous system. Too much adenosine during the daily cycle can cause havoc. It modulates the immune system, acts as a neurotransmitter, is deeply involved in digestion, the endocrine system, CNS and PNS and list is endless. But why me when billions of people drink lots of coffee with no ill effects - except maybe a bit wired. Maybe my mitochondrial ( mtDNA) 6kb deletion is making me very sensitive.

At a very simplistic level, adenosine is carefully regulated both intracelllar and extracellular via ENTs. Its half life is minutes. Excess is broken down to Inosine and up converted to AMP, cAMP, ADP and finally to ATP via the mitochondria. This very carefully managed. I'm obviously on the edge and all it takes is coffee or caffeine to push me into crisis.

So I would recommend to all Chronic Fatigue people to avoid caffeine - period. I'm now also suspicious that there may be far more people like me but the amount of caffeine they take in causes them more subtle problems rather than ER visit caliber problems I've experienced. I haven't looked into it as yet but I would also recommend everyone here to keep a close eye on their caffeine input and look for ways to modulate ( carefully) their adenosine cycle. Since adenosine has a very very short half life in minutes plus its utilization is both intracellular and extracellular, it can't just be tested unfortunately. Creative ways need to be found to vary the adenosine cycle carefully and look for effects. Good Luck
 

Violeta

Senior Member
Messages
2,895
@pgrovetom, this is so interesting! I don't understand it very well yet, but I think I need to.

Sure enough, I just googled Parkinson's and adenosine, and so many hits.

I drink decaf and at times at a small amount of regular, but don't drink much on a daily basis. I used to find that drinking some during the night would help me fall back asleep. I thought it was strange, but...

I prefer tea, but do find it makes symptoms much worse, despite all the literature saying how good tea should be for me.

It's not been too bad lately, but I had for many years been waking up with a drugged type headache, difficult to move, and one morning I decided to take my pulse and it was almost the same as yours, 53. It speeded up when I stood up, but couldn't stay standing or focus long enough to see if the jump qualified me for orthostatic hypotension. That's when I started to work on my issues from that point of view.

I see that meat can be a source of adenosine. I recently switched to vegetarian and the morning headache has been greatly reduced. I wonder if some people have to avoid even meat.

Amazing that adenosine causes restless leg and I had never heard that until today. I at times have had whole body restless leg, too. Strange, though, is that it was the worst when I was vegan and drank neither coffee or tea.

If you figure out anything else, please keep us posted.
 
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Violeta

Senior Member
Messages
2,895
If adenosine issue is my problem, too, and it seems to be, I am wondering why Butcher's broom, a norepinephrine agonist, would be so helpful.

I found this:

"In a variety of in vitro models, adenosine has been shown to inhibit norepinephrine release from sympathetic nerve endings. Adenosine A1 receptors are thought to be involved in"

"Butcher's Broom acts on the blood vessels by stimulating the release of norepinephrine, which then produces a vasoconstriction effect."

But what causes one to have so much extra adenosine?
 
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If adenosine issue is my problem, too, and it seems to be, I am wondering why Butcher's broom, a norepinephrine agonist, would be so helpful.

I found this:

"In a variety of in vitro models, adenosine has been shown to inhibit norepinephrine release from sympathetic nerve endings. Adenosine A1 receptors are thought to be involved in"

"Butcher's Broom acts on the blood vessels by stimulating the release of norepinephrine, which then produces a vasoconstriction effect."

But what causes one to have so much extra adenosine?

Adenosine goes through cycles saily so "too much" may not the best way to describe it
 

Violeta

Senior Member
Messages
2,895
Is the problem that the adenosine builds up because it isn't being metabolized. Is the problem a lack of adenosine deaminase activity?

A lack of adenosine deaminase activity might also be the cause of caffeine sensitivity?
 

Violeta

Senior Member
Messages
2,895
I can't get to this study, but this is very strange. Peroxynitrite does something beneficial?

"Peroxynitrite treatment reduces adenosine uptake via the equilibrative nucleoside transporter in rat astrocytes."

I take that back, this isn't a good thing.

"In the oxidative stress-loaded brain, extracellular adenosine levels are elevated and thereby neuronal damage is attenuated, but mechanisms underlying alteration of the extracellular kinetics of adenosine remain unclear."