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Supplemental Oxygen
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rickm Offline

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Post: #1
Supplemental Oxygen
Supplemental oxygen appears to be uniformly dismissed as a remedy for sleep apnea, yet I find but two minor studies of this possibility on Pubmed. Is there any clinical support for the application of supplemental oxygen to sleep apnea? I would appreciate responses from those who: (a) Have tried it, and (b) Who know more than I do.
02-12-2013 11:22 AM
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trish6hundred Offline

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Post: #2
RE: Supplemental Oxygen
Hi rickm,
WELCOME! to the forum.!
I haven't tried that but hang in there for more answers to your question.
Best of luck.

trish6hundred
02-12-2013 11:36 AM
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DocWils Offline

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Post: #3
RE: Supplemental Oxygen
Well, there IS some support for this, but does depend on what sort of sleep apnoea and at what level of severity. I addition, the studies that you cite, if they are the same I have seen, are not conclusive. Naturally, we use supplemental O2 routinely in hospitals, but for home use, there is less to support the efficacy against most common OSAs in comparison to the gold standard of CPAP. Not to mention the cost for home users of obtaining and replenishing O2 cylinders and properly administering them. Any clinical effect for OSA seems to be for the same reason that a CPAP works - continuous airway pressure, and nothing specific to do with the purity of the air mixture. In that sense there is no therapeutic advantage of using an O2 tube over a CPAP, and likely to be a considerable disadvantage at higher levels of pressure, when O2 can become dangerous for unsupervised use and potentially toxic.

As a line of enquiry it is a bit unusual, and I have to ask you why do you want to know, exactly? I do not think that for personal use it is something that will be easier for you than a CPAP, and if you are looking into doing a research project as a clinician, then you would have to clear it through your teaching hospital, which might not be easy, since we have so many years of experience now with O2 that the book is probably closed on that idea, interesting though it might be. If the reason is simply because the cannula look easier to wear, there are masks that mimic that shape, but since there is a greater volume of air being moved, the tubes are always going to be larger.
(This post was last modified: 02-12-2013 12:23 PM by DocWils.)
02-12-2013 12:18 PM
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PaulaO2 Offline
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Post: #4
RE: Supplemental Oxygen
I can see that it may help those with central apnea but not for OSA. OSA is a structural thing while CSA is a brain thing.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-12-2013 12:59 PM
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Shastzi Offline

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Post: #5
RE: Supplemental Oxygen
From a practical standpoint O2 by itself will never get into the lungs if the airway has collapsed.
Air pressure must be present to keep the airway from caving in.
...So sometimes a physician may order O2 in addition to CPAP therapy. It all depends on the patient's situation.

Wink
02-12-2013 02:01 PM
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rickm Offline

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Post: #6
RE: Supplemental Oxygen
(02-12-2013 12:18 PM)wilorg Wrote:  Well, there IS some support for this, but does depend on what sort of sleep apnoea and at what level of severity. I addition, the studies that you cite, if they are the same I have seen, are not conclusive. Naturally, we use supplemental O2 routinely in hospitals, but for home use, there is less to support the efficacy against most common OSAs in comparison to the gold standard of CPAP. Not to mention the cost for home users of obtaining and replenishing O2 cylinders and properly administering them. Any clinical effect for OSA seems to be for the same reason that a CPAP works - continuous airway pressure, and nothing specific to do with the purity of the air mixture. In that sense there is no therapeutic advantage of using an O2 tube over a CPAP, and likely to be a considerable disadvantage at higher levels of pressure, when O2 can become dangerous for unsupervised use and potentially toxic.

As a line of enquiry it is a bit unusual, and I have to ask you why do you want to know, exactly? I do not think that for personal use it is something that will be easier for you than a CPAP, and if you are looking into doing a research project as a clinician, then you would have to clear it through your teaching hospital, which might not be easy, since we have so many years of experience now with O2 that the book is probably closed on that idea, interesting though it might be. If the reason is simply because the cannula look easier to wear, there are masks that mimic that shape, but since there is a greater volume of air being moved, the tubes are always going to be larger.

Thanks for your insightful advice.

I have been diagnosed with mild sleep apnea and tried CPAP on two occasions years apart with the same result: after several months the cure was worse than the malady. Strongly positive results early on, however, lead me to question whether my apnea is really all that mild. I am also aware of the possibility that initial positive results may be a placebo effect.

My interest in oxygen stems from the possibility that the cannula and oxygen hose look to be more tolerable than the CPAP mask and air hose, not to mention the need to maintain a positive pressure in the CPAP mask. I have tried several CPAP masks and even the least intrusive ones appear to me to be monstrosities. I confess to prejudice against CPAP, but it is experience-based and in my opinion well-founded.

I had in mind an oxygen concentrator rather than bottled oxygen, and having a technical background am confident in my ability to safely manage the use of oxygen in my home. The possible need for supervision is another matter which I would investigate before proceeding.

You have probably explained why there is a paucity of research on the subject. It could be argued that a collective closed book might to some extent be the mass equivalent of an individual closed mind. In any event, the results of sleep facilitation are highly variable among individuals and I am not a researcher but rather an individual concerned only with his own response. So my question boils down to whether it is worth a try.

I observe that you are Swiss and appear to have a professional involvement. I am American and based largely on personal experience am cynical about our medical industry and our practice of medicine. Examples abound. Much medical research in the U.S. is industry funded and the CPAP industry is huge and powerful and naturally less than enthusiastic about alternate methods. You correctly refer to CPAP as a gold standard. We here are in the process of backing off from another "gold standard", the barbaric prostatectomy for prostate cancer in favor of radiation treatment. We are abandoning universal PSA testing for prostate cancer, despite understandable protests from those who live and profit from its treatment (For years Europeans have marveled at this practice which has little if any statistical effect on mortality.). I have read that St. John's Wort is the most commonly prescribed medication for mild depression in Germany; in the U.S. we prescribe expensive drugs, all of them burdened with serious side effects. There is no money in herbs. After years of injections and prescription antihistamines I found that I could manage allergic rhinitis with saline nasal irrigation. there is no money in saltwater.

Sorry to get off subject, but this is why when I find very little research on a treatment that may well be beneficial, I ask why.
02-12-2013 03:10 PM
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PaulaO2 Offline
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Post: #7
RE: Supplemental Oxygen
I think you are missing the mechanics of sleep apnea and CPAP use.

Obstructive sleep apnea is the airway closes in the throat. Those muscles that help us swallow and talk are considered voluntary muscles, meaning we control them. When we relax in sleep, those muscles relax. In the case of people with sleep apnea, those muscles, and the tissue around them, then fall together, blocking the airway.

CPAP works by keeping pressure in the throat, enough that the airway stays open. There may still be events, but they are less often and last much shorter a time period.

Oxygen would do nothing to help keep those muscles from relaxing and from collapsing.

There is a CPAP mask that is just like the oxygen cannulas. Google Nasal Aire II.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-12-2013 04:12 PM
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DocWils Offline

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Post: #8
RE: Supplemental Oxygen
rickm,

I understand your frustration, but the reason that there is little research into it is because we have around 130 years of experience with oxygen, and so have explored many if not all the possible ways to use it and abuse it. For sleep apnoea it is found that any therapeutic effect is not related to the oxygen itself (and this WAS looked into early on), but to the constant pressure, in short, a CPAP, and the result is that if we find a simple and effective way to treat something, then we prefer not to impose an expensive and potentially lethal way of doing it on the patient. That is why, except for certain cases, when a patient needs extra oxygen at home, these days it is done via a compressor with a continuous feedback system, similar to a CPAP, in fact, instead of cannisters (or bottles) with a pressure gauge, as we used to use years ago - the expense is less, it is safer for the patient, it reacts more quickly to a patient's respiration needs, and there are only a few reasons these days to insist on pure O2 for a patient (not to say we don't use it or recommend it for given conditions, but not a s a universal panacea). Added to which, O2 delivery systems tend to be single stream single pressure rigs, while CPAP devices respond quite dynamically to the breathing behaviour of the patient.

As for the cannula comfort, and I do not know if I am abusing the rules of the Forum's restriction on mentioning commercial companies here, but a company named DeVilbiss makes one in that style which has a reputation of being comfortable and not terribly prone to leakage. If you do obtain one (the Nasal-Aire II ....hmmmm.... I wonder what happened to the nasal-air I?) do let us know how that works for you. If you like it a lot, I might give it a go myself - I am constantly looking for a better system and prone to modding just about everything I get my hands on.

As for other "gold standards" - the prostate operation you refer to was the standard at a time that we didn't know better how to treat that disease, and is still in force for more advanced forms, these days using a robot (which my brother just underwent, btw, to amazing effect). We still test PSA levels in patients with a family history of cancer or have other risk factors, and for good reason - any clue is better than no clue, and the test itself is not expensive - in fact, it is around ten bucks or less most times. The reason it is given a grater scrutiny is because we now know that relying on it alone is simply not a safe diagnostic method. But it is still a member of the battery of tests that every man should have every few years past a certain age (and so is the doc sticking his finger up yer bum and telling you to cough).

Medicine is constantly evolving, and so we constantly move our standards, which is one reason why doctors have to continuously be re-educated. In fact, we cannot maintain our practice legally without it. Most of what I learned decades ago has been supplanted by better understanding and that is simply the nature of our profession - we continuously add to our knowledge and the greater the database, the more we can see what works best. The cancer that killed my mother thirty eight years ago is now, when treated at the stage that my mother's was first diagnosed, entirely treatable, and without the massive surgical disfiguration that she endured to buy her enough time to see her children half grown. The congestive heart failure that took my father two decades ago is now pretty much something that can be handled and his life extended. We learn - perhaps in the future we will have a simple laser treatment and boom! the apnoea is gone! But for now, CPAP remains the best method.

However, there IS an alternative that requires considerable daily discipline for very mild forms of apnoea, and is not successful on all forms by any means - digeridoo playing has been found successful in treating apnoeas that occur due to general throat laxity, by tightening up the muscles of the throat - no other instrument has been shown to be a successful substitute, and it is believed that the type of circular breathing has a toning effect on the tissue of the throat. It has further been shown that one must play the "doo" daily for the therapeutic effect to work, and that one must learn the proper technique from a trained teacher. Simply trying to play it on your own won't do - you have to do it properly or not at all. We actually have digiridoo training sessions sponsored by the LungenLega here in Switzerland.

As I said, not all patients are candidates for this therapy, and it only works in mild forms, although it has been shown to lessen the needed pressure on more extreme cases. Something to think about as either an alternative or a supplement. However, this is not something you should journey on by yourself. You need competent medical guidance in all these areas. As much as you don't trust the profit motive of the US medical community, the individual physician is still concerned that you get better, and he or she will look out for your best method of improvement.
02-12-2013 05:22 PM
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rickm Offline

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Post: #9
RE: Supplemental Oxygen
(02-12-2013 05:22 PM)wilorg Wrote:  rickm,

I understand your frustration, but the reason that there is little research into it is because we have around 130 years of experience with oxygen, and so have explored many if not all the possible ways to use it and abuse it. For sleep apnoea it is found that any therapeutic effect is not related to the oxygen itself (and this WAS looked into early on), but to the constant pressure, in short, a CPAP, and the result is that if we find a simple and effective way to treat something, then we prefer not to impose an expensive and potentially lethal way of doing it on the patient. That is why, except for certain cases, when a patient needs extra oxygen at home, these days it is done via a compressor with a continuous feedback system, similar to a CPAP, in fact, instead of cannisters (or bottles) with a pressure gauge, as we used to use years ago - the expense is less, it is safer for the patient, it reacts more quickly to a patient's respiration needs, and there are only a few reasons these days to insist on pure O2 for a patient (not to say we don't use it or recommend it for given conditions, but not a s a universal panacea). Added to which, O2 delivery systems tend to be single stream single pressure rigs, while CPAP devices respond quite dynamically to the breathing behaviour of the patient.

As for the cannula comfort, and I do not know if I am abusing the rules of the Forum's restriction on mentioning commercial companies here, but a company named DeVilbiss makes one in that style which has a reputation of being comfortable and not terribly prone to leakage. If you do obtain one (the Nasal-Aire II ....hmmmm.... I wonder what happened to the nasal-air I?) do let us know how that works for you. If you like it a lot, I might give it a go myself - I am constantly looking for a better system and prone to modding just about everything I get my hands on.

As for other "gold standards" - the prostate operation you refer to was the standard at a time that we didn't know better how to treat that disease, and is still in force for more advanced forms, these days using a robot (which my brother just underwent, btw, to amazing effect). We still test PSA levels in patients with a family history of cancer or have other risk factors, and for good reason - any clue is better than no clue, and the test itself is not expensive - in fact, it is around ten bucks or less most times. The reason it is given a grater scrutiny is because we now know that relying on it alone is simply not a safe diagnostic method. But it is still a member of the battery of tests that every man should have every few years past a certain age (and so is the doc sticking his finger up yer bum and telling you to cough).

Medicine is constantly evolving, and so we constantly move our standards, which is one reason why doctors have to continuously be re-educated. In fact, we cannot maintain our practice legally without it. Most of what I learned decades ago has been supplanted by better understanding and that is simply the nature of our profession - we continuously add to our knowledge and the greater the database, the more we can see what works best. The cancer that killed my mother thirty eight years ago is now, when treated at the stage that my mother's was first diagnosed, entirely treatable, and without the massive surgical disfiguration that she endured to buy her enough time to see her children half grown. The congestive heart failure that took my father two decades ago is now pretty much something that can be handled and his life extended. We learn - perhaps in the future we will have a simple laser treatment and boom! the apnoea is gone! But for now, CPAP remains the best method.

However, there IS an alternative that requires considerable daily discipline for very mild forms of apnoea, and is not successful on all forms by any means - digeridoo playing has been found successful in treating apnoeas that occur due to general throat laxity, by tightening up the muscles of the throat - no other instrument has been shown to be a successful substitute, and it is believed that the type of circular breathing has a toning effect on the tissue of the throat. It has further been shown that one must play the "doo" daily for the therapeutic effect to work, and that one must learn the proper technique from a trained teacher. Simply trying to play it on your own won't do - you have to do it properly or not at all. We actually have digiridoo training sessions sponsored by the LungenLega here in Switzerland.

As I said, not all patients are candidates for this therapy, and it only works in mild forms, although it has been shown to lessen the needed pressure on more extreme cases. Something to think about as either an alternative or a supplement. However, this is not something you should journey on by yourself. You need competent medical guidance in all these areas. As much as you don't trust the profit motive of the US medical community, the individual physician is still concerned that you get better, and he or she will look out for your best method of improvement.

My question has been answered and more. You have devoted a great deal of time to your reply and it is much appreciated.
02-13-2013 08:46 AM
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DocWils Offline

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Post: #10
RE: Supplemental Oxygen
No worries, mate. Hope you feel better...
02-13-2013 02:43 PM
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