High CO2 - Please help

[Biggonz]

Hi folks,
I am new to the forum but have been a CPAP user for a dozen years. I had a recent health incident that looked like a heart attack, but wasn’t. Now the doctors believe it’s my lungs and after several tests have narrowed it down to possibly my CPAP machine.
I have constant shortness of breath and the doctor suggests I am caring around too much carbon dioxide.
This is very sudden after being fat but active and strong for many years.… I literally can’t walk across the parking lot without getting winded. Has anyone heard of this before? Any ideas? It takes forever to get anything done through the insurance and I am miserable every day.
My machine is a REMstar a-flex… It’s pretty old… And I use the Swift nasal pillows.

[Julie]

Pressure settings?

Leaks?

Take any meds?

Been tested recently for other possible health issues?

Your MDs' speculation re CO2 may be (at best) just that... most doctors not educated in sleep issues, let alone how the equipment works, are scarily ignorant about most of it, and most masks have excellent CO2 vents.

[Snoregone Conclusion]

These symptoms could be cardiac in nature, too: see your doctors and get requisite tests, don’t depend on online sites, there are things that need to be done offline and this sounds like one of them.

[Stom]

If your doctor suspects this and you are having debilitating medical issues I'd have thought he'd have you tested to make a more positive diagnosis - but I don't really have specific medical knowledge about this as an issue, though. Sleep labs, among others, have CO2 sensors they can attach to your nose to evaluate your expired CO2 levels, which can also be compared to tests of blood gas CO2 levels.

https://en.wikipedia.org/wiki/Capnography

CPAP generally **decreases** your CO2 levels, so much so in a relatively small percentage of patients it can interfere with their normal CO2-driven drive to breathe, causing treatment induced central apneas. "Nocturnal non-invasive ventilation" is actually a treatment for too much CO2 when sleeping. So it's counter intuitive for your CPAP to be considered a cause of excess CO2. Your doctor is highly trained, so maybe he has a good reason? But, still, I'd expect a specific test of your CO2 levels to confirm his hypothesis since such tests exist and are not uncommon.

AFIK it would be unusual for CPAP to increase CO2 retention unless, maybe, something is wrong with the passive CO2 washout vents in your CPAP mask, or mask elbow. ResMed recommends cleaning the vent with a soft brush (they don't say it but typically this means a spare, clean tooth brush). Some people on the forum use a WaterPik to clean their mask vents, especially the diffused ones.

https://www.resmed.com/us/dam/documents ... er_eng.pdf

Either way, I think Snoregone Conclusion is right to suggest these are potentially serious symptoms that really deserve the right medical tests and attention, and so far, it doesn't sound like you've really gotten that. This seems like one of those cases where you need to advocate for yourself and get your doctors to follow through with a confirmed diagnosis and treatment.

[zoocrewphoto]

It sounds like you really need to get some testing done such as bloodwork and probably a treadmill test.

I have asthma in addition to sleep apnea, yet I have had two cases over the years where being out of breath with very little exertion was something else. One was due to an irregular heartbeat. I felt like I had an invisible cat on my chest, and assumed it was asthma acting up. My asthma WAS acting up, but it added the irregular heartbeat. I was off work for 2 weeks and still extra tired for a couple more weeks.

The other time was anemia due to iron deficiency. Again, I thought my asthma was acting up. I was out of breath while walking around at work. I was mouth breathing more. And I was having asthma attacks in the middle of the night. My inhaler was NOT helping. So, I went to the doctor. I had some other weird stuff bothering me, so I wrote it all down. I didn't think they were all related, but hoped she would look at the list and see a connection with at least some of it. She zeroed in on the iron and had me tested there. Waited until the next day to see what the test results were before deciding which prescription to go with (iron, or if not that, then increasing asthma meds and something for the restless leg). It was the iron (very low), and every odd symptom WAS related (extremely tired, "asthma" issues, bad restless legs at night, feeling cold more often, pain sensitive hands, weird food cravings, really stiff and tired after work, frequent hiccups, mouth breathing and dry lips, getting out of breath with very little exertion).

So, I would write down any symptoms you have, even if they seem unrelated, and have your doctor look them over. Ask if there are any hormone or vitamin deficiencies that should be tested for. Ask if you need to have any checks on your heart and lungs. It sounds like they have guessed at something that sounds pretty rare and skipped over many more common issues and haven't bothered to do any testing. Meanwhile, you feel like crap.

[Biggonz]

Hi guys, thank you for all your comments. I didn’t want to overwhelm too much with my very first post. The first problem with these symptoms happened at the end of a long hill walk that I do daily… Out of breath and my pulse wouldn’t come down after. I ended up in the ER later that day with chest tightness and shortness of breath. Had tons of tests done both pulmonary and heart and a nuclear stress test which I passed with no abnormalities. It was after all of this was eliminated that the doctor started looking to lungs. Even watching my chest CT, he felt that I had some trapping in my lungs… Where I wasn’t fully emptying my lungs on my regular breaths. I was put on two inhalers and prednisone ... But they didn’t do anything. Current theory is too much carbon dioxide perhaps from my faulty CPAP, old CPAP ...Or perhaps just the settings are bad. In addition, my insurance company after the fact approved a CT angiogram with calcium score that we are waiting on the results for. But since everything else is normal but the cardiologist and pulmonologist believe that test will be normal as well and that my lungs are the culprit. My machine is 10 years old end it has been 10 or 12 years since my last sleep study. I was just wondering if any of you have ever heard of excess carbon dioxide from CPAP therapy .

[LSAT]

Have you tried changing your mask? Make sure vents are not blocked?

[score69]

Have they actually drawn blood gases on you to verify your CO2 levels?

My MIL was recently taken to the ER, was non-responsive one morning at the nursing home. Similar symptoms to you for a while.

She had fluid building up in her lungs, ER doc said due to inactivity and being 'undertreated' on her CPAP. I can't remember her actual CO2 level at the time, but we almost lost her. She had a DNR the ambulance wasn't aware of, so they intubated her to get her going. She went a long time with high CO2 levels, has cognitive decline and her personality is completely different now. She spent 16 days in the hospital (5 days in ICU) before they got her to a safe point to discharge. She was diagnosed with acute respiratory failure and had a lung collapse due to fluid buildup.

High CO2 is nothing to play around with, I would get a real CO2 level checked if you haven't yet and try to get this addressed. My MIL was discharged on BiPAP therapy to replace her CPAP with 2L of O2/min 24 hours/day. They pulled over 35lbs of fluid off of her while in the hospital. It was building up in her chest cavity and not allowing her lungs to function properly. And cognitively she's probably never going to be the same. She was having cognitive decline for over a month prior to this, it was suspected to be Alzheimers at the time.

Seeing her go through this has really pushed me to start monitoring my CPAP therapy again and making sure I'm doing well. I've been monitoring my O2 sat at night as well since I've been through all of this with her.

[Pugsy]

I was just wondering if any of you have ever heard of excess carbon dioxide from CPAP therapy .

No.
Even if it was related ....it would/should only be very short term and not last through the day.
If anything cpap therapy washes out too much carbon dioxide in some people.

Now there might be a problem in terms of your cpap therapy itself not being optimal or your machine not functioning as it should due to age. It's time for a new machine...yours is well past it's expected life.

[igotsuckeredtoo]

I have heard they do supplemental oxygen with CPAP use for some people. But that will cost and require doctor visit maybe a new machine.
Can you do something to improve your wind? I mean like doing cardio which by its nature makes you breath harder which eventually increases your lung capacity and oxygen exchange rates which makes you breath less hard under the same effort. Unless there is something wrong in the ???i forget the name of the vessels that exchange gases in the lungs, you should be able to increase you lung capacity.

[raisedfist]

Have you had blood work done that actually shows high carbon dioxide levels? If so, a bi-level machine should help with that via pressure support.

[palerider]

I have heard they do supplemental oxygen with CPAP use for some people. But that will cost and require doctor visit maybe a new machine.

Plus, supplemental O2 won't reduce CO2, in fact, it can increase it.

i forget the name of the vessels that exchange gases in the lungs,

Alveoli... they're not vessels, they're little air sacks.