Oxygen Concentrators Oxygen concentrators make and deliver a high concentration of oxygen using a method to extract nitrogen from air. The Concentrator contains a material that has pores that just happen to be the size of nitrogen molecules. Air is forced through this material by the machine's compressor and acting like a sieve the nitrogen is removed leaving oxygen and the other inert gases which make up the air we breathe. Nitrogen as a gas makes up approximately 78% of the air we breathe while Oxygen makes up approximately 21% of the air we breathe, the remaining 1% is made up of inert gases like Carbon dioxide, zenon, and argon to name a few. The newer Oxygen Concentrators deliver Oxygen at a concentration of 96-97% at 1-3 liters per minute the concentration may drop 1-2 percent at flows of 4-5 liters per minute. These concentrations although slightly less than pure oxygen are well within the therapeutic range. The two different sounds you hear when your concentrator is working are the air being forced over the sieve material to extract the oxygen and then a reversal as the nitrogen is flushed out ready for another burst of air to filter. Your concentrator should have two fail safe devices: one to tell when it is inoperative and a second one to tell if the oxygen concentration drops below a certain level usually 83-85%. Note, all concentrators take a few minutes to achieve maximum output of oxygen after being turned on. Your only responsibility is to clean the dust filter located on the outside of your concentrator. There is a bacteria filter inside that is changed after so many thousand hours, your supplier will know when this change is due.

Nebulizers Your compressor driven Nebulizer uses a small compressor to generate air under pressure which flows into the nebulizer medicine cup. This stream of air under pressure passes out of a small opening and creates a negative pressure which pulls the medication in the cup up through a small tube. The medication carried in a stream along with the compressed air hits a baffle that breaks the liquid medicine into tiny particles. These particles are inhaled into the lungs for desposit in the lungs. It is a good idea to hold your breath momentarily after each breath to allow as many particles as possible to deposit in the lungs. Some of the particles are so small that they are exhaled after being inhaled. It is not recomended that you take deep breaths all the time during the treatment as this could cause you to hyperventilate, it is better to breathe normally and take in a deep breath every 5th or 6th breath.
Metered Dose Inhalers MDI While we are discussing nebulizers we need to mention Metered Dose Inhalers or MDI. MDI's are very useful and can do a great deal of good when used properly. An MDI that has a cannister filled with medicine that delivers a spray to be inhaled when the cannister is pressed downward into the mouthpiece to activate, should be used in a particular way. The cannister should always be shaken before use, you should exhale completely hold the mouthpiece in front of your open mouth or between your lips with your teeth apart and mouth slightly open. Start breathing in and depress the cannister immediately as you start breathing in when deep breath is in, hold your breath and count to 10. Starting to breathe in before depressing the cannister is extremely important. The medicated mist needs to follow the air into your lungs, if you are not breathing in when the MDI is activated the medicine will spray the back of your throat (we want the medicine in the lungs). Due to the importance of this coordination of breathing and activating we recommend a spacer or holding chamber when using a liquid cannister MDI. There are two reasons for using the spacer, one: you can take in a deeper breath because you do not have to start breathing in before activating the MDI. Two: the spacer gives better dispersion of the medicine with a less stronger taste of the propellant. When using the MDI with Spacer, insert MDI into Spacer in proper place, shake well, exhale completely place Spacer mouthpiece in your mouth past your teeth depress MDI cannister and breathe in slow and deep. Hold your breath and count to ten and then exhale. The newer MDI discus that disperse powder medication do not need a spacer, you should still hold your breath and count to 10 after the deep inhalation.

CPAP (Continuous Positive Airway Pressure)- The term CPAP is just what it sounds like, a continuous pressure set in centimeters of water pressure is maintained on the person's airways as a constant force of air. This is the most common treatment for Obstructive Sleep Apnea or OSA The force of the air is not enough to prevent exhalation, but is enough to keep airways that may become restricted or closed off during sleep open to allow the passage of air. The continuous air pressure is administered by a electrically powered machine through a hose attached to a nasal mask, nasal pillows, or the newest a large version of the nasal cannula. A person using CPAP must sleep with their mouth closed or the air pressure escapes. If keeping the mouth closed is a problem a chin strap may be necessary to help hold the mouth closed. A full face mask covering the mouth and nose can also be used. The nasal mask, pillows, or cannula are held in place by straps specifically designed for that purpose. The air administered by the machine can be humidified with cool air, warm humidified air or no humidity at all, according to the individual's preference. Oxygen can be intrained into the air being delivered via the CPAP device to help raise the oxygen level, if necessary in some individuals. Signs or symptoms of sleep apnea can be: feeling tired during the day, falling asleep easily during the day, loud snoring, waking up during sleep feeling like your are not getting enough air, and restlessness of the arms or legs. A sleep study must be performed monitoring: oxygen saturation, breathing, brain waves and heart rate. The CPAP therapy is prescribed by your doctor or the pulmonologists who interprets the sleep study. The sleep study is needed to justify reimbursement by your insurance carrier. In Obstructive Sleep Apnea remember the person continues to try to breathe, the obstructive problem prevents air movement. The CPAP clears the obstruction so air movement continues. Another less common form of Sleep Apnea is Neurological or Central Sleep Apnea the difference being that the Central Nervous system or brain center causes the apnea. Central Apnea differs also in that respiratory effort or the breathing effort also ceases during the apeneic period. Where as in Obstructive Sleep Apnea there continues to be an effort to breathe by the breathing muscles.

BiLevel CPAP or BIPAP - BiPAP or BiLevel CPAP differs from CPAP in that there are two set pressures. IPAP (Inspiratory Positive Airway Pressure) and EPAP (Expiratory Positive Airway Pressure, always lower than IPAP) BiPAP is not for everyone, it is used when CPAP cannot offer the needed ventilation for Sleep Apnea. BiPAP can also be used to treat Chronic Respiratory Failure. Chronic Respiratory Failure is characterized by a higher than normal PCO2 with a normal pH and a lower than normal PO2 (see Arterial Blood Gases). Chronic Respiratory Failure can be compounded or made worse during sleep. Chronic Respiratory Failure treated by administering BiPAP during sleep allows the needed therapy to occur during a time the individual is not normally active. The BiPAP treatment helps lower PCO2 which can effect a rise in PO2 which improves the condition found in Chronic Respiratory Failure.