Replies to This Discussion

Permalink Reply by Randal on March 1, 2010 at 7:12pm

Hey Jackie S thanks for the input. I will continue to try on the CPAP. I'll try and answer your questions. I meet with my Pulmonary Doctor in April, I have given up on the Sleep Doctor. It's a part time job for him. My O2 levels dropped during my tritation test, which was about 2 weeks before all the testing that took me off day time O2. I am going to ask the doctor in April if there is some kind of test I can do overnight at home. I am just on 1.5 O2 while sleeping. My Pulmonary Doctor said I would be be a perfect canidate for pulmonary rehab if I was not working. I live in Michigan just outside of Ann Arbor. Thanks again, you do your profes proud. All your answer and question (all posts) are very insightful.

Jackie S. said:

In some cases we automatically put a pt. with pulmonary disease such as COPD on a Bipap. Because it makes it easier for them to breath against the pressure (its a lower pressure when u exhale). But there are times when Cpap (which is one continuous pressure) is fine and can be tolerated even if u have COPD. It depends on the pt and the situation. If I put a Cpap on you and you c/o difficulty breathing I would switch u to Bipap. If u were ok initially in the lab with a CPAP i would leave you on CPAP. I would only change to Bipap later if I saw CPAP wasn't helping you. Being that u were on Bipap previously you may just not be used to the CPAP yet. If you continue to have a problem let the doctor know. How do u know ur O2 levels are still dipping? Is this during sleep or during the day? Are you on O2 24hrs or just for sleep?
I don't know where u live but if in NY that would be great b/c i have a pulmonary rehab at my job that u could really benefit from. We are the only non-hospital based rehab in the state of NY. It's really a great program.


Maybe they saw CPAP was enough to treat your Apnea. You can always ask the sleep dr. why ur no longer on BIPAP.
Randal said:

This is the first reference I see to xPAP and Oxygen levels on these boards. Let me give you a brief history and then maybe a few questions. This all started in Oct 2009. I was being prepped for a caterack operation. They put one of those pulse ox meters on my finger. I cann't remember if it was 84 or 88. Anastgeoligic (sp- the doctor that keeps you under) had me take a whole bunch of deep breathes and talked to me about my sleeping habits. We got it up to 90% and went ahead with the surgery. Made me promise to talk with my primary care doctor.. Talk to my Doctor in December and she suggested a Sleep Study. Study got scheduled for end of January. Mean while I'm feeling pretty bad. If I sat still for more then 20 minutes I was sleeping. January was a real bad month. Mother in Law passed away on the 7th and I feel asleep during the mass. Next week co workers got very concerned about me at work. I was falling asleep at my desk and sluring my speech. They told me to go home. Wife then took me to ugent Care and they sent me to hospital. I had respitory failure and Knee-Moan-Ya. Bad shape. After 6 days in hosiptal with heavy duty meds they rreleased me. They sent me home 2% oxygen and a auto BiPAP machine.w/oxy bleed. They based the BiPAP on my blood O2 and CO2 levels. ! week after the hospital I went for sleep test. You guessed Moderate Sleep Apnea. Come back in a week for titration. Remember, all this time I'm using a BiPAP set on auto with a range from 8 to 12. Went in for titration. They never looked at data from my machine. Jumping ahead the Sleep Doctor Rx a CPAP C-flex set at 10 with a 1.5 Ox feed. Only been on the CPAP for 4 days now but don't seem to be as rested. Is this in my head? If I'm not having Apneas why does my O2 levels drop. I pass the 6min walking test. Having moderate COPD is there a difference between BiPAP and CPAP? Would one help my O2 levels more? Sorry for the long letter but maybe I can get some direction. Thanks . .

Jackie S. said:

thats true about the 02. Usually cpap/bipap is enough to take care of the low o2 levels (caused by apnea). My job has a pulmonary rehab here so we see a lot of patients with chronic lung disease who tend to require added 02.

Judy said:

I was told Medicare rules required below 88% for more than 5 minutes before qualifying for 02 supplementation. And once when I was hospitalized they also cited 88%. Every time they found my levels below 90% they would tell me to take a deep breath. Sheesh!

And a BIG AMEN to "Nice thing about Cpap is it's just humidified air. Not another drug."

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

• ▶ Reply

Permalink Reply by Judy on March 2, 2010 at 11:16am

Hey, Randal! Good to see a fellow Michigander here! I'm north of you a way, more like the Saginaw area.

Yep, even your family doctor can order an overnight oximetry. You would get the overnight recording oximeter from your local DME provider w/that script

On the other hand, if you mean overnight oximetery EVERY night ... insurance will NOT buy an oximeter for you. *sigh* BUT you CAN buy one yourself if your wallet can handle the cost. Many PAPpers have purchased the Contec CMS 50D+ (has to be the Plus) that comes w/its own software. Or the SPO 7500 recording wrist oximeter w/its own software. And buying them online you get a better price (be sure to "shop" the prices) and don't need a prescription. If you find the best price somewhere online that does require a script, just ask your family doctor or whichever doctor you have the best rapport with to write you a script for a recording oximeter and software..

I will vouch for Pulmonary Rehab!!!! At least ours in Saginaw was very good - IF - you do your part. Medicare paid for the first 12 weeks I think it was. After that we could still keep going to Rehab to use their equipment, etc. for $5 a hour session if we wanted. I did for quite a while. At least until gas shot up so high I could't afford the drive in to Rehab and back home plus the $5 a hour. Isn't that sad? This country has been so going to hell in a handbasket. *sigh*

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Permalink Reply by Randal on March 2, 2010 at 11:43am

Thanks for the input. Go Michigan. Still working and using private insurance. I think I'm just about ready to throw the lever. I think I can save that much money if I do not have to use the concentrator. Any other brand meters to look at in that price range?

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Permalink Reply by Judy on March 2, 2010 at 12:15pm

Not that I've heard good reports on. Those I've read who have these two recording oximeters are very much satisified w/them.

Probably tho, the Nonin recording wrist oximter for which you have to buy the software separately is one of the best on the market. IF you have day time SOB and need 02 during the daytime as well Nonin makes a good non-data recording oximeter. I bought my Nonin Onyx about 5 years ago now. They've since come out w/newer models. I used it at home on the treadmill and exercise bike.

Does one need a script for a foam cervical collar? Did you buy yours locally or online? My sleep problems began w/a whiplash in 1994 - but I didn't have enough sense to let them take me to ER or to see my doctor for 3 weeks after when things hadn't improved all that much just sucking it up and swallowing the Tylenol. Xray at that time confirmed small cervical bone chip and hyperextension injury.

One thing I am finding w/all the full face masks I've looked at (have only tried two, found one I love) is that they tend to pull your chin/jaw backward due to the lower straps. Thus I end up mouth breathing w/in the mask and that leaves my mouth dry despite humidity as high as I can stand it (have COPD, can't breath well w/air too warm) and that leaves me concerned about my pearly whites (teeth).

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Permalink Reply by Jackie S. on March 2, 2010 at 8:59pm

Thanks for the compliment Randal. It's ok if ur 02 dropped during the titration that's why u were there. As long as they got ur levels up n apnea corrected by the end of the study is what matters the most. Judy is right and it's great she's in ur area! There is an over night @ home test in which u can wear a pulse ox to monitor ur O2 levels. U just have to be careful w/them b/c sometimes there can be false readings. For instance if the pulse ox became loose it may give all low readings. That's the benefit of being in a lab b/c we look out for those problems. but it can't hurt and it doesn't mean that will happen to you. Best of luck! Let me know how things work out for you.

Randal said:

Hey Jackie S thanks for the input. I will continue to try on the CPAP. I'll try and answer your questions. I meet with my Pulmonary Doctor in April, I have given up on the Sleep Doctor. It's a part time job for him. My O2 levels dropped during my tritation test, which was about 2 weeks before all the testing that took me off day time O2. I am going to ask the doctor in April if there is some kind of test I can do overnight at home. I am just on 1.5 O2 while sleeping. My Pulmonary Doctor said I would be be a perfect canidate for pulmonary rehab if I was not working. I live in Michigan just outside of Ann Arbor. Thanks again, you do your profes proud. All your answer and question (all posts) are very insightful.

Jackie S. said:

In some cases we automatically put a pt. with pulmonary disease such as COPD on a Bipap. Because it makes it easier for them to breath against the pressure (its a lower pressure when u exhale). But there are times when Cpap (which is one continuous pressure) is fine and can be tolerated even if u have COPD. It depends on the pt and the situation. If I put a Cpap on you and you c/o difficulty breathing I would switch u to Bipap. If u were ok initially in the lab with a CPAP i would leave you on CPAP. I would only change to Bipap later if I saw CPAP wasn't helping you. Being that u were on Bipap previously you may just not be used to the CPAP yet. If you continue to have a problem let the doctor know. How do u know ur O2 levels are still dipping? Is this during sleep or during the day? Are you on O2 24hrs or just for sleep?
I don't know where u live but if in NY that would be great b/c i have a pulmonary rehab at my job that u could really benefit from. We are the only non-hospital based rehab in the state of NY. It's really a great program.


Maybe they saw CPAP was enough to treat your Apnea. You can always ask the sleep dr. why ur no longer on BIPAP.
Randal said:

This is the first reference I see to xPAP and Oxygen levels on these boards. Let me give you a brief history and then maybe a few questions. This all started in Oct 2009. I was being prepped for a caterack operation. They put one of those pulse ox meters on my finger. I cann't remember if it was 84 or 88. Anastgeoligic (sp- the doctor that keeps you under) had me take a whole bunch of deep breathes and talked to me about my sleeping habits. We got it up to 90% and went ahead with the surgery. Made me promise to talk with my primary care doctor.. Talk to my Doctor in December and she suggested a Sleep Study. Study got scheduled for end of January. Mean while I'm feeling pretty bad. If I sat still for more then 20 minutes I was sleeping. January was a real bad month. Mother in Law passed away on the 7th and I feel asleep during the mass. Next week co workers got very concerned about me at work. I was falling asleep at my desk and sluring my speech. They told me to go home. Wife then took me to ugent Care and they sent me to hospital. I had respitory failure and Knee-Moan-Ya. Bad shape. After 6 days in hosiptal with heavy duty meds they rreleased me. They sent me home 2% oxygen and a auto BiPAP machine.w/oxy bleed. They based the BiPAP on my blood O2 and CO2 levels. ! week after the hospital I went for sleep test. You guessed Moderate Sleep Apnea. Come back in a week for titration. Remember, all this time I'm using a BiPAP set on auto with a range from 8 to 12. Went in for titration. They never looked at data from my machine. Jumping ahead the Sleep Doctor Rx a CPAP C-flex set at 10 with a 1.5 Ox feed. Only been on the CPAP for 4 days now but don't seem to be as rested. Is this in my head? If I'm not having Apneas why does my O2 levels drop. I pass the 6min walking test. Having moderate COPD is there a difference between BiPAP and CPAP? Would one help my O2 levels more? Sorry for the long letter but maybe I can get some direction. Thanks . .

Jackie S. said:

thats true about the 02. Usually cpap/bipap is enough to take care of the low o2 levels (caused by apnea). My job has a pulmonary rehab here so we see a lot of patients with chronic lung disease who tend to require added 02.

Judy said:

I was told Medicare rules required below 88% for more than 5 minutes before qualifying for 02 supplementation. And once when I was hospitalized they also cited 88%. Every time they found my levels below 90% they would tell me to take a deep breath. Sheesh!

And a BIG AMEN to "Nice thing about Cpap is it's just humidified air. Not another drug."

Jackie S. said:

your oxygen levels should never be below 90%-fyi

amith ram said:

My lowest O2 level was 88%, so I think that is ok?

Jackie S. said:

Don't worry about not being in Stage 3/4. As we get older we tend to give up these stages. That has nothing to do with your apnea. We tend to see the most apnea in REM. Seems you had the most events on your back (supine). Do you know your lowest oxygen level throughout the night? Mild sleep apnea is enough sometimes to still feel sleepy throughout the day. I have patients who have the same score as you and cpap did change their lives. Sometimes you have to go by the individual rather than just the numbers. Being that its mild u may even want to consider an oral appliance. The questions Rock asked are right on point as well. Is this guy sleep certified?

• ▶ Reply

Permalink Reply by Randal on March 2, 2010 at 10:04pm

I have a CMS 50E on order. I will let you know how it goes. Thanks again

Jackie S. said:

Thanks for the compliment Randal. It's ok if ur 02 dropped during the titration that's why u were there. As long as they got ur levels up n apnea corrected by the end of the study is what matters the most. Judy is right and it's great she's in ur area! There is an over night @ home test in which u can wear a pulse ox to monitor ur O2 levels. U just have to be careful w/them b/c sometimes there can be false readings. For instance if the pulse ox became loose it may give all low readings. That's the benefit of being in a lab b/c we look out for those problems. but it can't hurt and it doesn't mean that will happen to you. Best of luck! Let me know how things work out for you

• ▶ Reply

Permalink Reply by Judy on March 3, 2010 at 12:21pm

It doesn't hurt to use some tape to stabilize the oximeter sensor on your finger to reduce or eliminate those artifacts Jackie mentioned. I almost aways do. I've used the SPO 7500's earliest models w/the finger clip on sensor and w/the rubber finger cup sensor. I don't know what the newer models are using for sensor type. I taped both the finger clip on and the rubber finger cup w/some tape. I wasn't wild about the finger cup as there's a little tab in there that dug into my fingernail bed a bit - but appreciated that w/it I didn't have to fight w/the difficult On/Off button as we did w/the finger clip sensor.

I prefer the type of sensor used by the S8 ResLInk XPod finger sensor. You HAVE to tape that baby on. They even provide a specially shaped tape that you can get several nights' use out of - but I often add my own tape to it to extend its life even further. Just call me "cheap". I like the 3M Transpore tape. It comes in different widths and is scored so easily rips to the length and width you need or want it.

I noticed at my last titration that instead of a finger clip sensor and taping the finger clip they were using the same type sensor as the ResLink XPod sensor and instead of the specially shaped tape either the 3M Transpore tape or similar to tape the sensor on the fingertip securely (and not too tight).

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Permalink Reply by RL on March 3, 2010 at 1:43pm

Hi Randal,
Had to add my two cents - keep in mind that your body is still recovering from the pneumonia and family stress from your recent loss, not to mention the "sleep debt" you have from undiagnosed OSA. All of these factors will take some time for you to recover fully from, so hopefully, with more time you will be feeling better.

Thanks to all for your postings also. I think there is some useful info there that I had not seen before. It pays to read things that don't immediately appear to relate to one's personal situation.

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Permalink Reply by Randal on March 3, 2010 at 7:26pm

Thanks RL and Judy for the encouragement. It helps.

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