Urgent Mask Leaking Help

dataq1 wrote: ↑

Mon Dec 18, 2023 6:37 pm

Zaiforce wrote: ↑

Thu Dec 14, 2023 4:35 pm

If you could post a OSCAR report that would be helpful to assess the degree of her leakage as well the apparent ineffectiveness of her treatment. (Referring to your statement that her saturation was restored AFTER she stopped treatment, "her oxygen level did rise quickly once she took the mask off and had a few deep breaths.")
Is she unable to take a deep breath with the mask & Machine on?

My apologies if this request was covered previously.

Thank you for the reply.

I am not sure what OSCAR is? I am very new to the CPAP world sorry, all I know how to do is change the water in the humidifier tank, clean the mask/tubing and turn it on and off haha.

I do believe she can breathe properly with the mask on, as it has definitely been improving her so far (previously she was being re-admitted to ICU approx. every 2 to 3 weeks with type 2 respiratory failure (extreme co2 build-up).

After her 3rd trip to ICU they agreed that she could not wait for a proper sleep study etc. to be done (currently booked for January), and put her on BI-PAP support, so far it's been 6 weeks and no trip to ICU and he has seemed more like her old self and has better skin complexion etc, so it does seem to be benefitting her.

Prior to using the BIPAP machine in hospital, her oxygen saturation fell into the 70's and 60's when she woke in the morning, with blue fingers and blue lips etc.

It's just this past week since being at home that I have noticed the huge leak issues etc. and have been trying to fix them, my guess is she probably had the mask leaks in hospital also but the staff were not aware or not experienced enough with the machines to identify what was happening.

Although I am noticing the leaks by sound & feeling around the mask, is there any way to see the leak rate on the machine itself to get an actual number to reference from? Her BIPAP machine is a Philips Dreamstation.

Thanks!

Zaiforce wrote: ↑

Mon Dec 18, 2023 6:47 pm

is there any way to see the leak rate on the machine itself to get an actual number to reference from? Her BIPAP machine is a Philips Dreamstation.

Thanks!

Links to the excellent, free software Oscar are in my signature. Feel free to ask questions while you are learning it. We can help you interpret the results. Data is very important.

So an interesting development...

The knightsbridge chin strap I ordered for mum arrived yesterday so we tried it last night instead of the soft cervical collar.

It didn't manage to keep a good seal, her chin still dropped significantly causing large mask leak around the bottom of her mouth, probably due to us not having the chin strap up tight enough.

Weirdly though, when I entered her room around midnight to adjust the chin strap and mask for her, I tested her oxygen saturation and it was 93%, which for her is amazing (due to her COPD her oxygen saturation while awake is only 88-90% usually), so despite the big mask leak, her oxygen was going great, so I decided to allow the leak to remain and let her continue sleeping.

I entered her room again at 3.00am when I heard the mask leak getting even worse (the corner of the seal was actually in her mouth, leaving a huge hole), and tested her oxygen saturation then also, it was hovering between 87-89%, again pretty good for her considering she was only just woken up! Again, I allowed her to continue sleeping based on the oxygen being fine.

I tested her oxygen saturation again this morning when she woke (BIPAP mask still on and running) and her oxygen was 92%.

It is really perplexing to me that although the soft cervical collar provided a much better seal, her oxygen saturation seamed to be worse (her saturations upon waking up in the morning while using the cervical collar were 90%, 90% & 81% the past 3 days).

I have a theory, that although having a good seal is ideally the best scenario and obviously better than having a poor seal, achieving that by keeping her mouth mostly closed is a detriment to her, and that letting her mouth open widely for breathing seems to benefit her more than having a better seal with a more closed mouth.

It is going to take more investigation, and to be fair I did not take her oxygen saturation readings during sleep whilst wearing the cervical collar, only upon waking in the morning.

Ideally, I need a full face mask for her that allows her chin to fall open and still maintain a seal, but that seems impossible, and is definitely impossible with her F&P Evora full face mask.

The seal is still important as the reason she is on BIPAP therapy is to help her ventilation and remove co2 from her system, and her respiratory specialist told us the seal is important for her, but forcing her jaw mostly closed via whatever method used seems to actually cause more issues from my early analysis.

I am going to purchase her the F&P Vitera full face mask in the near future and trial that, in the mean time, based on her good oxygen saturations last night, I am reluctant to go back to using a method that mostly closes her jaw and will just let her sleep with the leak and her mouth open wide for good ventilation.

If it helps for analysis, her BIPAP pressures I believe are 10 exhale, 22 inhale, her inhale pressure is quite high.

The main reason she is on home BIPAP therapy is obesity hypoventilation syndrome, which has forced her into type 2 hypercapnic respiratory failure and ICU admission 3 times, each time it happened she had woken up hypoxic with blue fingers and lips the morning prior and had very highly elevated co2 levels (up to 114 co2 in her blood last time) and each time it was successfully treated in ICU with BIPAP therapy.

Apologies for such a long post.

It would be best if you used a recording pulse oximeter. Here is a list of ones supported by OSCAR - https://www.apneaboard.com/wiki/index.p ... _Oximeters

I favor the Contec CMS50F Wrist-worn Pulse Oximeter - https://www.amazon.com/Contec-Wrist-wor ... ref=sr_1_7

Maybe someone who has shopped for one recently can make a better recommendation. I think there might be some cheaper ones that are satisfactory.

ChicagoGranny wrote: ↑

Tue Dec 19, 2023 7:42 pm

It would be best if you used a recording pulse oximeter. Here is a list of ones supported by OSCAR - https://www.apneaboard.com/wiki/index.p ... _Oximeters

I favor the Contec CMS50F Wrist-worn Pulse Oximeter - https://www.amazon.com/Contec-Wrist-wor ... ref=sr_1_7

Maybe someone who has shopped for one recently can make a better recommendation. I think there might be some cheaper ones that are satisfactory.

Thank you

Are they more accurate with readings? Or does it just save you needing to remember the times?

It would be helpful, as I have been recording them all on a notepad to show her respiratory doctor in January, I might grab one of these

My doctor recommended the EMAY brand, as this is what is what is used in his office.
I purchased the EMO-80 for about 40 bucks a year ago. What I like about the most is that it takes readings each second and records them for display the next morning. You can even export the data to see the second by second readings. But it is not yet supported by OSCAR, however since you are not using OSCAR, that is not an issue.

While I can only tell you about my specific Oximeter, I compared it with the cardiac monitor at the hospital while my wife was a patient. It tracked the hospitals monitor within 1 unit over a period of a couple of hours. I was satisfied.

Here is an example (during the hospital test)

Tec5 wrote: ↑

Tue Dec 19, 2023 9:11 pm

But it is not yet supported by OSCAR, however since you are not using OSCAR, that is not an issue.

But, he may want to use OSCAR in the future. It's best to get an OSCAR-supported device now.

Yep, but for an inexpensive Oximeter. It’s hard to beat. Some day the Oscar folks will figure out how to read the CSV file from this device.

Just another quick question if that's ok...

My mum's machine is a Philips Dreamstation BIPAP machine, I was doing a bit of reading about the machine and I read that it's max IPAP pressure is 20?

Yet, when my mum is wearing the mask her EPAP pressure is always 9.9 or 10 and her IPAP is usually 22 to about 22.7, so I am not sure why the machine specs say its max IPAP is 20?

I thought her pressure settings were 10/22 but perhaps I was wrong and they were 10/20 and the extra 2 the machine is pushing out may be to account for mask leakage? (She does get a lot of leakage).

Do machines ramp up pressure above their set pressures to try and negate mask leak?

Sorry for these possibly dumb questions, I am just new to how this all works.

Thanks all

Zaiforce wrote: ↑

Sat Dec 23, 2023 6:01 am

I was doing a bit of reading about the machine and I read that it's max IPAP pressure is 20?

Don't know where you read that but all Bilevel machines have a max IPAP of at least 25 and some specialty models have a max IPAP of 30.

So the Dreamstation Bipap machine will go at least to 25 IPAP.

Zaiforce wrote: ↑

Sat Dec 23, 2023 6:01 am

I read that it's max IPAP pressure is 20?

Here are the specs as downloaded by Philips.

Default Machine Settings: 4-25cm H2O

https://www.cpap.com/productpage/pr-dre ... to-machine