I am Using Oxygen at Night. Do I need Oxygen when I Sleep?

Do I Still Need to Use Oxygen at Night during Sleep? Dear Dr. Mahler: About a year ago my primary care doctor ordered oxygen at night when I sleep. I guess that my oxygen level was low in the office, but my level was not monitored during sleep. She really didn’t explain things very clearly except that she said to use oxygen at 2 liters/minute rate.  I really can’t tell any difference using oxygen during the night or when I wake up.  Last May my husband and I went away to Maine for our anniversary and I didn’t take the oxygen concentrator with me.  I felt fine and now only use oxygen a few nights each month when I feel a little tired. What do you think? I am 73 years  and have moderate COPD according to my doctor, but never had complete breathing tests. Silvia from Newport, RI Dear Silvia: Insurance companies and the Centers for Medicare and Medicaid (CMS) have specific criteria (levels) for when they will pay for oxygen for an individual.  The oxygen level is usually
Oximeter which measures the percentage of oxygen being carried by hemoglobin in the blood

Oximeter which measures the percentage of oxygen being carried by hemoglobin in the blood

determined by a device that goes on your finger called an oximeter.  This measures the percentage of oxygen carried by the protein hemoglobin found in red blood cells.  The device sends wave lengths through the finger and a sensor determines the saturation of oxygen. This is abbreviated SpO2.
Diagram of oximeter to determine whether someone requires oxygen at night

The top piece of the oximeter emits light waves that pass through through the finger. The bottom piece has a sensor. Absorption of light differs between blood loaded with oxygen and blood lacking oxygen.

You qualify for using oxygen if your SpO2 is 88% or less.  If you level was 88% or below in the office a year ago, that would qualify you for using oxygen 24/7, not just at night. Did your doctor recommend using oxygen all of the time or just to use oxygen at night? The decision to prescribe oxygen in the office or clinic should only be considered when you are being treated with optimal medical therapy.  In brief, this means:
  1. Not smoking
  2. Use of both types of inhaled bronchodilators (called beta-agonists and muscarinic antagonists) that work by different mechanisms (ways) to relax muscle around the breathing tubes. Available long-acting dual bronchodilators include Anoro (a dry powder) and Stiolto (a mist) used once daily in the morning.
  3. In a stable condition.
Different studies show that from 27 – 70% of those with COPD with awake SpO2 90-95% may experience substantial drops in oxygen levels during sleep. However, the consequences of these drops in oxygen (called desaturation) is unclear. These drops may contribute to more awakenings (arousals) during sleep which could lead to sleep fragmentation. I suggest that you ask your doctor to recheck your oxygen saturation in the office.  If it is 88% or less, then you should be using oxygen all of the time. If it is 89% or higher, then it would be helpful to monitor your SpO2 when you sleep at home not using oxygen. This can determine if you have frequents drops in your SpO2 and can help guide a decision on whether you do or don’t need oxygen at night during sleep. Sincerely, Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.