Nasal pillows and oxygen

Hi. I sure hope someone can help me. I was released from the hospital day before yesterday. I had a major exacerbation of my COPD. Anyway while in the hospital they determined that I also have sleep apnea. I am scheduled for a sleep study but that is weeks away unfortunately. In the meantime, at the hospital they fitted me with a full face mask, which I hate. I am claustrophobic and besides that, the thing is like putting your face in a vice. So when I got home my oxygen provider brought me a machine and nasal pillows instead of the mask. It felt great compared to the mask, BUT, when it comes to actually using it, I have a huge problem.

In the hospital I had the same problem with the mask. They had put the oxygen so it was running through the machine. The machine was set to ramp from 6 to 14, but my sats dropped as soon as we got it started. I could breathe deeply and bring them back up but as soon as I breathed normally again they went down again. The solution was to put the oxygen directly to the mask. I use 2.5 liters.

Using the nasal pillow it is the same problem with my sats dropping. We put the oxygen in with an adapter right before the hose attached to the mask, but irregardless, my sats drop.

Am I not using the nasal pillows correctly or what? When I put them close to my nose I feel all kinds of air but as soon as I put them IN my nose I barely feel anything at all.

Any help at all will be so appreciated.

When "breathing" w/your nasal pillows and CPAP are you breathing thru your mouth at all? Between your lips?

The setting of 6 to 14 sounds like they gave you an APAP? Take a good look at the top of your APAP and tell us what brand and model it is.

How long do you leave the mask w/APAP on before you have to take it off?

I'm thinking in terms of the starting pressure being too low. The Ramp option set for too long. The A-Flex or C-Flex not being needed or set too high.

No, not at all. And I use a chin strap....but I have not even been able to go to sleep yet...the sats drop before I get to that point;/

I listed the likely areas of cause. I asked some questions you didn't bother to answer or even acknowledge. Chin straps don't prevent "the lip flutters" which are a common cause of too much leak thru the night. If you want help you have to share enough information for us to work with.

I am so sorry, I did not even see the other questions. What a dufus I am;/

Ok, it is a resperonics machine, with ResMed Swift FX nasal pillows. The hospital told the supplier of the Cpap to set it 6 to 14 so thats what they did.

I'm sorry, I don't know what APAP is??? But I have only been able to keep the mask on...less than 10 minutes before I am down to 85 on my sats, which at that point I bail. One time the machine had ramped up to 12, but it didn't make any difference.

Like I said I had the same problem with the full face mask until they put the oxygen hose right on the mask itself, then I stopped desatting. Is it possible that because with only 6 to begin with, all the oxygen is not being pushed to me or it is diluted somehow?

Brand and Model: Phillips Resperonics, Remstar Auto Aflex

CPAP machine...constant pressure is delivered.
APAP machine...you can have varying pressures.. your 6 starting out point and if the machine senses apnea precursors it will increase the pressure in response to those events up to the maximum that you machine is set at. APAP machines also can be set in CPAP mode to deliver a set pressure.

What is your starting O2 saturation before it goes down to 85% withing 10 minutes at 6 cm of pressure?

Normally O2 is added to cpap machines at the humidifier junction level and not at mask level.

I was going to send you a link for the provider manual for your machine so you can read about your machine but you are not registered so I can't send you a private message.
Please register and list your equipment like I have mine listed.
In the meantime..there is a video explaining your machines features. Also check out my signature line for information of software (SleepyHead) which you can also use.
http://www.cpaplibrary.com/machines.html scroll down till you see Respironics PR System One

You need to visit with your DME and tell them about the desats. If you can't maintain adequate O2 levels because you are breathing too shallowly then perhaps they need to re-evaluate the concentration.

The highest my 02 sats are when I start is 95 on 2.5 liters, and it could be as low as 1 if I have been talking a lot or moving about a little. Then after putting on the mask within 5 minutes the numbers start going down. I let it go to 85 today and called it quits at that point. My respatory theripist at the hospital wanted me to be on 2.5 so that when I get into trouble with my o2, there is someplace to go, and because that prevents co2 build up she says, but.....I am at a loss;/ I do appreciate your help so much!

Hanna wrote: and it could be as low as 1 if I have been talking a lot or moving about a little.

Is this a typo? As low as 1...you would be passed out permanently or the device is not recording properly.

What device are you using to measure your Oxygen level? A regular finger tip oximeter for use while you watch it or one that records over several hours. Have you verified that the device is accurate?

I would be taking all the stuff (machine and mask and oximeter) to supplier and be testing things with them and using another device to make sure that your device is reporting properly. They may need to alter O2 line placement if there is indeed such a drop in O2 but they need to see the problem in person and fix it in person.

Do you have other health issues or lung issues that will impact your ability to breathe or get proper ventilation?

Yes, sorry, that was a typo...I meant 91, when I begin. i run i91 to 95 if I am just sitting around or whatever. I have COPD, which is why the oxygen. The Dr. prefers I be between 88 and 93 so I don't build up co2.

I am using a finger oximeter and yes I have verified it. I got it while still in the hospital and compared it to the table top oximeter they had in the hospital, however I am hoping to buy one of those very soon.

I would suggest a face to face with your cpap machine/mask with your supplier and show them that the O2 levels are dropping below adequate levels even while awake..and let them come up with some method to add the O2 and have it keep your O2 levels where they need to be.
Either modify O2 line entry point or adjust O2 concentration since you say that even near your max pressure while awake that your levels go too low with your particular respiration force.
It is unrealistic to expect you to breathe "harder" to maintain O2 levels because you can't do it while asleep.

They should be able to make it work with the nasal pillows since that is the mask you prefer.

Currently they have an adapter between the hose on the mask and the rest of the hose, but it is like somehow the oxygen is diluted or...??? would it be dangerous to turn it up to perhaps 3 instead of 2.5?

You could try turning it up while you are awake and see if a small increase in concentration is sufficient.

I don't think that there is any danger with such a small increase but you really shouldn't have the desat while awake anyway. That part just doesn't make any sense.

There are some O2 users here on the forum and they could address the safety aspect better than I can since I have no direct experience using added O2. I bet they will be around tomorrow and comment further.

Thank you for all your help:)

Ahhh, good! Now we are getting some information we can work with. I also have COPD, am on 02 pretty much 24 hours a day, and of course, w/my VPAP Auto overnight (VPAP is Resmed's proprietary name for a bi-level PAP, just as BPAP is PR's (Phillips Respironics) proprietary name for their bi-level PAP).

I'm not a fan of nasal pillows masks myself. Just a personal preference, I'm not wild about such direct air pressure in my nasal passages. My preference was for the ole Respironics Simplicity simple nasal cushion mask due to there being so little of it, lightweight, no forehead brace, fit lower on the nose than most nasal cushion masks. Alas, I can't seem to keep my mouth shut. A chin strap only helped w/actual open mouth breathing. The chin strap could do nothing for "the lip flutters" so I still had too high a leak rate due to air sneaking out between my lips.

I've probably been thru 20 masks before trying 3 different full face masks until I found the Resmed Quattro FX. It is lightweight and has no forehead brace and less to it than most full face masks. I can read or watch TV whilst wearing it.

But back to the COPD and 02 saturation. At rest (watching TV, at 'puter, reading, etc.) my sats tend to run 88-92 on room air; 92-94/95 on 2L of 02 and 96-98 on 3L of 02. I don't do well w/the pulse regulators at all so when out and about on 3L pulse I'm not even sure how low I desat but its not pretty! After walking maybe 4 car lengths from my car to my doctor's waiting room, sitting for 5 minutes, walking maybe 2 car lengths to the exam room, all on 3L pulse my BP will be running 147/70+ whereas at home at rest on 2L continuous flow 02 my BP tends to run 98/51 w/a 69 pulse.

The above is just to give you something to compare too. Pugsy has given you EXCELLENT advice!!! Pack up your APAP, your mask and your 02 and go to your DME provider's RT and have him/her help you find the settings you need to be able to breathe w/your mask and APAP.

Meanwhile we need someone successfully using nasal pillows to address your question re:

... Am I not using the nasal pillows correctly or what? When I put them close to my nose I feel all kinds of air but as soon as I put them IN my nose I barely feel anything at all. ...

I'm taking a shot in the dark that you are probably tightening your Swift too tight. My understanding is that the pillows should fit snugly, but comfortably against the bottom of your nose but not actually penetrate up into your nose.

Has your pulmonologist ever referred you to Pulmonary Rehab?? It can't restore your lungs, of course, but it really can help to extend your endurance and ability to do.

Slinky wrote:Meanwhile we need someone successfully using nasal pillows to address your question re:

... Am I not using the nasal pillows correctly or what? When I put them close to my nose I feel all kinds of air but as soon as I put them IN my nose I barely feel anything at all. ...



I'm taking a shot in the dark that you are probably tightening your Swift too tight.

Ahh...this one.. with a starting pressure of only 6 cm...the nasal passageway will quickly adapt and what feels like a lot of air initially will quickly feel like no more hurricane very quickly going up the nose. Higher starting pressure will take a bit longer to acclimate to.
If air seems immediately seems stifling or suffocating with tension then the straps may be too tight. This would be immediate as opposed to the 10 minute desat thing and is why I didn't put the blame on the desats on the straps being too tight. If the pillows get squished with too much tension the "no air movement" feeling is both immediate and quickly profoundly uncomfortable and not something you would sit through for 10 minutes.