Dealing with elderly patient and bipap

Hi all,
My mom (82) has used a bipap at night for two years. Lately she’s been experiencing huge leaks. We’ve changed masks a number of times. After much troubleshooting and observation, my sister and I have determined that this is a behavioral issue. When my mom has 4-5 bad consecutive nights with bipap, so she isn’t expelling CO2. CO2 build up makes her confused (obviously) and a snowball effect occurs. The confusion increases and she starts removing the mask more often during the night and takes the mask apart (removes straps) and can’t put it back together. Snowball effect. More confusion leads to more mask problems. We’ve tried everything we can do to stop this behavior. We’re totally stumped. Does anyone have suggestions or any creative ideas to help her from removing the mask during the night, while exhausted and confused.

I don't understand how she is getting a CO2 build up. What kind of mask is she using? You expell CO2 by exhaling.

Is it possible she gained or lost even 5+ lbs? It's amazing what a diff. it can make to a FF mask and possibly a liner (see Padacheek.com) could help or a refit/size adjustment made to the mask, if not an overall mask change - there are so many available now (see Cpap.com for pix and reviews, etc) but FFMs need to be tried on lying down when your face changes a lot. Do you think humidification (on, off or at too high a setting) and or temperature could be issues?

LSAT wrote: ↑

Sat Jun 01, 2019 4:14 pm

I don't understand how she is getting a CO2 build up. What kind of mask is she using? You expell CO2 by exhaling.

A bipap is used to help people who have compromised lung issues. My mother has IPF; she has trouble getting O2 in and trouble expelling CO2. She is on O2. At night she uses a bipap (slightly different from CPAP) to aid in “blowing off the CO2 build up.” So at night, her O2 line bleeds into the bipap line, allowing for her to receive oxygen and bipap machine to aid in expelling CO2.

For people with compromised lungs, getting O2 is difficult. And as the disease progresses, expelling CO2 becomes more difficult, which is why she’s been using the bipap machine for 2+ years.

Sorry if I didn’t explain it better. Most people (especially in this forum) use a CPAP machine. A bipap is similar in many ways. Often we find great mask answers here. I understand your confusion with my question. Hopefully that clarifies how a bipap works — as best as I can — I’m not a doctor or a respiratory tech.

I know what a bipap is. (I think most people on this forum also know). You never completely explained your mother's problem or that she was using oxygen.

LSAT wrote: ↑

Sat Jun 01, 2019 4:14 pm

I don't understand how she is getting a CO2 build up. What kind of mask is she using? You expell CO2 by exhaling.

P.S. The mask she is currently using is the ResMed AirFit F 20. We changed mask model on 5/19/19. Her seal is better in that model however she’s more inclined to dismantle the mask and straps with the new model mask. When she pulls the entire thing apart, not only is she not getting the benefit of the bipap (blowing of CO2) but she’s also sleeping without any O2.

We’re at our wits end. The only thing we can think to do is hire a night nurse to watch her and help her put the mask back on. And that will be an expensive solution. So I was hoping for a less expensive, creative solution from the forum.

I forgot to include all that info & answer to that question previously.

LSAT wrote: ↑

Sat Jun 01, 2019 4:54 pm

I know what a bipap is. (I think most people on this forum also know). You never completely explained your mother's problem or that she was using oxygen.

I’m sorry. I wasn’t trying to talk down to you. I didn’t realize you knew what a bipap was. Maybe i misunderstood. I added some more info. Hopefully that helps. I live across the country from my mom. So I’m not the best “child” to explain everything. Apologies again if I sounded like a jerk.

Julie wrote: ↑

Sat Jun 01, 2019 4:18 pm

Is it possible she gained or lost even 5+ lbs? It's amazing what a diff. it can make to a FF mask and possibly a liner (see Padacheek.com) could help or a refit/size adjustment made to the mask, if not an overall mask change - there are so many available now (see Cpap.com for pix and reviews, etc) but FFMs need to be tried on lying down when your face changes a lot. Do you think humidification (on, off or at too high a setting) and or temperature could be issues?

Thanks. Very helpful info. I’ll run your comments by my sister who lives in the same city. My mother has been dropping a bit of weight. I’m going to cut & paste your reply to family now. Much appreciated.

Without seeing data from her machine, we'd pretty much just be guessing.

Hype2120 wrote: ↑

Sat Jun 01, 2019 2:38 pm

Hi all,
My mom (82) has used a bipap at night for two years. Lately she’s been experiencing huge leaks. We’ve changed masks a number of times. After much troubleshooting and observation, my sister and I have determined that this is a behavioral issue. When my mom has 4-5 bad consecutive nights with bipap, so she isn’t expelling CO2. CO2 build up makes her confused (obviously) and a snowball effect occurs. The confusion increases and she starts removing the mask more often during the night and takes the mask apart (removes straps) and can’t put it back together. Snowball effect. More confusion leads to more mask problems. We’ve tried everything we can do to stop this behavior. We’re totally stumped. Does anyone have suggestions or any creative ideas to help her from removing the mask during the night, while exhausted and confused.

I've heard of some people wearing oven mitts on their hands in bed. Others can get away with gently taping the mask cushion against their face, enough so that you wouldn't take the mask off in your sleep at least.

Do you know what machine she is using, and what her pressure settings are? We need some more information here.

Mask fit is probably the most important thing here. A leaky mask that wakes you up and makes you dislike therapy is a good way to have someone stop using it. I would make sure her current mask is using the correct cushion size for her and that the mask is fitted properly. I would recommend the Fisher & Paykel Simplus FFM for solving leak issues.

I can really sympathize with being the child who is trying to help from across the country. It’s very hard and complicated.

Do you think your mother is mainly reacting to the new mask? If so, can she articulate what it is that bothers her about it? Or is she taking the mask off at least partly because she feels she isn’t breathing well? If the latter, might her doctor be able to suggest different settings?

Why a full face mask?
She might be more comfortable in a nasal or nasal pillow mask.
And she might not feel compelled to tear it off. (or up)
At 82 years, I think she should be allowed enough comfort so she will be less inclined to fight therapy.
I find full face masks to be next to intolerable. For me. She might feel the same.

For a low tech solution a couple of stitches sewn into the strap connections would probably be enough to prevent your mom from taking the mask apart. Use a big, thick darning needle ..... two stitches .... secure with a knot.

If you don't have a needle, even some string wound around the connections would probably be enough to thwart her disassembly of the mask ...... whatever mask you select.

What is worse the cure or the disease? Is her total quality of life better or worse with the CPAP treatment? Think this situation through. Best wishes for her and your health and comfort.

My objection to this entire thread is calling her mother "ELDERLY" ,
I am 80 and do not consider my self elderl !