low oxygen from copd and asthma?

I have asthma and COPD, at night have very mild sleep apnea.  Although it has improved some, I wake up during the night many times, very groggy, its hard to wake up.  They did a sleep study, my oxygen is getting down to 68 percent at night.  The oxygen therapy doesnt seem to be helping.

Is the grogginess part of low oxygen?

I think my lung function has just decreased some.. I have had it for 57 years.

any recommendations?

[National Jewish]

It is likely that your grogginess is due to low oxygen levels and 68% is dangerously low.  The oxygen not helping suggests that it will not help, even with an increase in flow rate.

What you describe suggests that you should be on CPAP and then have its efficacy confirmed by another sleep study.  Please read our obstructive sleep apnea information at http://www.nationaljewish.org/disease-info/diseases/sleep/treatments/obstructive-apnea.aspx to learn more.

[millie1]

I just reread my sleep study, my oxygen gets down to 75 percent at night.. they said my hypoxemia is minimal.. that a artifact could be causing it.. well what kind of artifact? Never heard that.

Anyway.. I am very groggy while trying to wake up.. sometimes the sleep is so deep its hard to come out of.. but it could be because I am exhausted from lack of sleep.

Would love to know what others do to help themselves or help they found for similar problems.

[starion]

IF you live in the US, most insurers & Medicare will cover supplemental O2 for you and/or other equipment since your O2 saturation rate falls below 89%.  You need to work with the doc who ordered the sleep study & explore how much it helps you to use a Bi-Pap or CPap machine (with supplemental O2, if needed).
When they do the sleep study at the sleep clinic that tested my brother, if your O2 level indicates sleep apnea, they have the patient try sleeping with a Bi-Pap & see how s/he does.  If that's not sufficient, they may have the patient try sleeping with a CPap, as well as O2 as needed.
The key is to tell your docs that you're still groggy and ask to be treated so that you can sleep well and wake rested, with whatever equipment that involves.
COPD causes decreased O2 saturation rates; generally with asthma, O2 saturation rates are normal & fine, except sometimes for the duration of especially bad flares.
If your O2 saturation rate is low it can indeed make you wake and/or groggy.  When mine drops, I do not sleep well and sometimes get very nasty headaches as well.
Hope this is helpful.  You really need to ask your docs to help you get better & more refreshing sleep with higher O2 saturation rates.
Starion

Starion

[millie1]

I have a sleep study every year.. each time they say its not bad enough to put me on cpap or bipap.. I have about 10 breathing interuptions per hour, but my 02 level got down to 75 percent for at least 6 minutes at a time.  

My insurance paid for a oxygen concentrator.  I see no difference.  I still wake up with very heavy feeling some nights.   It seems like my lungs are not pushing air in and out right at night, so if the oxygen cannot get that deep could it not be doing much good?

I am concerned my lungs are losing elasticity.  

This is a very frustrating, sometimes frightening disease, but i work very hard at not letting it control me or my emotions.. I am proactive and want to help myself too.

I find that most doctors are so very busy anymore.. they cannot be with you every minute, somethings you have to figure out for yourself. But I do have a very compassionate kind doctor.

My sister goes to National Jewish very often, she is much worse than I am.
Very severe asthma.

[starion]

Dear Millie,

Here's a National Jewish page about Sleep Apnea.  Ask your doc if you can try to see whether a Bi-Pap or CPap makes any difference in how you sleep & feel.  If need be, ask if you can rent the machine, just to try it & see how if there is any noticable difference for you.  Good luck!  Starion

http://www.njc.org/disease-info/diseases/sleep/treatments/obstructive-apnea.aspx

Below is a revised definition of when Medicare covers sleep apnea:

http://www.talkaboutsleep.com/sleep-disorders/archives/medicare_disability_osadefinition.htm

(AHI = number of episodes of apneas and hypopneas per hour of sleep) has been utilized extensively in recent years in the published literature in the definition of OSA. The AHI has also been called the respiratory distress index (RDI).

Conclusion
CMS will revise the NCD for CPAP for the treatment of OSA (CIM 60-17) to the following: CPAP will be covered under Medicare in adult patients with OSA if either of the following criteria is met:

AHI

[millie1]

thank you for your help.  Sometimes you just want to talk to other people
with similar conditions, to know what helps and what doesn't and if they
are trying new treatments that help.

I know my breathing is very compromised at night.

I appreciate your quick and knowledgeable responses.  

You have COPD and asthma too?

Is anything helping you get some relief?

thanks again
millie

[Sunny602]

You say you have a very hard time waking up in the morning and feel groggy? Do you also happen to wake up with headaches? You might want to ask your doc about carbon dioxide build up in your blood. You might be a CO2 retainer which would explain your symptoms too. Have you had an arterial blood gas done lately, or better yet, did they do one on you after you woke up from your sleep study? If you are a retainer, then BiPAP would be the machine of choice for you, it would help blow off some of that extra CO2 meanwhile giving you a better night's sleep. I don't have COPD per say, but did live on O2 and BiPAP for awhile before being placed on a vent (due to diaphragmatic failure..also have other pulmonary issues such as asthma and CF) I hope this helps..Sunny

[millie1]

thank you for the information, I am going to make a appt with apulmonary specialist again and ask these questions.  I feel like I am really having serious difficulty at night.. I do not feel air flows in and out correctly, I am sure my diaphram plays part in it too.

Thank you for the great insight.

You have Cystic Fibrosis?  Thats a difficult disease.

It takes a lot of courage to face all this doesn't it?

Thanks again... hope today is a good day for you Sunny

love
millie

[starion]

Seeing a pulmonary specialist and explaining your situation is a great idea.  Yes, I have severe chronic asthma and severe emphysema too.  Before diagnosis, I was waking every night for months breathless.  Since then, I've been on inhaled steroids (Qvar) with a spacer and it has helped tremendously.  I'm also taking Spiriva (tiotropium bromide).  It has been very helpful as well.

The docs also evaluated me for gastric reflux and allergies & I'm being treated for those as well, which may be playing a role in optimizing my lung function also.

Many folks benefit from using a Bi-Pap, especially with their O2.  Good luck in getting all of this sorted out.  It can be improved, but you have to be persistent.

Starion

[millie1]

I have been to so many pulmonary specialists over the years, the last one
was very good.  They have done many tests, pulmonary function etc.  It just
shows my lung capacity decreasing.. they have me on a minimal of medicine.

When my sister started going to national Jewish they gave her so many tests, and started her on xolair.. she has severe unstable asthma.. the xolair really helped.  I am on a medicare hmo.. there is a lot of things they will not pay for.

But I know something is not working right.  Did you ever have your diaphragm tested to see if it works correctly?  I wonder how they do that?

I am going to ask my doctor about the qvar you mentioned.. is that its full name?

Thanks so much.. all this is info that is very useful. I truly believe in exchanging information, its invaluable.. as we can only spend a few minutes with the doctors.. and sometimes we just want info to help ourselves.

I go to see my doctor Thursday.. she is wonderful. I appreciate the new medicines mentioned.. I am going to ask about them.

I want xoponex but my insurance won't pay.. and advair gave me severe reactions.

thanks
millie

[Sunny602]

Yes with all of the other problems I face, the CF makes it tougher. I am on IV's many times a year for exacerbations, for weeks at a time. I too have Medicare, so I know what you mean about coverage. As far as the diaphragm goes, ,yes, there is a test that will show how it functions...it is called fluroscopy. It is a fancy xray that allows the doc see the movement of the diaphragm while doing several maneuvers. I have had this done, that is how the doctors determined the severity of my diaphragmatic issues (the PFT's showed severe restrictive disease as well...mostly neuromuscular). In a normal study, when someone breathes in, the diaprhagm goes down. When someone has a paralyzed diaphragm (this test is best for those who have one sided paralysis of the diaphragm), the diaphragm moves upward instead of downward with each breath. In my case, there was almost no movement of my diaphragm and it was clear that I was using my accessory muscles just to breathe. I believe that the diaphragm contributes 70% of the breathing effort, the rest accessories. I was in a sense using just my accessories to breathe, had severe respiratory failure as a result.
It is a good idea to ask all of these questions, write them down....I always forget something if I don't write them down. Perhaps your grogginess is a component of many things, hopefully your doc will be able to sort them out and treat you appropriately. I wish you luck on your visit...plese keep us posted! You are in my thoughts...Sunny

[Pat61]

A related discussion, low oxyegen level was started.