86yr old mother adapting to CPAP - doubts & questions

I saw some clusters on some of the graphs plus you talk about leaks and dry mouth. I don't know but maybe a soft cervical collar might be an option? We'll see what others say.
Does she have a hard time breathing when she tucks her chin?

Hi everyone, is it possible that I had to tell the dreamstation that I had changed the mask type and because of that we had all these problems? I remember vaguely that’s when we set up the machine I had to input what kind of mask we were using.
My brother was very careful when adjusting the mask so I don’t think it has been a problem of adjustment.

No, the settings on the machine are the same for all dreamwear X1... so that’s not the issue.

weiss27md wrote: ↑

Wed May 27, 2020 9:24 am

I saw some clusters on some of the graphs plus you talk about leaks and dry mouth. I don't know but maybe a soft cervical collar might be an option? We'll see what others say.
Does she have a hard time breathing when she tucks her chin?

A cervical collar is not an option with my mother, she has a very thick neck and would find it very confining. I saw it’s on other threads, people suggesting this solution, but unfortunately it’s not an option for my mother. Nevertheless thank you very much for the suggestion

-A chin strap might be an option. I bought one and didn't like I though. Supposed to be the best one to, the Knightsbridge Dual Chin Strap. For me the cervical collar worked ok.

-There's also practicing correct tongue posture. If done correctly and become muscle memory there will be zero mouth leaks. Put tip of tongue on roof of mouth half an inch behind top teeth. Then swallow with your tongue. This should suck your tongue to the roof of your mouth. You'll find it's impossible to breathe through your mouth when doing this. This will improve nasal breathing which helps with overall respiration. It also widens the palate which opens up the nasal airway.

-A good pillow might also help with the side sleeping. Maybe a nice contoured memory foam pillow. Will help keep the correct head posture when laying on side.

I have one of those C-shaped neck pillows that is filled with buckwheat hulls. I took out a lot of the hulls so it's soft and moldable. Sometimes when I'm having trouble keeping my mouth closed, I tuck that under my chin. I have a wide, short neck, too and I could never stand something like a cervical collar, but this does the trick--especially if I have to sleep on my back occasionally because of hip pain.

But has anyone seen such an awful resultsas I posted (AHI 42) when changing to dreamwear face mask? What could have caused that?
Thanks!

The 44 AHI one looks like mostly large leaks. You might post that daily graph again but with more info, a lot of it is cut off. I think a full face mask is just beneficial if you have mouth leaks that can't be fixed or nasal congestion that wont clear up.
You said the min is at 4 and 6 was suggested but that did not work, what about a minimum of 5?
Is there a reason the max went from 10 to 12? To me it looks like she takes off the mask when the pressure gets above around 8. If it was me I'd set the max to 8 or 7.

Lets see what others say though.

She's probably not sleeping well at all and that greatly increases the chances of false positive event flagging.
Plus she probably does need more pressure but can't tolerate it and until she can tolerate it then some real event flagging will happen.
Sort of a double whammy...bad numbers from false positive awake flagging along with simply apnea events not prevented because the pressure isn't able to hold the airway open and prevent the collapse.

If you want to take the time to learn how to evaluate the flow rate you can get an idea about false positive flagging.
While this talks mainly about central apneas....it isn't limited to centrals. We can have awake/arousal related OA or hyponea events as well.
http://freecpapadvice.com/sleepyhead-free-software

I doubt very seriously if all that AHI of 40 something is real asleep flagged events.

Well, it’s 2:30 am in Barcelona and we’re finally in bed. We’re back to the nose pillow, and trying the taped mouth with these contraptions I bought on Amazon. I hope she can withstand it. I’m wearing one too in solidarity.
I’ve gone back to a max of 10. The reason I had gone higher is because some nights she had spent 90% of the night at 10, which made me think she needed to go higher.
So far I hear no mouth leaks... fingers crossed!

Hi everyone!
The taped mouth was magic. An AHI of 3.81, and not lower because I think the tape got loose in the last hour.
I taped my mouth too to get an idea of what it was like and although it's uncomfortable I thought it was bearable. If my mother could tape her mouth every night without any allergic reactions or ill effects it might be the solution, because I don't think she could tolerate a chin strap, she has a very sensitive scalp.
I don't want to count my chickens though... let's see if we can reproduce this good result.
Thank you everyone for pitching in, it makes all the difference!

Hello everyone,

I need some advice. Currently my mom is still using the Dreamstation with the heated tube and humidifier, and we've tried the following masks:

-Dreamwear nasal cushion (her favorite, but every day that goes by it has more and more leaks... only 1 month of use)
-Dreamwear gel pillow (she will wear it, but no more than 2 nights in a row, it's obviously more invasive and uncomfortable, and makes her nose itch).
-Dreamwear full face (she wore it one night, total disaster, even though I'm told it was carefully adjusted, she was 98.86% of the time OVER leak redline, and an AHI of 44, obviously she was not capable to keep it in place -I was not there, it was my brothers turn to be with her-).

Settings are Auto, min. 4 cmH2O (any attempts to increase that have failed), max. 10 cmH2O (ditto, but will try to increase because often 90% of the time she's at 9.5 or 10 cmH2O). The ramp is set to SmartRamp ON, 20 minutes (that has been a recent adjustment after reading this article -that has nothing to do with my mom since she has almost no centrals-: https://academic.oup.com/sleep/article- ... m=fulltext )

For the last 10 days she's been taping her mouth. Otherwise she opens it almost immediately. She has headaches and a sensitive head, so any other solutions to keep her mouth closed are not viable.

I would love to make the nasal cushion work... it mystifies me why some nights are better than others, if she's sleeping on her left side it seems to fit better, but on her right side there is no adjusting the thing, it just keeps on leaking like crazy, with a time OVER leak redline always exceeding 25%. She tends to make small moves with her head that make the thing go out of wack, the more restless she is the worse it gets and she gets more restless...

So... my questions, I will be really happy with your experiences and advice:

1. Can it be that my mom's nose is too small to work well with the dreamwear cushion, and with use it has also stretched a little? The first night of cpap was magical, but it went downhill from there.

2. Would it be a good idea to try the AirFit N30i by Resmed? It seems to have a more structured pillow (which Jason aka TheLankyLefty27 found a negative compared with the dreamwear), but perhaps in my mom's case it would make for a better fit? I don't see her going for full face with all those straps.

3. If I purchase the N30i, would it be compatible with the heated tube of the dreamstation (from what I've read the answer is yes, but if that's not the case I would love to know now).

4. Again, if we try the N30i, and she's currently using Dreamwear's small frame and small cushion, is it logical to think she will need the small frame with Resmed? We will print the sizing template for the cushion, but the frame remains an unknown...

5. Another option I'm considering is the dreamwisp, any thoughts on that?

Thank you in advance. I brings great solace to have this forum, and I spend hours upon hours scouring for information and clarity!

Hi again,

I've been reading the reviews on cpap.com for the Resmed Airfit N30i.

It seems my mom is not the only one having leak issues with the Dreamwear pillow, and those that had problems with it seem to love the Resmed N30i, so I went ahead and bought it.

The only question mark is whether the size S pack that I've bought (based on the size S used on the Dreamwear) will be good or too small. The supplier said it should be ok... worst case scenario I will have to buy the standard frame.

It is very clear, after reading comments from people, that faces come in all shapes and sizes, and what is perfect on one person can be ill fitting on the other. Probably the advice and experience of a man isn't usually and necessarily applicable to a woman's face.

Fingers crossed that this mask will be "the one". Still having to sleep with her mouth taped is not the ideal solution, but after the fiasco with the dreamwear full face mask I don't dare trying anything similar again...

Still looking forward to your opinions on this.

Thanks!

There are so many masks on the market... not just the few you've tried, but you're asking us to speculate about which would be best for your mother who we don't know. Even if we did and saw her in person we couldn't do more than guess at which ones might work for her. Is there no way to get her to a dealer to try on various ones, lying down and relaxed, together with her usual one and compare to see what might work. I know myself all too well, but could not guess at what would work without trying on various ones and then seeing if they do the job overnight for a while. We'd love to help, but there are limits to our being able to guess at this... much as we'd like to. I hope you do find 'the right one' (tho' many of us still 'make do' with masks that aren't perfect in every respect) and let us know what happens.

Dulcecica wrote: ↑

Mon Jun 15, 2020 7:43 am

It seems my mom is not the only one having leak issues with the Dreamwear pillow, and those that had problems with it seem to love the Resmed N30i, so I went ahead and bought it.

I hope this works out for your mum. I used the N30i for a few weeks, and found it to be great. The only problem is that it tends to blow air downwards onto you, but that isn't a really major problem. I tried the Dreamwear one for the last couple of weeks, in case it was better. It was better in that it blew air away from me, but I had a lot of leaks and problems with it, which I didn't expect. I got the N30i back today, and I feel like I've been reunited with an old friend! I'm actually looking forward to using it tonight. I've only been on CPAP for a couple of months, but the N30i is the best one I've tried, (out of three that I've tried).
Good luck with it. Hope it works as well for your mum as it does for me.