gvz wrote:The actual mechanics of 02 use is very different however. The lungs take damage, this can happen from a variety of sources. Pneumonia, COPD, Emphysema or anything which causes hypoxia are typically conditions which cause long term damage to the lungs. Although the lungs do not technically heal themselves, they can (over time) find work arounds and return themselves to optimal efficiency. If a patient is found to be in some kind of respiratory distress they can be placed on supplemental 02 to alleviate their symptoms while they recover but here is the problem...
If they are on supplemental 02, their lungs may have no reason to repair the scar tissue or make any changes to their current condition. This is why it is better for patients to be weened off of oxygen therapy thereby allowing their lungs time to compensate for the 02 shortfall. A patient who dictates their own treatment may not see it that way however, they may be prescribed 3lpm 02, there by bringing their baseline sa02 up from 80% to 93% but instead they decide to give themselves 5lpm 02 because (I get winded if I stand up too fast) thus their resting oxygen level is 99% and their respiratory system sees no reason to fix or heal anything as it is getting far too much oxygen nomatter what it does. The lungs become an oxygen cornucopia where it hardly needs to work for a bountiful harvest of 02. With patients such as these, they will eventually come to the realization that it is difficult to be weened off of 02 therapy as their lungs have made absolutely no progress in healing itself. They are in as bad a shape as they were the day they started using 02.
Thanks for the reply. I'm curious, do you think the "issue of allowing the lungs to recover/find workarounds" in people with damaged lungs applies equally to being on oxygen 24x7, versus only during sleeping hours?
I must warn you that aside from 'The basics' my knowledge of focused respiratory care is a bit limited and some questions I'm going to deffer to a respiratory tech. I entered sleep science through an EEG field and have very little in the way of a respiratory background. What I can say however is that although respiratory damage that effects patients in a 24x7 capacity would need to be treated during sleep as well- sleep breathing disorders are an entirely different beast.
These are respiratory disorders which ONLY occur during sleep. If a patient was sent to me with a 24x7 respiratory disorder, I would expect them to be treated before the study along separate lines. As for sleep breathing disorders and the recovery which ensues... it really depends on the type of the disorder and the cause of the disorder. For example, Congestive Heart Failure, although having a side effect of Central Sleep Apnea... can be lethal in it's own right. On the flip-side however, if a patient were to receive treatment and recover from, that cardio problem he would thus recover from Central Sleep Apnea as well. Oxygen treatment in that case would only serve as a temporary measure until the patient's underlying cause had been dealt with.
Likewise patients who are suffering from altitude sickness (very common over here) would require 02 treatment at night until such time as they had acclimated (which does not take very long at all.)
Let's say a person has some level of damaged lungs + sleep apnea + the doctor prescribes oxygen for sleep only. Does that mean the person has no chance of their lungs "repairing", or maybe it is just a longer process?
I see what you mean however it should not really make a big difference. 02 during sleep does not impede your lungs from recovering all that much, mainly it is because you are no using it 24/7. Using oxygen, 7, 8 or 9 hours out of the day still allows for 15-17 hours a day where your lungs have to fend for themselves. Additionally, it would also depend on the reason that your physician is prescribing 02 to begin with. Some physicians put their patients on nocturnal 02 at the first sign of hypertension secondary to cardio problems if they suspect their patient might have apnea. This is usually a temporary measure to protect the heart from damage until they can get their patient into a sleep lab to be treated.
Other times patients will have chains of central apnea at night, sometimes it is even medication related if the patient is taking a lot of drugs which have respiratory suppression as a side effect. The nocturnal 02 can counter this and protect the patient from having bouts of chronic pneumonia while they are recovering. There are few things more dangerous to the lungs than chronic pneumonia. So in short, no, the lungs can easily recover and are not impeded by nocturnal oxygen. Nocturnal oxygen however is not a permanent measure in any sense of the word however. Remember that central apneas and yes, even most forms of respiratory damage, are transitory in nature. When you physician decides to decrease or even remove nocturnal 02 treatment, you may notice some slight discomfort at first however your lungs should adapt quickly if your physician has treated the underlying problem.
I guess this may depend on what criteria is used (level of damage?) for a doctor to slap oxygen on a person 24x7 vs. sleep hours only.
Very very much so. A person with a 24x7 respiratory problem that requires 02 is a person whose condition is threatening to spiral out of control and needs immediate treatment, where as a person who requires nocturnal oxygen can be related to any individual with a possible sleeping disorder of a respiratory nature. Sleeping disorders can spiral out of control as well however they have a lot farther to go before a patient will end up in the ICU staring at a respiratory tech.
When you refer to the damaged-lungs, you're serious about "baseline of 80% saturation" ? Wow, that sounds pretty bad / very damaged.
Some physicians actually consider baseline 80% to be uncomfortable non-emergencies. I've never liked 80% however because it is a little too close to the high 70s. I have patients that live on 88% however and that is considered acceptable but a lot of pulminologists. As far as sleep science goes however it is not so much a question of their baseline sa02 (as that belongs to the respiratory department) but centers more on sleeping desats and the causes there of. I've actually had patients that have desated to the 60s, 50s, 40s. I had one patient that dropped down to 17% at one point. It was an extremely brief moment however but he made the hall of fame in my book. I have never seen a larger desat than that. It was a minute and 30 second event and in ten years I've never seen anything like it.
If your baseline sa02 was in the mid to low 80s, you may not notice it outside of exertion. (moving around). While sitting in a chair relaxing you may suffer headaches and lethargy but it would not be until you tried to get up and move quickly that the full weight of it would hit you. People typically don't realize how little 02 they have in their blood until they attempt to use it.
