My brother-in-law has problems

[John M. Browning]

While the title of the thread has more truth than I will go into here , I do want to address his CPAP issues. My sister tells me he takes his mask off in his sleep every night, and in talking to her, and looking at his mask, he definitely has fit issues. I. showed her how to fit it correctly for him (info I got here btw, thanks!). But his issues go further than that I believe. I will post the info I pulled off his machine for advice.
He is using an M-series Auto with A-flex, data capable machine - I will be talking to her about getting a card reader for it. (Btw, I talked to her, and not him because we don't get along and there is no way he would listen to me.)
The machine was set for 12-16 cm, with a 90% pressure of 15.7. I raised the upper limit to 18. His leak rate is 49 l/m, so I assume he has some mouth leakage probs as well. His AHI was 22.1. And get this, his compliance data only showed 3 sessions over four hours in the past 30 days. What are your thoughts on this info?

[LinkC]

My thoughts are it doesn't matter much what the settings are if he keeps pulling the mask off. THAT (and leaks) are the first priority. Tweaking comes later.

[Pugsy]

M series machines show 7 and 30 day average AHI. Leak is total leak so normal mask venting is included in there too.
So you have to figure his vent rate with his mask at his pressure to see just how bad that leak really is. It probably isn't good but might not be grossly horrible.

His problem is AHI is high, even if it is just an average and you already know that the hours of use are poor.

He is blowing off his therapy for whatever reason he has come up with. Probably because "it doesn't really help" and with that AHI it isn't helping.

The minimum pressure is the most critical. Sounds like it needs to be raised a bit but to be honest, best thing is to look at the reports of at all possible. That would involve the purchase of the DT 3500 Infinner card reader. Cheapest place I have seen it on the internet is $54 plus S & H.

Find the vent rate for his mask at his pressure (choose say 14 since APAP) and compare that with the 49 L/min number to get idea as to how the leak really is.

Without software data, I would increase the minimum pressure by 1 cm. Give it a week, check AHI, if still high, another 1 cm increase. Consider switching to straight cpap at say 14. Maybe the pressure variations are disturbing him causing removal of mask. Straight CPAP might suit him better.
That minimum of 12 is ineffective though. Taking too long to prevent the events. Got to give it a better running start.

Above ideas are worthless if he won't keep the mask on. Gotta figure out what is going on there.

[BleepingBeauty]

While the title of the thread has more truth than I will go into here , I do want to address his CPAP issues. My sister tells me he takes his mask off in his sleep every night, and in talking to her, and looking at his mask, he definitely has fit issues. I. showed her how to fit it correctly for him (info I got here btw, thanks!). But his issues go further than that I believe. I will post the info I pulled off his machine for advice.
He is using an M-series Auto with A-flex, data capable machine - I will be talking to her about getting a card reader for it. (Btw, I talked to her, and not him because we don't get along and there is no way he would listen to me.)
The machine was set for 12-16 cm, with a 90% pressure of 15.7. I raised the upper limit to 18. His leak rate is 49 l/m, so I assume he has some mouth leakage probs as well. His AHI was 22.1. And get this, his compliance data only showed 3 sessions over four hours in the past 30 days. What are your thoughts on this info?

Re: taking the mask off in his sleep - tell your sister to tape the mask to his face so that, when he tries to take it off in the night, the tape will remind him to keep it on. Also, see if he'll wear the mask around the house while doing something relaxing - reading, watching tv, using the computer - just to get used to having it on.

The summary data you can get from the machine's display is better than nothing, but pretty useless when trying to troubleshoot particular problems. Can't really say much about his leak rate without knowing which mask he's using; but at his pressure settings, 49L/M doesn't sound like it's out of line on a Respironics machine. (Respironics machines report the entire leak, including the mask's intentional leak rate for venting CO2. ResMed machines factor in the intentional leak rate for whichever mask is being used and report only the leak that's over and above what it should be.)

In light of his AHI of 22.1 and his 90% pressure of 15.7, I'd raise the upper limit of the range (as you've already done), and I'd raise the minimum pressure to prevent more events. Since APAPs increase the pressure slowly after an event is detected, the goal is to set the minimum pressure where most events are prevented from happening at all. If he's having that many events on a regular basis, I think his minimum pressure needs to be a little higher. Maybe run at 13-18 for a week or so, and see how things go. If the AHI is still high, bump the minimum pressure to 14 and see how that goes for a week. Or switch the machine to straight CPAP mode and run it at fixed pressure. Make small pressure changes, one at a time, and let them run for a week or so before evaluating the data and changing anything again.

But his first problem is fitting the mask well and keeping it on. Without both factors being adequately addressed, effective therapy is not going to happen.

Good luck!

[John M. Browning]

Lol. Wearing his mask around the house... That isn't going to happen! Not that I can blame him, I wouldn't either.
I just spoke to him on the phone, and I can tell you he is motivated to be feeling better. He also understands the health issues involved. He is 43 with heart problems - he had a heart attack at 39, and his dad died in his 30's of a heart attack.
They are raising the min pressure to 13, working on the mask fit, and taping the mouth. I told sis I am doing that now, and she said he is definitely a mouth breather. I am going to order them a card reader also. I am not sure what exact mask he has but it looks a lot like my Comfort Classic. He had been cinching down tight, just like I did until I learned better.

Edit: It looks like a Comfort Gel from pictures online.

[BleepingBeauty]

Lol. Wearing his mask around the house... That isn't going to happen! Not that I can blame him, I wouldn't either.

Ahh, the evil vanity. It helps many people adapt to therapy, so there.

I just spoke to him on the phone, and I can tell you he is motivated to be feeling better. He also understands the health issues involved. He is 43 with heart problems - he had a heart attack at 39, and his dad died in his 30's of a heart attack.
They are raising the min pressure to 13, working on the mask fit, and taping the mouth. I told sis I am doing that now, and she said he is definitely a mouth breather. I am going to order them a card reader also. I am not sure what exact mask he has but it looks a lot like my Comfort Classic. He had been cinching down tight, just like I did until I learned better.

Edit: It looks like a Comfort Gel from pictures online.

It's great that he's motivated (especially since he has very good reason to be), because that's more than half the battle. Sounds like they're working on the known issues for now, and the data is in the works. Lookin' up!

The ComfortGel has an intended leak rate of between 27 and 32 lpm at a pressure range of 12-16. So his reported average leak of 49 IS too high (and that's now confirmed by your sister's report of him mouth-breathing). But that's about to change, if he can keep the mask on and his mouth taped shut. Fingers crossed!

FYI, the ComfortGel's leak rates (in lpm) for the proposed range are:

13cm 29
14cm 30
15cm 31
16cm 32
17cm 33
18cm 34

[John M. Browning]

My brother in law has continued to take his mask off in the night. He said he was getting a suffocating feeling, and taking it off. Since we knew he was moth breathing, my sister finally convinced him to use tape.

She texted me this morning: "Howdy.. I taped mikes mouth with duct tape last night .. Seriously! What kind of tape did you tell me to buy? He slept with the mask until 4! I cant wait to see if he feels better today."

So I sent him an email asking how he did, and made a comment about duct tape.

"I feel much better today, actually.I didn't know it was duct tape.  She had too good of a time taping my breathing passage closed, I think....  I'm getting a little worried!"

I will be installing their Encore software for them this weekend: I received their card reader this past week.

[LinkC]

Just make sure it's the BLUE duct tape!!

[archangle]

Tell him if the tape doesn't work, the next step is a nail gun.

DON'T use DUCT TAPE.

Seriously, don't even joke about using duct tape. Somebody will read that, think we're not joking and try it.

I hope nobody thinks the nail gun is a serious suggestion...

Seriously, be sure to get the medical tape. Be sure it comes off easily and cleanly. Try a small piece without taping the mouth completely shut to start with. Have him practice taking it off to be sure he can remove it in the middle of the night if necessary. I always made sure to fold an end of the tape over to have an easy place to grab on if necessary.

(Or use the blue painter's tape if you're comfortable with that.)

[John M. Browning]

I have told her (repeatedly ) to use the surgical tape.

I discovered that little trick of rolling over the end myself. It is helpful for when you get those 11PM wrong number calls like I got last night.