Troubleshoot — Cannot Desaturate

Contents

Some customers have issues desaturating. This is nearly always because of specific issues with user physiology. As a rule, only well-trained athletes and conditioned users will have predictable desaturation responses.

This article is split into two sections. The first section explains common issues with the user. The second section is a checklist for issues that may occur over time.

There are a handful of issues that may make a new user think LiveO2 isn’t working properly because a pulse oximeter does not readily show a decrease in oxygen concentration in the blood while using ‑O2. This often leaves the user wondering what is happening…

If the issue is with LiveO2, it’s easy to detect and correct the problems. When the issue is part of the user physiology — It’s more difficult to understand but still easy to test:

If the user ‘feels extra challenge’ on ‑O2 — the system is working properly.

User-specific desaturation problems

Most of the time users cannot desaturate because of one of these reasons.

#1: User metabolism challenge that interferes with blood oxygen exchange or poor hand circulation

Many new LiveO2 users have metabolic issues that interfere with blood gas exchange. There are three common dysfunctions:

Capillary shunting. These users exhibit unusually high O2 saturation levels because issues flow restrictions in capillary beds shunt blood around the tissue. Oxygen levels remain high because oxygen never reaches tissue and is underused.
Nutrient deficiencies. The body requires sufficient amounts of B‑vitamins to affect gas transfer to the tissue. Deficiencies inhibit transfer and may inhibit the ability to saturate or desaturate.

These issues often happen together. Each element reduces the user’s apparent ability to desaturate as read by a pulse oximeter.

Shunting prevents oxygen from leaving the blood
Nutrient deficiencies prevent oxygen from leaving the blood
Carbon monoxide and oxygen are indistinguishable by a pulse oximeter.

But… No matter how these factors interfere with the pulse oximeter there is a very effective test.

The users will feel the ‑O2 challenge. Inefficient respiration makes users very sensitive to reduced oxygen levels. That leads us to…

The simplest test for a new user

If your users feel extra difficulty on the ‑O2 setting then this is a strong and reliable indicator that the system is working properly.

Most users will slow down on ‑O2 and speed up on +O2. Users with compromised respiration will quickly notice the decrease in oxygen from 75% to 14% for LiveO2 AC.

#2 User was exposed to Carbon Monoxide

Carbon monoxide has a higher affinity for hemoglobin than oxygen and may be due to environmental exposure or internally generated as a result of dysfunctional cellular respiration. Pulse oximeters cannot distinguish blood-carrying carbon monoxide from blood saturated with oxygen. Users with carbon monoxide will not desaturate.

Carbon monoxide binds to hemoglobin sites just like oxygen. Pulse oximeters cannot distinguish hemoglobin with Carbon Monoxide from Oxygen. Carbon monoxide can be environmental or endogenic (from inside the body). Carbon monoxide binds to hemoglobin about 240x more readily than oxygen.

Carbon monoxide in the blood will prevent the pulse oximeter from reading correctly. It will read as though the blood is saturated with oxygen when it is not. We have also seen individuals who appear to have carbon monoxide toxicity when there was no known exposure to carbon monoxide as though it was endogenous (made inside the body) from inefficient metabolism.

When training with LiveO2 — the high binding affinity of carbon monoxide makes it look like the person cannot desaturate.

Carboxyhemoglobin

Carboxyhemoglobin is produced by the binding of carbon monoxide (CO) to hemoglobin. CO is generated during incomplete combustion of organic products and has toxic effect because it competes with oxygen for the same binding site in the Fe²⁺ of Hb. Hemoglobin bound to CO is unable to transport O₂. Hb has a 210-fold greater affinity for carbon monoxide than for oxygen, which explains the extraordinary toxicity of CO even when its concentration in the inspired air is relatively low. For example, breathing air containing 0.02% CO for 2 h causes symptoms, such as headache and nausea. A concentration of 0.1% produces loss of consciousness within 1 h and death by asphyxia in only 4 h. Car exhaust gases contain between 4% and 7% CO and toxic concentrations are readily achieved in poorly ventilated environments (garages). Carboxyhemoglobin has a cherry red color. For that reason, subjects intoxicated with CO show apparently “healthy” reddish lips and cheeks.

Contact your trainer for support. We have specialized protocols to expedite carbon monoxide release from hemoglobin.

#3 User’s body blocks desaturation

The most common reason user’s cannot desaturate is because their body is in a stress pattern. This pattern, resulting from chronic poor oxygenation, triggers the blood to hang-on to oxygen in preparation for a stress event.

This patten often resolves by progressive training but goes through two stages:

Progressive exertion with training with oxygen with escalating challenges
Escalating exertion challenge on low oxygen over time

This process uses the degrees of freedom to gradually increase the body’s willingness to use reserve oxygen attached to hemoglobin. Please contact your trainer to work with this.

#4 Hypotensive Shunting

Individuals with hypotension, low blood pressure, often lack enough pulse pressure at the capillary blood entrance to push blood through the capillaries. Instead blood routes through bypass shunts, and fails to deliver oxygen to tissue.

When hypoxic challenge does not cause the body to send blood through capillaries, oxygen remains bound to hemoglobin. Even though the air mixture has little oxygen, and the user is exerting, the body does not desaturate.

Hypoxia which further dilates arteries, may not trigger the heart to pump hard enough to overcome the capillary obstacles. These individuals will have difficulty desaturating.

When hypoxic challenge triggers the heart and vascular system to overcome this obstacle, a prolonged desaturation dip occurs as the breakthrough enables large segments of the body to repay oxygen debt.

When this occurs, the body will remain on a low oxygen saturation reading while the oxygen debt is paid. This can take 10 minutes or often more.

Escalation

If you are well conditioned, and use Adaptive Contrast, the you may want to consider upgrading to LiveO2 Extreme to access more aggressive hypoxia, with simulated altitude up to 22K feet.