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Lower oxygen sat level
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Lower oxygen sat level

My dad has severe sleep apnea and moderate COPD.He is on supplemental oxygen. He should be on O2 for 24 hrs, but he takes like 15 to 17hrs a day.
I have few questions on my dad’s sleep apnea and supplemental oxygen and oxygen saturation level.
I wish I could attach the sleep study with this.
His Bipap machine Respironics Bipap auto SV with humidifier.
His mask Flexfit 431.1, His EPAP/IPAP is 27/25 cm H2O along with the supplemental oxygen 2 L/min.
He uses the Bipap machine with oxygen while sleeping and gets full night sleep.
But his oxygen saturation level is not going above 90% even when he is on oxygen.
His oxygen sat is between 85 to 88% with and with out O2.
But his sleep study shows that it was greater than 90% when he was with the machine and O2.
This should not be the case, right?
His O2 level should go up while he is on O2. Do you think that he is losing some of the O2  from the mask?
He doesn’t have any discomfort or doesn’t feel bad. But he has stuffy nose for last 3 days.Today he got his lowest O2 sat count which is 65%.
But the O2 level is alarming for us and the worst part is it fluctuates.One sec it would read 80, next second it would be 70.Why dose it fluctuate like that?
He uses Nonin 9500 Onyx Fingertip Pulse Oximeter.Please advise us what is happening.

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Sorry, but I am a bit confused by some of the information you have provided.  For example

His Bipap machine Respironics Bipap auto SV with humidifier.
His mask Flexfit 431.1, His EPAP/IPAP is 27/25 cm H2O along with the supplemental oxygen 2 L/min.
He uses the Bipap machine with oxygen while sleeping and gets full night sleep.
But his oxygen saturation level is not going above 90% even when he is on oxygen

As far as the above goes, it sounds alright, save for his oxygen sat not rising above 90%.  One would expect it to rise but any where around 90% would be fine, especially if he is experiencing good quality sleep.

You then state: His oxygen sat is between 85 to 88% with and with out O2.
But his sleep study shows that it was greater than 90% when he was with the machine and O2.

My first question would be, were the conditions of oxygen delivery the same or nearly so, in the two circumstances.  Something as simple such as oxygen leakage (as you suggest) could be the answer.  You then mention the wide swings in oxygen saturation.  This too suggests an oxygen delivery problem, either at the oxygen source or at the mask.

And then you state: Today he got his lowest O2 sat count which is 65%.

This score  is unacceptably low.

The best advice I can give you is that you contact the “sleep doctor” for his/her opinion.  It will probably be necessary to repeat his sleep testing and seek correlations between the falls in oxygen saturation and direct observations by sleep personnel regarding mask tightness, oxygen flow, respiratory rate and depth.  He may still, despite the BiPap, be having obstructive sleep apnea.

As for this statement: His EPAP/IPAP is 27/25 cm H2O

These are high pressures.  You and the sleep doctor should reevaluate these pressures to determine if they are necessary and optimum to control recurrent airway obstruction.

Your questions can only be answered with certainty, with sustained, direct observation of your father’s breathing pattern and the effect of any (especially abnormal) changes on oxygen saturation.  For this to be valid will require careful calibration of the oxygen percent measuring device.

Good luck
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