XPAP and oxygen..what is your titration level of oxygen?

[dllfo]

My Pulmonologist is out of town, so I am on hold with this one. I have been waking up tired, so I started checking my pulseox. This morning it was 80.
After several minutes it was 82...getting dressed, etc. Once it got up to 84.

I wanted to try oxygen with my Auto Bipap, but the asst Dr. said no, he wasn't sure what titration to use.

I have the "in line" device to hook an oxygen line up to, and I have the Home Fill II unit for "all night" use, but I won't do it without the dr. saying it is ok.

I am normally titrated at 2 LPM on Oxygen and Heliox. I do not want to use the Heliox unless it becomes necessary.

I just ate dinner, washed the dishes, put the dog out, walked in here to post this and my pulseox is 84. When I get on oxygen, the pulsox goes up as high as 97. When my pulseox is low, I have the wife read it to confirm it, then she tries the unit out to see what her readings are. She is usually 97.

So what oxygen titration do YOU use at night?

(And yes, I am still waiting for an opening at the big respiratory hospital in Denver...I can leave on a moments notice.)

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, auto

[DP]

You are asking for some pretty serious medical advice. Given your sats during the day it sounds like you have a serious underlying problem. Do you have COPD? Lung cancer? CHF? Given what info you have provided I think you need to go to the nearest ER.

[dllfo]

DP - I must not have worded it right...I am NOT asking for any medical advice.
I am asking anyone who is using oxygen with their XPAP machines, what is their titration level. No advice at all. Just a simple...if you use oxygen with your machine, what is the titration?

As for my underlying problems, you are correct. They are very serious.
As for going to the ER, they don't want me, they send me straight into the Critical Care Unit. Some of you may remember the last time where they put a nurse at the foot of my bed to watch me...my heart rate was in the upper 30s
and they couldn't figure out why.

I don't want to bore you with my overall health issues, I was just hoping to hear from a few people who do use oxygen at night.

[Goofproof]

I was started on CPAP with O2, when I came home from bypass surgery. The Dr. wanted me to use 2LPM, the cpap pressure remains the same. I tried to explain as the cpap air stream was being vented so fast you wouldn't get much of the 2 LPM of O2 being inputted, so I set mine at 4 LPM into cpap, and probably still wasn't getting as much as in the day, which was 2 LPM.

Two things to check, you need a O2 inlet at the HH outlet that has a check valve, to stop reverse flow of O2. Or use the mask O2 inlet with the check valve in the cpap air line. Also I had a O2 Concentrator for a supply, Not all forms of O2, can be used on cpap. It has to supply the correct flow rate and overcome the cpap pressure.

Jim

I no longer use O2, they put me on it at 90, and after 4 months took me off it, still at 90, That makes a lot of sense, not.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[dllfo]

Jim,
my memory is so darned bad I had to search for this topic.

I do not have any "valve" action that I know of, do you have a part number or a picture?

My adapter is blue, I hook the O2 line on it and tried 2 LPM, not good. Then
the next night, 3 LPM and that was 87 pulseox. Better than the 80 without it.
Since the Owner's manual implies this unit is not to be prescribed or used...I
forget the term....don't use this unit if the prescription is over 3 LPM. Yeah, it
goes to 5 LPM. But three was too low, and I wouldn't want to damage their equipment, so I played with it until my pulseox was 95 in the morning.

For the DMEs and other experts, does anyone know why the unit is set up to
run up to 5 LPM, but they don't want you to do it????

Almost all the time now, if I am taking a nap, fall asleep, etc. the wife wakes
me with pulseox in her hand. I test it immediately. I am usually 80.
Sitting around the house today, and most days, I am 83-87 while sitting up.

Since Apria does not have many of these Home Fill two units, I didn't want to rock the boat until I get back from the hospital in Denver. I do know my first item on the agenda there is a new sleep study and the lady talked like I may do two nights of sleep study. Not sure why.

Thanks for the info Jim

[Slinky]

Most likely when you were told you would probably have two sleep studies what was meant was the first would be a sleep evaluation w/CPAP and no 02 and based on those results a second study w/CPAP and 02. Or perhaps the first study on just 02 and the second study w/02 and CPAP. At least that would be my guess.

I started 2L of 02 overnight prior to CPAP. When I was started on CPAP I was told I wouldn't need the 02. I was started at 6 cms of pressure which was later increased to 8 cms of pressure. When I progressed to a certain point and had no further I purchased my own recording oximeter and printed out some 10 nights worth of results to present to my sleep pulmonologist. THAT got his attention. 2L of 02 was then added to my CPAP. My overnight sats recordings IMMEDIATELY improved to 90% or above all night.

I have a DeVilBiss 5L concentrator. I was never told not to run it at 5L. On the other hand my scripted level was 2L and there was never any discussion of turning it higher, altho I was shown how to select the 2L level so obviously I would know how to turn it higher.

When we added the 02 to the CPAP it was just a simple matter of the little plastic adapter that fits over the hose connector on the CPAP integrated humidifier, it has a small "connector" on its side that the 02 tubing connects to just as it would to a cannula and then the mask hose is just attached to the end of the plastic adapter. Its not much more than a short hard plastic tube w/a "nipple" for the 02 tubing to slide on.

[Goofproof]

From the Remstar APAP .pdf: WARNING!

When using Oxygen with the Remstar Auto, thw oxygen supply must comply with local regulations for medical oxygen.


When using Oxygen with the Remstar Auto,

A Respironics pressure valve (part number 302418) must be placed in-line with the patient circuit.

Mine came from Lincare with the O2 compresser.
This one does not appear to be the correct one.https://www.cpap.com/productpage/O2-Enr ... apter.html The correct one will have a check valve built-in and a external vent to dump the O2 when the machine is off. Jim

[dllfo]

slinky - What you are saying about the sleep study makes sense. While I do not look forward to spending two night wired up, I am so tired right now, I have to do something. It is 12:31pm Sat. and my pulseox is 83. Just sitting here typing.

The fitting you are describing sounds exactly like the adapter I have.

BUT, WOULDN'T IT BE BETTER, MORE ACCURATE, TO PUT THE ADAPTER OUT BY MY MASK?

I have two of the six foot hoses, so I could even put the oxygen entry point at 6 ft from the machine or at the air outlet at the heated humidifier.

Jim, I can stick a pencil thru the O2 adapter I was given by Apria. This adapter has a hole in it and a plastic "plug" for that hole. next to it is a male device to put the oxygen hose on.

I just played with the set up a little bit. I was running it right next to the HH, but now realize I can put it immediately in front of my mask. If I put the oxygen hose immediately in front of my mask, I would think that would
give me more oxygen, maybe not.

The device I have absolutely does not have any form of check valve. It is straight through.

I will try looking around in the web to see if I can find a picture of the part numger you gave me.

Thanks to both of you.......

[Guest]

you need to attach the O2 line at the CPAP machine for a better mix. but please don't increase your o2 above what the Dr. has prescribed. normally 2-3l/night is enough. but what you have to becareful of is your Co2, you may be a Co2 retainer and thats why it's important not to change your O2 level. depending on your medical condition, with some pt's we are happy to accept nadir's at 88-92%. you may be feeling tired due to this. (Co2)

[fidget]

You actually get a better 02 flow putting it back by the CPAP. And you are running the concentrator while you sleep, not the homefill tanks right? The homefill tanks pulse on demand, and the continuous flow of the CPAP doesn't trigger the tank to give you the oxygen. You might also consider ditching one of the 6 foot tubings, all the studies on how this stuff works were done with one 6 foot tube.

If your sats are running that low, you should be on your oxygen all the time.

As for the check valve, it's there to keep oxygen from venting back into the cpap machine, which could theoretically be a fire hazard. If you're shutting the oxygen off, or removing the tubing before you shut the cpap off, the air flow will vent it by itself, and no problemo. It's never happened that the Respironics rep that explained that to me knows of, but Respironics put that in the manual, as a just in case, so they can't be held liable. Somewhat like the warning that tell you not to spray the paint directly into your face. Duh.

The reason for not turning the oxygen up higher than prescribed without clearing it with your doctor first, is that people with lung problems have a different breathing drive than people without. If you get too much oxygen, your body won't blow off the carbon dioxide, and it'll build up in your body. If your carbon dioxide level gets too high, your brain won't remember to breath, and you could literally die.

CO2 narosis is a sleepy, "drunk" feeling, and can be very dangerous. You could have 98% sats, and still be in a great deal of trouble. It's a balancing act, and not something to play with yourself.

It's common for people with lung problems to focus completely on getting those sats up, but in honesty, some people actually can get in trouble running even over the low 90s.

Please see a doctor, it sounds like things could be getting into a bad way with you. Please don't just guess, and please don't expect people on a message board to advise you, this is honestly dangerous, and I worry for your life.

[Guest]

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. I think it (C02 blood concentration is more related to respiration rate and depth of breathing. Your own body is fairly efficient at regulating blood CO2 levels by controlling your respiration rate and depth of inhalation without your conscious input.

As a fighter pilot, (in very good health at the time) I have used 100% 02 inflight for extended periods of time, up to 9 hours on occasion, with no ill effects. The oxygen regulators in use during my time had an automatic mode that gave you the O2 amount you needed to maintain a sea-level partial pressure of O2 in the lungs, based on the pressure altitude your were at inside the cockpit (which was normally below 10,000 ft). There was also a switch that could deliver 100% O2 if you chose to use it. Many of us chose to use it a lot, since it made you feel more alert, increased your visual acuity a little, and just felt good all around.

If 100% O2 breathing made your CO2 levels get very much out of "whack" ( a technical term for out of tolerance) , then I would be dead ten times over.

Caution: I have no medical qualifications, whatever. Just some experience in use of O2 in unusual circumstances.

[dllfo]

5:42pm, I just took a nap, with the oxygen on. I moved the oxygen "inlet" from the heated humidifier to just before my mask. I don't feel any different.

My wife came in to wake me at 4pm. I took the mask (and oxygen supply)
off. I kept falling back asleep. We checked my pulseox and it was 80. The machine was still producing oxygen, so I put it back on. After about five minutes I checked my pulseox and it was 93. As I type this, I put my SPO 5500 back on my finger, it was 82. Not good.

Littlemo, how can I measure my Co2? I am sure there are machines that do it.
I feel tired ALL THE TIME. The only time I have felt good, was when they put me on 60mg of Prednisone a day for ten days. I felt like I could run a marathon at that time. I felt great. AND my lower back did not hurt for days.

I don't remember what my pulseox was at that time, but I had so much energy my wife said I was now hyper. I told her I might not be hyper, maybe this is the real me without the pain to wear me out. And that is how
I was before being rear-ended twice. I felt great.

So something in my body...in my lungs...is really screwed up. THAT is why
I am going to the National Jewish Hospital in Denver.

OK, I have moved the oxygen inlet back to the machine. I am running the
machine at 3 LPM right now. Two was the original titration for "use as needed" but 2 LPM did not seem to raise my pulseox much, so I moved it up and down to check my pulsoox at each setting.

I am running the concentrator, not the small tanks. Next to my bed is a pair of E sized bottles with a Y adapter bringing the oxygen and Heliox into one
cannula. I try not to use them when I can use the concentrator, plus I have the 2 little..uh....M9 bottles? I forget which size they are, small with pressure demand regulator. I do not use the pressure demand unless I am awake.


I am seeing a top pulmonologist, but the last time I called in, asking for
advice, he said ""GO TO DENVER". My Primary Care Doctor will order what I
need, if I ask. I had to buy my SPO5500 because they didn't bother testing me at home like I asked them to do.

I am NOT looking for medical advice per se, I am asking people what their
titration was set at and how did it work. I fully understand this is a forum and not the doctor's office. Where to put the oxygen input....you would think Apria would have told me. They didn't. I called and the person said he wasn't sure, they would call me back. They didn't. They will Monday.

I will call my pulmonologist Monday, telling them it may be July before I get in Denver, how about keeping me alive until then.

Thanks so much for the help, I know I am not functioning well mentally, I
am tired and listless all the time (unless I am on high doses of Prednisone, which has its own side effects). The Co2 thing is one side of the equation I had not thought of, but my doctor should. Maybe saying 2LPM is how he is balancing my Co2.......I don't know, but I will Monday. I called his stand by doctor a couple of times. Worthless. Probably a good doctor, but when you work for a well known doctor in his field, I think the assistants may be intimidated.

We will see.

[Goofproof]

BUT, WOULDN'T IT BE BETTER, MORE ACCURATE, TO PUT THE ADAPTER OUT BY MY MASK?

Jim, I can stick a pencil thru the O2 adapter I was given by Apria. This adapter has a hole in it and a plastic "plug" for that hole. next to it is a male device to put the oxygen hose on.

I just played with the set up a little bit. I was running it right next to the HH, but now realize I can put it immediately in front of my mask. If I put the oxygen hose immediately in front of my mask, I would think that would
give me more oxygen, maybe not.

The device I have absolutely does not have any form of check valve. It is straight through.

I will try looking around in the web to see if I can find a picture of the part numger you gave me.

The object of the check valve is to positive seal off the input to the XPAP from O2 if the XPAP shuts off. The one they gave me in the hospital did not have a check valve, I had left my good one at home.

Some FF Masks have O2 ports on the mask, it might give you more O2 that way, but it would be easyier to pull the line off the mask too. I hope you get it sorted out soon , i don't like your O2, being so low.

The best to you. Jim[/b]

[Slinky]

You really should have a Pulmonary Function Test and/or an Arterial Blood Gasses test just to see where you are at. Any of your doctors can order either or both of them. The results just might add more urgency to your request for an appointment in Denver and get you on and/or higher up the Cancellation list.

The PFT and/or ABG can determine whether you are a C02 retainer or not if I remember correctly. ANY doctor can also order the overnight oximetry or a daytime oximetry for crying out loud. So what's your doctor's problem?

In addition to reducing inflammation prednisone can have an energy boosting effect, almost to or to the point of hyperactivity as a side effect, usually an undesirable side effect. Have you ever had a Multiple Sleep Latency Test for narcolepsy? That may be contributing to your exhaustion in addition to your oxygen desaturations. Actually, it sounds more like oxygen starvation.

Do you have cardiac problems? Congestive heart failure. Fluid around the heart or lungs?

You would probably get more help w/the oxygen situation at the EFFORTS forum and e-mail list.

EFFORTS@EFFORTSLIST.ORG

They have some excellent pulmonary rehab respiratory therapists that are very helpful and informative and willing to answer questions. And lots of experienced emphysema and COPD patients to share experience and advice.

[blarg]

Talk to your doctor. Seriously.