Supplemental Oxygen - pros and cons?

[The Sheikh]

I use an Everflo Q to infuse 4L/M into my S9 Auto's airline to the mask. My Contec 50E recording oximeter was showing my SpO2 dropped substantially below 90% (like down into the 70's) most nights.

Thanks for the info -

Question: Does your O2 supplement simply bring the overall average % up and you still have the same drops in range, but starting at a higher level? Or does the O2 come on when a sensor decides your O2 desat has dropped to a critical level?

For example, without an O2 supplement, let's say your O2 drops from 90% to 75% during a severe desat event. This is 15% points of drop. Now what if you are adding 4L of 02 and the blood level starts at 98%. Why wouldn't the drop still be 15% points down to 83%? I would think we would need a valve to cut in and add O2 when needed, rather than keeping O2 on all the time so that we are close to O2 saturation when not needed....

Or maybe O2 desat is not a linear thing.

Get what I am wondering?

Tom

[Todzo]

I use an Everflo Q to infuse 4L/M into my S9 Auto's airline to the mask. My Contec 50E recording oximeter was showing my SpO2 dropped substantially below 90% (like down into the 70's) most nights. The result of this is that your autonomic nervous system arouses you in order to breath more deeply. The other result of this and much more dire is that your BP skyrockets while the body attempts to correct oxygen starvation any way it can.... leading to stroke risk.

However, you say your SpO2 is above 90% throughout the night based on a recorded report. I would suggest that you are well oxygenated and do not require supplemental O2 as far as apnea is concerned. My desats always line up with apnea events.

Hi torontoCPAPguy!

The O2 probably does help stablize breathing and help get the O2 level back up after an event. But why is the breathing so unstable in the first place?

Look at the flow data near the events. Are you using a large volume of air?? So then - assuming your lungs work pretty well - your SpO2 levels are up during that phase (I think likely). But - then - you stop breathing and - bamm - the SpO2 levels drop like a rock with JATO assist!!!

My point with the questions about desaturation speed tie into this directly - - if what I describe above is true - that you desaturate quickly (faster than an SpO2 downward change of 2% in 30 seconds -- I would guess you move as fast as 15% in thirty seconds or over seven times as fast) then I think a lot of cells are pre-starved so to speak and then get fed "all at once" draining the blood stream of oxygen and likley producing a lot of CO2 all at once.

I think it is likley that the arousal/awakening occure slightly previous to the apnea and perhaps cause it to be as a restorative event. The heavy breathing proceeding are likely partly due to the released CO2 from all those cells being fed at once, and partly due to the O2 levels being drawn so low at once.

What the extended rebreathing space approach does is to keep the CO2 levels from dropping so low that circulation shuts down and oxygen transport is frustrated. So the cells remain fed and perhaps the O2 sensors keep from going hyper and creating a false demand for air that you really do not need. In Europe, I have heard, they are experimenting with supplemental CO2 to do the same thing.

The only answers in use for this in the U.S. that I am aware of are supplemental O2, extended rebreathing space, and our highest technology PAPs.

In terms of lifestyle things that I believe would help:

1. Reduce Stress (I have found this to be the most effective strategy dealing with all Sleep Apnea Issues in terms of lifestyle).
2. As much as practical, incorporate exercise. Aerobics, and after some training with aerobics interval training. I think these exercise the breathing reflexes and help some of the sensors work better and make nighttime breathing more stable. This I say watching my own data and doing the exercise regularly. You do need to start slow under a doctors care. My starting goal was to do my 10,000 steps a day (still a goal - up to 75% in the summer) - adding interval training when I arrived in my new digs and now bicycleing now needing to make it to a town six miles away. I note the positive effects after I do the exercise and cumulateive in my data numbers (and needing a new belt recently since the old one became too big!!).
3. Stay away from violent media. No "ID TV" for Todzo in spite of my victim of violent crime status (nice to see an incident worked out in an hour indeed!). I think we need to live life more real and that violent media stimulates my already over stimulated nervous system which would tend me toward more unstable breathing at night since nerves, I have observed in my data, do seem to do that. I do not have TV in my new digs and probably never will.
4. Less carbs near bedtime,
5. Anti-inflammitory and anti-oxidant foods.
6. Optimal Breathing training using a pulse oximeter to find the lowest heart rate keeping exercion constant by controlling breathing.

I hope we find good answers to this soon.

Todzo

[torontoCPAPguy]

Don't be afraid to advocate for yourself. I went out and bought a used oxygen concentrator at first before the Everflo Q. But even before that I took my nightly SpO2 readings through the night with a CMS50E Contec oximeter... as soon as I showed those to the sleep doc he wrote the Rx for the oxygen "******+O2**********" was all it said.

[Todzo]

I use an Everflo Q to infuse 4L/M into my S9 Auto's airline to the mask. My Contec 50E recording oximeter was showing my SpO2 dropped substantially below 90% (like down into the 70's) most nights.

Thanks for the info -

Question: Does your O2 supplement simply bring the overall average % up and you still have the same drops in range, but starting at a higher level? Or does the O2 come on when a sensor decides your O2 desat has dropped to a critical level?

For example, without an O2 supplement, let's say your O2 drops from 90% to 75% during a severe desat event. This is 15% points of drop. Now what if you are adding 4L of 02 and the blood level starts at 98%. Why wouldn't the drop still be 15% points down to 83%? I would think we would need a valve to cut in and add O2 when needed, rather than keeping O2 on all the time so that we are close to O2 saturation when not needed....

Or maybe O2 desat is not a linear thing.

Get what I am wondering?

Tom

Hi again Tom!

I think supplemental O2 needs to be on all the time to be effective.

There are those who believe that supplemental O2 helps by keeping an over sensitive O2 desaturation sensor from generating so much of a "breath harder" signal that the arousals and hypercapnic central apneas do not develop. To me that makes a lot of sense. When an arousal or hypercapnic event does occure there is also increased central nervous system activity (stress hormone induced) which tends to make that silly over sensitive O2 sensor to be even more hyper and tends to trigger even more events.

Anymore I tend to be more afraid of those things which I believe set my body up for events. Indeed, the fact that desaturation is so many times faster than it should be makes me believe that many cells are at least under supplied with O2 in spite of much O2 being in the blood stream prior to the event (all that heavy breathing - indeed!).

In my case many events went away when I moved away from an area I have come to consider dangerous (five extra holes in my body from a knife along with a very beat up eye along with weekly murder reports kind of convinced me!!). I think that the "stress background" has a lot to do with all things that make AHI or breathing stability events occur.

But things did get better with optimal breathing training, probably because it allows more desaturated blood cells to circulate in the body during the day so perhaps helps the desaturated blood cell sensor to be a bit less sensitive. As well, the CO2 levels run a bit further away from the hypocapnic state moving those sensors thereby as well as making for better circulation.

To the less stress in a new "less crime" place was added constantly having to walk up the hills here. Since I carry a pulse oximeter on my belt it was easy to make these times into "interval training" times. I am suspicious that aerobic and especially interval training very well exercise our breathing reflexes. I do "optimally breath" as I do this as well. It does appear to make me less sensitive to unstable breathing according to my nighttime data.

I think that supplemental O2 would be very much a second choice for me - way after the above. If you have extra O2 at night but not during the day I think you would tend to breath more during the day and perhaps too much so.

Everyone who I know to be very healthy lands around 96% SpO2 when measured. If my SpO2 is above that, I will slow my breathing down, indeed, experience tells me that my lowest heart rates occur near the 96% if doing moderate exercise and 95% if at my desk (the levels were 97% if doing moderate exercise and 96% at my desk when I was starting out). I do find that after some good exercise (new bicycle these days) I will land near the 96% mark even when I am excited about what I am doing.

Well I went on a lot longer than intended. I hope it is useful to you.

Have a great week!!

Todzo

[themonk]

Hi themonk!

You might find it interesting to obtain the detailed version of your SpO2 data from your sleep study. I am kind of guessing but I think that OSA will always tend one toward desaturation upon a reduction of air flow espicially later in the night (after several events). <snip>

Late to respond, but I do have the full copies of both of my reports. In fact, I know them so well I found errors in both of them which prompted them to be re-scored, currently underway. And to speak to your point, I had no O2 issues during either study - early or late at night, supine or not supine, etc.

[Todzo]

Hi themonk!

You might find it interesting to obtain the detailed version of your SpO2 data from your sleep study. I am kind of guessing but I think that OSA will always tend one toward desaturation upon a reduction of air flow espicially later in the night (after several events). <snip>

Late to respond, but I do have the full copies of both of my reports. In fact, I know them so well I found errors in both of them which prompted them to be re-scored, currently underway. And to speak to your point, I had no O2 issues during either study - early or late at night, supine or not supine, etc.

Hi again themonk!

Not even 3% dips near the events?

I think this speaks well of your athletic training.

Carry on,

Todzo