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COPD & Sleep Apnea
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COPD & Sleep Apnea

Male, 59, diagnosed with COPD 2 years ago and Sleep Apnea.  Retaining carbon dioxide, O2 level is about 95%.  Heavy smoker and will not quit. Obese.  Has passed out on several occasions and was taken to ER.  He will not do anything to help himself.   I know it is progressive and expecially since he chooses to ignore all of it and claims to feel "fine".  Activity is already limited, but with lots of excuses as to why he can't do something.  My question is are there any signs or symptoms that I should be looking for as this disease progresses? I have had to give up trying to get him to realize what he is doing and now I just have to cope with it.  Doctors have already told him what he needs to do and the consequences.  I am concerned that he will pass out while driving or something like that.  Or that I will wake up one morning and he won't.  What is the life expectancy after diagnosis and no change in habits (I know that is a hard one)?  
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To retain carbon dioxide and have an oxygen level of 95%, one must be on oxygen.  The mortality rate for individuals with even mild hypercapnia (pC02 > 50) is said to be 40 to 50% at one year.  It could be less than a year with continued heavy smoking.  It is highly that the combination of hypercapnia and carbon monoxide levels from smoking seriously interferes with oxygen delivery to this man's tissues.  This might explain his 'passing out'.  Given the strong likelihood that he will pass-out again, he definitely should not be allowed to drive.  Doing so will endanger himself and others.  Please speak to his doctor about this.

What you should be looking for are changes in his ability to 'think straight', bouts of confusion, excessive sleepiness or drowsiness, difficulty with speech or expressing himself, and the inability to use his legs or arms well.  Unfortunately, as you expressed your concern, the first sign of worsening may be that he does not awaken in the morning.

You and he should speak with his doctor about what are referred to as, end-of-life-decisions, specifically to the decision to be put or not put on mechanical ventilation when he either passes out or has to be hospitalized for breathing difficulty.
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