CPAPtalk.com

TCLynx wrote: ↑

Sun Aug 04, 2024 10:39 am

When I test the mask or adjust the pressure higher though he doesn't like his cheeks inflating. (He notices it at a pressure of 7 or above.)

Regarding the chipmunk cheeks, I read about someone overcoming the situation by inserting some gauze between the straps and the cheeks.

https://www.reddit.com/r/CPAP/comments/ ... heeks_win/

Now I still had the chipmunk cheeks problem. Side note, my husband had a procedure that required him to change a dressing with gauze. I suddenly thought about stuffing gauze between my cheeks and the face straps. It worked. I finally was able to sleep through most of the night. I don't know why I never thought about that. I'm a nurse and I use gauze all the time. Tomorrow at work, I am going to get split gauze because it is softer than regular gauze. But they also sell it at most drug stores!

The F & P 431 flex fit pack came in the mail yesterday!!! So based on the other mask the tech fitted last Thursday, I put the large seal/pillow on it. We tested out the fit and seal a bit in the afternoon and then he used it last night.

So here are the images

Looking at the whole time he wore it, not perfect but better than before. I guess we may need to do a better job of shaving since his chin is covered in stubble. I think we need a better electric shaver for him. (He has had facial hair most of his adult life only being clean shaven for about 10 years before I went to college before he let it grow back. We trimmed it off to make dealing with a mask easier but he hasn't been initiating keeping it shaved so I've been doing it and it isn't something I'm good at.

Here is that section of the night with minimal leaking

This was after he went back to bed on his right side instead of his back. At the end he did roll back onto his back and then it appears that he pulled the mask off in his sleep at the end. Perhaps not actually asleep but before things got really bad (back when he was still getting some rem sleep) I believe he had been sleepwalking at times. Or having sleep hallucinations as he woke up.

Looking at the part of the night with no significant leaks: he's getting obstructive events when the pressure drops. Check the prsessure for each obstructive event and try raising the minimum just a bit above it.

37.4% of the night over leak redline is not good - and I doubt that much leak is caused by facial hair.

Are you fitting the mask when he's lying down? Are you using Resmed's "Mask fit" test?
Look for manufacturer's videos about mask fitting or troubleshooting leaks.

He's got a pretty sizable baseline leak even in the time with not so much large leak.
Hard to see it with the scale being used.
Go in and change the leak reporting so it isn't fixed scale. Change the y axis to "auto fill" or "override". That way you can see the reline easier and more clearly.
To change the y axis...using OSCAR go down to the leak graph and put your mouse over the words "leak rate" on the left side of the leak graph and then right click your mouse. From the menu that drops down choose "y axis" and expand it and change it out of "defaults".

See how my red line is shown much more clearly here.

Pugsy wrote: ↑

Fri Aug 09, 2024 9:54 am

Change the y axis to "auto fill" or "override". That way you can see the reline easier and more clearly.
To change the y axis...using OSCAR go down to the leak graph and put your mouse over the words "leak rate" on the left side of the leak graph and then right click your mouse. From the menu that drops down choose "y axis" and expand it and change it out of "defaults".

it already is set to auto fit.
Problem is when he has really large leaks they are like over 100 lpm and that has been happening regularly.
I'm taking one small win at a time, he was below the large leak threshold for almost half the time he wore it, that is a HUGE improvement over most of the past 2 1/2 weeks.

ozij wrote: ↑

Fri Aug 09, 2024 6:55 am

Are you fitting the mask when he's lying down? Are you using Resmed's "Mask fit" test?

We are checking the mask and adjusting it after he is lying down. And I did do the mask test yesterday when I first tested the fit on him. adjusting the bottom straps and then the top ones and then the crown strap.

ozij wrote: ↑

Fri Aug 09, 2024 6:55 am

Looking at the part of the night with no significant leaks: he's getting obstructive events when the pressure drops.

He had actually rolled onto his back right near the end of the session and that I believe is when the OA happened. On a different night when he had minimal leaks when I had him in the house because of the storm, he was still getting OA events even with the pressure up over 9 when he was on his back. As in, I don't think his prescribed max pressure of 10 is going to stop obstructive events when he is on his back and when they tried to take the pressure higher in the titration study, the centrals got even worse. As in if we can get the leaks under control for long enough that the doctor thinks there is enough data he can analyze, then I kinda expect that they are going to drag him back in for another titration study on ASV methodology. We can largely mitigate the OA events with positional therapy (though it is kinda tricky since the mask seems to make him less comfortable getting onto his sides.)

TCLynx wrote: ↑

Fri Aug 09, 2024 11:42 am

it already is set to auto fit.

Try changing it...maybe over ride choice will work. Play with your own parameters.
Either that or make the leak graph much larger. When the red line is down almost on the 0.0 line (visually anyway) it makes for a much more difficult evaluation of leaks.

Ok I was actually able to upload an image today.

Definitely still not perfect but when he woke up around 3 am (2 am on the graphs) he said he felt like he got some good sleep. I wonder what he will say if he actually really does get good sleep?
Anyway, most of the night was below the Large Leak level but this F&P 431 mask is leaking around his chin a little even when I think I have it adjusted about as good as I possibly can as soon as he moves. And yes I have tried the mask fit and had him lay down then sit up so I can adjust it then lay back down to check it etc.
I'm kinda at a loss what to try next.

So I called the DM Supplier and left a message. They apparently have had to farm out the respiratory techs returning phone calls because I got a call back from some one from another state. His recommendation was to just keep trying basically. And you should probably switch back to the Vitara Mask and just keep trying to re-fit it and practice putting it on during the day.
Sigh. Not much help there.

ack the internet ate my post!!! I had just written up a post and hit submit and then it tells me I need to log in and the post is gone. I was logged in!

Monday with the Vitera Full Face mask


Then Tuesday with the fisher and paykel HC431 with mask liner

I don't think the mask liner was big enough for the Large mask but I had hoped it would help with the leaks around the chin. But he slept so long last night that I'm trying it again seeing as the AHI was pretty low for him.

I sent a message to the sleep Dr asking them to look over the data and please help. Now they want me to schedule an appointment via telehealth or go into the office. I'm not sure what they are going to be able to do via telehealth other than maybe adjust the settings?

Well that didn't really work.

Ok, so Thursday we had an appointment (telehealth) with the sleep Medicine Practice and they recommended that perhaps we need to try a nasal mask and chin strap since we don't seem to be able to keep the full face masks from leaking real bad. They also adjusted his settings to a Min of 4 and max of 8 thinking that perhaps the higher pressures were contributing to larger leaks. Also she recommended one of the masks that has the frame tubes running up to the top of the head so the tubing is out of the way and less likely to pull and break the mask seal. So Monday the Equipment supplier will be bringing some nasal pillow masks to try.

Interesting that the new settings didn't seem to actually kick in until the middle of the night Thursday?


And then here is Friday


Used Vitera Full Face with new settings for those two nights. Leaking was better but he didn't use it for very long either night and was rather confused Both Mornings.

I was thinking that maybe I should go in and change the EPR to a lower setting or perhaps even disable it?

Ok Still using Vitera Full Face with new settings.

Saturday New Aide helping him


Sunday My night to help him all night.


So last week talking to the Sleep Medicine practitioner they think an AHI of 8 would be good enough for him. Not sure if that means an overall AHI of 8 or if they mean an AHI of 8 for each type of event would be good enough. They won't really take action of Unclassified events other than to tell us to work on getting a better seal. Well last two nights in a row we had a pretty darn good seal for him. And still having enough OA events that I don't feel like the cpap is really helpful for him especially when he has always had more CA events than OA events. And the mask makes him less comfortable rolling onto his size which generally does just as much to reduce his OA events as the cpap does.

I think by far the best numbers we have seen was the night I had him sleeping on the couch in my Living room because of Storm Debby. Has anyone here greatly improved their apnea by changing their bed? I don't know how feasible it is to give him a new bed right now since he is living in a trailer (we live in a little apartment in the Barn) but we are in the process of building the house and when we get to move in (hopefully before the end of the year) we will need a new bed for Dad and I'm wondering what might be best.

They brought a nasal pillows mask for dad today and he will be trying it with a chin strap tonight.

Well this sucks. This is how he did his first night on the Nasal Pillows.


Any recommendations? When we put it on him he is constantly asking what he is supposed to be doing. We keep telling him just breath normally and go to sleep. And now I'm adding keep your tongue in the roof of your mouth and keep your mouth shut and breath through your nose.

He did complain of a runny nose this morning so I'm going to start having him use flonase again and perhaps I need to back the humidity back down to 4 (we had set it to 5 after he complained of dry mouth with the full face mask early on) but since we managed to improve the seal with the full face mask the other day I think it was too humid and dripping on him.

So do we need to give this nasal pillows mask a longer try or is he better off going back to the Vitera Full Face where we maybe got the leaking a little under control this past weekend and the AHI was at least below 30.
I really need him to have a better night tonight since I can't be home with him tomorrow.