Needs help choosing the right mask. Adjusting to CPAP.

[Pugsy]

Do large leaks affect accuracy of AHIs detection?

Possibly....meaning the event detection could be reduced because when there is a really big leak the machine might not even be able to sense that it happened. One of the reasons we stress limiting large leaks is because we don't know if a nice low AHI is because nothing happened or the machine simply missed them. If nothing happened that is one thing but if the machine was clueless that's a whole different problem.
The machine will usually flag UAs when it starts having trouble sensing events when there are big leaks. UAs..unclassified apneas because while the machine knew something happened it couldn't tell what it was that was happening.
Up to around 40 or 50 L/min excess leak we expect to see UAs if something happened. Above 50 and it gets really iffy as to whether or not the machine can sense anything.

When we have a very brief time in large leak...obviously not going to make that big of a difference in the AHI if a handful of events are missed but could make a big difference when half the night is spent in large leak.

So we look at how deep into large leak territory a person goes as well as how long they stayed there.
15 minutes in large leak...not a big deal no matter how big....3 hours...whole different thing.

[samurai3005]

Do yourself a favor though. Don't lose track of your own health in helping your dad. Think about the airplane oxygen masks. When the plane cabin loses pressure at high altitude, you're supposed to put your own oxygen mask on before you put your child's oxygen mask on so that you don't lose consciousness before you can help your child. The longer you keep yourself healthy, the better you can help your dad.

Thanks for the consideration! I just think of myself being lucky to be able to provide him the support he needs at this time while my work still allows it. Thinking like this just keeps pushing me on.

Do large leaks affect accuracy of AHIs detection?

Possibly....meaning the event detection could be reduced because when there is a really big leak the machine might not even be able to sense that it happened. One of the reasons we stress limiting large leaks is because we don't know if a nice low AHI is because nothing happened or the machine simply missed them. If nothing happened that is one thing but if the machine was clueless that's a whole different problem.
The machine will usually flag UAs when it starts having trouble sensing events when there are big leaks. UAs..unclassified apneas because while the machine knew something happened it couldn't tell what it was that was happening.
Up to around 40 or 50 L/min excess leak we expect to see UAs if something happened. Above 50 and it gets really iffy as to whether or not the machine can sense anything.

When we have a very brief time in large leak...obviously not going to make that big of a difference in the AHI if a handful of events are missed but could make a big difference when half the night is spent in large leak.

So we look at how deep into large leak territory a person goes as well as how long they stayed there.
15 minutes in large leak...not a big deal no matter how big....3 hours...whole different thing.

Thanks Pugsy. I'll try to minimize the leak in order to get a good look at how the treatment affects the true AHIs.

So after my last reply 30 minutes, my dad woke up for a bathroom trip so I was able to put the CPAP on again. It went on for another 3 hours so here goes the OSCAR report...

night.PNG (154.55 KiB) Viewed 7147 times

I notice that there were still huge leaks but maybe this was because my dad just preferred "being fitted" while lying down. I told him to just sit up for me for a couple of minutes so that I can get all the straps and fitting tight and good but he was just too tired (or lazy?) to do just that. I figured that might have caused the unfitted pillows to leak when he tossed and turned.
However, like DreamRider said, during the time when there wasn't big leaks (i.e: 1am to 2am), there wasn't any event either, but he was still "just on" 5cm H2O. Does this mean that the 5cm H2O was enough to keep his airway open, thus, eliminating obstructive events from happening?

[Pugsy]

Does this mean that the 5cm H2O was enough to keep his airway open, thus, eliminating obstructive events from happening?

Pretty much that's what it means. He's lucky in that he doesn't need much pressure to hold his airway open and prevent the airway from collapsing.

[samurai3005]

Does this mean that the 5cm H2O was enough to keep his airway open, thus, eliminating obstructive events from happening?

Pretty much that's what it means. He's lucky in that he doesn't need much pressure to hold his airway open and prevent the airway from collapsing.

Thanks again Pugsy! I guess I just need to keep pushing him to get used to this. I think we're in the right way. Maybe just a little bit mask tweaking if the leaking problem couldn't be properly fixed.

I also did some search on this forum and found some answers (maybe one of them was yours? sorry but I don't recall, I was surfing many threads at a time) saying that when the leak rate is below or around 20L, the AHI should be reliable enough on this device, am I correct?

[Pugsy]

I also did some search on this forum and found some answers (maybe one of them was yours? sorry but I don't recall, I was surfing many threads at a time) saying that when the leak rate is below or around 20L, the AHI should be reliable enough on this device, am I correct?

20 L/min wouldn't have been a number that I would have used. I would have used much higher.
24 L/min is what ResMed uses as the red line threshold for large leak territory but things don't totally go to hell once we hit 25 L/min or 29 L/min. Instead it is a gradual worsening where the higher we go the worse it gets.
From my own personal experience with some large leak reports I didn't start seeing UAs until my leaks got up around 35 L/min so even up to 35 L/min the machine could still sense something but just didn't know what to call it. So the sensors were still working to some extent.

I personally don't even bother looking at a big leak unless it hits 30 L/min and then the extent of my looking usually is to see how long I was there.

I don't really pay any attention to the 95% number either. It's too easily skewed higher from a rather short lived period of time in large leak.

Always though....I preface my leak comments with "as long as the leaks don't wake me up I don't worry too much about them unless extremely prolonged and/or really deep into large leak territory".
Any leak that wakes us up need to be fixed no matter how big or how small because anything that disturbs our sleep is unwanted.

[samurai3005]

So this is the report for the 2nd night. Although the report said he started the CPAP at 23:00 but it was actually around 21:00 because I forgot to put the SD card back in.

night2.png (118.25 KiB) Viewed 7122 times

Unfortunately, last night, the ResMed chin strap became fragile because the Velcro was falling off on the 2 side straps, which made the fitting became harder, especially when the pressure was raised and his mouth was dropping too many times. But the times when he remembered to close his mouth, he said the pressure became natural for him eventually (phew!). At around 1am, when he turned from his back to the side, he said he felt the pressure change in his nose a bit funny (because the pillows?) so he just unconsciously took the mask off. Normally I would put it back on but because the chin strap was so bad so I just let him continue to sleep.

Guess I'll have to find a new chin strap before tonight's sleep! I contacted the ResMed distributor and they said the one I got was the only one left in their stock. If I want another one, they'll have to restock, which would take 3-4 weeks . Sigh.

[DreamDiver]

So this is the report for the 2nd night. Although the report said he started the CPAP at 23:00 but it was actually around 21:00 because I forgot to put the SD card back in.
night2.png
Unfortunately, last night, the ResMed chin strap became fragile because the Velcro was falling off on the 2 side straps, which made the fitting became harder, especially when the pressure was raised and his mouth was dropping too many times. But the times when he remembered to close his mouth, he said the pressure became natural for him eventually (phew!). At around 1am, when he turned from his back to the side, he said he felt the pressure change in his nose a bit funny (because the pillows?) so he just unconsciously took the mask off. Normally I would put it back on but because the chin strap was so bad so I just let him continue to sleep.

Guess I'll have to find a new chin strap before tonight's sleep! I contacted the ResMed distributor and they said the one I got was the only one left in their stock. If I want another one, they'll have to restock, which would take 3-4 weeks . Sigh.

Most chin straps are badly designed and ineffective. In the States we can get the PapCap. Also there may be a mask strap by Pad A Cheek made to fit specific models of mask. I wish I could give you more suggestions, but of all the straps out there, these are the ones that have worked for me. Others may have additional suggestions.

Chris

[samurai3005]

So this is the report for the 2nd night. Although the report said he started the CPAP at 23:00 but it was actually around 21:00 because I forgot to put the SD card back in.
night2.png
Unfortunately, last night, the ResMed chin strap became fragile because the Velcro was falling off on the 2 side straps, which made the fitting became harder, especially when the pressure was raised and his mouth was dropping too many times. But the times when he remembered to close his mouth, he said the pressure became natural for him eventually (phew!). At around 1am, when he turned from his back to the side, he said he felt the pressure change in his nose a bit funny (because the pillows?) so he just unconsciously took the mask off. Normally I would put it back on but because the chin strap was so bad so I just let him continue to sleep.

Guess I'll have to find a new chin strap before tonight's sleep! I contacted the ResMed distributor and they said the one I got was the only one left in their stock. If I want another one, they'll have to restock, which would take 3-4 weeks . Sigh.

Most chin straps are badly designed and ineffective. In the States we can get the PapCap. Also there may be a mask strap by Pad A Cheek made to fit specific models of mask. I wish I could give you more suggestions, but of all the straps out there, these are the ones that have worked for me. Others may have additional suggestions.

Chris

Thanks for the suggestions, Chris! I also want to explore the optimal chin strap for the long run since I can ask for a relative to bring it home from the U.S. But that would take quite some time.

Come to think about it, the ResMed chin strap I used didn't do a very good job of keeping the jaw up, but instead, it was more about keeping the lower lips closed. Looking at the chin straps you suggested, those looked far more powerful to hold the jaw up compared to mine.

I hope that by using the new chin straps, I would be able to control the leaks and perhaps look into a few more mask options if my dad still has trouble adjusting when changing sleep positions.

[samurai3005]

So this is this afternoon's nap. He pulled it out after 45 minutes and he said he felt suffocated. I popped the OSCAR up immediately to see how it's been doing and from the looks of it, seems like the machine was running properly, aka detecting an OA and thus increasing pressure to prevent it from happening, right?

I guess the reason why he felt suffocated was because he wasn't used to breathing out against 6-7 cm H2O? Do I have to get him used to this pressure, for example, setting the minimum pressure to 10 and make him use it while awake? He's sleeping now so I can't discuss what he really felt when he wanted to remove the CPAP.

[samurai3005]

Finally, the first full night in a CPAP. He didn't take it off unconsciously! The only time he needed to take it off was for a bathroom trip. Can anyone give me a little bit feedback on the report? I'm not so sure if I should let him stay on with this mask considering the usual leak rate?

8May.png (125.18 KiB) Viewed 7090 times

I also asked him how he felt and he said he felt good (was expecting for a "great" answer but at least it wasn't something negative eh). The blood pressure his morning was also lower than usual (111/72 versus the usual 125/80).

[Pugsy]

At this point I would put the leak rate on the back burner for now and concentrate on his just sleeping through the night without taking the mask off.

Not quite 20% of the night in large leak which amounts to not quite 2 hours and only 1 hour of it was in one large block. The rest of the large leaks were spread out and sporadic and short lived. No UAs were flagged and I would suspect that they would have been if some sort of apnea event had happened. It's not real pretty but I have seen much worse even on myself.
It's not pretty but it's far from horribly horrible and considering the battle you are having with your dad....I would count it as a win and not make too many changes in anything right now as long as he can sleep decently. I have a feeling you will be the first to know if the leaks start waking him up a lot.

I know you want his therapy to be perfect...I would do the same for my mom but getting him to sleep with the mask and machine on is the first priority right now. Without that...nothing else really matters. Baby steps are still steps and still progress.

[zonker]

I also asked him how he felt and he said he felt good (was expecting for a "great" answer but at least it wasn't something negative eh). The blood pressure his morning was also lower than usual (111/72 versus the usual 125/80).

just so you know, what you're doing is AWESOME. you are truly devoted to making your father's life so much better and helping him to stay around that much longer.

i agree one hundred percent with what pugsy has said.

he's on the path. get him used to keeping the mask on, then tweak his therapy.

good luck!

[samurai3005]

At this point I would put the leak rate on the back burner for now and concentrate on his just sleeping through the night without taking the mask off.

Not quite 20% of the night in large leak which amounts to not quite 2 hours and only 1 hour of it was in one large block. The rest of the large leaks were spread out and sporadic and short lived. No UAs were flagged and I would suspect that they would have been if some sort of apnea event had happened. It's not real pretty but I have seen much worse even on myself.
It's not pretty but it's far from horribly horrible and considering the battle you are having with your dad....I would count it as a win and not make too many changes in anything right now as long as he can sleep decently. I have a feeling you will be the first to know if the leaks start waking him up a lot.

I know you want his therapy to be perfect...I would do the same for my mom but getting him to sleep with the mask and machine on is the first priority right now. Without that...nothing else really matters. Baby steps are still steps and still progress.

Thanks a lot Pugsy! You have given me great confidence. Though we’ve got a long way to go but none of this would have been possible without the help of you wonderful people.

Another side note: my dad was ordered an in-lab tiltration by the sleep clinic after I returned their Philips System One Auto (they concluded my dad had failed the at-home tiltration process - whatever that means). I wonder why my dad would need one considering he had undergone a full PSG (which led to a clear diagnosis) and he would have to use an APAP anyway. I noticed from the OSCAR reports from these last few days that my dad rarely needed a pressure higher than 11cmH2O. Is this the number that the sleep doctors wanted to look for when they ordered my dad an in-lab tiltration?

[samurai3005]

I also asked him how he felt and he said he felt good (was expecting for a "great" answer but at least it wasn't something negative eh). The blood pressure his morning was also lower than usual (111/72 versus the usual 125/80).

just so you know, what you're doing is AWESOME. you are truly devoted to making your father's life so much better and helping him to stay around that much longer.

i agree one hundred percent with what pugsy has said.

he's on the path. get him used to keeping the mask on, then tweak his therapy.

good luck!

Didn’t see your reply while writing a response to Pugsy. Thanks zonker! I realized my family is fortunate enough to be able to follow the treatment. Normally an Airsense 10 Autoset/Dreamstation costs 2000 usd here in Viet Nam. The masks are also double-priced (200$ for the Airfit P30i my dad is using). Insurance wouldn’t even cover the PSG, let alone the CPAP!

[Pugsy]

I have no idea what number the sleep lab people would target. Seems like different places do different things and we don't know what machine they might have planned to give him after the time with the first machine.
Most likely they would have targeted the 90% pressure...which is the pressure where the machine was at OR BELOW for 90% of the night.
It is not the overall average pressure.
At least here in the USA that is what gets looked at more often and not the max so much. It's really a meaningless number that is easily skewed to the high side with just a short period of time at higher pressures. It's not the holy grail of pressure settings that a lot of people think it is.