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Low O2 sat. when falling asleep
Hello Dr.,
I'm a 24 year old male who is on the skinny side and doesnt snore.  For the past year or so I've had off and on trouble sleeping.  I decided to borrow my uncles pulse oximeter that he has and to see if I was having any changes in my O2 sat b/c everynight as I start to dose off and fall asleep i get this smothering feeling and feel like i'm not breathing deep enough.

So i did some experimenting w/ the pulse ox and during the day my O2 saturation is always around 97-99%.  However, at night when i'm dosing off to fall asleep and i get this strange smother feeling (like i'm not breathing deep enough) or even sometimes when i dont have that feeling but when i'm about to fall asleep, i look down at my finger and the pulse ox reads anywhere from 86-90%.  As soon as i notice that low reading i take a few deep breaths and it goes back up to normal. This only happens if i'm going to sleep and not focusing on anything else.  When i'm laying in bed w/ the lights off watching tv the readings are always normal.

I had an echocardiogram done in the past year and it was normal.  I also had recent bloodwork and everything was normal except my TSH was 3.75 which is a bit high for me (a few months ago it was 1.9 and it is always in that range around 1.8-2)...I also have had unexplained mild elevations in my ALT since Novemember and i finally had a liver biopsy in july which showed mild nonspecific portal and periportal hepatitis.  They just been watching my alt since then and it's been 71 a month after biopsy on august 2 and 52 10 days ago.  

What could this low pulse ox % thing be?  What kind of tests show i seek out and what kind of doctors.  Sometimes i have shortness of breath but i had a chest xray and pulmonary function test and they were normal.  I also had echo like i said and exercise stress test a year ago.  Everything has been normal.  However, like i said, this low ox sat. at night is strange b/c it correlates w/ the smothering/not breathing deep feeling i'm getting as i'm dosing off to fall asleep.  There was even a few times when i woke up feeling like i couldnt breath but i shalked it off as anxiety.  It's strange though b/c i dont snore and i'm not overweight, so sleep apnea doesnt make sense.  The other symptom i've been having is heat intolerance this summer as well.

Could this be high pulmonary pressure or some kind of lung disease?  I do have back pain on my mid left side but it hurts really bad on certain twists/movements, so not sure if it could be my lungs?

thanks for helping me figure out the direction i should go w/ this pulse ox reading issue.  i've checked it many nights to make sure it is accurate and it continues to do the same low reading when i'm dosing off.  thanks again.

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233190 tn?1278553401
Sleep apnea would be the condition I would consider and want to evaluate for.  The most reasonable test would be an overnight sleep study, which can be discussed with your personal physician, or via referral with a pulmonologist.  

The sleep study would evaluate for desaturations and diagnose any episodes of apnea (i.e. moments where breathing briefly stops).  If sleep apnea is present, the treatment is with a CPAP (continuous positive airway pressure) machine.  

You may want to discuss this option with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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