Dori's Husband

Here are some of Dori's husband's daily details. I ahve given her some thoughts but want others here to tell her what they think about the data. I posted the last 3 nights (I think!) and some random ones she sent me via email.
She is unfamiliar with Photobucket so I'm posting for her. Any comments most welcome!
Thanks!
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I'm bumping this up since it's getting lost in the list!

Thanks.

That's mighty nice of you Hawthorne

So just to recap, I'm not sure what we're looking for here... Doris are you looking to "tweak" the therapy, or are there still major issues besides the large leak rate? I mean, is he still feeling very tired, is he awakeining at night, ... what are the main issues you're worried about?

All in all I think the charts look pretty OK , except for the leaks. Leaks are always difficult with full face masks, but then it might be time to try a different one? The average pressure seems to be quite variable - but that could be due to the leaks... or to congestion?

As far as the Mac's silicone - just roll it into a snake and put around the mask where the interface touches/leaks with hubby's face. Also be sure to wash the mask daily with mild soap (not antibacterial, etc) and/or vinegar, and sometimes washing the face before going to bed also helps (in my case I find an oily face gives a better seal so I don't wash my face before bed )

I guess I should mention here that I randomly picked some good and some not so good nights from the reports that Dori sent me. I did post the last 3 nights reports as well as some earlier ones.

I thought the leak rate is a problem except for a couple of the nights that I posted here. On many of the nights (that I did not post) his 90% was at 15 cm which is his top pressure and his leak rate was worse. The VS was way high on many of the earlier reports as well. As I looked at reports from back to Oct. 10, the leak rate has improved but is still not great. The VS has improved a lot.

I'm thinking it might be good to open up the top to 20 cm and maybe raise the minimum, since he was titrated at 13cm. His minimum is currently at 11cm and maximum at 15cm.


I believe that the masks were changed at one point since he started therapy. I'm not sure when that was. Maybe Dori can fill us in on that. Both were full face masks.

He started with a nasal mask during titration and was switched to a full face during the night because of mouth breathing.

I posted so that she could get other input on what might be done, I would think particularly about the leak rate and any tweaking that might improve therapy.

Thanks for the additional info. I think it will do no good to start changing the pressure until the leaks are under control. Assuming the mask is adjusted correctly and they've tried the Mac's solution, I would suggest to go hunting for a better-fitting mask. IMHO...

BTW what's VS?

The AHI #s look good. But the leaks still need work. Even if the leaks aren't causing the AHI to go up(Machine will compensate for some leak), The leaks could be disturbing his sleep leaving him feel unrested in the morning. I agree with Echo, gotta get those leaks under control first. Once the leaks are fixed then look at pressures and possible changes.

Brenda

VS is "Vibratory Snore".

I agree that the leaks appear to be the major problem right now. A better fitting mask may help a lot. Then we can tweak from there.

Dori mention maybe trying a nasal mask and a chin strap. I, personally had no luck with chin straps at all.

I never had any luck with a chin strap either. If Dori's husband isn't willing to use tape or poligrip(if the chinstrap fails) he will need a full face mask that fits well. Everyone should have at least one FF mask that works for them anyway.

Brenda

I've been using the pap-cap in combination with a FFM and I've found it helps keep my jaw from dropping. The jaw dropping was causing a LOT of leaks. I leave it a bit looser than you normally would, so that way I can still slightly mouth breath in case I'm congested, but it keeps my jaw from dropping so much that it dislodges the mask. YMMV.

The chinstrap and pap=cap are completely useless for me when it comes to a nasal interface. I can still leak like there's no tomorrow unless i tape my mouth completely shut.

p.s. I thought he WAS using a FFM??

Yes, he is using a full face mask. Dori was wondering about a nasal mask and chin strap since he is having trouble with leaks and the full face mask. I guess they have to find the right full face mask for him or maybe try the combo you use, echo - the pap-cap and the full face mask.

There's obviously a connection between leak and pressure. My Quattro has a "base leak rate" of 48 when the pressure is 16. My question would be, is the leak the cause of the pressure increases, or the effect? Could the leak rate increases be normal for the higher pressures?

Just wondering.....

A higher pressure will have a higher exhaust rate. But these are not straight lines, they are jagged up and downs. Since the AHI is good, it seems that the sounds of the mask leaks may be what is causing arousals and preventing a good nights sleep. A well fitted mask should be able to withstand the pressure range being used in this case and keep a good seal.

Brenda

Thanks to all who replied, and a special hug to Hawthorne. Mike's a mouth breather, so he started with a FF from the beginning, ComfortGel, could not get a good seal, and nose got banged up, then switched to the UMFF and it got a little better, but still leaking. We tried the Mack's tonight for the first time, and will update you on that. He turns a lot from side to side, so that doesn't help. I also think I'm fiddling around with the flex settings too much. I know it's a personal comfort level, but Mike doesn't give me much feedback on anything, he's a little "foggy", age related, I was told by Dr, so I'm flying blind on all levels so to speak. He does seem more rested and alert, fewer naps and stays up later at night, so there's been improvement. We have a followup visit with our sleep doc on 11/6. Again thank you for your help and I welcome all suggestions and opinions. I certainly don't have too many myself. Dori

When he naps, is he napping with his machine?

Is the hose routed up and over his head? If he's moving a lot from side to side, and the hose is simply resting on the bed covers, it could be that the hose is pulling on the mask causing leaks.

I have mine attached to a rope that hangs from the ceiling (no, really!)
Others use various different contraptions to hang the hose up, e.g. plant hanger on the headboard, etc.
Check out this set of links collected by RestedGal, on hose management: viewtopic.php?f=1&t=10640