Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: respiratory/co2/bipap/desatrespiratory/co2 retention/bipap/desatsHello everyoneI am a caregiver to my 47y male [5'11 155lbs, Caucasian, no alvohil quit smoking in 2020 after 22 years of cigarettes and lots of cannabis, on 60mg sildenafil 3x a day; inhaled treprostinal, b1, Folic acid, vit d, calcium, o2 and temporarily prednisone after hospital] partner with CHF, pulm hypertension, and copd emphysema. DX in 2018. Was put on 3L of o2 24/7 in 2020 and then May of this year began having frightening symptoms which turned out to be CO2 retention. He's been to the hospital 3x in 5 weeks, been intubated once and on hospital bipap twice. We have our own bipap bit it's part of the philips recall so until we became aware of this co2 problem, we weren't using it. The dr recommended we do as it was riskier without it.However everytime I would put him on it, he would desat 10-15% and hold there. I thought it was the machine, the mask, the toxic fumes from the recall, etc. I have now rented a machine, have a new mask, and when he got out of the hospital o2 sats were good while on it. However its now been 2 weeks, although using it every day and trying to keep him out of the hospital his CO2 has built back up judging by his symptoms.Been trying to use the bipap anyway and just fight to keep o2 sats up, had a mask leak the other day , finally got the new part and it doesn't seem to be leaking anymore but still he desats 30%, it seems like it takes some time (hr , hr and a half) to burn off the first layer of co2 before he can stabilize o2 sats so just been trying to get him over that hump.When o2% drops it seems to get stuck like airway is closed or diaphragm paralyzed! If I crank the o2, sometimes it works to help his sats cycle up, but mostly not. I haven't been able to keep Bipap on more than hhr at a time the last day as it drops under 80, and a couple times under 70. Trying to do some research and my theory was a bronchospasm but his inhalers (prosir snd combivent) and/or breathing treatment of a Ipratropium bromide/albuterol seem to make his sats worse than before use.Last night it cycled down to mid 70s on the bipap for the 5th or 6th time but wouldn't come up and I pulled him off, put him back on the cannula. However the spasm continued once he was off it, no matter how much I cranked the o2, it would cycle down to 70s or low 80s and sit there awhile. Then it might cycle up but fall right back down. He was making efforted breaths, with a high respiratory rate. Took ages before this cycle stopped and his o2 sats stabilized in 90s.My question is does this sound like a bronchospasm? Hypopnea? Paralyzed diaphragm? Just recently got a wellue o2 ring and have noticed so me drops to 78% out of nowhere, when he's just sitting and it will hold there for 10-30 seconds and then go up. I've actually noticed on the chart a couple days ago, it happened 3x, almost exactly 10 minutes apart while on bipap so was wondering if it was related to the heart cycle. Don't know if these events are even related/the same thing.Any insights? I can't keep him on the bipap/can't get out the co2 when I can't keep his o2 up!! I was gonna leave in the cannula and just hold the bipap mask up to his face tonight so it's easy to remove if o2 starts falling but still may help trigger some deep exhales to blow off co2? Is this a good idea or not? To kind of spot treat without strapping everything on that's difficult to get off, switch over to cannula if sats drop?I'm at the end of my rope, haven't slept more than 1 hr increments for months, i really don't want him going hmback to the hospital they always seem to break something else on him!! The drs cant understand the anount of damage to his lungs for his age/history. Are there diaphragm exercises to strengthen? Does it sound like a spasm? Any theories or information helps!. ### Response: Most likely the oxygen supply is decreased due to high pressures inside the mask during inspiration. Do you have a second oxygen supply and nasal cannula? If so, put on a nasal cannula under the BiPAP mask and run it at 8-15 L/min. This will help provide a higher amount of oxygen during inspiration..