How many CPAP users require supplmental O2? Updated reports

[slaaplekker]

I've been on CPAP for about a month, and to be honest I don't feel much if any better most days. My statistics from my machine look pretty good AHI, is always less than <2.0 and usually <1.0 so from the CPAP side I think things are OK. So I decided I should also check my 02 saturation and purchased one of the recording Oximeters. I slept one night without CPAP to get a baseline and then compared a normal night with CPAP. The O2 sats are marginally better on CPAP. I still had events below 88 and my basal 02 Sats moved from 92.3 to 92.9 with CPAP but I still had some desats events dipping down in the upper 70's. Previous official overnight Oximeter tests and my sleep study both showed similar dips I think my lowest on an official test was 71%.

I already understand the dangers of low 02Sat's, for many years I worked as a Clinical Laboratory Scientist and have performed literally tens of thousands of blood gas tests over the years, so I'm not taking this lightly.

I'm picking up an official Oximetery tonight since the Dr's office needs one done on their equipment before they decide whether I need to have 02 added to my CPAP.

I've also tinkered with increasing my base pressure to see if that helps and have had minor success when raising my range from 8-15 to 9-15 to 10-15. My normally nightly range for the last month has been between 8-11 CM/H20.

I only know of one other CPAP user who has 02 added to their CPAP so I'm just wondering how common it is to need additional 02?

thanks
John

[Slinky]

Generally, well actually, to the best of my knowledge supplemental 02 w/CPAP should NOT be needed UNLESS one has an underlying lung condition. Even many w/COPD are better treated w/proper PAP titration than w/02 supplementation in addition to CPAP. The good RPSGTs do not even consider 02 supplementation until they've proven PAP can't be titrated to eliminate the desats.

Given what you are saying I would think that a good thorough PFT and possibly even ABG would be a good idea. My pulmonologist didn't fool around, he put me thru a full PFT and INSISTED on a 6 minute walk on room air IMMEDIATELY followed w/in 20 seconds by an ABG when I first started w/him. And silent GERD should also be seriously considered and an upper endoscopy done.

[Jaylee]

Not me but my Dad does.

[profoundapnea]

I have read some with ephysema and copd (basically chronic smokers) have needed oxygen supplementation. I have been wondering if I need it, because my oximeter stayed around 90-95 when I had it, never 100, and my numbers in teh sleep test were so low my heart stopped. The numbers were higher once I got on the bipap.

[slaaplekker]

Thanks Slinky, I've already had the endoscopy done for another reason and it was clean. Already have GERD and have for 20+years. I've been on every PPI that was released over that time. The PPI's have always been a life saver. I'm paying for them out of my pocket now since the insurance claims they are only approved for <21 days. I will see how the overnight Oximetry compares with my CMS-50D+ that I have. Maybe it is just off. I'm planning on wearing it the whole time on a different hand but same finger that I always do and see how that goes.

My friend that is on supplemental O2 actually had O2 added during the sleep study so he has been on it since day one and he is just a young guy around 30 if he is that old.

I appreciate the information.

regards
John

[slaaplekker]

I have read some with ephysema and copd (basically chronic smokers) have needed oxygen supplementation. I have been wondering if I need it, because my oximeter stayed around 90-95 when I had it, never 100, and my numbers in teh sleep test were so low my heart stopped. The numbers were higher once I got on the bipap.

That doesn't sound good you might want to follow up with the Doctor and see what your results are now that you are on sleep therapy. I don't smoke but my parents did but that was many years ago since I was in a smoking environment.

My doctor mentioned a follow up overnight Oximetry when was getting the prescription for my APAP so he already had it in mind. I just jumped the gun and bought an Oximeter since I didn't want to have to wait to schedule one an be billed $50 every time. The nurse didn't sound like it that abnormal to add O2 so I was wondering how common it is.

I think 95-97% is considered normal saturation at least it is around here where we are at 4336ft. I only ever saw 100% in the hospital when a person was on O2 and if the results came back that high they almost always decreased the amount of O2 the patient was getting. I would be happy if my sats stayed above 92%.

They really couldn't get a decent reading for me on the titration study. The sleep doc basically said that 9 looked like the best fit given the results. They made it up to 13 but my results on pressures above 9 had more AHI's they higher they went.

Thanks for the feedback everyone.
John

[Mycopsycho]

I received my oxygen generator today and tonight will be my first night on it. In my sleep study my O2 sat level averaged 83% and fell to 73% at one point. In a follow up nocturnal pulse oximetry test after being on cpap for about 10 days my average was 86% with a low of 74% and a high of 90%. My PCP ordered up an oxygen bleed into my cpap and this is what begins tonight. This is a big life style change for me so I will follow this thread and others related to the subject with interest. I'm about to request a referral to a pulmonary specialist or sleep doctor since I'm not sure how knowledgeable my PCP is in this area.

[Goofproof]

I go with what Slinky said. I don't think much benefit is gained from added O2 with XPAP, they generally add 2 units of O2 to the mix, most of that is washed out by the vent. When I was on it I cranked it to 4 units on cpap and 2 in the day. After one year they stopped the O2, (what I don't understand my stats were the same as when they put me on it.)

Your equiptment is listed in ICONNY instead of TEXT, and no mask is listed at all. I'm betting you use a nasal mask!!!!! You should post the Dailies from your software so others can see whats really going on. Leak rates make data collection poor. Jim

[Slinky]

These home 02 concentrators can be noisy and throw a lot of warm air. We put mine in a room adjacent to our bedroom on a scrap of carpet (we have hardwood floors) and hubby drilled a small hole in the shared wall just above the footboard and ran the tubing thru the hole to my VPAP.

You will also want to notify your electric power company that you are on life-saving equipment (i.e. oxygen) and ask if they have a discount rate for those using 02 concentrators. Our electric supply company does and they sent us a form to have my doctor fill out and sign and then return to the power company. These home concentrators can add a hefty amount to our electric bills. In some areas, if used 24 x 7, they can add $30 to $40 to the monthly electric bill.

[fogman]

My cardiologist had me on O2 before my sleep tests were completed. After one week on CPAP (which made a big difference in how I felt the next day) I had a new oximeter test that showed lowered O2 saturation even with the CPAP. My cariologist requested that the oxygen concentrator be hooked up to my S9. I would certainly prefer to up my pressure (currently 7 cm) rather than put up with the noisy O2 machine. Perhaps I should talk to my doc about this. In any case, CPAP is working very well for me. My AHI is consistently below 3 and I feel so much better.

[scbeaver]

To those on oxygen concentrators, What brand is your machine? My wife is on O2 at night and we keep the concentrator in the living room and run a 25 foot hose to the bedroom to keep the noise down. I just changed DME's and during our visit O2 concentrators came up. The Respronics EverflowQ concentrator is QUIET. You could have it in the bedroom with a fan on and not hear it. We are in the process of changing. By the way Lincare provides the noisy Invacare unit.

Sleep Well

Steve

[Slinky]

I had a DeVilbiss 5L for 4 years when it died. (It wasn't new when it was provided to me). My provider replaced it w/an Invacare Platinum XL 5L. Both were/are noisy and expel a lot of heat. When traveling out of town in 2008 the 3L DeVilbiss I had been give to take w/me died and my provider made arrangements w/a local provider to give me a loaner.

I so wish I had paid attention to the brand and model!!!! It was soooo quiet as compared to the DeVilbiss and Invacare that I've had for use!!! It was provided to me in Rochester, MN by NorthWest Medical Care out of St Paul, MN. I was staying just across the street from Praxair in Rochester but they wanted to gouge my local provider too much for the loaner concentrator and it was cheaper to go w/NorthWest Medical Care. I don't know what concentrator Praxair would have provided but I sure did like the concentrator that NorthWest Medical Care provided!!!!!

[slaaplekker]

I go with what Slinky said. I don't think much benefit is gained from added O2 with XPAP, they generally add 2 units of O2 to the mix, most of that is washed out by the vent. When I was on it I cranked it to 4 units on cpap and 2 in the day. After one year they stopped the O2, (what I don't understand my stats were the same as when they put me on it.)

Your equipment is listed in ICONNY instead of TEXT, and no mask is listed at all. I'm betting you use a nasal mask!!!!! You should post the Dailies from your software so others can see whats really going on. Leak rates make data collection poor. Jim

Hi Jim,

Thanks for the reply and the information. Here is the latest info I can get from the Encore Viewer for whatever reason it only allows me to see the data that is more than a day old. I'm guessing it is because today isn't complete so it won't show last nights data but here is the data from the night before.



and here is last nights Oximetry results from my CMS-50D. I don't have the official Doctor's report back and probably won't until next week.




And I updated my mask, I wasn't sure what I had when I set up my profile so now that is complete and it is a Respironics Easy Life nasal mask. The DME said that is the one that he uses, I tried it at the office and it felt better than the others so I've been trying to get it to work for me. I thought the leaks looked pretty good but maybe I'm wrong.

thanks
John

[sleepmba]

Generally, well actually, to the best of my knowledge supplemental 02 w/CPAP should NOT be needed UNLESS one has an underlying lung condition. Even many w/COPD are better treated w/proper PAP titration than w/02 supplementation in addition to CPAP. The good RPSGTs do not even consider 02 supplementation until they've proven PAP can't be titrated to eliminate the desats.

Given what you are saying I would think that a good thorough PFT and possibly even ABG would be a good idea. My pulmonologist didn't fool around, he put me thru a full PFT and INSISTED on a 6 minute walk on room air IMMEDIATELY followed w/in 20 seconds by an ABG when I first started w/him. And silent GERD should also be seriously considered and an upper endoscopy done.

Excellent point. It looks as if Slaaplekker is on APAP. In the lab, when I have to deal with low Oxygen sat's and CPAP is not doing it, I go to BiPAP. Most of the time, BiPAP will bring up blood Oxygen levels better than straight CPAP or APAP. Maybe a BiPAP trial or BiPAP titration could be arranged through your doctor.

[Slinky]

Thanks, SleepMBA, I forgot to get around to the bi-level bit. As a look at my sig will tell you, that bi-level bit is where I am at now.