Needs help choosing the right mask. Adjusting to CPAP.

Pugsy wrote: ↑

Fri May 08, 2020 6:25 pm

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.

I think I should show my sleep doctor the OSCAR reports after we’ve undergone a few more full night sleep. Figured I should bring along my laptop in our next visit so that he can see for himself whatever data he needs. I’m glad that he doesn’t need a too high pressure to keep his airway open, even when there are large leaks.

samurai3005 wrote: ↑

Fri May 08, 2020 6:23 pm

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!

oh, no worries. when pugsy "speaks", you'd be a fool not to "listen"!

Let me preface this by saying I am still a fairly new PAPer. While I am sleeping MUCH better, I still have trouble with multiple arousals and going back to sleep. What I find helps me is to have something else to focus on rather than (especially in the beginning) the CPAP mask/machine and the stress of want to and being unable to fall asleep. I use meditation music. There are even special stories to help you fall asleep. Perhaps something like could take your father's mind off the fact that he has something foreign on and around his face? Especially since when he is engaged during the day, on his laptop, he finds it easier, having his mind engaged at night while trying to fall asleep at night might help as well. I restart the music when I wake to help fall asleep as well.

BTW, I think your father is very lucky to have you helping him!

booksfan wrote: ↑

Sat May 09, 2020 8:05 am

Let me preface this by saying I am still a fairly new PAPer. While I am sleeping MUCH better, I still have trouble with multiple arousals and going back to sleep. What I find helps me is to have something else to focus on rather than (especially in the beginning) the CPAP mask/machine and the stress of want to and being unable to fall asleep. I use meditation music. There are even special stories to help you fall asleep. Perhaps something like could take your father's mind off the fact that he has something foreign on and around his face? Especially since when he is engaged during the day, on his laptop, he finds it easier, having his mind engaged at night while trying to fall asleep at night might help as well. I restart the music when I wake to help fall asleep as well.

BTW, I think your father is very lucky to have you helping him!

Thank you so much for the kind words! You are correct regarding the benefit of taking one's mind off the CPAP breathing work. After all, the machine is designed to help my dad, it's never meant to hurt him, so whatever discomfort he's feeling might as well be improved over time with trial and error and perseverance. I learned this the hard way in the last couple of weeks.

So this is the 2nd full-night! My dad said he felt good waking up this morning. Although he still felt a little bit irritating regarding the P30i pillows whenever he changed position but he managed to stay on and fixed the mask himself then fell into sleep again! I guess a bigger sized pillows should do the trick, but that will only be possible when I purchase the whole Standard frame Airfit P30i. The ResMed distributor only gave us a small one.

I don't know if I'm biased or not but I feel like he's getting more energy. Yesterday he didn't even bother taking an afternoon nap!

One thing I'd like to ask is what happened at 04:44 (see image below) to trigger a rise in pressure? Judging from the event flags as well as flow rate, I don't see any changes in flow that looked like an OA or CA?

The increased flow limitation was what caused that increase in pressure.
Flow limitations are one of the warning signs the airway is trying to collapse. If left untreated they can easily grow up to be full grown OAs or hyponeas.

Often people see an increase in pressure and don't see a corresponding OA or hyponea but the machine's auto adjusting algorithm also responds to flow limitations and snores because both are signs the airway is trying to collapse.
So entirely normal and expected to see a little higher FL and see the machine increase the pressure at about the same time.
The machine was just doing its job.

Pugsy wrote: ↑

Sat May 09, 2020 5:15 pm

The increased flow limitation was what caused that increase in pressure.
Flow limitations are one of the warning signs the airway is trying to collapse. If left untreated they can easily grow up to be full grown OAs or hyponeas.

Often people see an increase in pressure and don't see a corresponding OA or hyponea but the machine's auto adjusting algorithm also responds to flow limitations and snores because both are signs the airway is trying to collapse.
So entirely normal and expected to see a little higher FL and see the machine increase the pressure at about the same time.
The machine was just doing its job.

Thanks Pugsy, that makes perfect sense.

My sleep doctor said if I could get my dad to have a full 7 night sleep and get him the data (at-home auto PAP titration) then we won’t have to get back to the sleep lab for an in-lab titration anymore. I’m ordering a couple of things on cpap.com at the moment to optimize my dad’s treatment, since I’ve discovered they do offer international shipment.

I’m so glad I’ve found this board. It’s so great to have wonderful people helping me and my dad out. I’ll get back for more OSCAR updates.

He's adapting pretty well to the CPAP, I think. He's learning to self-adjust the pillows to make sure there isn't leak whenever he changes position and also not to remove it unconsciously. Only 1 time last time he removed it to have a pee and forgot to put it on (and I was too asleep to wake up, feeling pretty sinful the next morning!).

So this is last night: This is this afternoon nap: We're ending the trial and also getting a brand new machine tonight. Hopefully with a bigger sized Airfit P30i cushion, we'll manage the leaks better in the nights ahead.

I wonder if there's still anything that is left for me to do to optimize the therapy? Or I should just simply keep doing this?

samurai3005 wrote: ↑

Mon May 11, 2020 3:02 am

He's adapting pretty well to the CPAP, I think. He's learning to self-adjust the pillows to make sure there isn't leak whenever he changes position and also not to remove it unconsciously. Only 1 time last time he removed it to have a pee and forgot to put it on (and I was too asleep to wake up, feeling pretty sinful the next morning!).

So this is last night:
10May.png

This is this afternoon nap:
10May afternoon nap.png

We're ending the trial and also getting a brand new machine tonight. Hopefully with a bigger sized Airfit P30i cushion, we'll manage the leaks better in the nights ahead.

I wonder if there's still anything that is left for me to do to optimize the therapy? Or I should just simply keep doing this?

samurai3005, you've pretty much scoped out the situation. Your dad is adjusting to a new normal, and with your continued help, it looks like it's going to work. As Pugsy suggested, now is more about getting him used to the mask throughout each night and keeping it from large leaking. Once he's had a week or so of stable large-leak-free nights, you could try tweaking pressure, but at such a low pressure and with such a low AHI, any changes you make will likely be tiny. Technically, he's already mostly dialed in. So yeah! Just keep helping him as you have been -- again, remembering that your health is also important. No guilt trips allowed since you need your sleep too, okay? So glad the P30i is working for your dad!

Chris

DreamDiver wrote: ↑

Mon May 11, 2020 5:26 am

samurai3005 wrote: ↑

Mon May 11, 2020 3:02 am

He's adapting pretty well to the CPAP, I think. He's learning to self-adjust the pillows to make sure there isn't leak whenever he changes position and also not to remove it unconsciously. Only 1 time last time he removed it to have a pee and forgot to put it on (and I was too asleep to wake up, feeling pretty sinful the next morning!).

So this is last night:
10May.png

This is this afternoon nap:
10May afternoon nap.png

We're ending the trial and also getting a brand new machine tonight. Hopefully with a bigger sized Airfit P30i cushion, we'll manage the leaks better in the nights ahead.

I wonder if there's still anything that is left for me to do to optimize the therapy? Or I should just simply keep doing this?

samurai3005, you've pretty much scoped out the situation. Your dad is adjusting to a new normal, and with your continued help, it looks like it's going to work. As Pugsy suggested, now is more about getting him used to the mask throughout each night and keeping it from large leaking. Once he's had a week or so of stable large-leak-free nights, you could try tweaking pressure, but at such a low pressure and with such a low AHI, any changes you make will likely be tiny. Technically, he's already mostly dialed in. So yeah! Just keep helping him as you have been -- again, remembering that your health is also important. No guilt trips allowed since you need your sleep too, okay? So glad the P30i is working for your dad!

Chris

Thanks DreamDiver! You've always been so considerate!

Turns out the upgrade to medium size P30i cushion was a huge success, at least in terms of managing large leaks.
Here's his afternoon nap And this is last night Again, he might have unconsciously removed the mask around 1.30am while I was asleep. I asked him whether he felt uncomfortable and he said he didn't even remember removing it. This is something that I should improve on in the next few days.


Did anyone use a SleepOn (go2sleep) oxymetry to double check the AHI of the CPAP? I had my dad worn it last night and it said last night my dad's AHI was 25. It even said my dad had SpO2 drop even in the time when the Airsense 10 reported 0 event/0 flow limitation. I understand that this thing is not very accurate but how accurate is the flow detection of the Airsense Autoset 10?

samurai3005 wrote: ↑

Tue May 12, 2020 4:59 pm

Did anyone use a SleepOn (go2sleep) oxymetry to double check the AHI of the CPAP? I had my dad worn it last night and it said last night my dad's AHI was 25. It even said my dad had SpO2 drop even in the time when the Airsense 10 reported 0 event/0 flow limitation. I understand that this thing is not very accurate but how accurate is the flow detection of the Airsense Autoset 10?

So glad for your continuing success! The AirSense 10 is a pretty miraculous machine. From the flow rate graph, I can zoom in on any of my central apneas and point out the heart beat reflected in the waveform just from the pushback pressure in my lungs due to the airway being fully open. The same is true of the S9. It's possible the flow limitation graph may be less accurate, but I'm not sure that it is, given that it's used to help regulate pressure in an Autoset. I hope if I've mispoken, others will come along to explain better.

I'm unfamiliar with SleepOn, but it looks like something I need to research! I hope others will come along with a better reply on that score. There are a lot of great oximetry tools out there, but they may not be confirmed as reliable by your doctor. It may be worth confirming that your sleep data and your SleepOn data are synced time-wise. If your Dad is having extended periods with oximetry below 90%, regardless of when he's on the machine or awake and off the machine, you may need to talk with your sleep doctor about getting some oximetry done with your dad using oximetry tools that your doctor deems reliable.

Chris

I have been using the sleepon for three or four weeks. Results correlate pretty well it’s my sleepyhead data. I use a Resmed 10 VPAP. Problem with the ring is it’s sensitivity I’ve noticed it gives very low SpO2 readings Intermittently which it assumes to be Apneas when it’s more likely my movements have dislodged the ring momentarily. If I ignore these the AHI is remarkably consistent with my CPAP.

PS I like this device very easy to set up and fun to use the analysis. Good for a novice to reassure them that their CPAP is doing its job and for $100 it’s not expensive. Not compatible with Sleepyhead so not as easy to correlate data But worth the effort. Hope this helps

I went from a nasal mask over the nose to the AirFit p10 nasal pillow and I love it no discomfort at all. Perhaps with the small nose the size small may work. I
Use a medium on my mask.