Little Experiment - Friday Night

Night before last, I was in a bad mood and just didn't feel like listening to the oxygen concentrator hum and bump and carry on all night. I just didn't turn it on. I decided NOT to use it last night again. I fell asleep listening to my ipod and was on my back for a long time before I woke up and turned over on my side.

I did an overnight just to see if the lack of oxygen would have any serious impact. Being on my back for a long time was an accident, but still happened so it became a part of the equation.

Wow. I had 22 oxygen desaturations, averaging 30.3 seconds, down to a low of 77%.

Even though the noise drives me insane, I think I'll turn the oxygen back on tonight -- don't you think?

Madalot wrote:Wow. I had 22 oxygen desaturations, averaging 30.3 seconds, down to a low of 77%.

Did you perchance have any below-90% periods that lasted at least 5 minutes? If so, your sleep doc might want to consider at least reassessing the AVAPS target Vt, EPAP, and/or BPM settings:

AVAPS titration protocol wrote: Unable to maintain SpO2 >90% for 5 continuous minutes?

AVAPS protocol's YES decision branch wrote: 1. Increase tidal volume to patient comfort by 10 ml increments for optimal therapy
2. Assess EPAP, consider increase
3. Assess rate, consider increase
4. Consider adding supplemental O2

P.S. I still love that avatar... Any little creatures who are neither rodent nor microbe, yet cuddle a sink, are okay by me!

Maybe you can string together enough tubing to put the concentrator somewhere outside your bedroom so that it's quieter.

I think that noise and the heat generated must be SO annoying!

My sister-in-law keeps her concentrator in an adjacent room.
Long tubing lets her get all over the house.
When she worked, she had one there with enough tubing to take her all over the place.

-SWS wrote:Did you perchance have any below-90% periods that lasted at least 5 minutes? If so, your sleep doc might want to consider at least reassessing the AVAPS target Vt, EPAP, and/or BPM settings:

AVAPS titration protocol wrote: Unable to maintain SpO2 >90% for 5 continuous minutes?

AVAPS protocol's YES decision branch wrote: 1. Increase tidal volume to patient comfort by 10 ml increments for optimal therapy
2. Assess EPAP, consider increase
3. Assess rate, consider increase
4. Consider adding supplemental O2

P.S. I still love that avatar... Any little creatures who are neither rodent nor microbe, yet cuddle a sink, are okay by me!

If I'm reading the report correctly, I had a lot of desaturations, but it seems that I spent about 17 minutes TOTAL between 85% - 90%, but it doesn't appear that there is a block of UNINTERRUPTED time really low. The report indicates that TOTAL time below 88% was only 2.4 minutes, so it seems that the rest of that 17 minutes was between 88% - 89%. I have looked at the data and it looks to me like I have a lot of serious dips, but they don't last. It looks like I hovered in the low 90's, then would dip way down into the 80's or even 70's, then skyrocket back up into the upper 80's or lower 90's, then almost immediately take another nosedive. There were about 3 periods of time during the night where the graph looks like a rollercoaster ride down, up, down, up. To be honest, I'm amazed I slept through all of that!!

I am going to contact my doctor to find out exactly what she feels the situation needs to do in order for her to want to make changes to the therapy. I'm not 100% positive what she CAN do because we already know that raising the EPAP could be a problem since I couldn't breathe against the higher pressure (although admittedly, a slight increase may be okay). The IPAP pressure is already going up as high as 23, this reduced from 30 when we found it pushing 27 and I accused the machine of trying to kill me. We lowered the BPM because when it was much higher, the machine was forcing me to breathe way faster than I could handle. And I'm already on oxygen so that's already in there.

I'm wondering if as distasteful as it may be, perhaps this is as good as its going to get for me, unless I'm willing to use the ventilator in a more invasive way. I'm wondering if that could be the reality of the situation.

But before I get all "gloom and doom," I will ask her these questions.

I have always liked sink kitties, too. They are very cute.

Janknitz wrote:Maybe you can string together enough tubing to put the concentrator somewhere outside your bedroom so that it's quieter.

I think that noise and the heat generated must be SO annoying!

Actually, we discussed doing this. It could be done, but would be very inconvenient because of my mobility issues. I tend to lay in bed watching TV, sometimes for several hours, before I get hooked up and turn on the oxygen. I would have to physically get out of bed to turn the concentrator on, then walk back to bed. Not impossible, but not ideal either. Plus, the way our house is set up, there's really NOT another room to put it in.

Noisy or not, I will use it again tonight, as I usually do. I was in a foul mood Wednesday night (darned teenagers) and since I didn't seem any worse for the wear on Thursday, decided to do it again with the monitor. The monitor told me that I probably wasn't doing as well as I might have thought.

Thanks for the suggestion though. In truth, I'd rather deal with the noise than worry about moving from room to room turning the thing on and off.

My pulmonologist didn't get excited about any very brief drops below 90%, but anything that was low enough or long enough to cause an increase in pulse rate most certainly would cause a corresponding spike in blood pressure and it is the spike in blood pressure that kills. The low sats do create problems on their own and the pulmonologist wants to see mostly over 90% SpO2 with VERY little below 90%. My pulmonologist has endorsed my use of 2 - 3L/M of O2 in order to maintain this during the night but stated that it should not take more than 3L/M of O2 infused to do this and is, in fact, putting me through a whole battery of tests to see if there are other causes for my desats that can be treated or addressed without O2 infusion (for instance allergens causing asthmatic reactions). It's playtime here. We are trying everything from inhaled steroids to bronchodilators before bed WITHOUT O2 and WITH O2 at the same level of infusion to see if there is a difference and how large the difference is. I am about to undergo allergen testing for every allergen known to mankind (prepare your arms, your front, your back.... I insisted they remain above the waist however) and three full pages of various testing to get a new baseline and eliminate various possible causes for desats. The answer, apparently, is NOT simply to infuse some O2 although it is a good stopgap measure while all the tests are taking place. It is important that your SpO2 be above 90% pretty much all the time although she seems to tolerate very brief spells under 90% begrudgingly. Certainly anything under 80% is cause for serious investigation and that's why I am going to be poked and prodded for two or three days. God Bless government health care.

torontoCPAPguy wrote:My pulmonologist didn't get excited about any very brief drops below 90%, but anything that was low enough or long enough to cause an increase in pulse rate most certainly would cause a corresponding spike in blood pressure and it is the spike in blood pressure that kills. The low sats do create problems on their own and the pulmonologist wants to see mostly over 90% SpO2 with VERY little below 90%. My pulmonologist has endorsed my use of 2 - 3L/M of O2 in order to maintain this during the night but stated that it should not take more than 3L/M of O2 infused to do this and is, in fact, putting me through a whole battery of tests to see if there are other causes for my desats that can be treated or addressed without O2 infusion (for instance allergens causing asthmatic reactions). It's playtime here. We are trying everything from inhaled steroids to bronchodilators before bed WITHOUT O2 and WITH O2 at the same level of infusion to see if there is a difference and how large the difference is. I am about to undergo allergen testing for every allergen known to mankind (prepare your arms, your front, your back.... I insisted they remain above the waist however) and three full pages of various testing to get a new baseline and eliminate various possible causes for desats. The answer, apparently, is NOT simply to infuse some O2 although it is a good stopgap measure while all the tests are taking place. It is important that your SpO2 be above 90% pretty much all the time although she seems to tolerate very brief spells under 90% begrudgingly. Certainly anything under 80% is cause for serious investigation and that's why I am going to be poked and prodded for two or three days. God Bless government health care.

Good luck with all the tests, torontocpapguy! I'll keep you in my thoughts.

I just looked at the overnight report again and it does appear that my pulse rate jumped up during the desaturations. It was running between 55 - 65 mostly, then jumped to around 80 and stayed close to that during the same time period.

I think in my case, they already know what's causing all this, so testing really isn't going to do much. I know I need to touch base with my doctor and just ask her what her critieria would be for changing the therapy. I just haven't done it yet. I thought it was interesting how not using the oxygen for two nights impacted my overnight pulse ox tests.

Madalot : May I ask you how do desaturations happen? did you have an increase in apnea index or without any effect from apnea?

I am just concerned can desaturation happens with good AHI numbers? or it has to happen with apnea?

williamco wrote:Madalot : May I ask you how do desaturations happen? did you have an increase in apnea index or without any effect from apnea?

I am just concerned can desaturation happens with good AHI numbers? or it has to happen with apnea?

I'm afraid I can't answer this, williamco. Because my problems are not believed to be sleep apnea per se, they aren't monitoring those numbers. They do occasional downloads from the ventilator, but AHI and such aren't being watched for me.

I'm sorry.

Well, I went back to everything regular last night -- 2L oxygen and made sure I didn't fall asleep on my back.

Overnight pulse ox showed lowest level at 90%. Noisy or not, it appears that the oxygen IS definitely making a positive difference, so bump and clank shall continue to be a part of my sleep process!!

Janknitz wrote:Maybe you can string together enough tubing to put the concentrator somewhere outside your bedroom so that it's quieter.

I think that noise and the heat generated must be SO annoying!

+1

DreamDiver wrote:

Janknitz wrote:Maybe you can string together enough tubing to put the concentrator somewhere outside your bedroom so that it's quieter.

I think that noise and the heat generated must be SO annoying!

+1

The first night I had the oxygen concentrator with the ventilator, my bedroom sounded like a hospital room -- and it was so depressing. My husband and I have adjusted and both CAN sleep over the noise, but I still prefer the quiet. That's why I didn't turn the oxygen on for two nights because I was enjoying the more peaceful quiet.

Unfortunately, our house is a Cape Cod style and the master bedroom is off the family room/front foyer. There really isn't a good place to relocate the oxygen concentrator. Plus my mobility issues make it a more daunting task to turn it off and on if it's located in another room. The importance of vent on, then oxygen on and reverse in the moring (to prevent the oxygen from running into a breathing apparatus that isn't running) would make it so much more complicated for me.

So, I'm stuck with that horrible noise maker. I was hoping that the overnight pulse ox wouldn't indicate too much difference so I could occasionally skip the oxygen, but that didn't turn out to be the case.

Madalot wrote:

Janknitz wrote:Maybe you can string together enough tubing to put the concentrator somewhere outside your bedroom so that it's quieter.

I think that noise and the heat generated must be SO annoying!

So, I'm stuck with that horrible noise maker. I was hoping that the overnight pulse ox wouldn't indicate too much difference so I could occasionally skip the oxygen, but that didn't turn out to be the case.

I know that around Christmas time, they sell these remote control plug connectors used for turning lights on and off remotely. We got one last year that could control three different sets of lights from a three-button controller. It surprised me to realize it used 8amp plug controllers, meaning it could probably even handle a small heater or a computer power strip. I use one control to turn my computer power strip on and off.

Here's one that's a different model, but same idea. It plugs into your wall socket and you plug your device into that. The remote could sit on your bedside.

http://www.amazon.com/Remote-Controlled ... 563&sr=1-1

If the concentrator has a physical on-off switch (for instance you could pull the plug to turn it off and plug it back in to turn it on) you could probably use one of these as a remote.

We have so many very clever people on this forum. If that wouldn't work, surely someone else one amongst us could come up with a simple remote control button for you.

This one is almost identical to the one I bought. It works from across the house.

http://www.amazon.com/Stanley-31164-Wir ... _pr_sims_t

Thanks, DreamDiver!! I appreciate the information on these things. I might ask my husband about them and look into them. For the moment, we're going to tolerate the noise since it seems to be necessary for my health. But the humming and clanking are definitely distracting, so this may be something we should look into. However, my house just isn't set up for this to be an easy "fix" but it's worth investigating, especially considering these remote controls.

Thanks!!