I am on straight CPAP, not a bi-level. My sleep pulmo made no changes to my set pressure of 8 cms when he added the 2L of supplemental oxygen via my concentrator and the adaptor at the integrated humidifer/mask hose connection. My 02 DME is the one who added the adapter and assurred me that this was safe and the correct way to add supplemental 02 (Resmed has a similar warning to the Respironics warning).
Since I don't know diddley-squat about all this I have no choice but to rely on the advice of my 02 DME. (Thank God, not my CPAP DME!!!)
XPAP and oxygen..what is your titration level of oxygen?
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator |
Women are Angels. And when someone breaks our wings, we simply continue to fly.....on a broomstick. We are flexible like that.
My computer says I need to upgrade my brain to be compatible with its new software.
My computer says I need to upgrade my brain to be compatible with its new software.
Trust me, fidget is very much correct on this. I am an RT. That's exactly the stuff I went to school to learn. The key being people in normal health. He's not in normal health, he has a myriad of health problems, not just apnea.I am not at all sure that what fidget says about C02 vs O2 is correct. For people in normal health, I believe that the percent of O2 being breathed in is not very much related with CO2 concentration in the blood.
This is dangerous stuff, this is not just sleep apnea. He belongs in an intensive care right now.
He's in metabolic acidosis, that's why he's sleepy, and not making a lot of smart decisions, he needs to be under a doctor's care now.
from emedicine.com:
Under conditions of oxygen deprivation and decreased oxygen delivery to the tissues, anaerobic metabolism produces excessive amounts of lactic acid. Most disease processes that result in decreased oxygen delivery also frequently lead to diminished hepatic function, further compounding lactic acid accumulation.
Central nervous system manifestations can include headache, lethargy, confusion, or any change in mental status secondary to a decrease in intracerebral pH. Cerebral vasodilation occurs as a result of a metabolic acidosis and may contribute to an increase in intracranial pressure.
You're severly oxygen deprived, I can only guess at what other health problems you have, but it sounds like at least some cardiac stuff. Kidney?
Seriously, you should be in an ER now.
Under conditions of oxygen deprivation and decreased oxygen delivery to the tissues, anaerobic metabolism produces excessive amounts of lactic acid. Most disease processes that result in decreased oxygen delivery also frequently lead to diminished hepatic function, further compounding lactic acid accumulation.
Central nervous system manifestations can include headache, lethargy, confusion, or any change in mental status secondary to a decrease in intracerebral pH. Cerebral vasodilation occurs as a result of a metabolic acidosis and may contribute to an increase in intracranial pressure.
You're severly oxygen deprived, I can only guess at what other health problems you have, but it sounds like at least some cardiac stuff. Kidney?
Seriously, you should be in an ER now.
to bgalb
This is what I'm talking about, this is the least of his problems right now, the chronic oxygen deprivation is his biggie right now. But he shouldn't self treat because of the following:
CO2 retention is a pathophysiological process in which too little carbon dioxide is removed from the blood by the lungs. The end result is hypercapnia, an elevated level of carbon dioxide dissolved in the bloodstream. Various diseases may lead to this state; disturbed gas exchange may lead to impaired excretion of the gas. In addition, breathing air with a high carbon dioxide concentration may also lead to hypercapnia.
The principal result of the increased amount of dissolved CO2 is acidosis (respiratory acidosis when caused by impaired lung function); other effects include tachycardia (rapid heart rate) seizures, coma, respiratory arrest and death.
CO2 retention is a problem in various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). Patients with COPD who receive excessive supplemental oxygen can develop CO2 retention, and subsequent hypercapnia. The mechanism that underlies this state is a matter of controversy. Some authorities point to a reduction in the hypoxic "drive" when oxygen is administered. However, it is unclear whether such a hypoxic drive exists in the first place. An alternative explanation is that, in patients with COPD, the administration of oxygen leads to an increase in the degree to which diseased alveoli are perfused with blood relative to other, less-diseased alveoli. As a result, a larger fraction of blood passes through parts of the lung that are poorly-ventilated, with a resulting increase in the CO2 concentration of the blood leaving the lungs.
As CO2 levels increase, patients exhibit a reduction in overall level of consciousness as well as respiratory effort. Severe increases in CO2 levels can lead to respiratory arrest.
CO2 retention is the hallmark of type II respiratory failure. While in type I any degree of hypoxia is compensated for by hyperventilation (and a decrease in CO2), this mechanism fails in type II. Mechanical ventilation (through intubation, CPAP or BIPAP) may be indicated, or infusion of doxapram.
CO2 retention is a pathophysiological process in which too little carbon dioxide is removed from the blood by the lungs. The end result is hypercapnia, an elevated level of carbon dioxide dissolved in the bloodstream. Various diseases may lead to this state; disturbed gas exchange may lead to impaired excretion of the gas. In addition, breathing air with a high carbon dioxide concentration may also lead to hypercapnia.
The principal result of the increased amount of dissolved CO2 is acidosis (respiratory acidosis when caused by impaired lung function); other effects include tachycardia (rapid heart rate) seizures, coma, respiratory arrest and death.
CO2 retention is a problem in various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD). Patients with COPD who receive excessive supplemental oxygen can develop CO2 retention, and subsequent hypercapnia. The mechanism that underlies this state is a matter of controversy. Some authorities point to a reduction in the hypoxic "drive" when oxygen is administered. However, it is unclear whether such a hypoxic drive exists in the first place. An alternative explanation is that, in patients with COPD, the administration of oxygen leads to an increase in the degree to which diseased alveoli are perfused with blood relative to other, less-diseased alveoli. As a result, a larger fraction of blood passes through parts of the lung that are poorly-ventilated, with a resulting increase in the CO2 concentration of the blood leaving the lungs.
As CO2 levels increase, patients exhibit a reduction in overall level of consciousness as well as respiratory effort. Severe increases in CO2 levels can lead to respiratory arrest.
CO2 retention is the hallmark of type II respiratory failure. While in type I any degree of hypoxia is compensated for by hyperventilation (and a decrease in CO2), this mechanism fails in type II. Mechanical ventilation (through intubation, CPAP or BIPAP) may be indicated, or infusion of doxapram.
I am familar with the two O2 bleeds mentioned - the one that dllfo mentioned sounds exactly like what lincare gave me - cheap hard platic with a temperature read socket opposite the O2 line feed connector and plastic caps over each - the other one cpap.com sells I like better and is a lot sturdier, but neither meets the warning given by respironics. Lincare also didn't care that their bleed device didn't meet the warning.
The second thing I wish to add to this thread is the whole idea of what an ideal person does with O2 / CO2 levels and a person with pulmonary problems does are mile apart. There is the notion of CO2 retention (CO2 breather is another term I have heard and not sure if the same) for a person with lung problems. I know all about CO2 retention first hand. I landed up in the hospital several years ago with a PCO2 in the mid 60's and too low a blood pH based on ABG blood test. Of course my PO2 wasn't exactly that high either at the time. I wasn't "tubed" but sure met the criteria I was told but I knew I had to breathe from the diaphragm to survive.
The third thing I wish to remind people who are one O2 and CPAP of is - don't use pulse O2 with cpap or you will never get any O2 at night. I have seen several posts over time here about people wanting to get a portable O2 device for travel and use it with CPAP. Beware!!!!!!!
Fidget is right on about not using pulse O2 at night with apnea and also about the whole CO2 issues in my lay understanding.
The second thing I wish to add to this thread is the whole idea of what an ideal person does with O2 / CO2 levels and a person with pulmonary problems does are mile apart. There is the notion of CO2 retention (CO2 breather is another term I have heard and not sure if the same) for a person with lung problems. I know all about CO2 retention first hand. I landed up in the hospital several years ago with a PCO2 in the mid 60's and too low a blood pH based on ABG blood test. Of course my PO2 wasn't exactly that high either at the time. I wasn't "tubed" but sure met the criteria I was told but I knew I had to breathe from the diaphragm to survive.
The third thing I wish to remind people who are one O2 and CPAP of is - don't use pulse O2 with cpap or you will never get any O2 at night. I have seen several posts over time here about people wanting to get a portable O2 device for travel and use it with CPAP. Beware!!!!!!!
Fidget is right on about not using pulse O2 at night with apnea and also about the whole CO2 issues in my lay understanding.
A lot to digest. fidget is correct in several areas, I started to send him a long, long PM with my current medical problems, then saved it to MS Word and sent him a short PM.
I have little faith in our ERs. The last time I went in, they did not know what
Vocal Cord Dysfunction was, they nearly killed me with Nitrolingual. I passed out, my wife gave me two shots of nitrolingual, the EMT arrived, she handed him the VIAL OF LIFE information (all my prescriptions, doctors, their phone
numbers, etc), but the EMT hit me with 2 more shots of Nitrolingual. I am trying to say Pulmonary, not cardiac, as they left the Critical Care Unit they hit me with two more squirts of nitrolingual, THEN they had a nurse sit at the foot of my bed the rest of the day because my heart rate was in the 30s. Nor did anyone know what VCD was, not even the Respiratory people at that hospital. NOR did they have Heliox there, my rescue agent.....so ER around Sacramento does not impress me. I am sure it is like many things, depends on who is there.
He is sharper than the majority of people I have dealt with. I have had multiple PFTs, PSTs, Blood Gases, Methachlomine Challenge tests, Bronchoscopys......my case is very, very complicated. THAT is why my specialist called Denver last week to get me elevated on their cancellation
list. I apologize to the forum for getting away from CPAP/BIPAP stuff.
I honestly don't know what to do next. As was mentioned earlier, I also
used to fly back to Okinawa between 45,000 and 50,000 feet due to low
fuel, we breathed 100% oxygen for hours and hours. No problems then.
Part of me wonders if I might just be a person whose norm is a pulseox of
85-87? Just like blood pressure, perhaps I will run lower. I could go back to my old flight physicals, but I don't remember them testing our pulseox.
One good thing we are doing here is to cover some things others never think of. I emailed my sleep study to a couple of our old timers, I had Cheyne-Stokes Respirations, PVCs, OSA, Central Sleep Apneas, and some other stuff. My titration was set at something like 4/20 and the Respironics Auto Bipap set me up where I needed to be. I don't have the answers, but
now that I am on Medicare, I will have to learn the rules again. I am only 61, but when you go on SSDI you are forced into Medicare.
I don't mind calling Apria right this minute, demanding they get me the proper part for my oxygen adapter, but they would not know what to get.
I will call Respironics Monday, asking them for the exact part number, then
call Apria and tell them exactly what I need, unless they don't mind violating Respironics guidelines. I will call my pulmonary doctor Monday, asking for the tests or equipment to check my Co2 levels.
But at a certain point, there is not much I can do. Ride it out. Is there any way we can check the Co2 at home? What machine do the doctors use? HEY, it is 9:46am and I am up to 88 on the pulseox. By the way, I take my pulseox, then have my wife read it, then she takes her own to see if the machine seems to be working ok. So far my SPO 5500 has been good.
My wife is muttering about my leg cramps at night, might be lactic acid?
My urologist told me I have pelvic floor damage, you don't want to know the rest of that one.
I want to thank all of you for taking your time to thoughtfully write out your
ideas, I will print this, look up the big words (2 syllables or more for we Irish)
and try to digest it again. Thanks again, time to put the mask on..
10pm, my pulseox is 83.
I have little faith in our ERs. The last time I went in, they did not know what
Vocal Cord Dysfunction was, they nearly killed me with Nitrolingual. I passed out, my wife gave me two shots of nitrolingual, the EMT arrived, she handed him the VIAL OF LIFE information (all my prescriptions, doctors, their phone
numbers, etc), but the EMT hit me with 2 more shots of Nitrolingual. I am trying to say Pulmonary, not cardiac, as they left the Critical Care Unit they hit me with two more squirts of nitrolingual, THEN they had a nurse sit at the foot of my bed the rest of the day because my heart rate was in the 30s. Nor did anyone know what VCD was, not even the Respiratory people at that hospital. NOR did they have Heliox there, my rescue agent.....so ER around Sacramento does not impress me. I am sure it is like many things, depends on who is there.
He is sharper than the majority of people I have dealt with. I have had multiple PFTs, PSTs, Blood Gases, Methachlomine Challenge tests, Bronchoscopys......my case is very, very complicated. THAT is why my specialist called Denver last week to get me elevated on their cancellation
list. I apologize to the forum for getting away from CPAP/BIPAP stuff.
I honestly don't know what to do next. As was mentioned earlier, I also
used to fly back to Okinawa between 45,000 and 50,000 feet due to low
fuel, we breathed 100% oxygen for hours and hours. No problems then.
Part of me wonders if I might just be a person whose norm is a pulseox of
85-87? Just like blood pressure, perhaps I will run lower. I could go back to my old flight physicals, but I don't remember them testing our pulseox.
One good thing we are doing here is to cover some things others never think of. I emailed my sleep study to a couple of our old timers, I had Cheyne-Stokes Respirations, PVCs, OSA, Central Sleep Apneas, and some other stuff. My titration was set at something like 4/20 and the Respironics Auto Bipap set me up where I needed to be. I don't have the answers, but
now that I am on Medicare, I will have to learn the rules again. I am only 61, but when you go on SSDI you are forced into Medicare.
I don't mind calling Apria right this minute, demanding they get me the proper part for my oxygen adapter, but they would not know what to get.
I will call Respironics Monday, asking them for the exact part number, then
call Apria and tell them exactly what I need, unless they don't mind violating Respironics guidelines. I will call my pulmonary doctor Monday, asking for the tests or equipment to check my Co2 levels.
But at a certain point, there is not much I can do. Ride it out. Is there any way we can check the Co2 at home? What machine do the doctors use? HEY, it is 9:46am and I am up to 88 on the pulseox. By the way, I take my pulseox, then have my wife read it, then she takes her own to see if the machine seems to be working ok. So far my SPO 5500 has been good.
My wife is muttering about my leg cramps at night, might be lactic acid?
My urologist told me I have pelvic floor damage, you don't want to know the rest of that one.
I want to thank all of you for taking your time to thoughtfully write out your
ideas, I will print this, look up the big words (2 syllables or more for we Irish)
and try to digest it again. Thanks again, time to put the mask on..
10pm, my pulseox is 83.
Installing Software is like pushing a rope uphill.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
Close but no "Cigar", It wont fit between the stock XPAP and HH, it probably doesn't Vent the O2 from the hose when it does shut off, and it has no port for O2 inlet. It's just to prevent water from flowing inth the XPAP outlet. Jimjules wrote:https://www.cpap.com/productpage/respir ... chine.html
Part 302418 (or 302423 is a pack of 5)
Use data to optimize your xPAP treatment!
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
dllfo, and everyonefollowing this tread!
can we just summerize here!
as an RPSGT the advise that we give in the sleep lab is to bleed O2 through the CPAP outlet, not through the mask (like we used to do ) it's because it gives a better mix.
Do not change the O2 level, this is prescribed by your physician there is a reason it's at this setting. Just like you wouldn't double up on any other type of prescribed medicine or even choose yourself to change the prescription in your glasses! the setting is individual to the pt's health needs.
DO NOT worry about trying to get your spO2 into the high 90's, you may be doing yourself more damage than good. remember when you are lying down (and asleep) it will be lower, when your up and walking around, it will be better.
If you where in Canada, i'd be telling you to go to emerge, but I know it's different in the U.S.
can we just summerize here!
as an RPSGT the advise that we give in the sleep lab is to bleed O2 through the CPAP outlet, not through the mask (like we used to do ) it's because it gives a better mix.
Do not change the O2 level, this is prescribed by your physician there is a reason it's at this setting. Just like you wouldn't double up on any other type of prescribed medicine or even choose yourself to change the prescription in your glasses! the setting is individual to the pt's health needs.
DO NOT worry about trying to get your spO2 into the high 90's, you may be doing yourself more damage than good. remember when you are lying down (and asleep) it will be lower, when your up and walking around, it will be better.
If you where in Canada, i'd be telling you to go to emerge, but I know it's different in the U.S.
[quote="littlemo"]dllfo, and everyonefollowing this tread!
can we just summerize here!
as an RPSGT the advise that we give in the sleep lab is to bleed O2 through the CPAP outlet, not through the mask (like we used to do ) it's because it gives a better mix.
Do not change the O2 level, this is prescribed by your physician there is a reason it's at this setting. Just like you wouldn't double up on any other type of prescribed medicine or even choose yourself to change the prescription in your glasses! the setting is individual to the pt's health needs.
DO NOT worry about trying to get your spO2 into the high 90's, you may be doing yourself more damage than good. remember when you are lying down (and asleep) it will be lower, when your up and walking around, it will be better.
If you where in Canada, i'd be telling you to go to emerge, but I know it's different in the U.S. quote]
I would trust a sleep lab tech. I was supposed to be on 2L O2 for my sleep lab test, was it provided, NO! Was a HH provided, NO! They barely could find a set of leads that worked, out of three sets tried, and this was a lab built in the last two years, as a sleep lab only. I've still got that Beach Front property in the Rocky Mountains for sale too.
As far as glasses, I have 4 pairs bought from a drug store, different strengths, on a good day I only use two strengths, some days it takes all four. (Sugar). Jim
can we just summerize here!
as an RPSGT the advise that we give in the sleep lab is to bleed O2 through the CPAP outlet, not through the mask (like we used to do ) it's because it gives a better mix.
Do not change the O2 level, this is prescribed by your physician there is a reason it's at this setting. Just like you wouldn't double up on any other type of prescribed medicine or even choose yourself to change the prescription in your glasses! the setting is individual to the pt's health needs.
DO NOT worry about trying to get your spO2 into the high 90's, you may be doing yourself more damage than good. remember when you are lying down (and asleep) it will be lower, when your up and walking around, it will be better.
If you where in Canada, i'd be telling you to go to emerge, but I know it's different in the U.S. quote]
I would trust a sleep lab tech. I was supposed to be on 2L O2 for my sleep lab test, was it provided, NO! Was a HH provided, NO! They barely could find a set of leads that worked, out of three sets tried, and this was a lab built in the last two years, as a sleep lab only. I've still got that Beach Front property in the Rocky Mountains for sale too.
As far as glasses, I have 4 pairs bought from a drug store, different strengths, on a good day I only use two strengths, some days it takes all four. (Sugar). Jim
Use data to optimize your xPAP treatment!
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
Goofproof wrote:Close but no "Cigar", It wont fit between the stock XPAP and HH, it probably doesn't Vent the O2 from the hose when it does shut off, and it has no port for O2 inlet. It's just to prevent water from flowing inth the XPAP outlet. Jimjules wrote:https://www.cpap.com/productpage/respir ... chine.html
Part 302418 (or 302423 is a pack of 5)
It's part number 302418. Check the manual. The larger end fits on the HH, and the tubing fits on the smaller end. It has a 22mm end, a bulge with a one way valve in the middle, and a 15 mm other end.
It doesn't do anything for your oxygen delivery, though, it's to protect the machine. Shutting your oxygen off before turning the machine off serves the same purpose.
I hope you find some help, soon. It sounds like you're so very frustrated.
BTW, I didn't get a PM.
You can't really reliably check your C02 at home, it takes blood gasses. It's not just the C02 you have to watch, it's the PH, and the balance between it all.
Oh, does your bipap have a back up rate? That alone might make all the difference in the world for you.
Sometimes auto titrating isn't the best option. If you're retaining C02, and having a lot of Centrals, you might be getting into trouble that way. You might need a higher inspiratory pressure, and a back up rate to make it all work.
I'm glad you're going to National Jewish. If anyone can help you, I have faith they can.
PS, I'm not a he
It doesn't do anything for your oxygen delivery, though, it's to protect the machine. Shutting your oxygen off before turning the machine off serves the same purpose.
I hope you find some help, soon. It sounds like you're so very frustrated.
BTW, I didn't get a PM.
You can't really reliably check your C02 at home, it takes blood gasses. It's not just the C02 you have to watch, it's the PH, and the balance between it all.
Oh, does your bipap have a back up rate? That alone might make all the difference in the world for you.
Sometimes auto titrating isn't the best option. If you're retaining C02, and having a lot of Centrals, you might be getting into trouble that way. You might need a higher inspiratory pressure, and a back up rate to make it all work.
I'm glad you're going to National Jewish. If anyone can help you, I have faith they can.
PS, I'm not a he