86yr old mother adapting to CPAP - doubts & questions

Dulcecica wrote: ↑

Thu May 14, 2020 10:51 am

Thank you Pugsy, I will try to find out what EPR is... a setting on the cpap machine? And have her test it during the day while sitting down (is that the idea?).

Another question I have is, has anyone tried Melatonin? The pulmonologist prescribed one every night at 22pm (my mom usually goes to sleep between midnight and 1am)... she declined to try it, but I was wondering what you guys think.

I have used Melatonin for years....I at one time used the 5MG but as I got older, I dropped down to 3mg. It definitely helps me fall asleep, but I need help staying asleep after about 5 hours.

A note to Dulcecia,

If you decide that she should not have an "automatic" fear not. This machine can be set to a fixed pressure and will function exactly like the non-automatic model. No need to replace it.

Here some replies to your advice:

Pugsy wrote: ↑

Thu May 14, 2020 3:53 pm

Sorry...my bad. The DreamStation has exhale relief called AFlex....for some reason I was thinking ResMed machine.
Try A Flex set to 2 or 3 with minimum pressure of 6 and see how she does with it while awake.

Thank you Pugsy. Next week will be my turn to be with my mom and I will try this by daytime, see how she feels about it.

kaiasgram wrote: ↑

Thu May 14, 2020 4:03 pm

You are 100% correct about this. A year or so ago my 91 year old mother tried to get started on PAP after getting a severe sleep apnea diagnosis. Unfortunately she gave up not long after starting to use the machine. She never got leaks under control and unlike your mom, she was absolutely not open to support or help from any of us family members who are veteran PAP users. But like your mom, she *does* have a tendency to be her own worst enemy! She quit, saying "It didn't make me feel any better." She never really understood how her many health issues over the years -- sleep interruptions, heart issues, and..... could have been related to her untreated sleep apnea, or how PAP therapy might have helped.

So, good for your mother and good for you

Kaiasgram, I would not say my mom is open to support, and last night she took the thing off at 5:15 am (had gone to bed at 1:30 am)... so the jury is still out whether she will embrace the treatment or not, but since she is pretty much aware of half choking all night one would say she would at least make an effort, time will tell. But if she expected a miraculous improvement I guess she's in for a disappointment. Sorry about your mom, it's frustrating when people do not want help and the obviously need it.

LSAT wrote: ↑

Thu May 14, 2020 5:19 pm

I have used Melatonin for years....I at one time used the 5MG but as I got older, I dropped down to 3mg. It definitely helps me fall asleep, but I need help staying asleep after about 5 hours.

Thank you LSAT. Actually she has no trouble going to sleep, just fear of going to bed. Always says she's going to sleep on the sofa seating down, which is not really an option because it's uncomfortable as hell, so eventually she gives in and goes to bed, but then she sleeps until 11:30 am, no trouble. So I think we will skip Melatonin for now, knowing she also has a tendency of feeling every secondary effect any medicine has.

D.H. wrote: ↑

Thu May 14, 2020 6:25 pm

A note to Dulcecia,

If you decide that she should not have an "automatic" fear not. This machine can be set to a fixed pressure and will function exactly like the non-automatic model. No need to replace it.

Thank you D.H., that fact is what sold me to go for the Dreamstation auto, the fact that it could be used as a normal cpap!

I have a couple of questions that I hope Pugsy can answer.

I saw on another thread her explanation that erratic flow rate waves can possibly be a sign of wakefulness.
Here is a detail of my moms chart for Friday night:
1. Is it reasonable to say that my mother was actually awake by looking at the erratic shape of the waves?
2. Would that influence the average AHI for the night, if these are indeed false positives?
3. How does Oscar calculate the second by second AHI on the chart? Here it says the AHI is 14, but what would it be based on? I suspect it's the average of the previous 1 hour.

I can actually see her oxigen saturation is pretty good, but the AHI is out of wack and possibly messing with the average AHI... what do you think?

I can also positively identify mask adjustments, since my mother gets taped all night, she has a camera on top of the pillow. 6 am, mask adjustment, irregular waves, wham! Thank you!

Looks like awake breathing false positives to me.

The AHI graph is a new graph each hour. So each hour it starts over. Not particularly useful especially when some false positives from being awake are thrown in. Remember the machine only reports air flow...it doesn't have any way to subtract awake erratic flow.

AHI over the entire night is a per hour average of all flagged events...real or awake.

I can't really tell much when all I get are snippets without seeing the whole picture of the night as well. I don't mind the snippets but I need the big picture as well.

The AHI graph itself...I don't even bother looking at it in most situations. It's going to reflect only a one hour segment each time.

Thank you Pugsy, I hope to try the machine during daytime next week with a minimum pressure of 6, see if she gets used to it.

But just remember the machine won't give valid data if she uses it while awake - breathing patterns then are very different even if the machine doesn't 'know' if you're awake or not. It's one thing to wear it while trying to acclimate to wearing it at night, but another to have the machine on in daytime (or night) while she's awake.

Julie wrote: ↑

Sun May 17, 2020 10:19 am

But just remember the machine won't give valid data if she uses it while awake - breathing patterns then are very different even if the machine doesn't 'know' if you're awake or not. It's one thing to wear it while trying to acclimate to wearing it at night, but another to have the machine on in daytime (or night) while she's awake.

Thank you Julie, I will keep that in mind. The idea is to get her used to a pressure of 6 (as suggested by Pugsy I believe), so that she doesn't ask to have the machine shut down or the ramp restarted when she wakes up from what she feels is excess pressure. The goal is to have her acclimate.

Last night she removed the mask after 3 hours.

I am no Nasa scientist but even I can see the difference between the previous night (cpap on all night) and this night (3 hours of cpap only) by looking at the screenshots of the oxymeter. Sorry it's in Spanish, but the graphic speaks for itself. While on cpap (even though oxygen is not optial) it looks much better than without that looks like an earthquake.

Hello again everyone,

I need help with the OSCAR data, but first an update.

We're still struggling to make the apap work for my mother.
She will wear it for 6-8 hours, no problem, but we have major leaks with the dreamwear pillow, particularly when the carer is there at night. The nights I'm there I seem to be able to adjust it better. She has also started mouth breathing... I bought the dreamwear mouth mask, I might convince her to try it, she has also tried the gel cushions, but it's not as nice as the pillow. She also has a very very itchy nose, I will talk to the doctor today about that issue and all the others.

Right now I have a problem with OSCAR. I'm going to the doctor today, and wanted to print a report.
There seems to be incongruities with the data. Yesterday's AHI was an awful 13.25, but the welcome page and "most recent" on the Statistics show 9.72 (that's a value that doesn't coincide with any one day). I can send the full data if anyone needs it to troubleshoot this.

Then again I might be doing something wrong... Thank you in advance for your help!

bump

Impossible to know why the discrepancy without seeing the full detailed report. Snippets are pretty much useless.

Apologies Pugsy, you are totally right.
Here is the screenshot, also of the sessions (that might be the origin of the problem?).
By the way the doctor said that an AHI of 5 to 10 is acceptable for an elderly person, as well as an average of 92% SpO2, at least for now... is that reasonable?
Thanks!

All sessions seem to be turned on but there were some periods of large leak. I am wondering if the large leak times may have messed with the calculations a bit. The machine couldn't sense and record properly and the software when doing its calculations became messed up.
There's also some Breathing Not Detected going on. All this adds up to the calculations probably just getting messed up. I wouldn't worry about....nothing you can do about it anyway.

I would NOT be happy with an AHI of 5 to 10 no matter how old the person was if I was for sure the person was asleep when those events got flagged.

I know in some areas of the world 10 is considered an okay number but here in the USA it's considered way too high. Heck, that 10 AHI is enough to earn a person a machine if they aren't on a machine. 10 per hour sleep disturbances...one every 6 minutes...
How do you think you would feel if I come to your house and poke you with a stick and wake you up every 6 minutes.

We don't need the AHI graph...it's redundant information. We can see the concentration of flagged events on the events graph.
Might be better to make that Events graph a bit larger so everything isn't scrunched together so much it's hard to see the lines.

Your mom needs more minimum pressure....but then we sort of already knew that. Once she can sleep and sleep with more pressure and not fight it so much...the hyponeas and OAs will reduce.
I am thinking at least 7 cm minimum.....

Thank you Pugsy.
An AHI of 10 did not sound like an acceptable value to me either. I will enlarge the events graph tomorrow, see how things went.

Hello again.

Yesterday my mom tried for the first time the dreamwear face mask... what a disaster. I was not there, my brother was, and she took it off on her own at some point. I doubt she will want to try it again, we will see.
Pugsy, I tried to increase to 6cm (had tried it for a while in the morning and it seemed she was ok with it), but when she put it on at night she immediately complained. No idea if the ramp can start at 4, but from then on the minimum can be set to 6 or 7 cm.
This total disaster was last night with the facemask... obviously it was not well adjusted and she slept terribly with no benefit whatsoever... This is the night before with the dreamwear pillow, not great but yet: So... back to the drawing board, fighting leaks, dry mouth and itchy nose. Tonight I sleep with her so I will be able to see first hand what's going on.

Any thoughts?