RESULTS OF O2 INFUSION INTO APAP AIR LINE! Interesting.

[torontoCPAPguy]

Hello all. As many of you know, I and several other forum members have been 'forced' to infuse O2 into our CPAP/APAP lines in order to maintain a sufficient SaO2 level to induce solid sleep including REM sleep being uninterrupted. I have not put up all of the graphs with SaO2 dropping down into the low 70% range; nor have I put up the graph of the first night where my SaO2 was up in the 97-98% range. The graph of high and steady SaO2 is from my second night with oxygen flow set to 4L/M and is annotated as will the future graphs be. I am targeting 95% of steady SaO2 and am looking to have another sleep study done with EEG to determine what my L4 and REM sleep looks like. I have not posted my S9 data either as it pretty much shows what it always does; namely, my leak rate is minimal, my apnea events have been reduced to 0 or 1 per night and my hypopnea events have been reduced to the same. That was my first objective - namely, a mask that fit without leakage and getting my events and numbers to the best I could. However my SaO2 was still dropping into the 70's and most assuredly causing awakenings even if not full awakenings. Thanks to the members of this board I knew what to show to my MD's and what questions to ask... I have had three seperate MD's not specializing in sleep study variously tell me that my SaO2 at night needed to come up, I would sleep better and it was healthier and refered me to a top notch pulmonologist for further evaluation. I am walking in with data in hand and asking for a sleep study to determine the quality of my sleep, especially REM sleep and awakenings, etc. After two nights on infused O2 I am feeling better during the day but awakening groggy and it seems to be taking me longer to 'wake up and get going'. I am attributing this to the fact that I am simply not used to copious quanitities of deep sleep. Yesterday and last night were amazing! I had a two hour nap on APAP with SaO2 around 97% constant yesterday afternoon. I again napped after dinner for about 4-5 hours WITHOUT O2 and the dragged myself to the bedroom where I turned on the APAP machine and got it running and then turned on the O2 concentrator, hauled on the Mirage Quattro FFM and adjusted for zero leaks and laid down to sleep. I was out like a light and slept something in the order of ten or eleven hours! (A first). More info to follow as I play with the O2 infusion level and my new optimum APAP pressure range, which appears to have gone DOWN for some reason (which I don't understand excepting that perhaps my hypopnea events are no longer as much of an issue with infused O2?). My apnea events remain at zero (0).

Here are some oximetry studies - pick the ones with supplemental O2 infused into the APAP air line!

By the way, I found, using an oxygen tester (Maxtec MAX O2) that adding 5L/M of O2 into the hose near the humifier only raised the oxygen content of the air presented at the mask from 20.8% (normal room air) to 24.8% (normal room air pressed at 13cm H2O towards the mask combined with 5L/M O2 infused). So note that the difference in presented oxygen content is not HUGE, but makes a significant (HUGE?) difference in SaO2. I am now wondering what effect it is having on my REM sleep and only a sleep study with EEG is going to tell me that. I see the pulmonologist next week and all of this is probably going to blindside her as she is expecting a patient with hat in hand I think.

August 24 AM:





August 21 AM:



September 18 AM:

[torontoCPAPguy]

Just to point out:
1. I have not posted all of my studies especially the ones showing me going down to the 70% range SaO2 during the night; there are several of those.
2. I DO NOT RECOMMEND PLAYING AROUND UNLESS AND UNTIL YOU HAVE EDUCATED YOURSELF AS BEST YOU CAN AND KNOW WHAT YOU ARE DOING AND THE RISKS INVOLVED AND DO SO ONLY UNDER THE SUPERVISION OF AN MD AND WITH EYES WIDE OPEN.
3. Personally, my next step of development of my magic bullet will be a feedback loop for administration of O2 based on SaO2 levels, similar to what gvz has done. It is not a cheap solution at this point but having most of the gear required excepting the addressable oxygen valve I am about ready to go with it but want to get things settled down to the best they can be at THIS point before proceeding to look for the magic bullet and the very best treatment I can find.
4. The ultimate solution for me may not, in fact, be mechanical but rather lifestyle change or at least include lifestyle change. Elevating the head of my bed to allow my diaghram to take in more room air; losing weight to try and reduce apnea events without the use of a blower, elimination of the need for pain medications for arthritic pain and injured disks, etc.

It would be great to hear of similar experiences with supplemental O2, cause and effect, so that we may ALL become better educated with regards to the topic.

One last caveat. Asides from the MAJOR caveat that this should only be undertaken with the supervision of a doctor.... if you do it on your own you undertake the associated risks involved, it is important to note that the body, during REM sleep, in a convoluted process essentially uses CO2 in the blood to regulate breathing and inducing additional O2 into the bloodstream may compromise this autonomic nervous system reaction - just so that you are aware. I have not found any ill effects thus far myself but each of us is different.

[LoQ]

Just a quick note. You are not measuring SaO2, you are measuring SpO2. Though they are often close in value, they are not always the same and are measured differently. In particular, a smoker may have a higher value of SpO2 than SaO2, resulting in false assurance that all is well if you are using SpO2 as a proxy for SaO2. There can also be a difference for patients that are anemic.

[torontoCPAPguy]

Just a quick note. You are not measuring SaO2, you are measuring SpO2. Though they are often close in value, they are not always the same and are measured differently. In particular, a smoker may have a higher value of SpO2 than SaO2, resulting in false assurance that all is well if you are using SpO2 as a proxy for SaO2. There can also be a difference for patients that are anemic.

A revelation! Never noticed the difference. Off to educate myself. Thanks for pointing this out.

[torontoCPAPguy]

One MORE thing guys!

The pulse oximeters do NOT read out SaO2 (blood oxygen saturation)!!!!!!

They read out in SpO2 which is close but there IS a difference.

Time to GOOGLE SaO2 and SpO2!!!!!!!!!!!!!!!!!!!!
Wow. We learn something new every day.
And by the way, the readings of the Contec 50E which I use are not to be used for therapy (according to Contec) but are accurate in the 70-100% range to +/- 2% if I can decipher the decoded Chinese manual correctly. I have found the readings, as a matter of interest, to always be accurate within one digit of the hospital type oximeters during therapy, etc. I check my oximeter and my Accutor automatic blood pressure machine (don't even ask how I wound up buying THAT thing on eBay) and ensure that they are accurate, and they are.

Time to read up on SpO2 versus SaO2 gang.

It is important information to know.

[LoQ]

One MORE thing guys!

The pulse oximeters do NOT read out SaO2 (blood oxygen saturation)!!!!!!

They read out in SpO2 which is close but there IS a difference.

Hello? Didn't I just say that, only with more precise language??

[torontoCPAPguy]

You sure did... I just wanted to make sure it was in RED and get folks to read about the difference. I have been calling it SaO2 all along and needed in my mind to point out what you had said in RED for my own peace of mind.

And I thank you again for pointing out my error and heading me along the path of knowledge once again!

[torontoCPAPguy]

Looks like I'm talking to myself here. Used reduced O2 and reduced CPAP/APAP range last night and still had a pretty high SpO2 at 97%..... and slept poorly for the first part of the night and then got up and returned to bed 30 min later. Slept like a log. Am just waiting to take my son to the airfield and then I'm coming home and going to grab another couple of hours of sleep to make up for the lost sleep last night. Will report back when I haul the data out of the oximeter later. One thing is for certain and that is that my sleep is much more solid with the O2 being infused and I am attributing that to no desats during REM sleep to awaken me. I still wake up groggy but during the day have much more energy.

Anyone else care to share?

gvz has his Contec oximeter data integration software ready to test and looks like he is looking for beta testers for "hobby use".

[Madalot]

Looks like I'm talking to myself here. Used reduced O2 and reduced CPAP/APAP range last night and still had a pretty high SpO2 at 97%......

I'm watching, my friend!! I am excited, on your behalf, that it seems adding oxygen to your cpap IS making a significant difference. I've had oxygen since my bipap and we kept it when I moved to the ventilator. I'm considering requesting an increase in the oxygen (I'm at 2L) because the last several overnight pulse ox tests have shown me down into the upper 80's, with last night's low down to 82.

I may not be saying a whole lot, but I AM watching your progress here.

[M.D.Hosehead]

I may not be saying a whole lot, but I AM watching your progress here.

Me, too. Most people don't have the damaged lungs you do. Still, I wonder how many people with OA who have "acceptable" average sats of, say, 93%, and whose nightly desats never fall below 90%, would still feel a difference with supplemental O2.

[LoQ]

Still, I wonder how many people with OA who have "acceptable" average sats of, say, 93%, and whose nightly desats never fall below 90%, would still feel a difference with supplemental O2.

Bingo. You win the prize.

As snoredog used to say, one day science will catch up to what I'm saying.

[torontoCPAPguy]

Looks like I'm talking to myself here. Used reduced O2 and reduced CPAP/APAP range last night and still had a pretty high SpO2 at 97%......

I'm watching, my friend!! I am excited, on your behalf, that it seems adding oxygen to your cpap IS making a significant difference. I've had oxygen since my bipap and we kept it when I moved to the ventilator. I'm considering requesting an increase in the oxygen (I'm at 2L) because the last several overnight pulse ox tests have shown me down into the upper 80's, with last night's low down to 82.

I may not be saying a whole lot, but I AM watching your progress here.

Thanks for chiming in - makes one feel better for some reason. You definitely want to keep your SpO2 in the nineties and I have targetted 95% as my 'ideal' prior to seeing my pulmonologist in a few days. I want to show the before and after graphs and get another sleep study or at least an EEG ordered up along with my own gear running at my settings just to see what my REM sleep looks like. I can tell you that today there seems to be something of a 'spark' in me that could be the beginning of a return to some semblance of normality. The "golden bullet" as my friend gvz says.

2L/M when mixed in with all of that airflow is pretty low infusion.

Thanks for your kind words.... I'm so very excited at the prospect of getting some solid sleep with a bunch of REM thrown in!

[torontoCPAPguy]

I may not be saying a whole lot, but I AM watching your progress here.

Me, too. Most people don't have the damaged lungs you do. Still, I wonder how many people with OA who have "acceptable" average sats of, say, 93%, and whose nightly desats never fall below 90%, would still feel a difference with supplemental O2.

There's one way to find out! My guess is that anyone with OSA is going to feel a bit better despite their lack of desaturations during the night. I am guessing that it will extend their REM sleep time even if only marginally; it will get the body working at peak efficiency while asleep with less effort (in especially the liver). But there IS a price to pay for the benefit and that is that once awake and OFF the O2 infusion, one can feel a little extra effort needed to suck in all that air to maintain the same or sufficient SpO2 levels.... at least for a while. Didn't notice when it ended this AM... but it went on for a good half hour give or take. It was just 'noticeable' and not by any means a struggle.

The main benefit that I am seeking is solid and lengthened REM sleep with my body and its organs functioning at max possible efficiency. It is a bugger to sleep a full 8 - 10 hours and wake up feeling tired (as opposed to just groggy). And to have your 'get up and go' 'got up and went' by 5 p.m. to the extent that you cannot even think of the effort of an evening outing - preferring the couch to anything else, even dinner.

THAT spark is beginning to appear today I think (I hope) and if I can just keep my pressure range so that my events are nil and keep my infusion of O2 to the point that I hang around 95% SpO2, I think I will have found my 'sweet spot' and be able to take graphical data to the pulmonologist (first visit!) next week. Boy is he going to poop his pants or what? The only reason that I am going to a pulmonologist at this point is to (a) validate what I am doing and (b) try to get another sleep study ordered up so that I can get an EEG hooked up and see if I am indeed getting the REM sleep I am looking for. And other advice will be gratefully accepted and faithfully applied as they say... but I have an agenda.

[Madalot]

You definitely want to keep your SpO2 in the nineties and I have targetted 95% as my 'ideal' prior to seeing my pulmonologist in a few days.

Yeah, I'm getting a little concerned at this point. I have been doing pulse ox monitoring every night and I was staying in the middle 90's most of the night and the drops were usually only to around 90 or so.

The last 4 or 5 nights have definitely NOT been as good. Last night's report (only 6hr 11min because I went to bed late) showed 3 events, averaging 37.3 seconds with one event down to 84%. The night before was down to 82%.

I guess I need to contact my doctor about it and see what she says. I think in my situation, unless it shows a serious downward trend, she may not address it.

Would you (anyone) consider suddenly doing this (after a long time staying in the 90's) to be an issue that needs addressing?

[torontoCPAPguy]

Every time I think that there is a science to this thing; along comes empirical data that proves me wrong. Yours, for instance. Mine, last night. I ran 2L/M last night and found my SpO2 remained pretty much in the 90's all night long... even up into the high 90's. I had one minor hypopnea event all night. But, alas, I did not sleep well for some reason.... I had several awakenings and thus my earlier statements that one can only really co-relate all this data and make conclusions with an EEG running to see what happens during various stages of sleep, in especially REM sleep.

Yes, if my SpO2 were constantly running below 90% especially significantly below 90% at night I think I would want to talk to my pulmonologist about it. I am hoping to do just that in about a week and hoping to get another sleep study ordered up so I can see (we can see) what is happening.

I have no idea why the bad night of sleep last night. Constant awakenings but SpO2 was pretty good at 2L/M. Tonight I am going to crank 'er back up to 3L/M at leave my pressure at 12 cmH2O - 16 cmH2O as I seemed to have no issues with events at those pressures and my target is now to keep my oxygen saturation up in the 90's and sleep well through the night.

We shall see what happens but one thing is for certain and that is that, thus far, the infused minimal amount of O2 makes a big difference in my SpO2 through the night. It should be, theoretically, eliminating one cause for arousals from REM sleep.

In your case, with SpO2 dropping down into the low 80's suddenly I wouldn't panic but I would want to speak with my pulmonologist about it. Any changes taking place? Less worries. Narcotic or other pain killers or med changes. Etc. These could all be potential causes.