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Supplemental O2, Fatigue & Breathing Thru Mouth


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The O2 percentage of those whose lungs are healthy tends to range between 97 and 99%. It is when our O2 percentage drops below 91% that we tend to be prescribed supplemental O2 to bring us up to 91-94% (generally not higher because there is a danger of carbon dioxide poisoning if we let our levels reach maximum percentages; i.e., 97-99%).

Most of us who are on supplemental O2 do not have our own oximeters (which measure both O2 percentage and pulse), but in my case I purchased my own out of pocket due to the facts that that (1) mine tends to fluctuate significantlyu; and (2) when I'm at sea level I can often cease using supplemental entirely (as vs. here at home in mile high country).

I've been on supplemental O2 since May of '07, primarily due to a bout of radiation pneumonitis that inflamed my lung tissue, primarily in my right lower lobe, the location of my primary tumor. At home, I use an electric oxygen concentrator; when away from home, I've used--variously--compressed oxygen, liquid pulse oxygen, liquid continuous feed oxygen; and a portable oxygen concentrator when flying.

Most of the time I've been able to keep it down to 1 liter (2 liters on exertion), which also means that most of the time when I'm in California (at sea level), I've actually been able to forego its use entirely.

There have also been a number of occasions during the last year and a half when my supplemental O2 needs have risen drastically (as high as 4-5 liters)--usually due to a return bout of radiation pneumonitis (which also requires an increase in Prednisone dosage), but sometimes for inexplicable reasons.

This past week I had another "scare;" i.e., I awoke one morning and measured my oxygen just after getting up to go to the bathroom and back to bed, whereupon I discovered it was at only 76%.

Over the next couple days, it continued to fluctuate drastically and, needless to say, based on my current situation, I jumped to the "logical" conclusion that my lungs were deteriorating (presumably due to a growth in size and number of new nodules).

I cannot deny that this thought was depressing and when I put it together with the fact that I've been tiring more easily last couple weeks, I have to admit to becoming anxious, with the result that my ever-present tendency to insomnia also worsened (aided of course by the Prednisone).

Then, this Friday, my hospice RN came to check my vitals, etc., and according to her, my lungs sounded as good as ever; i.e., the right lower lobe, location of the primary tumor, has always been bad, but according to her, the remainning four lobes continue to be clear.

I mentioned to her that my insomnia had been worse of late and asked if fatigue could be the cause, but she said fatigue should have no effect on my O2.

That's when my own light bulb went off (despite chemo fog!) and we both now believe that I may have spolved the mystery; that is:

I have always had a tendency to breath through my mouth (adenoidal) rather than my nostrils and when I went on supplemental O2 last year, initially I had to work at remembering to breathe through my nose (where the cannula is).

HOWEVER, when I am tired, I tend to fall back to mouth breathing and last week I was particularly tired (having only had 10 hrsnd. sleep in three days the first part of the week). And, according to my RN, everyone tends to breathe through their mouth when tired (a primary reason for snoring as well).

And, I had had two good night's sleep in a row when she came by Friday and my supplemental O2 was back down to 1-2 liters (from 3-4 liters earlier in the week).

I have been paying close attention since Friday and have caught myself "mouth breatihing" several times, have corrected the problem and had no more severe fluctuations (I was even able to stay at 1-2 liters at the Rockies-Astros game in Denver last night! :D)

Anyway, I just thought I'd pass this info along to those of you who are also on supplemental O2 in case it might be of help.



PS Check out my new (first ever) tatoo below!

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Thanks, Sandra and Katie.

Re breathing, interesting thing happened this a.m. I woke, went to bathroom, came back to bed and my O2 was down to 88% even though I was at 1 liter. I left it at 1 liter and fifteen minutes later, tested it again and it was back up to expected 93%.

It occurred to me that maybe the reasoon it was so low is that I had been sleeping with mouth open last night (breathing through mouth instead of cannula). :(

So... I'm going to leave a message with my RN asking for a mask (rather than cannula) to wear only at night or when napping so that it won't matter which way I breathe when I'm sleeping. The worst that can happen is that I'll know I need to seek another solution to this particular mystery. :D

With love and affection,


PS I love tattoo also. My daughter was with me when I got it and she actually got one, too (hers is on her ankle whereas mine is on my upper arm). Her grilfriend was with us and she lost her mother to breast cancer two years ago so she got one, too, except her ribbon is filled with pink (as vs. ours being clear).

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It's good to read your post. Those are really interesting observations about the differences in oxygen level being influenced by the way you breathe. It makes a lot of sense and I'm surprised that I never heard my husband's pulmonologist mention this. It just sounds like common sense to me. I'll have to ask my mom about hers. Sure hope that possibly the mask will help you at night. Oh yeah, I love your tatoo too. It says it all. Take care dear , Carole.



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There is also a thing you can get that will keep your mouth closed at night. I think there is a chin strap deal that people with sleep apnea wear to keep their mouth closed so the c-pap can work. Anyway, somewhere in the recesses of my mind I seem to recall someone saying you could get this strap to wear without the whole c-pap thing. IT might be more comfortable than the O2 mask.


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Hi, Sue.

I think there are a lot of things our pulmonologists neglect to tell us--not on purpose, but because they just take it for granted.

Other examples are:

(1) that all the breathing exercises in the world don't help to improve our lung capacity as much as a one mile walk every day (doesn't even have to brisk--and one mile is simply four long blocks out and four long blocks back).

(2) that our O2 fluctuates regularly, sometimes just due to exertion levels; other times because of other health issues; and of course, possibly because we're breathing through our mouth.

Re the former, I wasn't allowed to walk for months due to osteoporosis (prior to going on O2 after contracting radiation pnemonitis, I was walking 2 miles a day) and their fear I would get more stress fractures. After my vacation in August (which included sailing a 70 ft. boat and walking all over Cabo, Ensenada and San Diego), I decided phooey on that and am now trying to walk at least some every day (my stress fractures were all sacral, which means that sitting without a memory foam cushion is definitely still a no-no).

Re the latter, I purchased an oximeter in the summer of 07 right before taking off for So. Cal (where I didn't need O2 due to being at sea level). After I got back i continued to use it and found it very helpful as it let me know when my O2 was affected by my activities (such as walking up handicapped ramp--I now crank up my O2 to do that); and also advance notice that my radiation pneumonitis might be acting up again.

Oximeters can be purchased cheaply if you don't go through a medical supply house (I purchased mine for $160 thru REI (a non-profit sports coop that carries them for mountain climbers), but they have them online for as cheap as $50 (just google the word, oximeter).

I definitely think they're worth it, especially when you consider that they also provide warning if you've got your liters set too high (creating danger of carbon dioxide poisoning).

Anyway, enough of that. Time now for me to call RN re mask! :-)

With love and affection,


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Sandra, Looove the new picture.

Carole, So good to see you back on site. Love the tatoo. I've learned that my mobile internet is only good for a short time here in the Jersey farmland so I didn't have time to reread your initial post. I'm not dealing with O2 issues but did I understand that fatigue itself is linked to mouth breathing? If so, Ry I'm all for that chin strap. It would make sense to me. I feel sure I'm a mouth breather because when my attention is called to my breathing and I'm told to inhale through my nose and exhale through my mouth, I have to concentrate on it. I have significant allergies which I'm sure have contributed to the habit of mouth breathing.

I am on my "gift" of six weeks between chemos for this trip. I have two weeks to go but as of now (like my previous 4-wk gift), I have not seen significant change in my energy level and still get quite fatigued when I am even a shadow of my old "energy bunny" self. I want my life back for however long I can have it before my cancer progresses and that is dependent on increased energy level. I will try almost anything to accomplish that.

Judy in Key West

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Hi, Judy.

The only way that fatigue is related to mouth breathing is that if one is tired, one is more likely to breathe through the mouth than the nostrils.

That wouldn't matter (other than increased snoring and dry mouth) unless one is on supplemental oxygen, in which case the oxygen is normally administered via a cannula directly to the nostrils. If you're tired and breathing through your mouth, you're not getting as much supplemental O2 as if you were breathing through your nostrils.

I have been trying to concentrate on breathing through my nostrils while awake and also to get more sleep (started taking Restoril every night again), and have definitely seen an improvement in both O2 levels and energy.

In the meantime, my O2 mask was delivered today and I plan to start wearing it at night and when napping (assuming it's comfortable--if not, I'll try chin straps instead).

Re your own lack of energy, do they test your O2 regularly? I know that many (most?) cancer patients suffer from "cancer fatigue," but don't know if low O2 levels can also cause fatigue.



PS I love your new pic, too, Sandra, and ditto for my new tattoo, Judy! :D

In 1960, Americans spent 17.5 percent of their income on food and 5.2 percent on health care. Today, they spend 9.9 percent on food and 16 percent on health care.

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Last night was my first use of mask rather than cannula and it appears to hav made quite a difference; i.e.:

1. Earlierthis week I was awakening every morning with my blood ox levels in mid eighties (and one day last week I dropped to 76%), possibly because I was breathing through my mouth whereas supplemental O2 is usually admistered via cannula to nostrils. As a result, I was raising O2 liters from 1 to 2 while sleeping.

2. When I woke this a.m. after having worn full mask all night, my O2 at 2 liters, my O2 was at a whopping 97%! (which is actually potentially dangerous due to possibility of carbon dioxide poisongin). I dropped it immediately to 1 liter and tested it again at 15 minutes later, at which time it was still 95% (I try to keep in recommended range of 91-93%).

Thus, it appears that mouth breathing may have been the culprit although I think a few more days' testing will provide more accurate information.

I'm still also taking 2 Restoril every night in order to get as much sleep as possible (breathing through the mouth still being more likely when one is tired).

Will keep you posted as to my personal "clinical trial" results.

With love and affection,


PS Mask was surprisingly unobtrusive so won't be asking for chin strap yet.

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