Sleepyhead shows horrific night, NEED to make a change

[nimboo]

http://imgur.com/fdEheH1

What do I need to change? Please help me...

I just updated sleepyhead, and it is now doing a great job with the Aircurve 10 data, showing two pressure lines. Beautiful. But those events??

Horrible. As you can see, he woke up at midnight to urinate - which is what he used to do BEFORE his apnea was treated. He felt terrible after waking up today.

Please help, I really need advice.

Current settings:

Epapmin: 7
Ipapmax: 13
Pressure Support: 3

[Wulfman...]

Looks to me like he might have been on his back or some other position........or, was just laying there awake and breathing very minimally.

If that night was an exception, I wouldn't make any changes. This therapy is about "averages" and you don't make changes based on one night.


Den

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[nimboo]

Just now I changed his ipapmax back to 25, I think that's what needs to be done. Would love feedback to hear if that was the right move.

Also, I just updated the screenshot, edited the original post - I corrected it to include flow rate, I messed this up before (sorry palerider).

Here it is: http://imgur.com/fdEheH1

To give a little more info:

From a suggestion I received in this thread: viewtopic.php?f=1&t=111305&p=1068361#p1068361

I had limited my dad's Ipapmax to 11. This actually worked great, and solved the problem my dad was having with the pressures getting too high.

HOWEVER - this was with my dad's nasal mask. As soon as my dad received the Quattro FX everything went to shit.

So I upped the ipapmax to 12 - didn't fix the problem. Then I updated it to 13 and you have the shitshow in the imgur link above.

Why are the pressures suddenly needing to be so much higher than the nasal mask? Why was an ipapmax of 11 perfectly sufficient with the nasal mask, but now don't work?

I don't know, but I'm pretty sure the right move for tonight is to unlimit the ipapmax, and put it back to 25.

Really appreciate any help here...I have no idea what I'm doing, just trying to help my dad. Thanks guys.

EDIT: Oh hey wulfy Thanks for responding. It is actually a pattern, for about the last 5 nights ever since he switched to the Quattro FX. I'll make a new album, since I made the last one before the sleepyhead update.

He has terrible sleep for the first hour or so, then suddenly he is fine. Give me a second and I'll post an album of last several nights with the Quattro FX.

EDIT 2: Here is that album: http://imgur.com/a/H8KZV

EDIT 3: He was laying on his back.

[Wulfman...]

EDIT 3: He was laying on his back.

That's what it looks like to me. Lots of Flow Limitations. Any idea what position(s) he's in the rest of the night when things settle down?

If you can't get him to change his position in the beginning, maybe the increased pressure might help. Won't know till you try.


Den

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[robysue]

EDIT 3: He was laying on his back.

That's what it looks like to me. Lots of Flow Limitations. Any idea what position(s) he's in the rest of the night when things settle down?

If you can't get him to change his position in the beginning, maybe the increased pressure might help. Won't know till you try.


Den

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I'm inclined to agree with Den here. If your Dad was lying on his back (or was awake) that could explain the huge number of clusters. In that case a bit more pressure might indeed help.

[nimboo]

I just checked with him - he says he believes he was sleeping on his back the entire night.

He finds it to be impossible to lay on his side with the Quattro FX mask - he said the mask leaks when he does, unlike with his nasal mask.

He did try to elevate himself though - which I think just makes him slump, but he claims it helps.

I'd think the best back laying position would be to keep your back completely straight. He wants to sort of be sitting on a ramp going up like in a hospital bed, but he doesn't replicate it very well with pillows. I think he should just switch to laying flat on his back.

Really hoping the higher pressures do well for him tonight.

Thank you guys, I'll update back tomorrow

EDIT: It is possible the Large mask is too big for him, but I'm not sure, the leakages don't seem too bad (except for that one night where the leak lasted like 15 minutes)

[Wulfman...]

I just checked with him - he says he believes he was sleeping on his back the entire night.

He finds it to be impossible to lay on his side with the Quattro FX mask - he said the mask leaks when he does, unlike with his nasal mask.

He did try to elevate himself though - which I think just makes him slump, but he claims it helps.

I'd think the best back laying position would be to keep your back completely straight. He wants to sort of be sitting on a ramp going up like in a hospital bed, but he doesn't replicate it very well with pillows. I think he should just switch to laying flat on his back.

Really hoping the higher pressures do well for him tonight.

Thank you guys, I'll update back tomorrow

If he's using a standard fiberfill pillow, that sounds typical for full face masks. Many of us use various types of bed pillows that allow for side sleeping.......they're a little firmer and the head doesn't sink in and push the mask out of alignment.
Forum searches on "buckwheat" or "Chiroflow" will lead to many discussion threads about the various types we use.
I use the Chiroflow water-based pillow. Have been long before I started this therapy and it has worked well with this therapy.
And, I cannot sleep on my back......period!


Den

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[Wulfman...]

It's quite possible that the mask is too large, but no way of telling from here.
I know that when I acquired a Quattro in Large size it was a bit larger than the Ultra Mirage Full Face in Large size I had been using for a few years. So, some of them, even from the same manufacturer can vary a bit in dimensions with the same size.
But, I can also use a UMFF in Medium if I choose to. I'm kind of right in the middle of sizes, but a Large is just a bit better for me.


Den

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[palerider]

http://imgur.com/fdEheH1

What do I need to change? Please help me...

I just updated sleepyhead, and it is now doing a great job with the Aircurve 10 data, showing two pressure lines. Beautiful. But those events??

well, when you've got the pressure maxed out on a lowered ceiling, and there's tons of obstructives, it's pretty clear that more pressure, as you surmised.... is the answer.

[Gasper62]

There's an old saying..."if it ain't broke, don't fix it". Why have you changed to a new/different mask that produces the "shitshow" ? Any reason to not go back to the mask that worked well ?

[Mudrock63]

Just a thought, but my FFM came with a larger diameter hose than my nasal mask. There is a setting on my machine for hose diameter. So possibly could the hose diameter be larger with the FFM, thus possibly diluting the pressure if the machine is set at the smaller diameter hose setting but working with a larger diameter hose? Just a thought.

[Julie]

He should look into PapPillow.com...

[robysue]

He finds it to be impossible to lay on his side with the Quattro FX mask - he said the mask leaks when he does, unlike with his nasal mask.

How bad were the leaks with the nasal mask?

Unless the leaks with the nasal mask were really seriously out of control, you dad may be better off using the nasal mask so that he can sleep on his side if that's what he wants to do.

[palerider]

Just a thought, but my FFM came with a larger diameter hose than my nasal mask. There is a setting on my machine for hose diameter. So possibly could the hose diameter be larger with the FFM, thus possibly diluting the pressure if the machine is set at the smaller diameter hose setting but working with a larger diameter hose? Just a thought.

just the opposite, actually.

the smaller hose has more resistance, so the machine raises the pressure to compensate for that. using a regular hose with slimline settings gives you too much pressure.

[lilly747]

Could it be that your dad's head is flopping forward cutting off his airflow? If so more pressure is not going to work.....his neck needs to be sableized