CO2 Monitor Update

[ahujudybear]

As many of you know, Milwaukee's Froedtert Memorial Lutheran Hospital has a new CO2 monitor installed in their sleep lab (YAY!) Unfortunately, it is being handled by the same incompetents who do all the rest of their sleep studies (BOO)

Here is my take on the test last night.....

Well, guess I sort of blew this one....

I could not get to sleep. My shoulder was aching across my back and the bed linens made my throat tickle. My stomach was gassy from taking Tylenol with no food. I had also brought some yogurt to eat before going to bed but was not given any time to eat it (I hadn't eaten since 5:30 and was to have a blood test the next AM, so could not eat after midnight!). And I was NOT very tired at 9 PM.

They were VERY put out that I was to use my own BiPAP. They (three different people) told me they couldn't do it, that it would not work, that it could not be connected to their equipment, that they would have no way of changing the settings, etc., etc. Finally they called the Dr. & she told them to use my equipment at my settings. During the night when they came to put on a wire thing that was some sort of flow monitor, they put it right below my nose - right where the mask sits. I told the technician that it would ruin the seal. "Well, you're the one who insisted on using your own equipment!" (Thinking about it later, it would have been worse with their mask because it was stiffer material than mine. What they needed to use was a full face mask.)

Wonder of wonders.... by morning my mask was sealed almost with no leaks at all! ( She wanted to know what kind it was that it had performed so well!)

Oh - and when she came in to take off the wires, she shut off the BiPAP without any warning or telling me she was doing it! When I said something, she said that all I had to do was to open my mouth to breath! Yeah Right::: IF I had known. She said there was no harm in it, that her stepfather walks around the house wearing his mask, disconnected from the hose. She said that there are vent holes that expel the CO2. I then explained to her that those only work when the machine is pushing air through the hose!

I did sleep after she put on the mask (dozed a few times before that). She said that my O2 levels did not go below 90% all night through and that there was no CO2 concentrations. I can't wait to SEE the results of the study!

Oh! The CO2 monitor! This is a very small and very soft (almost like a gel) cannula and tubing. It is very comfortable. Much smaller and softer than the ones they use for O2. But a new wrinkle was a flow monitor. Now when the lab director saw my nasal mask, she said they probably wouldn't have to use the flow monitor... but the technician used it anyway. It had a flexible wire lead like all the other leads, but was worn over the ears like a cannula. Under your nose was a twisty thing of wire that goes from just into the opening of your nostrils to the top of your upper lip. She said that it monitored the heat from your expelled breath to determine whether you were exhaling through your nose or your mouth. I suppose that's needed to validate the CO2 data?

Oh!! And she gave me the CO2 cannula upside-down! I told her so and she said it was correct (I have spent the past month learning about these things and wearing them.... the delivery tubes curl slightly and you wear the thing with them curled downward inside your nostrils. She insisted that they go with the curl upward - against the inside of your nose! <LOL>)

She must have said eight or ten times to trust her, that she knew what she was doing. She also left the light on for over half an hour or more once during the night, and never did give me the call button. She said that she knew all about BiPAP machines! That was her job! Before she left for the first time, I told her that the plug for my BiPAP was draped over the back of the chair, so she would know where it was when she needed it. She threw it on the floor. I told her that it might be harder to find in the dark down there on the floor. She picked it up again and I told her (for the third time) I didn't know where she wanted it plugged in... then she plugged it in. ( !!) (Where do they get these people???)

I'll be talking with Dr. Franco in a few weeks about this study. Seemed to be a bit of a waste of time since I couldn't relax enough to go to sleep without the BiPAP or so early in the evening.

Oh! and she had ordered "lots of pillows"... <LOL> there were EIGHT pillows on the bed!

Maybe you folks will have a better time of it? Good luck!

- JB

[neversleeps]

Judy, I am always riveted when you recount your experiences with the sleep doctor, et al, and this is no exception!!

"Trust me, I know what I'm doing."
Didn't want you to use your Bipap.
Put the CO2 cannula on upside-down.
Shut off the Bipap without warning.
Left the lights on.
Didn't know the vent holes expelled CO2 with the aid of machine's airflow.
Didn't give you the call button.

Wow!! Imagine what might have happened if she DIDN'T know what she was doing.....

[Sleepless on LI]

I think you should change your name to durable-ahujudybear. You took a lickin' and kept on tickin'. Maybe timex-ahujudybear? What an experience. I guess as long as they got some results to give you out of that ordeal, it will be worth it in the end.
Seriously, I think the members on this site need to open our own sleep clinics and show the world what compassion and knowledge can do for people going through what they're put through when they undergo sleep studies. Is this where they put all the misfits from Resipiratory Therapy class who don't make it in the real world? And to insist she knew what she was doing? Like Neversleeps said, could you imagine if she didn't??? Ay, caramba!!!

[ahujudybear]

Love your replies!!! Thanks!

I spoke with Dr. Franco yesterday on the phone and here is what she said....

Hi everyone.

I spoke with the pulmonologist yesterday about the test and learned a few surprising things. (I will be seeing her in about 3 weeks for a thorough review of the sleep study. This was just a brief phone conversation with her (Dr. Franco).)

She was not surprised that my O2 levels did not fall below 90%. She said that after a person has been using a PAP machine, their muscles will build up a reserve of strength which will carry them through a night or two without the machine!

And she said not to worry about the Medicare requirements. This test was to be considered "fine tuning" and not a basis for entitlements.

She said that all the pillows were provided because the hospital bed was not available on the night of my study (she had forgotten to reserve it). She said that she wanted me to sleep with the head of the bed elevated to assist in my breathing without the BiPAP, and so provided "lots of pillows" for me to use!

She also said that two unusual things occurred while I was sleeping with the BiPAP... I began snoring during REM sleep, and my CO2 levels dropped quite a bit at the same time... Oh! Of course! If I was snoring, I was breathing through my mouth and the CO2 monitor would not be able to pick up the air to analyze it because it was not moving through my nose! Duh! (Maybe?)

She recommended my raising the expiratory pressure to 5 for a couple of nights and let her know how that goes. (I tried it for a nap and woke up to a chest spasm, then had another spasm in the PT treatment room. I tried it during the night last night but kept waking up. These changes take time to get accustomed to so I will try it once again tonight.)

She also said that the sleep technicians were themselves often operating in a state of sleep deprivation because they often will stay up during the day when they have a day off, and then try to work through the night! Anything out of the ordinary then becomes a real problem for them to figure out. That sounds scary. I'd rather think they were undertrained and somewhat unimaginative/stupid than to think that they were too sleepy to function properly.

- JB

[Sleepless on LI]

She also said that the sleep technicians were themselves often operating in a state of sleep deprivation because they often will stay up during the day when they have a day off, and then try to work through the night! Anything out of the ordinary then becomes a real problem for them to figure out.

And what is the new facility you'll be going to for any future sleep studies?

[BP]

ahujudybear, thanks for great posts. I do have one quick question for you or anyone else.

Aren't all CPAP masks designed to expel CO2 even if the machine is off? I always thought this was a safety feature, that if you suddenly lost power in the middle of the night your exhalation would flush CO2 out of the mask so that you wouldn't suffocate.

Thanks,
BP

[christinequilts]

ahujudybear-

You and I need to chat and compare notes on strange things that can happen during sleep studies...especially when it is not a standard OSA study & CPAP titration. Having the CO2 monitor sounds like a good idea- I will have to check if my sleep lab has it or not.

I will be having another study done in few months for my severe CSA and you can bet this time I will be talking to my sleep doc about making sure I have a tech who is both experienced and prepared for a BiPAP ST study...and preferably the tech will only have me and not 1 or 2 other patients to monitor. My first titration, almost 2 years ago, I lucked out and got a tech who'd been doing sleep studies for 15 years but she had no idea until she got to work at 9:30 that is was for a BiPAP ST study. The person who schedules which room and tech each person is assigned too assumed it was just a regular CPAP/BiPAP study and didn't even have me in a room that they could do a full BiPAP ST study. My tech ended up running around, trying to get everything straightened out (I refused to stay if they couldn't do the test as ordered by the doctor), get the right equipment set up & quickly review procedures for BiPAP ST studies. She didn't even start setting up her other patient, who was in for a split night study, until 10:30. She got to me a little after 11 and it still took until midnight before lights out for me...good thing I had ambien or I wouldn't have been able to sleep as well as I did.

I do still wonder if more of my centrals could have been taken care since they were only able to stop about 50%- leaving me with 30+ per hour. I even ened up with a lower O2 desats on titration then I had in my origninal study-I was between 80-89% O2 for 3 times as long as the first study. If I remember correctly, you are using BiPAP for breathing support for your post-polio syndrome which is probably more similiar to my situation then OSA is for either of us...we really do need to talk...I think looking back at your post that you and I keep missing each other since both of us have other health problems and aren't always as active on the board at the same times.

Can you increase your pressures by smaller increments to get to teh EPAP your doc recomends? I can't remember but I know my Synchrony can go up by .5, if not by .1.

Christine