Advice For Family Member

Longtime lurker, but first post. I've come to greatly value the knowledge and advice shared here and hope you all can help yet again.
This post is about/for a family member, Zach. I feel like I'm not doing a very good job helping with his new PAP therapy. I am the goto guy for my friends and family for PAP (and all things medical) issues and usually am able to get them squared away quickly. There is a great deal of back story and drama going into this diagnosis, however, for the sake of brevity, I'll stick to the salient points. That said please ask questions as needed.

Equipment: ResMed AirCurve 10 VAuto (Rx: PS 4 Min EPAP 6 Max IPAP 17), AirFit F20 (medium) Mask
Started Therapy 18 June 2018

Zach is a 58 y/o male not overweight and no history OSA or the like. He was seen by cardiology to evaluate bouts of nocturnal tachycardia - on a whim after three months of test cardio sent him for a sleep study. The split night study was by all accounts hellacious and his pulmonologist and I have very little confidence in the data, but here it is - Total AHI 26.9 (all supine), no REM sleep, longest apnea 61 seconds, lowest Spo2 82%. Sleep tech did make a note that she was unable to control the apneas even with 25cmH2O pressure - however given the mask was cracked and leaking like a sieve I was dubious. Fast forward a couple of months pulmonologist orders a Auto Bi-level machine and it is agreed we will duct tape and chicken wire this titration etc at home. A second sleep study is scheduled for April 2019 but I doubt I can get him back in the door - they were that nasty. Pulm follow up is in August so I have some time to try and make some progress.

First off he doesn't have a well fitting/comfortable mask - I know that is fundamental to this whole process and we have tried six and more are on the way as fast as UPS can get them here - the F20 is the best so far. No leaks and comfortable unto 10cmH20 but beyond that even with all my tips and tricks it either leaks horribly or is too painful to wear - so we are working on the mask issue. Plus, I'm not convinced lots more pressure is the answer, he is kind of a little guy and common sense tells me to be cautious.

Anyway, here is some SleepyHead screen shots any thoughts or suggestions will be greatly appreciated!!

The blocks of time without apneas are side sleeping - unfortunately because of some spine/joint issues side sleep is not a long term option. The pressure changes are all over the map - pressures had to come down because of the mask discomfort - he hated the PS feeling and much prefers a constant pressure, so fine, for now. Bite guard is in the near future. Soft C-collar caused neck pain and radiculopathy.

Thank you all so much for any ideas on where to go from here!!

Welcome to the forum.

Please review this thread for which graphs to include. When we try to include too many they all end up being so tiny it's hard to evaluate them. No need to redo these though. It's painfully obvious that things aren't working well at these settings. Just review this thread for the next time.
5 graphs on the right is about all you can squeeze into one image. Events, flow rate, pressure (don't need masked pressure at this time), leak and flow limitation. Just those for now and if we need something else we will ask.

viewtopic/t158560/How-to-post-images-for-review.html

If he doesn't like the feel of PS....let's see if we can still use auto mode and try to figure out his pressure needs without PS.
Go to auto mode...and
Set PS to 0
Set the minimum to 13 and max to 25.
This will essentially take bilevel out of the picture and make the machine a single pressure but the pressure can auto adjust if needed.
See what happens.
This way he will have a more constant pressure without PS while he is awake and once he is asleep the machine can auto adjust up to what would hopefully hold the airway open. The machine will only go to where it feels the need. We need to see where it thinks it needs to go and maybe help it out a bit with more optimal minimum but until we see where it wants to go it's hard to figure out.

Thank you so much for your help!

I’ll let you know how it goes once the mask issue is resolved - hopefully soon.

kdspuck wrote: ↑

Thu Jun 28, 2018 2:38 am

...he doesn't have a well fitting/comfortable mask - I know that is fundamental to this whole process and we have tried six and more are on the way as fast as UPS can get them here

Quite correct, comfortable mask is critical. Consider trying my mask (click on it to see details) with pillows and covers mouth. Works well for low and high pressures. Many of us make an extra strap to retain pillow fit.