Suggestions, please?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Suggestions, please?

Post by Morbius » Sat Jan 31, 2015 6:55 am

palerider wrote:
BleepingBeauty wrote: (I'm sure Mom, who's usually quite negative about everything, convinced Dad that it was useless to try. She told me, "He's 85, he's not well, he has enough on his plate right now, and this is just one more thing to pile on." And she worried that the machine noise would keep *her* awake. He, unfortunately, was now agreeing with that mindset. GRRR.)
you can always bring out the nuclear option and ask her, in front of him, why she wants him to die sooner, and have worse health until he does.
Listen kid--

At 82/85, the threat of death has long ceased to be "The Nuclear Option".

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Suggestions, please?

Post by Morbius » Sat Jan 31, 2015 7:10 am


User avatar
BleepingBeauty
Posts: 2454
Joined: Thu Apr 02, 2009 5:30 pm
Location: Aridzona ;-)

Re: Suggestions, please?

Post by BleepingBeauty » Sat Jan 31, 2015 8:43 am

Sleeprider wrote:What great progress! You can just see where he relaxes into the therapy and has a quiet couple hours. Well done. I wish I had done this for my dad who died of chronic heart failure. He was remarkably lucid, but his wife put him in a memory care unit. Supplemental oxygen couldn't overcome the apnea, and I was 1500 miles away and couldn't do much to help.

I hope you continue to do what you can to help your dad. Hopefully he will recognize the greater comfort, and this will help him. No fun to watch our parents go through this slow decline.

Tom
Thanks, Tom. No, it sure isn't any fun. When I first saw my dad recently, I was amazed at how much he now looked like his own father; the resemblance had always been there, of course, but seeing how frail and fragile he is at this point in life just screamed mortality and smacked me in the face. It was like being in a time machine, and my grandfather had magically reappeared.

I'm very glad I'm finally able to intervene in my dad's care (especially concerning his suspected apnea, which is the one condition I know something about thanks to this forum and my own years-long experience). It's definitely been on my radar for a long time now but, like you, living so far away from him made it virtually impossible for me to do anything about it, as I couldn't even count on my mother to be my ally.

So I'm taking full advantage of the fact that I'm here now and am able to bend my dad (and my mother) to my will. hehe I've gotten him to use the machine each day so far, and she's backed off a bit with the negativity. She and I duked it out the other day, and now she seems somewhat contrite. She hasn't apologized, of course, but she's quieter than normal. (I'll take that over the usual crummy attitude any day. )

Thanks for your support.
kteague wrote:Can't offer much in the way of suggestions, just wanted to say Hi and acknowledge how difficult it is to be the caregiver - even more so when family dynamics are such as you describe. Hope things fall into place without too much opposition.
Hi, Kathy, and thanks for your input (which is always welcome). Yep, it's a tricky family dynamic here but, as I said above to Tom, I'm glad to know I can apparently have my way with both of my parents and make them do what's right (eventually, anyway). My mother does seem to be acquiescing to me, as she can see that the attention I give to Dad is doing some good. I actually got Dad outside yesterday, which has been a bit of a battle, as his pride kept him from being seen in a wheelchair by anyone. He's able to walk around the house (with a walker); he just isn't as steady on his feet as I'd like. So him actually going for a walk in the neighborhood was out of the question; I just wanted to push him in the wheelchair. Thankfully, a little gentle prodding got him to agree to go out with me and the dog. It was just around the block, took about 20-30 minutes (we went slowly, as he held the dog's leash and the dog wanted to mark practically every shrub we passed), but he was *outside* and getting fresh air and sunshine. Made me feel really good to finally get there (after pleading with him quite a bit the last time I visited, to no avail). I intend to keep pushing him to go with me every day. Thanks for the encouragement.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Suggestions, please?

Post by Morbius » Sat Jan 31, 2015 8:47 am

BleepingBeauty wrote: Image
ISTM that those aggressive pressure increases should have resulted in a few more NRAHs, but on closer review, look like they just missed criteria.

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Suggestions, please?

Post by Morbius » Sat Jan 31, 2015 9:02 am

Morbius wrote:ISTM that those aggressive pressure increases should have resulted in a few more NRAHs, but on closer review, look like they just missed criteria.
However, let me put NRAH into proper perspective:

When you see one NRAH, that does not necessarily mean that only the last A/H was non-responsive-- it is most likely that all of that sequence was non-responsive.

User avatar
BleepingBeauty
Posts: 2454
Joined: Thu Apr 02, 2009 5:30 pm
Location: Aridzona ;-)

Re: Suggestions, please?

Post by BleepingBeauty » Sat Jan 31, 2015 12:09 pm

Morbius wrote:
Morbius wrote:ISTM that those aggressive pressure increases should have resulted in a few more NRAHs, but on closer review, look like they just missed criteria.
However, let me put NRAH into proper perspective:

When you see one NRAH, that does not necessarily mean that only the last A/H was non-responsive-- it is most likely that all of that sequence was non-responsive.
Thanks. I'm not too concerned about this initial data and have no idea how much of it can be trusted to be accurate. I'll feel better about his data when I know (without a doubt) that he's actually sleeping when it's being recorded. We're not there yet, and I'm just grateful that he's willing to wear it during the day (to appease me, I'm sure) because it *will* prepare him and ready his face/mind to wear the mask at night (when he's truly unconscious and is liable to fight it in his sleep). Regardless, for whatever reason, he's willing to do it; and that makes me glad because he's meeting my initial goal.

One battle won. Onward and upward!
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Suggestions, please?

Post by Morbius » Sat Jan 31, 2015 1:27 pm

BleepingBeauty wrote:I'm not too concerned about this initial data and have no idea how much of it can be trusted to be accurate.
OK then there's 2 possibilities, keeping in mind that that thing cannot reliably differentiate central apneas from obstructive:
  • He's awake, and you're generating a pile of central apneas; or
  • He's asleep, and you've run that thing to 17.0 cmH2O and haven't put a dent in the apneas, and in that last 45 minutes, made them worse. Frankly I'm really finding it hard to believe the guy had obstructive apnea impervious to 17.0 cmH20 and made it this far.
Consequently, one should consider a (considerable) central component, and open-ended APAP is generating chain-centrals, which, "IMHO", may not be the safest thing to do in an 85 YO (especially if he has co-morbidity).

oxoxoxox

Mb

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Suggestions, please?

Post by palerider » Sat Jan 31, 2015 1:41 pm

Morbius wrote:
palerider wrote:
BleepingBeauty wrote: (I'm sure Mom, who's usually quite negative about everything, convinced Dad that it was useless to try. She told me, "He's 85, he's not well, he has enough on his plate right now, and this is just one more thing to pile on." And she worried that the machine noise would keep *her* awake. He, unfortunately, was now agreeing with that mindset. GRRR.)
you can always bring out the nuclear option and ask her, in front of him, why she wants him to die sooner, and have worse health until he does.
Listen kid--

At 82/85, the threat of death has long ceased to be "The Nuclear Option".
fair enough, besides, BB hadn't mentioned that pure evil was her opponent there.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Last edited by palerider on Sat Jan 31, 2015 3:23 pm, edited 1 time in total.
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: Suggestions, please?

Post by Wulfman... » Sat Jan 31, 2015 1:46 pm

Morbius wrote:Listen kid--

At 82/85, the threat of death has long ceased to be "The Nuclear Option".
I was wondering what identity you'd come up with next.

Good to know you're still around.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
BleepingBeauty
Posts: 2454
Joined: Thu Apr 02, 2009 5:30 pm
Location: Aridzona ;-)

Re: Suggestions, please?

Post by BleepingBeauty » Sat Jan 31, 2015 3:53 pm

Morbius wrote:
BleepingBeauty wrote:I'm not too concerned about this initial data and have no idea how much of it can be trusted to be accurate.
OK then there's 2 possibilities, keeping in mind that that thing cannot reliably differentiate central apneas from obstructive:
  • He's awake, and you're generating a pile of central apneas; or
  • He's asleep, and you've run that thing to 17.0 cmH2O and haven't put a dent in the apneas, and in that last 45 minutes, made them worse. Frankly I'm really finding it hard to believe the guy had obstructive apnea impervious to 17.0 cmH20 and made it this far.
Consequently, one should consider a (considerable) central component, and open-ended APAP is generating chain-centrals, which, "IMHO", may not be the safest thing to do in an 85 YO (especially if he has co-morbidity).

oxoxoxox

Mb
I'm not even sure Dad *has* apnea yet; I insisted on having the spare machine with me and testing him because Mom says he occasionally wakes her up with coughing/gasping/snorting. Sure sounds like apnea to me, but I live across the country, so the machine was necessary just to find out IF and to what extent apnea may be an issue (and, if it turned out to be, to dial him in pressure-wise and get him using the machine every night). He says he sleeps well (8-9 hours a night), but he often goes back to bed after breakfast. Initially, I chalked up the daytime tiredness to his having had two rounds of full-on anesthesia when he first got sick and needed surgeries. I know that anesthesia knocks the shit outta me for weeks, so I figured he might just be dealing with a long recovery due to the after-effects. But the surgeries were back in September, and he shouldn't still be tired all this time later if the anesthesia was solely to blame.

And as I said, I don't think this data can be relied upon just yet. I'll have a much better idea of what's what when I get the results of the overnight pulse ox and we can see if he's de-satting to a worrisome level.

For now, since I'm in only a diagnostic mindset, I left the top end of the pressure range open to 20, just to see what the machine wanted to do. He's now at a starting pressure of 8 and, as you can see from the limited 2.5 hour session yesterday, he topped out at 9. When I'm convinced he needs therapy, I'll tighten the range. Apnea runs in his side of the family (one of his brothers, my older brother and me, so far), but I'm the only one who has had an issue with centrals. My uncle and my brother both have straight CPAP machines (which is what I started with, but only because my then-sleep doctor was an idiot).

Anyway, I'll just keep on keepin' on, see what the pulse ox says, and go from there. Thanks for your concern.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

User avatar
BleepingBeauty
Posts: 2454
Joined: Thu Apr 02, 2009 5:30 pm
Location: Aridzona ;-)

Re: Suggestions, please?

Post by BleepingBeauty » Sun Feb 01, 2015 9:35 am

Just wanted to post a quick update: Dad's being much more cooperative than I had hoped (YAY!) and is willing to use the machine whenever he's back in bed during the day (like right now). I could hear him snoring this morning (I was up early), and I also heard a few snorts and gasps. I have a feeling I'll have him using the machine all night very soon. Another bonus is that Mom has really chilled about him using the machine and now seems to be okay with all of it.

I've gotten Dad to go out with me a couple of times recently, too - once to walk the dog around the neighborhood, and then I took him to the grocery store with me yesterday. This is a big deal because he hasn't gone out of the house (or wanted to) since he came home from the hospital in early November except for follow-up appointments with doctors. He initially said he didn't want to go each time I've invited him out, but he backs down with a little prodding and encouragement from me, and we go. I'm really happy about that, and it feels like I'm right where I need to be. And I think the fact that Mom sees him being more active than he has been in months is going a long way towards alleviating her worries, which is great because (1) it means her shingles might go away faster, and (2), she's a lot less contentious towards Dad (or me re: my efforts on his behalf); I think she's seeing potential, and that makes me happy.

The only thing that concerns me is those times he'll have to get up for the bathroom during the night when I'm also asleep; I have little confidence that he'll be able to manage disconnecting from the machine (and then reconnecting).

Ooh, I just thought of something to solve that problem: He came home from the hospital with a couple of small plastic urinals (for someone who's bedridden); perhaps I can have him use one of those at night instead of him having to get out of bed and go down the hall to the bathroom. I think I'll leave one on the nightstand and urge him to do just that.

I think I'm covering the bases. Please tell me if I'm missing anything or if there are other suggestions that will help in this situation. TIA
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

Sleeprider
Posts: 1562
Joined: Tue May 06, 2008 5:57 pm
Location: Murrysville, PA

Re: Suggestions, please?

Post by Sleeprider » Sun Feb 01, 2015 9:42 am

Sounds great. I would enable the auto-on function just in case he masks up with the machine off, it will self-start.

Great progress.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: Sleepyhead software. Just changed from PRS1 BiPAP Auto DS760TS

User avatar
BleepingBeauty
Posts: 2454
Joined: Thu Apr 02, 2009 5:30 pm
Location: Aridzona ;-)

Re: Suggestions, please?

Post by BleepingBeauty » Sun Feb 01, 2015 9:46 am

Sleeprider wrote:Sounds great. I would enable the auto-on function just in case he masks up with the machine off, it will self-start.

Great progress.
Really great suggestion, so TYVM!

(So glad I have this forum to rely on when my brain is apparently farting. LOL)
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.

User avatar
Madalot
Posts: 4285
Joined: Sat Jan 30, 2010 7:47 am

Re: Suggestions, please?

Post by Madalot » Sun Feb 01, 2015 12:19 pm

Hey BB --

Your update sounds promising. You keep up the GREAT work with your dad. Your parents are VERY lucky to have you.

Keep the board posted, k?

_________________
Mask: FlexiFit HC431 Full Face CPAP Mask with Headgear
Humidifier: HC150 Heated Humidifier With Hose, 2 Chambers and Stand
Additional Comments: Trilogy 100. S/T AVAPS, IPAP 18-23, EPAP 10, BPM 7

User avatar
BleepingBeauty
Posts: 2454
Joined: Thu Apr 02, 2009 5:30 pm
Location: Aridzona ;-)

Re: Suggestions, please?

Post by BleepingBeauty » Sun Feb 01, 2015 12:28 pm

Madalot wrote:Hey BB --

Your update sounds promising. You keep up the GREAT work with your dad. Your parents are VERY lucky to have you.

Keep the board posted, k?
Thanks, Maddie! I'm just glad my dad's been cooperative so far and that Mom seems to be on-board now. What started out as a battle has turned into a really positive experience for everyone at this point. Here's hoping that continues.
Veni, vidi, Velcro. I came, I saw, I stuck around.

Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy. ;))

PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.