Needs help choosing the right mask. Adjusting to CPAP.

samurai3005 wrote: ↑

Mon May 04, 2020 8:15 am

However, in the long run, I have great doubt that the Airfit P30i will be tolerable for a full night sleep due to:
- Its side tube is relatively thin and I think it'd get blocked once my dad turns his head. The pillow he's using is just an ordinary one.
- He will definitely unconsciously open his mouth which would make his mouth dry. Maybe a chin strap is the way forward?

The side tube will NOT get blocked even when someone lays on it. The air just switches to coming primarily from the side that is not experiencing in any pressure on it. There are several masks available that use this sort of air in the frame system and the air flow is NOT compromised at all. I have used them myself....and I am primarily a side sleeper. Put that concern out of your mind.

Cross the dry/open mouth issue if/when you come to it. Using a full face mask doesn't guarantee that a person won't get dry mouth anyway. Just means no therapy pressure is lost when a full face mask is used. We have lots of people using full face masks that get the dry mouth so much they use some sort of oral hydrating product to help with adding moisture to the mouth.

And yes....first order of business is to just get him okay with using the mask and machine and actually being able to sleep with it.
Without use and sleep...doesn't really mean much what mask he uses if he hates it and won't use it or can't sleep with it.

Pugsy wrote: ↑

Mon May 04, 2020 8:29 am

samurai3005 wrote: ↑

Mon May 04, 2020 8:15 am

However, in the long run, I have great doubt that the Airfit P30i will be tolerable for a full night sleep due to:
- Its side tube is relatively thin and I think it'd get blocked once my dad turns his head. The pillow he's using is just an ordinary one.
- He will definitely unconsciously open his mouth which would make his mouth dry. Maybe a chin strap is the way forward?

The side tube will NOT get blocked even when someone lays on it. The air just switches to coming primarily from the side that is not experiencing in any pressure on it. There are several masks available that use this sort of air in the frame system and the air flow is NOT compromised at all. I have used them myself....and I am primarily a side sleeper. Put that concern out of your mind.

Cross the dry/open mouth issue if/when you come to it. Using a full face mask doesn't guarantee that a person won't get dry mouth anyway. Just means no therapy pressure is lost when a full face mask is used. We have lots of people using full face masks that get the dry mouth so much they use some sort of oral hydrating product to help with adding moisture to the mouth.

And yes....first order of business is to just get him okay with using the mask and machine and actually being able to sleep with it.
Without use and sleep...doesn't really mean much what mask he uses if he hates it and won't use it or can't sleep with it.

Thanks Pugsy, I understand. If the machine turns out to be an eureka moment, I'll happily purchase it for the long run. Although the cost is a bit prohibitive, they're charging me 2000 USD for one! Of course we don't have DME or Medicare nor the insurance covers this. We'll have to pay out of pocket. Hope it's worth the shot, considering my dad has recently recovered from stroke. He's also diagnosed with Cerebral Small Vessel Disease.

I just wanted to say I think your plan for gradual adaptation is a very good one. If he uses the machine during the day while he is doing something pleasant and distracting (e.g., reading or watching TV), that will help a lot. It'd be a good idea for him to try to spend several hours a day this way. Then giving it a try with some naps makes sense.

And when it comes time to retry night-time use, it might help him to feel that getting in several hours at first is fine. I know many people think it's best to shoot for all-night use from the beginning, but easing into things may work better for some people. Of course, the goal is all-night use, but it may be easier to reach and sustain if the approach is somewhat gradual.

Progress can happen in small steps.
Masks really are a personal thing. Dry mouth and mouth leak are always a consideration.
There's no harm in trying lots of different masks if you can. No reason to limit your options if you don't have to.
Hopefully, you'll help him figure out a way to eliminate those challenges with a mask that works for him.
It's great that this machine feels better for him!

Chris

One reason people mouth breathe (and take off the mask) is air hunger. His starting pressure at 5 may explain that. He may be more comfortable if you bump up the minimum pressure. It IS harder to exhale, but not that much.

samurai3005 wrote: ↑

Mon May 04, 2020 8:15 am

@palerider, Pugsy, DreamDiver, Miss Emerita: thanks for the detailed explanation. You gave me great cause to try out this new machine.

Update: So I got the Airsense Autoset 10 now. I have to say, the machine looks very professional. My current setting is:
- Comfort: Starting pressure: 5cm; Ramp time 15 minutes.
- Min pressure: 6cm H2O
- Maximum pressure: 15cm H2O
- EPR 3 - full time.

So, here's a thing, EPR 3 means a 3cm drop in pressure in between inhalations, however, that pressure can't go below 4, so right now at start, it's 6 inhale, and 4 exhale, when the pressure goes up, it'll still be 4 on exhale until the pressure gets above 7.

samurai3005 wrote: ↑

Mon May 04, 2020 8:15 am

However, in the long run, I have great doubt that the Airfit P30i will be tolerable for a full night sleep due to:
- Its side tube is relatively thin and I think it'd get blocked once my dad turns his head.

those masks with the side tubes are supposed to be able to provide enough air with one tube blocked.

samurai3005 wrote: ↑

Mon May 04, 2020 8:42 am

Thanks Pugsy, I understand. If the machine turns out to be an eureka moment, I'll happily purchase it for the long run. Although the cost is a bit prohibitive, they're charging me 2000 USD for one!

Secondwindcpap.com ships internationally, check 'em out.

So I got him to try it on during the day when he was working. He said he felt fine working on this laptop while putting the CPAP on. We tried a few 1-hour sessions in the past 2 days and it went well. So we decided to try with a full afternoon nap. I also got a ResMed chin strap on him to make sure he wouldn't open his mouth unconsciously.

After 40 minutes (during that time I had no idea if he ever went asleep) he wanted to remove it . He said he still felt like he had to push so hard to breathe out in this thing. Then I said "but the machine said things went well for the past half hour, Dad!" and he said "that was because I was trying my hardest but this is my limit. Just get this off me". Sigh... So I checked with OSCAR and it said the pressure my dad was on the most time was just 5cmH2O, which means he was exhaling against only 4cm H2O (EPR 3). Then how the hell could it make him feel so difficult to breathe out?

I'm so confused.

samurai3005 wrote: ↑

Wed May 06, 2020 1:03 am

So I got him to try it on during the day when he was working. He said he felt fine working on this laptop while putting the CPAP on. We tried a few 1-hour sessions in the past 2 days and it went well. So we decided to try with a full afternoon nap. I also got a ResMed chin strap on him to make sure he wouldn't open his mouth unconsciously.

After 40 minutes (during that time I had no idea if he ever went asleep) he wanted to remove it . He said he still felt like he had to push so hard to breathe out in this thing. Then I said "but the machine said things went well for the past half hour, Dad!" and he said "that was because I was trying my hardest but this is my limit. Just get this off me".
nap.png
Sigh... So I checked with OSCAR and it said the pressure my dad was on the most time was just 5cmH2O, which means he was exhaling against only 4cm H2O (EPR 3). Then how the hell could it make him feel so difficult to breathe out?

I'm so confused.

It can be frustrating. It may take some time for him to acclimatize to the pressure. If you're looking for something to help motivate him, you can tell him the pressure is keeping his airway open so he doesn't stop breathing. It's saving his life. His last 15 minutes had some large leak, but the breathing looks regular. It's possible he may have nodded off.

His pressures are unusually low, and yet he's having trouble on exhale against 4cm. Other factors may be involved. How mobile is your dad? Any meds that affect breathing?

Chris

My dad is currently in the 2nd hour of his full night sleep. Seems to me he did actually go into sleep this time. Fingers crossed!!

I also check the “Run mask fit” option on the machine and it said Bad with a red downside smiley. I tried to check where the leak is. His mouth was closed (thanks to the chin strap), no air shooting through the nostrils’ sides. However when I placed my finger below the Climateline pipe (where it connects to the Airfit P30i), I felt air shooting out (image). Am I doing something wrong? I should contact the ResMed guy but it’s kinda late already.

samurai3005 wrote: ↑

Wed May 06, 2020 9:33 am

My dad is currently in the 2nd hour of his full night sleep. Seems to me he did actually go into sleep this time. Fingers crossed!!

I also check the “Run mask fit” option on the machine and it said Bad with a red downside smiley. I tried to check where the leak is. His mouth was closed (thanks to the chin strap), no air shooting through the nostrils’ sides. However when I placed my finger below the Climateline pipe (where it connects to the Airfit P30i), I felt air shooting out (image). 1BFCFD4C-A386-41E8-AEF7-4A8CED0B2D41.jpeg

Am I doing something wrong? I should contact the ResMed guy but it’s kinda late already.

It shouldn't exactly be "shooting" out in one direction with this mask, if I'm not mistaken.

That particular elbow is set to dissipate a small air flow "leak" in all directions around the swivel. This area is supposed to leak at a small leak rate in order to prevent asphyxia. That's normal. Are you feeling it like something blowing out of a straw, all in one direction (not normal), or is it just dissipating weakly all around the swivel (normal) ?

Chris

DreamDiver wrote: ↑

Wed May 06, 2020 9:43 am

samurai3005 wrote: ↑

Wed May 06, 2020 9:33 am

My dad is currently in the 2nd hour of his full night sleep. Seems to me he did actually go into sleep this time. Fingers crossed!!

I also check the “Run mask fit” option on the machine and it said Bad with a red downside smiley. I tried to check where the leak is. His mouth was closed (thanks to the chin strap), no air shooting through the nostrils’ sides. However when I placed my finger below the Climateline pipe (where it connects to the Airfit P30i), I felt air shooting out (image). 1BFCFD4C-A386-41E8-AEF7-4A8CED0B2D41.jpeg

Am I doing something wrong? I should contact the ResMed guy but it’s kinda late already.

It shouldn't exactly be "shooting" out in one direction with this mask, if I'm not mistaken.

That particular elbow is set to dissipate a small air flow "leak" in all directions around the swivel. This area is supposed to leak at a small leak rate in order to prevent asphyxia. That's normal. Are you feeling it like something blowing out of a straw, all in one direction (not normal), or is it just dissipating weakly all around the swivel (normal) ?

Chris

Thanks for replying Chris! Guess I have company for tonight’s “guard”

I just checked like you said and it was just dissipating weakly all round the swivel. I guess it’s normal then. Sorry to raise such unnecessary issue.

So he just pulled the mask off. But this time there is a progress! I asked him “Dad, do you want me to put it on again?”, he nodded, looking kinda unconscious, and he allowed me to put it back on! While putting it on I took a peep at the sleep report on the machine’s device and it said 3 hours, 0.6 AHI, 2 smiles, 1 red (for the mask fit) and 1 green (I couldn’t remember what it told). The other parameters, I couldn’t remember. Guess I’ll find out once I pop the OSCAR tomorrow. But this sounds like good news, am I right?

Hope it continues like this

samurai3005 wrote: ↑

Wed May 06, 2020 10:02 am

Thanks for replying Chris! Guess I have company for tonight’s “guard”

I just checked like you said and it was just dissipating weakly all round the swivel. I guess it’s normal then. Sorry to raise such unnecessary issue.

So he just pulled the mask off. But this time there is a progress! I asked him “Dad, do you want me to put it on again?”, he nodded, looking kinda unconscious, and he allowed me to put it back on! While putting it on I took a peep at the sleep report on the machine’s device and it said 3 hours, 0.6 AHI, 2 smiles, 1 red (for the mask fit) and 1 green (I couldn’t remember what it told). The other parameters, I couldn’t remember. Guess I’ll find out once I pop the OSCAR tomorrow. But this sounds like good news, am I right?

Hope it continues like this

Yes! Fantastic!

Progress, even in small steps is a good thing.

Chris

So he was tossing and turning quite a bit which made the fitting loosen. He unconsciouly took it off again. This time I just removed it and called it a day. Because I know I won't be able to stand there and put it on for him all night. So this is the OSCAR report... A few questions come to mind:
1/ Looks like there were some large leaks. I figure it must have been because the pillows couldn't fit in his nostrils once he slept on his sides. Maybe a full face mask for tomorrow's night?

2/ Do large leaks affect accuracy of AHIs detection?

3/ What do I tell my dad tomorrow regarding this report? I want to feed him something positive so that he'd have motivation to persevere.

Thanks a lot for your help, guys! I couldn't be more grateful.

samurai3005 wrote: ↑

Wed May 06, 2020 11:03 am

So he was tossing and turning quite a bit which made the fitting loosen. He unconsciouly took it off again. This time I just removed it and called it a day. Because I know I won't be able to stand there and put it on for him all night. So this is the OSCAR report...
tonight.PNG
A few questions come to mind:
1/ Looks like there were some large leaks. I figure it must have been because the pillows couldn't fit in his nostrils once he slept on his sides. Maybe a full face mask for tomorrow's night?

2/ Do large leaks affect accuracy of AHIs detection?

3/ What do I tell my dad tomorrow regarding this report? I want to feed him something positive so that he'd have motivation to persevere.

Thanks a lot for your help, guys! I couldn't be more grateful.

1. Why not try the full face tomorrow night? There were significant large leaks with this graph. Maybe a full face will help.

2. Large leaks make AHI less accurate, primarily under the area of large leak. For instance, when I am experiencing large leak, many times my machine cannot determine whether it was obstructive or central, so it marks it as unclassified apnea (UA). Under some circumstances, it may miss it altogether. Large leaks generally are times when therapy isn't being received.

3. The best part is that where he wasn't large leaking, there are no events flagged. Looking at the early part of that wave form after the first two restarts, he might have actually slept a bit. With the right mask fit, at these settings, it's entirely possible your father will be able keep his sleep apnea well-treated. All it will take is perseverance and patience. You're amazing.

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.

Sleep well!

Chris