More questions about O2?

The DME gave my wife one of the cheap "T" adapters, and the hospital gave me a similar cheap one. My guess is at 2.5 liters, the flow output of the oxygen concentrator is very tiny compared to the CPAP machine. Any O2 buildup in the mask and hose is probably purged in the first second or so.

I'd like to change the subject back to one of my original questions:

frh wrote:4. Should I leave the ambien at home the night of the sleep study? (knowing I will not really get to sleep, and my AHI will be through the roof?)

About 6 weeks after my knee replacement surgery last year, my body started telling me it wanted more oxyconton. There is no way I am going to allow myself to get addicted to it. So I stopped taking it. After that I had a hard time getting to sleep and any light or noise would wake me. It doesn't help that my wife has insomnia, and turns her netbook or the TV on a couple of times a night. After staring at the ceiling for a couple of weeks I went to see my GP. He prescribed ambien. I have been taking it most every night for almost a year.

This is one of the nights I printed out to show the sleep doc. (He told me not to stop taking it by the way.) Notice a lot of obstructive and central apneas, but none of the hypopneas like I have almost every night when I do take ambien. I suspect the ambien suppresses my breathing and therefore is a contributing factor to why O2 makes me feel so much better. This is what a night without ambien looks like:


My feeling is since this is an entire night titration, I will let the sleep tech play with the dials for a couple of hours without it. (Who knows, maybe he will find a setting that actually allows me to sleep without it.) Since I don't really expect to get much sleep, it shouldn't be a problem waking around 1 am to take it. As long as they let me get 4 or 5 hours of sleep after I take it, I should be OK driving home.

Take i with you and discuss it with the technicians. Since you take it in order to sleep at home, it should, in my opinion, be taken into account. They want you to sleep, without sleep they can't test or titrate you. Without sleeping you will be spending hours staring at the ceiling of a very pricey motel without the compensation of "companionship".

I asked one of my MD's about Ambien; he suggested that the deeper I slept and the more soundly that I slept in that stage of deep sleep, the shallower my breathing was likely to be. Hence, taking Ambien or other sleep enhancement chemicals will get you down into L4 or REM sleep and keep you there longer but the result will be shallower breathing and lower SaO2. On the other hand, NOT taking Ambien may do just the same thing even on the first night without it... but more likely on the second or third night as your body will be craving deep sleep and will try to get you down there. Result? Shallow breathing and lower SaO2. Looking at your data WITHOUT AMBIEN I am struck by the number of apnea events you are showing, but OTOH, the total lack of hypopnea events (?). Am I reading the data correctly? This would indicate to me that your desaturation is not due to shallow breathing but rather due to apnea events including and especially centrals from the graph.

I am in Ontario and have had two sleep studies done; one before CPAP and one after CPAP. As my SaO2 continues to fluctuate widely I do not believe that having a third or even a fourth sleep study would be an issue if prescribed by my respirologist. Thus far, my situation is, I have to wait weeks to see my respirologist unless there is a cancellation that I can rush to fill. My GP has said he knows zip about oxygen infusion into my CPAP line - gotta see my respirologist at least. My rehab MD has said that O2 infusion is likely to improve my nightime SaO2 but he cannot prescribe same, I have to see my GP or respirologist MD. Sheesh.

My gut feeling is that O2 infusion in small quantity is going to make a major difference in my nightime SaO2 but I have to get the Rx if I want a brand new government sponsored oxygen concentrator. Nobody in Ontario seems to want to sell them; they all rent them out at around $400 a month (cash cow) so I bought a used one on Craig's list. An Invacare Mobilaire V with flowmeter. As far as using it is concerned, I note that my masks all seem to have a nipple for an oxygen line! If you have a Mirage Quattro check out under the rubber covers... it's an O2 port. However, in the interest of safety I have ordered an anti-flowback valve from cpap.com made by Respironics along with the O2 infusion adaptor. Sleep soundly. No explosions.

That's my story. I have no idea of what to say to your respirologist to sway a decision asides from presenting logical evidence of the difference that O2 infusion has made. In other words, show the SaO2 desaturation, show the addition of O2 at 3L/m and how you did that, show the results of the infustion of O2 infusion. Remember that these MD's are scientists and trained to rely on empirical data to make decisions (either that or prescribe a pill). It is hard to argue with logic is what I am thinking and that is the way I intend to approach it with my respirologist; two or three weeks of oximetry and S9 data graphs followed by infusion of perhaps 2L of O2 (pretty hard to get into trouble with a machine that can only put out 5L maximum) and the data that results from same. And ASK for the prescription for the O2 concentrator being up-front and telling him that your insurance will not pay for the equipment without an Rx. They all understand money. Tell him you would like to know if it is advisable to see him on a regular basis to monitor your progress (they all love repeat business that is in/out fast). I really can't think of anything else that you can say or do to sway a decision unless you happen to have an MD who is a close friend or relative and even then they are unlikely to issue an Rx without a file of data.... hence the importance of the data that you bring to the table in a professional manner along with perhaps a sleep study with and without supplemental O2.

I have experienced what a high level of O2 infusion feels like in hospital as well as what a low level of O2 infusion feels like... at 5L of O2 with nasal canulas it was something of a help... at 3L of O2 by nasal canulas it was more of a bother spending time getting the dried globs out of my nose and moisturizing my nostrils to stop the bleeding that it was worth and I simply hung up the O2 line and put up with the nurses poking me all night telling me to breathe more deeply.

I thought the same way at first too, GoofProof. BUT - there is the issue of liability to consider. If the DME provider provides the 02 adaptor for the 02 bleed in to your xPAP, they have a liability and a pretty serious one. The PAP manufacturer has CTA w/their disclaimor in the Users Manual. Both my local Respironics Rep and my local Resmed Rep have told me in private conversation that the manufacturer's warning is simply a CTA warning.

I wanted to post an update about my sleep study Sunday night for anyone who might be following this topic. I also wanted to reply to toronto's last post.

I got to the sleep center right on time at 9:15 Pm. The tech was busy with another person, so I just watched TV for an hour. By the time she got me hooked-up it was after 11.

We talked as she was wiring me up. She told me she worked at another facility for 5 years and this one for over a year. She knew all of the sleep doctors I know about (and she did not like a couple of them I don't like). It really surprised me she had no idea what a S9, or Rescan was, other than she heard Resmed came out with a new machine. She seemed confused when I said it was an APAP machine. She also did not know what I meant when I used the term EPR. I had to explain it was the same as C-flex. She was not happy to find out I had the clinicians software or knew how to change the settings. But after she found out I knew what she was talking about she told me the doc orders said to eliminate centrals and hypopneas and get my AHI under 2, and try BiPap if necessary to control the centrals.

I am used to sleeping through the night, but I woke at 1 am and again at 4 am to use the restroom. Each time I woke the pressure seemed less than I am used to. She woke me at 6 am and would not tell me anything about pressures, etc., but it seemed like she got what she wanted. She did not hook me up to O2.

Monday was horrible. I started feeling exhausted/sleepy on the drive home. As soon as I got home I laid down for a 2-1/2 hour nap (with O2). I thought I slept pretty good, but my AHI was 12.3. I had a headache and could not stay alert the rest of the day. I really wanted to go to bed before 7 pm, but waited till 9. I used O2 again and slept for 9 hours. I still had the headache today, but not as bad. (By the way, I do not normally have headaches.)

toronto, I was really surprised you noticed the lack of hypopneas on the last screenshot I posted! I could easily be wrong but I have been equating them to ambien suppressing my respiration. I know I would be better off without it. But without it I would go back to waking-up several times a night when my wife turns on the TV or starts typing on her netbook computer. I'd rather keep taking it than be sleep deprived. When I think it is time to quit taking it, I'll just do it.

I'm not even sure if my breathing is really shallow. I don't know what normal breathing should look like on the flow graph. If it is shallow like I think it is, I believe it (like my slow heart rate at night) is more neurological than physical. Now that I can breathe through my nose, I don't think I need much pressure to keep my airway open.

I am not surprised I have centrals at night. I often find myself forgetting to breathe during the day. If I do it during the day, why wouldn't I do it at night? Sometimes I wonder if I should even be concerned about controlling centrals, as long as obstructive apneas and hypopneas are controlled?

I looked closely at the quattro mask and you are right, the ports are there. But using them would defeat the swivel so I'll stick to the "T" fitting. I've been using it for 3 weeks without an anti-flowback valve, so I'm not concerned that anything bad will happen.

I understand that I really should install the software for the CMS 50D plus oximeter, but my desktop computer is messed up. I don't want to try to install any software that might make it crash (until I can get it fixed). I could put the software on my laptop, but my fingers are just too big and clumsy to actually do anything useful on it. (So most of the time it just sits there in it's case, waiting to go with me if I need it.) That's not much of an excuse, but I still haven't been able to concentrate well enough to re-write my business website (or even fix the broken links on it) - yet.

I think the biggest problem I will have with talking the doc into O2 is my numbers (as recorded by ResScan) do not change with the infusion of O2 into the mask. What does change (in a big way) is how I feel. There seems to be much more of a cause and effect difference in the way I feel with O2 than I would have ever imagined. If I am without it for even one night, I feel really crappy the next day.

I would much rather do it with a prescription and the doctor's help. But I will dial-in my therapy (with the help of the good folks on CPAPtalk) if I have to. (And that's the first thing I told him at my first visit.) My gut feeling is the new sleep study will not recommend O2.

I am now curious as heck to see what they have to say; presumably, if your SaO2 issue has not been addressed they should be Rxing O2 infusion but it puzzles me that they did not even attempt at some time during the night to at least try minor O2 infusion to see the results. Please let us know the moment you know what the story is. In the meantime I am ordering an Everflo Q for $700 delivered and am going to infuse 2L of O2 to see if it brings up my SaO2 and stabilizes it in the mid 90% range and what the end effect will be. I am plumbing it in same as you have and picking up the plumbing parts on Friday. Already have a Mobilaire V (used one) that I can begin with if I get antsy, but think that the Everflo Q shouldn't take more than a couple of weeks to arrive. Fingers are crossed for you - sometimes I really wonder if they have a clue as to what they are doing. I really do.

frh wrote:... I was really surprised you noticed the lack of hypopneas on the last screenshot I posted! I could easily be wrong but I have been equating them to ambien suppressing my respiration. I know I would be better off without it. But without it I would go back to waking-up several times a night when my wife turns on the TV or starts typing on her netbook computer. I'd rather keep taking it than be sleep deprived.

frh, I fail to see WHY you would prefer to keep taking Ambien long-term than to ask your wife to go to another room to watch TV or type on her netbook computer. I also fail to see why your wife would be so selfish as to continue doing so when she is aware it disturbs your sleep and that you have a sleep disorder. I fail to see WHY the two of you would rather that you take Ambien long term than to sleep in separate bedrooms. When I wake during the night and can't get back to sleep I leave our bedroom and go to another room to use the computer unti I feel I can go back to sleep rather than disturb my husband's sleep. Just because my sleep is disturbed doesn't mean I want to or should disturb his.

Slinky wrote:frh, I fail to see WHY you would prefer to keep taking Ambien long-term than to ask your wife to go to another room to watch TV or type on her netbook computer. I also fail to see why your wife would be so selfish as to continue doing so when she is aware it disturbs your sleep and that you have a sleep disorder. I fail to see WHY the two of you would rather that you take Ambien long term than to sleep in separate bedrooms. When I wake during the night and can't get back to sleep I leave our bedroom and go to another room to use the computer unti I feel I can go back to sleep rather than disturb my husband's sleep. Just because my sleep is disturbed doesn't mean I want to or should disturb his.

Slinky, I do not think my wife is being selfish. If anything, I should have been a lot more careful about what I said. I really would prefer not to elaborate on her health issues here. In all fairness, she has not turned the TV on in the middle of the night for a couple of months since some of the medications that were keeping her awake at night were changed. Anyway, ambien is an easy workaround for me. If it is why I seem to need O2 at night to feel good during the day, I am OK with it.

frh, I'm so sorry you wife has health issues too. You are right, we do what we have to do. I wish you both much success w/your therapies and better health.