saturation C02 level's drop while trying to use

Im hoping someone here can help me, I went back to see the drs that got me the trilogy, I have not yet had a sleep study because my need is mainly I'm a c02 retainer or I have neromuscular pulmanory failure and am hypercapnic, the dr increased my trilogy from 12/8 to now 18/10 rr15.
I use C02 24/7 @ 2.5lpm and my C02 during sleep is now bumped to 4 LPG.
My big problem is my saturation drops below 70 as soon as I start to fall asleep, I thought it was all because of leaks but I think I have those all fixed for now. My husband sat up and watched my saturation level and each time we tried I quickly dropped below 70 so we aborted what am I doing wrong? I feel like I'm not getting my last breath really out before my next one is being forced down me, and does it make any difference where the oxygen line enters? We have tried the back of the trilogy machine and also on the tubing itself, at both ends. Has anyone had low saturation levels while using there non- invasive vent? Any input is appreciated, I hoping Madalot will see this.
TIA all

Anyone here use oxygen with there cpap? Or bipap? I'm interested in talking about any success?

Yes. I use 2.5 LPM into an adapter at the mask. This generally keeps my nadir above 88 and my average around 92 or 93.
Without the O2 I would drop to the low 80s and occasionally the high 70s.

I am confused by your reference to CO2 rather than O2.

You may want to get in touch (PM) the member Madalot she uses both O2 and a trilogy.

bwexler wrote:Yes. I use 2.5 LPM into an adapter at the mask. This generally keeps my nadir above 88 and my average around 92 or 93.
Without the O2 I would drop to the low 80s and occasionally the high 70s.

I am confused by your reference to CO2 rather than O2.

I guess I'm not very well versed in all the lingo I'm new to all this I was only referring to my oxygen, thanks for the correction, I learn something new daily my problem is when I try to go to sleep my saturation level drops fast and we stop and I go back on my cannula at 2.5lp.

My dr just changed my setting and also told me to bump my 02 to 4 lpm when hooked up! Clearly something is wrong, my setting on my bipap were 12/8 and auto for something else but this trilogy the dr increased my presure setting to 18/10 and a rr15 I feal like I'm not getting my last breath out before my next one comes and it prevents the fresh 02 from making it to my lungs if this makes sense?

BlackSpinner wrote:You may want to get in touch (PM) the member Madalot she uses both O2 and a trilogy.

Thanks I will pm Madalot also.

I have to say that this doesn't make any sense at all and you are justified to be concerned.

Looking at some possibilities...

When you go to sleep you stop breathing? If not what is your respiration rate? and what is a "normal" respiration rate?
Your mask set up may be allowing you to re-breath some of your air? I don't think this is going on but it needs to be eliminated. Are your mask vents open and working?
When you go to sleep you loose circulation to your hands? This would render the oximeter results from a finger mounted unit inaccurate. Perhaps an earlobe unit would tell a different story?
Your oxygen supply is corrupt and your oxygen metering equipment is malfunctioning? This is also highly unlikely but should be checked.

At any rate you need to contact your doctor and report that you are seeing your oxygen levels drop to 70% even at higher O2 flow rates. Tell them you think 70% may be a "little on the low side", and you feel like crap. That should get their attention.

Indi's Gmomma wrote:My husband sat up and watched my saturation level and each time we tried I quickly dropped below 70 so we aborted what am I doing wrong? I feel like I'm not getting my last breath really out before my next one is being forced down me, and does it make any difference where the oxygen line enters? We have tried the back of the trilogy machine and also on the tubing itself, at both ends. Has anyone had low saturation levels while using there non- invasive vent? Any input is appreciated, I hoping Madalot will see this.
TIA all

How did your husband watch your saturation level? What was he watching?

Madalot wrote:

Indi's Gmomma wrote:My husband sat up and watched my saturation level and each time we tried I quickly dropped below 70 so we aborted what am I doing wrong? I feel like I'm not getting my last breath really out before my next one is being forced down me, and does it make any difference where the oxygen line enters? We have tried the back of the trilogy machine and also on the tubing itself, at both ends. Has anyone had low saturation levels while using there non- invasive vent? Any input is appreciated, I hoping Madalot will see this.
TIA all

How did your husband watch your saturation level? What was he watching?

Yes hubby stayed up and watched my larger Drive Oximeter (model #18715) with the alarm turned off so I could fall asleep. I do have neuropathy in my hands and feet from Gullian Berré but Hosp confirmed my low sat with abg's (arterial blood gass)

Have you seen a pulmonologist? This strikes me as an issue that's well above our pay grade, so to speak.

You have told me via PM that your Trilogy is set up in S/T Mode with AVAPS (you read it off the screen).

I use the same mode with AVAPS as well.

I would be interested in your specific AVAPS settings:

Min IPAP
Max IPAP
EPAP
Tidal Volume

If anyone with more experience comes in, they'll want to know what these settings are.

I just saw a Pulmoligist but basically only to get this trilogy going, at this point I have not been tested for sleep apnea or for a sleep study although the Pulm ordered it (to be scheduled)

Dr marked under bi-level pressure settings 18/10 RR15 oxygen 4 lpm I copied this from the form I gave my rt.
Before I the script said I??? 12 EPAP 8 Eauto? Oxygen 2 auto timing m mode b? pap (?=can't make out)

What does the above all stand for?

Thanks to everyone that helps

Indi's Gmomma wrote:I just saw a Pulmoligist but basically only to get this trilogy going, at this point I have not been tested for sleep apnea or for a sleep study although the Pulm ordered it (to be scheduled)

Dr marked under bi-level pressure settings 18/10 RR15 oxygen 4 lpm I copied this from the form I gave my rt.
Before I the script said I??? 12 EPAP 8 Eauto? Oxygen 2 auto timing m mode b? pap (?=can't make out)

What does the above all stand for?

Thanks to everyone that helps

I am concerned that AVAPS is enabled but you haven't been told what those settings are. I hope whoever set it up knew what they were doing with it.

It ALMOST looks like they ordered Auto EPAP, but according to what you told me, you are NOT using AVAPS-AE (just plain AVAPS like I am).

Indi's Gmomma wrote: Dr marked under bi-level pressure settings 18/10 RR15 oxygen 4 lpm I copied this from the form I gave my rt.

These settings mean:
IPAP = 18 cm H20; the pressure during the inhalations is set to 18 cm H20, which is sort of high, but not exceptionally high.

EPAP = 10 cm H20; the pressure during the exhalations is set to 10 cm H20.

RR = 15; the back up respiratory rate is set to a fixed 15 breaths per minute. If your RR drops below that the machine kicks in and switches from EPAP to IPAP in an attempt to trigger an inhalation.

O2 = 4 L/min; the oxygen is supposed to be bled into the system at a rate of 4 Liters per minute. That's on the high side, probably because you're still dealing with some serious O2 desats.

Before I the script said I??? 12 EPAP 8 Eauto? Oxygen 2 auto timing m mode b? pap (?=can't make out)

This script has the settings set at:
IPAP = 12 cm H20; the pressure during the inhalations is set to 12 cm H20

EPAP = 8 cm H20; the pressure during the exhalations is set to 8 cm H20.

RR = appears to be set to Auto; the back up respiratory rate determined on the fly by the machine based on the last several minutes of "normal" breathing. If your RR drops below that automatically determined RR, then the machine kicks in and switches from EPAP to IPAP in an attempt to trigger an inhalation.

O2 = 2 L/min; the oxygen is supposed to be bled into the system at a rate of 2 Liters per minute.

****************
The two scripts are VERY different from each other. You write:

Im hoping someone here can help me, I went back to see the drs that got me the trilogy, I have not yet had a sleep study because my need is mainly I'm a c02 retainer or I have neromuscular pulmanory failure and am hypercapnic, the dr increased my trilogy from 12/8 to now 18/10 rr15.

Any idea on what the doc used to determine the new settings?

You also write:

[With the new settings] I feel like I'm not getting my last breath really out before my next one is being forced down me

and

[With the new settings] I feal like I'm not getting my last breath out before my next one comes

It sounds like the RR = 15 breaths per minute is set high enough where you are simply not "keeping up" with the machine's desire to trigger an inhalation every 4 seconds. You need to inform the doctor about how you feel like you are not able to fully exhale with these settings. It's also worth asking the doc why the RR is set to 15 and whether you might be more comfortable if the RR was set a wee bit lower.

Finally you write:

and does it make any difference where the oxygen line enters? We have tried the back of the trilogy machine and also on the tubing itself, at both ends.

It is critically important to have the O2 fed into the system in the correct place. The durable equipment provider (DME) that provided your Trilogy should have set this up for you and should have taught you and your hubby how and where to attach the oxygen line.

Maybe part of your on-going low O2 saturation problem is due to the O2 line not being attached to the system correctly.

I'd call the DME and tell them that you and your hubby are confused about how and where to attach the O2 line into the Trilogy system and that you need help with that immediately. If they can't tell you or send someone out to help you out, then you need to call the doc's office and tell them that you don't know where the O2 should be attached to the Trilogy system AND that the DME can't seem to help you either.

Robysue --

Excellent input and suggestions. I know in my situation, if they had my backup rate to 15, I'd be hyperventilating. Anything above 7 for me is rushed. My last sleep study, the tech bumped it up to 8 and I knew immediately he had done it because it woke me up.

And there is a port on the back of the Trilogy, lower right hand side (as you're looking at the back) for the oxygen to be attached.

Thanks for chiming in on this, Robysue! I'm glad you're onboard to help the OP.