Sleeping with O2

[starion]

Dear LungLine Nurse,
Thanks for the opportunity to ask this question.  I have severe COPD & severe asthma & will be at National Jewish for my annual re-evaluation.  While there, I need to use supplemental O2 for sleep & exertion (only at altitudes, like Denver).  I have a VERY difficult time adjusting to using the cannula to sleep with and would appreciate ANY tips you have to help make sleeping with O2 more comfortable.  I tried cutting off the nasal prongs, but the cannula rolled & I ended up not getting much sleep or O2 last time.

I've read about the OxyArm, Softhose cannulas, Salter Comfort Head Cannula and putting the cannula in my mouth to sleep.  I would GREATLY appreciate any suggestions and advice you have of effective strategies folks have used to sleep comfortably with oxygen as it is my biggest challenge in using the oxygen I'm prescribed in Denver.  The provider I use in Denver is Lincare via their Englewood branch.

Aloha,
Starion

[National Jewish]

The OxyArm™ is an open-type of oxygen delivery system.  The Mike Cannula is a microphone-type oxygen delivery system.  Both are well tolerated, especially during sleep.  Please check with Lincare to see if they can provide either one of these for your use in Denver.

[AndyRRT]

Starion,

I'm sorry to hear you're having a tough time sleeping with the nasal prongs. I do hear some complaints from my patients regarding this. Msotly about how the prongs themselves cause irritation in the inside of the nares. With this, I suggest using a different brand of cannula. Some companies carry nasal prongs that "flare" out at the tips. This is supposed to prevent sliding inside the nares and have a more "secure" fitting. Other are the plain ole' straight ones. Regardless, what I ussualy did with them was I would trim the prongs down about 1/2 way. Not completely off. This is why they were probably rolling off your face.

Nasal prongs are probably your best bet. Anything else is going to be too bulky or expensive for that matter. How much oxygen are you on anyways?

-Andy, RRT, CPFT

[starion]

Thanks for your thoughts & suggestions, Andy.

I'm on 2 liters/minute for exertion & sleep when at 5000 feet altitude.  At sea level (where I live), I do NOT require any oxygen & generally maintain saturation rates of 94-97% 24/7.

Someone suggested a Salter Head Comfort Cannula with a padded headband as being especially comfortable, and Lincare is looking into getting that for me.  Other suggestions are certainly welcome as well.  Lincare says many folks have difficulty adjusting to sleeping with O2, so I guess that's somewhat comforting, knowing the problem isn't unique to me.  Someone said pediatric cannulas are sometimes a bit more comfortable, but I've never tried those.

I just find it hard to adjust to having ANYTHING in my nose all night.  During the day, I can put up with it, especially since I don't need to wear O2 while I'm just sitting, so I can give my nose a break.  

Starion

[AndyRRT]

Another suggestion is a device called a Nasal Mask (or a pig-mask)

We used these at the Dana-Farber CAncer Institute in Boston. It a mask like device that cups around the tip of your nose, yet still secures like regular nasal prongs. The mask itself has two small holes across from each other that directs the oxygen flow into the nares. We used these because the prongs not only irritated our patients noses, but the direct flow also dried out their nares and put them at risk of bleeding. (we dont like patients with low platlets counts to bleed!)

Here is a link of a photo of what ehy look like. They are relatively inexpensive. Give it a try!

-Andy, RRT, CPFT

http://trimed.freeservers.com/TM/adultbiflo1.jpg
http://trimed.freeservers.com/TM/biflomaskped.jpg

[starion]

Thanks for this suggestion--are these masks pretty well tolerated?  They look considerably more comfortable than the cannula to me & not as scary as I had invisioned masks.  I'll ask the Lincare RRT when I next speak with him--he's looking into the Salter Head Comfort Cannula with padded headband that someone else recommended as more comfortable than traditional cannulas.

Aloha,
Starion

[AndyRRT]

To be honest, I dont think you're going to like the Salter systen. Universally, the standard nasal prongs are the most tolerated. The nasal mask doesnt poke your nostrils, its just sits on the mustache of your lip. Its larger than nasal prongs, but less invasive, per'se.

People tolerated the nasal mask just fine. You have to remember though that since this isn't direct flow into the nares like standard nasal prongs, oxygen can lost around the nose, lessening your inspired oxygen intake. I have found that some patients required an extra liter of oxygen to make up whats lost.

-Andy, RRT, CPFT

[starion]

Thanks for your candor.  The Lincare RRT had never heard of the biflo nasal masks and will be looking into it.  I've already tried the nasal cannula prongs & am certainly willing to increase my O2 flow as needed if this method requires it to keep adequate oxygenation.  It's nice to have options & I appreciate your thoughts, candor & sharing.
Starion

[AndyRRT]

Starion,

Be sure you check with your doctor before you change your oxygen literflow. also, let it be known that people with COPD don't typically have saturations of 96-97%. You're body isn't used to having higher oxygen levels, and has adjusted without it. In the hospital, we titrate patients oxygen levels to bve maintained between 88-92%. Anything higher is excessive and can cause respiratory depression.


Goodluck kiddo....and keep in touch!

Andy, RRT, CPFT

[starion]

Thanks for your insights, Andy.  I am an atypical COPD patient anyway, since NO ONE can figure out WHY I have COPD & MY O2 SATs are often in the 94-97% range at sea level, though they can drop to 90-92 with exertion, particularly inclines.  My O2 SATs are often 94-96% when flying & at rest at 5000 feet as well, but I will work with my pulmo to figure out how to titrate my O2 properly, with my pulse oximeter.

Just got off the phone from chatting again with the nice Lincare RRT & he says I've given him a LOT to think about & discuss with the Salter rep.

Aloha,
Starion

[starion]

LungLine Nurse and Andy RRT & Everyone,
Thanks for all your suggestions and comments.  I'll call Lincare again & see what they can provide.  So far, they have offered the standard cannula and the salter Micro 1616.  I'll call again on Monday & ask.
Aloha,
Starion