Oxygen Concentrator changed everything!

[ajack]

If I were you, I'd try and get the cpap working for you. I would post the sleepyhead charts and ask for advice on fine tuning. The sleep doctor and the sleep test would have shown any serious lung issues that needed o2 or bpap.

Unless the doctor who prescribed the o2, is fully monitoring you and your cms doesn't count. You should have had blood gas level tests and this is where a specialist comes into play. You can do yourself a disservice and frankly putting your health at risk from over oxygenation, google it.
https://en.wikipedia.org/wiki/Oxygen_toxicity

[Sleeprider]

I still think I'll stick with my response (#3 in this thread). You are affected by central apnea or CPAP induced complex apnea. I think a CPAP set at a fixed lower pressure rather than auto would help resolve CA at least better than your original results. I can't explain why the addition of oxygen improves your CPAP results as this is an unconventional approach, but personally, if it works that's great.

I disagree with ajack that the concentration of oxygen you are receiving through a bleed at 3 L/m diluted with CPAP flow has any relationship to oxygen toxicity syndrome he linked to.

[OpalRose]

methodicalfool,

Here's the thing....we are not doctors here, and there is a concern over using supplemental oxygen without a doctor monitoring you.

I can see the difference it made for you, but it might be wise to search out a Pulmonologist for advice. They have lung function tests they can run and see if there is a need for supplemental oxygen. This would give you peace of mine if you continue to use it.

[ajack]

The wiki link to going blind etc was for effect, to show that o2 shouldn't be treated lightly. I suggested he do his own Googling.
As you know, the sleep doctor had already discounted the need for o2. A second doctor prescribed off the unverified accuracy of the cms reading and this was based on a cpap treatment that was substandard in outcome. I wouldn't call this best practise. A return back to the sleep doctor and a titration, could have been a better move.

I also think you are on the right path to limit the pressure, to see the clear airway outcome. Given the tidal volume of 380 and what appears to be pressure induced CA. There are as well, probable nasal mask leak/mouth breathing issues with the present cpap treatment, that may need working on.

[jsielke]

I can see why you feel better with oxygen. Your sleep Study showed you at or below 90% for a 1HR and 45 minutes and below 88% for 39 minutes. Your body was starving for oxygen. The additional oxygen caused your body to produce more CO2 which triggers the brain to breath. Without the extra oxygen the higher pressure from CPAP washing out the CO2 from your lungs and the brain didn't get the trigger to breath. That's guess anyway.  Still need a ASV machine though.

I had almost the same results with the O2 levels during sleep dropping BELOW 80% on occasion. My daytime SpO2 levels run 94-97%. During the day I breath more deeply, learned in pulmonary rehab, and emphasized in my Tai Chi, called diaphragmatic brearthing. But at night, I breath more shallowly. BIPAP helped a lot, but the addition of supplemental O2 really made the difference, keeping my nightly SpO2 levels from dropping below 90%. Incidentally, I have COPD as well as apnea, but do not use O2 during the day.

[OpalRose]

I feel like I'm nagging, but......find a good Pulmonologist. They can run lung function tests that rule out anything that might be keeping your Oxygen levels low while on Cpap only.

Then have him send those reports to your sleep doctor.

[Sleeprider]

In this case oxygen was prescribed by his physician based on evidence of desaturations during sleep.  That may well be warranted based on the evidence from the pulse oximeter, but it does not address the root cause.  The problem here is a sleep specialist that completely rejects the notion that his patient has central or complex apnea that a CPAP cannot address.  There can be no doubt that the numbers of central apnea that were occurring with the CPAP set at 6-12 pressure with EPR at 3 would account for the low oxygen results observed. 

The answer is to evaluate for a sleep therapy that resolves apnea to prevent SpO2 desaturation.   None of us is particularly qualified to evaluate or recommend oxygen use in this case, however we can comment on the current state of CPAP use as posted.  The only chart we have is this one with oxygen.



I think we can agree, this is not an acceptable chart for a couple reasons.   The use of a minimum pressure of 6.0 with EPR at 3 results in EPAP pressure being too low to consistently avoid OA and H events, and it's still possible that if pressure increases, that will again trigger the CA seen in the chart posted before O2. With the oxygen, for some reason, the incidence of OA is low enough that pressure does not escalate to where CA are induced.  This does offer hope that if pressures are kept low , CA should be much less of a problem. I would like to see the result of a trial using APAP with a minimum of 6.0 and maximum pressure of 8.0 with EPR at 1, without the use of supplemental oxygen, or a fixed pressure of 7, again with low EPR. Even if the current approach is continued, it would be prudent to limit maximum pressure to about 8.0 where we have seen CA begin in the other chart.

Normally oxygen is not the first resort when the cause of desaturation is a high level of apnea.  It happened to have the desired result in this case of increasing SpO2 during sleep, but it is more coincidental that the apnea is resolved to acceptable levels.   It seems better to either find a CPAP solution that resolves the apnea AND SpO2 issues, or if CPAP fails to resolve CA in the absence of supplemental O2, move towards ASV treatment which would.  This is a really interesting case because we just haven't seen someone add an oxygen bleed and resolve complex apnea.  It's unconventional, but does the end justify the means?

[Walla Walla]

Sleeprider I don't disagree with you. I would like to say that also seeing a Pulmonologist would also be the right thing to do. If his oxygen is dropping during the daytime that's something that needs to be checked.

[Sleeprider]

Totally Walla! We don't know, but even the primary doc should have done a complete blood workup with CO2, RBC, Hemocrit etc.

[methodicalfool]

Thank you all for sharing your thoughts and concerns. I really do appreciate it!

I've done some research on local pulmonologists and will probably get an appointment soon.

Meanwhile, I finally got access to my sleep doctor's patient portal so I could send him an update to let him know about the oxygen concentrator. I also noted the signs that I have central sleep apnea. I know the doctor had intended to make some adjustments to my CPAP machine so I'm curious if the changes he'll make will will be along the lines of the ones that others have recommended here.

Anyhow, if anything interesting develops here then I'll post about it again. :-)