Supplemental Oxygen

JennyLouWho · Post by **JennyLouWho** » Thu May 24, 2007 10:44 pm

Hey y'all! I have found so much useful information on here. Thank you all very much! Another question...My pulmonologist said that I may have to use the CPAP with supplemental oxygen in the near future. My question is: what the heck are we breathing in every night if not oxygen? Why would one even need more oxygen then is being blasted up our noses? I know what the doc said, but I want more input from y'all. (I think y'all may know more than he does anyway!) I was on oxygen before CPAP because I had pneumonia and even after it cleared up, my blood ox. levels were in the 70's while sleeping.(Well, duh, I have OSA)Immediately after waking, they return to normal. This is what got me the sleep study in the 1st place.I still haven't received my sleep study results yet, so I can't help y'all there if you want info. from that. I have asthma, and mild COPD, but I just cannot understand why one would need MORE oxygen. Thanks for any help you can give me.

kavanaugh1950 · Post by **kavanaugh1950** » Thu May 24, 2007 11:33 pm

YOU ARE BREATHING OXYGEN BUT AT A MUCH LOWER LEVEL THAN IF YOU SUPPLEMENT. ROOM AIR IS 20-21% OXYGEN AND THATS NOT ENOUGH FOR SOME PEOPLE TO KEEP THEIR BODIES OXYGENATED. GOOD LUCK, PAT

carlitguy · Post by **carlitguy** » Fri May 25, 2007 8:33 am

I was hoping this topic would get some replies. I have been on APAP since September and while I do sleep I wake up about 5 a.m. or thereabouts and can not go back to sleep. I am going to see the best specialist available up here but I have had to make an appointment in march for June 4th. My oxygen levels were in the low 70's and I am wondering if this issue is still my problem.
Dean in Canada

Slinky · Post by **Slinky** » Fri May 25, 2007 9:29 am

JennyLouWho wrote: ... I was on oxygen before CPAP because I had pneumonia and even after it cleared up, my blood ox. levels were in the 70's while sleeping.(Well, duh, I have OSA)Immediately after waking, they return to normal. ...

And may I ask, what do you consider "normal"? 90% to 100% is considered "normal", BUT normal "when"? When you are just lazing around the house, watching TV, etc? What about when you are walking briskly from the car to the store? What are you sats then? Do you get short of breath during the day? When do you get short of breath? What does it take to make you short of breath? If your sats are 92% when sitting watching TV for any length of time, you're w/in "normal" sats ranges - but - I'll betchya your sats drop BELOW 90% when you climb the stairs from basement to ground floor level! And what about your heart rate when you drop below 90% sats??

betty303 · Post by **betty303** » Fri May 25, 2007 9:35 am

Have you seen the results of your sleep study?

Your saturation levels could easily be below "normal" even when you are on CPAP - consequently you would need supplemental O2.

Just getting room air blown in does not guarantee that your sats. levels are adequate.

Wulfman · Post by **Wulfman** » Fri May 25, 2007 10:06 am

My doctor prescribed additional oxygen on my prescription, but I decided against it. I figured that if I was not having apnea/hypopnea events during the night, my breathing SHOULD bring my O2 levels up. During the day, my O2 levels were in the mid to upper 90's anyway.
A few weeks after going on CPAP, my sleep doctor ordered an overnight pulse-oximetry test.......end of discussion.

Added Note: I've never used the additional oxygen I was prescribed.

If you haven't done an overnight pulse-oximetry test (it should be FREE) while you're on CPAP, you might want to pursue that with your doctor.

Den

Slinky · Post by **Slinky** » Fri May 25, 2007 10:23 am

Yup, Den is right!!! I "knew" that my CPAP wasn't enough but had to push my sleep doctor about an overnight oximetry whilst on CPAP. He opted for a loaner AutoPAP to better titrate my pressure. That helped but .... I still wasn't satisfied that maybe we shouldn't double check my sats w/an overnight oximetry. The oximetry data resulted in the addition of 2L of 02 to my CPAP therapy.

Guest · Post by **Guest** » Fri May 25, 2007 11:02 am

When I had my sleep study my O2 sats dropped down into the mid 70% during the day they run about 84 to 86%. I am on oxygen 24 hrs a day. Now my O2 sats during the night run about 91 to 93%. The xpap may not bring your O2 sats up to where your Doctor wants them to be. I tried a couple of nights without the supplemental O2 and could tell a big difference the next day. Very tired and worn out feeling.

JennyLouWho · Post by **JennyLouWho** » Fri May 25, 2007 7:18 pm

As usual, thanks to everyone who submitted a reply and for your quick responses!

kavanaugh1950 (Pat).....thank you for the good luck!

carlitguy (Dean).....I am only getting 3-4 hrs. of sleep per night. This after a little over a mth. on CPAP. The first week was horrible, but the 2nd week I was sleeping an average of about 5-6 hrs. having gotten more or less used to the mask, hose, etc. NOW...I am getting less and less sleep. The 3-4 hrs. I get on CPAP are really good, but I, too, wake up and cannot go back to sleep. AND, I am still getting those dreaded morning headaches. The only difference I have seen so far since being on "the hose" is that I no longer get the awful night sweats. (I just attributed that to normal menopausal hormone thingys!) So, I too, wonder if my ox. sats are down. If ours are in the 70's, I would think that this could be part of you problem.

Slinky...I am assuming that "normal" is 95 or greater. At least this is what they told me in the hospital. And, yes, I WAS in a hospital bed at the time. No one ever thought to see what my sats were while I was walking down the hall. Go figure! I have no clue what my sats are during normal activities, but I CAN and do walk at least a mile a day...at least 3 days a week I walk 3. I DO huff and puff, but I just thought that was the hills! Normal household activities (I do not work except for as a housewife) I do not really notice heavy breathing that much. Maybe slightly winded when doing some of the more strenuous things such as sweeping and moping.

Betty...As to my heart...I am on so much meds. for my heart and I know one slows my heart rate down. I am normally tachycardic without my meds. I am having another health issue that is interfering with my heart rate, but would be interesting to see what the low ox. stats do to my heart rhythm. I haven't seen my sleep study results yet, but during my sleep study, I told my tech that I was on oxygen and he said if my sats dropped down to the 70 for 20 mins. or longer, they would come in and give me supplement oxygen. They didn't, so I assume IF didn't.

wolfman (Den)...I am certainly gonna ask my pulmonologist (then INSIST if met with resistance) to give me the overnight pulse oximetry test. This is the same test I had in the hospital which is why I was on the oxygen to start with and why my pulm. wanted the sleep study. I am assuming that with the CPAP my pulse ox. was ok since there has never been any mention about oxygen since, except for the "possibility" of it after my pulm. reviews how I did on the CPAP. Who knows. It is all so confusing. I just wanna sleep! I will gladly do the supplemental oxygen if need be. After all, what is ONE more thing stuck up my nose!

Sorry this is so long, but wanted to address everyone who was so kind as to reply. Thanks again everyone. Sleep well and sweet dreams!

Slinky · Post by **Slinky** » Fri May 25, 2007 7:38 pm

70% ??? I was told by my sleep tech that if my sats went below 88% often or very long she would have to call the doctor for an order to put me on 02.

Joethespy · Post by **Joethespy** » Fri May 25, 2007 7:50 pm

This can be a confusing issue. There are two different values that we are concerned about when we study SaO2 levels (level of oxygen saturation in the blood). When there is an apnea or hypopnea, there is usually an associated oxygen desaturation. That means that the oxygen was at one point and dropped 4% or greater to a lower point. This is the low desaturation point that is reported on the sleep reports. Once normal breathing returns the blood begins to resaturate and return to that baseline. The next issue is what is that baseline? A normal baseline is 95 to 100 % SaO2. Smokers and patient's with lung disease do tend to have a slightly lower baseline. Medicare guideline for supplemental oxygen is that the baseline must remain below 88% for more than 5 minutes during monitoring. This monitoring can be done on a sleep study or with an overnight pulse oximeter. Oxygen should not be used to treat a desaturation unless it is spontaneous. spontaneous desaturations are those not caused by apneas. Their origin can be pulmonary or cardiac related or both. Oxygen is normally used to bring up the sustained baseline level of oxygen saturation. This may be needed even if on pressure therapy.

Hope this helps....Joe

Slinky · Post by **Slinky** » Fri May 25, 2007 8:02 pm

Thanks, Joe. Actually, my sleep doc turned me loose for 6 months at a pressure of 8 cms and 2L of supplemental 02.

Things are MUCH better w/this combo. BUT, we "ain't" there yet and I have no intention of struggling along for another 4 months like I did my first 4 months on CPAP.

I've switched DMEs for my mask supplies in order to get a decent fitting, comfortable mask. I purchased an AutoPAP (but then came the Recall) so for the time being I've upped my supplemental 02 to 3L (with great improvement) and scheduled an appointment w/another sleep doctor for a second opinion.

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