Oxygen and CPAP Connection Questions

Previously "If need home oxygen therapy and due for new APAP, should I consider a change of machine from A10?" and "How to qualify for oxygen through Medicare?" See my latest questions in my last post on page 4 of this topic

It appears that I have low oxygen saturation levels and may need home oxygen therapy. I was just hospitalized on an emergency basis in the heart/pulmonary monitoring unit due to breathing difficulties. I had my old Airsense 10 for Her with me, to which they hooked up oxygen. It made a world of difference in getting to sleep and sleeping soundly, which is hard for me in a hospital and at home.

To get home oxygen, evidently a six-minute walking test that shows low oxygen saturation levels is required. I had one in the hospital but, by sheer determination (or a faulty oximeter), I didn't qualify. The pulmonologist I met in the hospital has me scheduled for another test, as everyone in the hospital is convinced I need home oxygen except for the hospital dr. who coordinated my care. I wonder if a new sleep study is needed too.

I am due for a new APAP machine (motor has exceeded its normal life and 5 years is up), but DME procrastination means I still don't have a new A10, even though the dr's paperwork was done more than a month ago. Just wondering if there is a better setup for a new machine if I do need home oxygen. Maybe the delay in getting a new APAP can work to my advantage. I see the new pulmonologist on July 30 for the new six-minute walking test (oxygen desat test) and hospital follow-up visit, so of course I will seek answers there. However, in the meantime, any experience of anyone in my situation would be helpful.

For anyone looking for a good pulmonologist who also understands sleep apnea/CPAP use in the Baltimore, MD area, I may have found one. PM me for details. The one i met in the hospital seemed to be the first to understand that I am not getting through the slightest exertion without being unable to catch my breath, and this has been going on for years.

I have had 2 COVID tests before hospitalization, both negative, so COVID is not a suspect in my case. I have been on APAP for 10 years, using 2 different machines, so this is not a newbie issue.

Thank you for any thoughts and suggestions.

Maryland CPAPer2 (previously Maryland CPAPer--board sign-in issue from several months ago never resolved)

There isn't a "better" cpap/apap out there that is designed for people who need to add oxygen...but ResMed does have a handy little heated hose for the AirSense and AirCurve 10 machines that is.

There is a heated hose with a special little hole connecting place to bleed in the added O2.
https://www.cpap.com/productpage/resmed ... ircurve-10
This lets the oxygen bleed into the line at a place to at least mix in with the humidified air from the humidifier.

I saw what you said over in the thread about the headaches and humidity with added O2 that didn't have added humidity. If you do get home O2...the home units should also add moisture. Plain O2 is just too drying. You will end up needing/using the humidity from the AirSense and the humidity that the O2 unit adds. O2 adding machines at home usually also have something to add moisture as well built into the O2 delivering machine.
Did they stick the adapter for the O2 line right at your hose to mask junction so the added O2 just went pretty much directly to your mask and never got to really mix with the humidified air much? That's usually how they do it.

ResMed hasn't come out with a newer model than the AirSense/AirCurve yet ...no one has and none that I have ever known of have ever been designed to make special accommodations for adding oxygen. Now that doesn't mean that next month ResMed or Respironics won't offer something next month....they keep new models in the works a closely guarded secret. We never know what new features might be on the new machines in the works or when they will be released.

Pugsy wrote: ↑

Sat Jul 18, 2020 3:58 am

I saw what you said over in the thread about the headaches and humidity with added O2 that didn't have added humidity. If you do get home O2...the home units should also add moisture. Plain O2 is just too drying.

If you're just adding a couple LPM of O2, you don't need added humidity, it's a small enough percentage of the cpap air.

Adding humidity with O2 is a fair amount of work, you *have* to use distilled water, and fresh at that, and change it frequently, because the O2 is bubbling through it, unlike the cpap, it *can* carry contaminants and bacteria into the O2 flow, there's bunches of cautions in the manual.

Is the other test they have you scheduled for another 6 minute walk test? If they haven’t done one already and the walk test doesn’t reveal anything if I were in your shoes I would push for a cardiopulmonary exercise test (during a CPET they monitor you while on a exercise bike or treadmill). That will hopefully reveal any issues that could be causing your low O2 levels and shortness of breath with exertion. It would also be advisable to check your O2 levels while using your CPAP. A good inexpensive first step would be to ask your doc to order overnight oximetry. If your O2 levels while sleeping are on the low side, but not low enough for your insurance to cover O2 your doc might be willing to prescribe O2 if he/she believes you would benefit from it and you’re willing to pay for a concentrator out of pocket. My son uses supplemental O2 with his CPAP and while his O2 is covered by insurance we ended buying an O2 concentrator out of pocket because over the long term it was actually much cheaper to buy a concentrator then to pay to perpetually rent one from a DME.
As far as what machine is the best, if I were you I would go with ResMed. The heated hose with built in O2 connection Pugsy linked to is really nice. My son uses O2 with his Dreamstation which is added to the machine thru an adapter that plugs in between a non heated hose and the machine. I may be wrong but I don’t believe that there is a heated hose that you can plug O2 into available for the Dreamstation. If you like to run with a higher humidity level the ResMed has a larger humidifier chamber then the Dreamstation, we have to run a stand alone humidifier in my son’s bedroom to keep his Dreamstation from running dry.

Good luck, hope they can find and figured out how to address any underlying issues that landed you in the hospital!

It sounds like you are also dealing with insurance requirements in order to get your oxygen and new machine. When I had my knee replaced, the nurses made a note in my charts that my oxygen level dropped when I slept. Three hours after I got home, a man showed up with an oxygen concentrater and an oxygen tank for me to use when sleeping. The six minute test sounds like an insurance company requirement. Medicare and most other insurance companies will no longer replace CPAP machines after five years. They will be replaced only if they fail, and the cost to repair is more than a certain percentage of cost of a new machine. Your DME is probably trying to get approval from the insurance company prior to giving you a new machine. If you offer to pay for it yourself, they will gladly send it to you right away.

Pugsy wrote: ↑

Sat Jul 18, 2020 3:58 am

Did they stick the adapter for the O2 line right at your hose to mask junction so the added O2 just went pretty much directly to your mask and never got to really mix with the humidified air much?

Yes. I was happy with such a simple solution.

Thanks for your help. I got a heated hose when I first got the A10 5 years ago but have never used it.

Maryland CPAPer

colomom wrote: ↑

Sat Jul 18, 2020 9:14 am

Is the other test they have you scheduled for another 6 minute walk test? If they haven’t done one already and the walk test doesn’t reveal anything if I were in your shoes I would push for a cardiopulmonary exercise test (during a CPET they monitor you while on a exercise bike or treadmill). That will hopefully reveal any issues that could be causing your low O2 levels and shortness of breath with exertion. It would also be advisable to check your O2 levels while using your CPAP. A good inexpensive first step would be to ask your doc to order overnight oximetry. If your O2 levels while sleeping are on the low side, but not low enough for your insurance to cover O2 your doc might be willing to prescribe O2 if he/she believes you would benefit from it and you’re willing to pay for a concentrator out of pocket. My son uses supplemental O2 with his CPAP and while his O2 is covered by insurance we ended buying an O2 concentrator out of pocket because over the long term it was actually much cheaper to buy a concentrator then to pay to perpetually rent one from a DME.
As far as what machine is the best, if I were you I would go with ResMed. The heated hose with built in O2 connection Pugsy linked to is really nice. My son uses O2 with his Dreamstation which is added to the machine thru an adapter that plugs in between a non heated hose and the machine. I may be wrong but I don’t believe that there is a heated hose that you can plug O2 into available for the Dreamstation. If you like to run with a higher humidity level the ResMed has a larger humidifier chamber then the Dreamstation, we have to run a stand alone humidifier in my son’s bedroom to keep his Dreamstation from running dry.

Good luck, hope they can find and figured out how to address any underlying issues that landed you in the hospital!

They ordered a heart stress test that uses Lexiscan (an injection) to simulate treadmill use in the nuclear medicine dept. They said treadmill tests were all discontinued due to COVID, for which I am thankful because I have never mastered a treadmill. I don't walk at the same pace as any machine. I developed headache and jaw pain shortly after the test started, for which they gave me an antidote that took those symptoms right away. They said I passed the stress test. The dr. said that people who pass this stress test are unlikely to have a heart attack in 2 or 10 years, not sure which. I saw 10 years later online.

I have been so exhausted since getting home on Tuesday (after 5 days in the ER and 3 different rooms with increasing capability of monitoring), so lack of oxygen during CPAP use at home has not stopped me from sleeping my life away. It did prevent me from adopting a new rescue cat on Friday, for which I was preapproved. I said it was not fair to bring a cat into the turmoil of my health at this time. Next issue--how do cats treat oxygen lines and heated humidifier lines? I use a hose cover to keep cats from puncturing it. My last cat died in February, sadly, so it has not been an issue, but I miss the love a furry friend adds to one's life.

Thank you for the information on how the Dreamstation and A10 handle oxygen and for sharing your experience.

Yes, I am trying to meet insurance requirements for a new APAP and oxygen. I am lucky the A10 hasn't died yet but 5 years of hard use definitely seems to be life span for the machines I have used. The previous machine was a Phillips Respironics, and when it died, it was dead.

Okie bipap wrote: ↑

Sat Jul 18, 2020 9:27 am

It sounds like you are also dealing with insurance requirements in order to get your oxygen and new machine. When I had my knee replaced, the nurses made a note in my charts that my oxygen level dropped when I slept. Three hours after I got home, a man showed up with an oxygen concentrater and an oxygen tank for me to use when sleeping. The six minute test sounds like an insurance company requirement. Medicare and most other insurance companies will no longer replace CPAP machines after five years. They will be replaced only if they fail, and the cost to repair is more than a certain percentage of cost of a new machine. Your DME is probably trying to get approval from the insurance company prior to giving you a new machine. If you offer to pay for it yourself, they will gladly send it to you right away.

Bummer. Yes, I am dealing with Medicare requirements to get the machine and oxygen covered, using the same DME as for the last 5 years. The current hitch in getting the new A10 seems to be that I had to have an office visit with a dr. specifically to talk about APAP issues and a specific statement from the dr. that I was compliant with the use of the machine and that the treatment benefitted me. She wrote that with her prescription for the new machine, but due to COVID, we had not had an office visit in the required timeframe, and never talk about APAP except for me to say I am using it and I think it is helping. I have office visits with my primary care dr and the pulmonologist to cover that base.

Thank you for letting me know Medicare has changed the 5-year rule. However, my machine is saying normal motor life has been exceeded and the DME is not saying anything other than needing dr's notes. I asked if hospital notes would suffice, but it's hard to get 4 hours of use per day of a CPAP in a hospital, with someone appearing every hour or so to draw blood, check vitals, and/or announce that the remote monitoring says I am not still alive when all I is doing is sitting in bed watching TV while still breathing..

They want to do a "six minute WALKING test" to determine if you need oxygen
---while you are SLEEPING?
Am I missing something here?
Sounds like something an HMO might pull to prolong your suffering . . .

chunkyfrog wrote: ↑

Sat Jul 18, 2020 10:20 am

They want to do a "six minute WALKING test" to determine if you need oxygen
---while you are SLEEPING?
Am I missing something here?
Sounds like something an HMO might pull to prolong your suffering . . .

No, the six-minute walking test while you are walking with someone with an oximeter is done while awake and not on oxygen. It is to see if you can walk six minutes without added oxygen. You fail if you go below a certain oxygen saturation % during the walk and probably don't make it to 6 minutes. If you fail, I think they then add oxygen to another walk after a period of rest and see if it helps. The prescribed oxygen would be used while awake and/or with CPAP.

A nurse did a trial run of the test in the morning and stopped me after a couple of minutes. He said my oxygen levels were poor and I would fail the test. He used a different oximeter, and those machines seem to all read differently. I had 3 on at a time sometimes in the hospital and the levels all were low but varied from each other.

If done properly, I would probably fail the six minute walking test. The official version was done with someone with a wheelchair to catch me and I was racing to keep the wheelchair from running into me. I was mad at that point in the day because the test was supposed to have been done 4 days earlier and kept getting postponed. I just wanted to be let out of that asylum by then. I had driven to the ER 5 days earlier and the hospital nurses told me my car had either been stolen or had a boot on it for being parked there so long. I told them the six-minute walk would be to check on my car, but of course it wasn't. When the hospital staff feels the need to upset you to make you get a false reading on a test, I think it's time to leave. My car was untouched, thankfully.

palerider wrote: ↑

Sat Jul 18, 2020 5:40 am

Pugsy wrote: ↑

Sat Jul 18, 2020 3:58 am

I saw what you said over in the thread about the headaches and humidity with added O2 that didn't have added humidity. If you do get home O2...the home units should also add moisture. Plain O2 is just too drying.

If you're just adding a couple LPM of O2, you don't need added humidity, it's a small enough percentage of the cpap air.

Adding humidity with O2 is a fair amount of work, you *have* to use distilled water, and fresh at that, and change it frequently, because the O2 is bubbling through it, unlike the cpap, it *can* carry contaminants and bacteria into the O2 flow, there's bunches of cautions in the manual.

I replied to you, palerider, but my reply seems to have vanished. Major bummer if I have to use distilled water, as I use 2 A10 humidifier tanks per night of sleep as it is. Can you send me a link to the manual to which you refer? How long have you used oxygen, and how much has it helped? Thanks for your input.

Is your doctor trying to justify oxygen all of the time or only when sleeping? Mine was for only when sleeping. I used it for almost ten months until I could get tested and have a bi-level machine to use. My oxygen would often drop to dangerous levels when I slept without a bi-level machine. As long as your CPAP machine is operating, Medicare does not want to replace it. For Medicare to replace the machine, you would need to have it sent in for repair and then if the cost to repair was too high, they would replace it. Other wise, they will repair it and return it to you. As long as the motor still operates correctly, they will do nothing. This is why we have spare machines available for our use. If ours fail and have to be sent in for evaluation, we still have machines to use while ours is being evaluated and repaired.

MarylandCPAPer2 wrote: ↑

Sat Jul 18, 2020 9:56 am

They ordered a heart stress test that uses Lexiscan (an injection) to simulate treadmill use in the nuclear medicine dept. They said treadmill tests were all discontinued due to COVID, for which I am thankful because I have never mastered a treadmill. I don't walk at the same pace as any machine. I developed headache and jaw pain shortly after the test started, for which they gave me an antidote that took those symptoms right away. They said I passed the stress test. The dr. said that people who pass this stress test are unlikely to have a heart attack in 2 or 10 years, not sure which. I saw 10 years later online.

I have been so exhausted since getting home on Tuesday (after 5 days in the ER and 3 different rooms with increasing capability of monitoring), so lack of oxygen during CPAP use at home has not stopped me from sleeping my life away. It did prevent me from adopting a new rescue cat on Friday, for which I was preapproved. I said it was not fair to bring a cat into the turmoil of my health at this time. Next issue--how do cats treat oxygen lines and heated humidifier lines? I use a hose cover to keep cats from puncturing it. My last cat died in February, sadly, so it has not been an issue, but I miss the love a furry friend adds to one's life.

Thank you for the information on how the Dreamstation and A10 handle oxygen and for sharing your experience.

Yes, I am trying to meet insurance requirements for a new APAP and oxygen. I am lucky the A10 hasn't died yet but 5 years of hard use definitely seems to be life span for the machines I have used. The previous machine was a Phillips Respironics, and when it died, it was dead.

It's great that the heart stress test with Lexiscan was normal. With the cardiopulmonary exercise test they monitor both cardio and pulmonary function while you exercise, my guess is the stress test with Lexiscan is focused on the cardio side of things. Do you have any diagnosed pulmonary issues? If not have they ever done any testing to check your pulmonary function? With COVID it's understandable that they aren't able to perform many tests, but down the road it might be worth looking into. If you do need daytime O2, it would be nice if they could figure out why you need it.

If you're having desats at night perhaps your doc can use that to get you qualified for O2 with your CPAP. That will just get you a concentrator and maybe a backup tank for power outages which you can't carry around with you during the day, but you could use it during the day when sitting. All insurance is different, but with our insurance my son had to do a sleep study w/CPAP to qualify for O2. Overnight oximetry would be an quick, inexpensive way to see what your nighttime sats look like so it might be worth doing even if you need a sleep study to qualify for the O2.

As far as getting a cat the O2 tubing is much more fragile than CPAP tubing, but it's not very expensive to replace. We recently lost our 16 year old dog and ended up coming home from the humane society with 2 puppies. We ran the O2 tubing along the ceiling and it so far it has survived the pups. If you have already have a heated hose and don't feel a need to use it I would stick with the cheaper non heated hose. To add the O2 you can just get a little adapter that fits between the hose and machine.

colomom wrote: ↑

Sat Jul 18, 2020 11:46 am

MarylandCPAPer2 wrote: ↑

Sat Jul 18, 2020 9:56 am

They ordered a heart stress test that uses Lexiscan (an injection) to simulate treadmill use in the nuclear medicine dept. They said treadmill tests were all discontinued due to COVID, for which I am thankful because I have never mastered a treadmill. I don't walk at the same pace as any machine. I developed headache and jaw pain shortly after the test started, for which they gave me an antidote that took those symptoms right away. They said I passed the stress test. The dr. said that people who pass this stress test are unlikely to have a heart attack in 2 or 10 years, not sure which. I saw 10 years later online.

I have been so exhausted since getting home on Tuesday (after 5 days in the ER and 3 different rooms with increasing capability of monitoring), so lack of oxygen during CPAP use at home has not stopped me from sleeping my life away. It did prevent me from adopting a new rescue cat on Friday, for which I was preapproved. I said it was not fair to bring a cat into the turmoil of my health at this time. Next issue--how do cats treat oxygen lines and heated humidifier lines? I use a hose cover to keep cats from puncturing it. My last cat died in February, sadly, so it has not been an issue, but I miss the love a furry friend adds to one's life.

Thank you for the information on how the Dreamstation and A10 handle oxygen and for sharing your experience.

Yes, I am trying to meet insurance requirements for a new APAP and oxygen. I am lucky the A10 hasn't died yet but 5 years of hard use definitely seems to be life span for the machines I have used. The previous machine was a Phillips Respironics, and when it died, it was dead.

It's great that the heart stress test with Lexiscan was normal. With the cardiopulmonary exercise test they monitor both cardio and pulmonary function while you exercise, my guess is the stress test with Lexiscan is focused on the cardio side of things. Do you have any diagnosed pulmonary issues? If not have they ever done any testing to check your pulmonary function? With COVID it's understandable that they aren't able to perform many tests, but down the road it might be worth looking into. If you do need daytime O2, it would be nice if they could figure out why you need it.

If you're having desats at night perhaps your doc can use that to get you qualified for O2 with your CPAP. That will just get you a concentrator and maybe a backup tank for power outages which you can't carry around with you during the day, but you could use it during the day when sitting. All insurance is different, but with our insurance my son had to do a sleep study w/CPAP to qualify for O2. Overnight oximetry would be an quick, inexpensive way to see what your nighttime sats look like so it might be worth doing even if you need a sleep study to qualify for the O2.

As far as getting a cat the O2 tubing is much more fragile than CPAP tubing, but it's not very expensive to replace. We recently lost our 16 year old dog and ended up coming home from the humane society with 2 puppies. We ran the O2 tubing along the ceiling and it so far it has survived the pups. If you have already have a heated hose and don't feel a need to use it I would stick with the cheaper non heated hose. To add the O2 you can just get a little adapter that fits between the hose and machine.

The hospital doctors were just ordering tests to eliminate possibilities. The one in charge of my care seemed to be biased toward the heart being a cause of problems but nothing supported that. The walking oxygen test was the last test that I knew of that was scheduled to be performed. I don't want home oxygen if I don't need it, but everyone except one dr. was saying I needed it. The hospital experience seemed to have no direction except to keep me confused and frustrated.

I had lung function tests in the past--5 years ago--but the dr. retired. Now I have found a new pulmonary dr. due to this hospitalization. They weren't able to diagnose and treat my problems 5 years ago and the problems have just gotten worse. Nobody has looked at my sleep data, that I know of. The pulmonologist from 5 years ago required bringing in the machine and SD card to each visit, then lost the SD card every time. I gave up after a couple of visits. Nobody has been monitoring my sleep or pulmonary care since then.

Thanks everyone for your help. It is greatly appreciated.

Do you have a recording pulse oximeter that you can use at home both while asleep and awake to see what your oxygen levels do?
They aren't horribly expensive and some are compatible with OSCAR/SleepyHead.
Somewhere between 50 and 100 bucks depending on how fancy you get.