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Oxygen at Night


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#1 Jane M. Martin

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Posted 26 November 2007 - 03:49 PM

Dear Dr. Adams,

Here's a question I get a lot from patients in our pulmonary rehab program.

What's the advantage of using oxygen at night and not during the day? Is it because the breathing sometimes slows down and / or is more shallow during the night and the oxygen levels drop?

Here's another oxygen-related question I wonder about. We go by the magic number "88%," that is, if somebody has an oxygen saturation at 88% or lower on the pulse oximeter, they qualify for supplemental oxygen. My question is this: If they are 'living' at 89% or so much of the time, is that really enough for staying as healthy as possible? I've heard that there are findings telling us that by using this guideline we're letting our patients be "too low."

Thank you!

Jane.

#2 Francis V. Adams

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Posted 26 November 2007 - 04:30 PM

Hi Jane:

Another great question.

Oxygen levels are lower for everyone during sleep. This relates to a more shallow breathing pattern that we all assume during sleep. Some alveoli drop out of use so 02 levels fall. If you are starting out with an awake 02SAT above 94% it is unlikely that the sleep level will be below 88%. It is best, however, to do a sleep oximetry study and see the actual 02 levels at night. This is relatively easy with a pulse oximeter that has a printout or memory. Home care companies usually set this up with an order from the MD.
When 02 levels fall below 88% it constricts the blood vessels (pulmonary arteries) in the lung. This produces a higher pressure which is transmitted to the heart. The end result can be a weakening of the heart muscle or congestive heart failure so it is important to maintain 02 levels above 88% for the entire day.
Another common 02 problem is that 02 levels in COPD patients typically fall during exertion. Again an oximeter can document this and if levels fall below 88%, portable 02 is required.
I do believe that 89% is better than 88% although I understand that it doesn't seem significant. What we know is that the blood vessel constriction occurs at a certain level and it can be that at 1% higher 02SAT, constriction does not occur but at the lower level it does.

Dr. Adams

View PostJane M. Martin, on Nov 26 2007, 03:49 PM, said:

Dear Dr. Adams,

Here's a question I get a lot from patients in our pulmonary rehab program.

What's the advantage of using oxygen at night and not during the day? Is it because the breathing sometimes slows down and / or is more shallow during the night and the oxygen levels drop?

Here's another oxygen-related question I wonder about. We go by the magic number "88%," that is, if somebody has an oxygen saturation at 88% or lower on the pulse oximeter, they qualify for supplemental oxygen. My question is this: If they are 'living' at 89% or so much of the time, is that really enough for staying as healthy as possible? I've heard that there are findings telling us that by using this guideline we're letting our patients be "too low."

Thank you!

Jane.

Dr. Adams
adamsmd.com





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