Implications of turning machine off & continuing to sleep?

What are the implications/consequences to someone wearing a chin strap and a nasal mask who turns the machine off and continues to sleep with the mask?

I'm by no means an expert, but logic tells me that with the mask and chinstrap on, drawing only available air at a reduced rate due to sucking it in through the nasal pillows, you would almost certainly have more events than you would without the mask or machine.

It would be interesting to see the data from an oximeter during this 'experiment'.

Cheers,
xena

SleepingUgly wrote:What are the implications/consequences to someone wearing a chin strap and a nasal mask who turns the machine off and continues to sleep with the mask?

Was this intentional, accidental, or a theoretical question?

Accidental. My son. Woke us wearing the mask at 4am saying he had a headache. Data shows no data between 12:20am and 4am. We bought a UPS so this sort of thing wouldn't happen!

SleepingUgly wrote:Accidental. My son. Woke us wearing the mask at 4am saying he had a headache. Data shows no data between 12:20am and 4am. We bought a UPS so this sort of thing wouldn't happen!

Oh, I understand now. I think the only implications are that there is no therapy, no positive pressure during that time, so he would have the apneas, hypopneas occurring that he would have when not on the cpap therapy. Also, you would have no recorded info about the events since the machine was off.

I was thinking about you and wondering how your son was adjusting.

SleepingUgly wrote:What are the implications/consequences to someone wearing a chin strap and a nasal mask who turns the machine off and continues to sleep with the mask?

If the hose is still attached, he will be rebreathing his exhaled air. Apart from the loss of pressure and the return of apnea, there will be decreased O2 and increased CO2. It will be worse than simply not doing CPAP.

In theory, he should open his mouth before suffocating, even with a chin strap, although the instructions on my Respironics chin strap warn of suffocation risk.

With someone else in the room watching you, try it yourself. Put on your mask and hose. Disconnect the other end from the machine and breathe through the nose for a while. Have someone else nearby in case you pass out. Don't wear a chin strap.

What machine does he have? Can you set it to autostart?

I wish it were easier to find an anti-asphyxia valve that fits on the mask end of the hose. Hospitals use them, but I can't seem to find them available online.

I hope your son is okay and only suffered a headache. Bless him.

He has the S9 Autoset. I can set it to Smart/Auto Start. The problem is that I don't want to enable Auto Off. I'm afraid the machine won't detect his breathing and will turn off. It's a possibly irrational fear based on the doctor telling us never to use APAP with young children, as children have died on APAP because the machine doesn't reliably detect their breathing. So I'm just worried that the machine will turn off and we'll be in the same place.

SleepingUgly wrote:He has the S9 Autoset. I can set it to Smart/Auto Start. The problem is that I don't want to enable Auto Off. I'm afraid the machine won't detect his breathing and will turn off. It's a possibly irrational fear based on the doctor telling us never to use APAP with young children, as children have died on APAP because the machine doesn't reliably detect their breathing. So I'm just worried that the machine will turn off and we'll be in the same place.

On the PRS1, I can enable Auto On without enabling Auto Off. Does the S9 not allow you to do that?

archangle wrote:On the PRS1, I can enable Auto On without enabling Auto Off. Does the S9 not allow you to do that?

The S9 does not have a separate setting for that. It has only "SmartStart" (which can be enabled or not.)

Tami, on page 21 of the Provider manual I have for the S9 Auto (and Elite), it says this:

"If you enable SmartStart, the patient’s device will start automatically when the patient breathes into the
mask and stop automatically when they remove their mask."

A huge leak would look to the machine as if a mask had been removed, so it might stop if the leak was enormous... but... if the person moved the mask even just a little to lessen the leak, the machine would sense a difference in airflow and would start up again. The person wouldn't necessarily have to wake up and deliberately move the mask. Just getting restless and moving in sleep might shift the mask a bit and change the "leaky" airflow enough to make the machine start up again.

At any rate, since your son is wearing a nasal mask, not a FF mask, he'll be able to breathe through his mouth in his sleep (even with the chin strap on) and isn't going to suffocate. He could have apneas, sure, if a leak from a dislodged mask is bad enough that he's not getting full therapy, but hey... he was getting those for many years before he was on CPAP. So...one night or an occasional night of a leak to the point of machine shutting off will pale in comparison to the many nights of good therapy he's getting now.

SleepingUgly wrote:The problem is that I don't want to enable Auto Off. I'm afraid the machine won't detect his breathing and will turn off.

The ResMed machines I've used, including the S9 Auto, are extremely sensitive to the slightest airflow from the person. I don't think you need to worry about it "not detecting his breathing." I'd turn SmartStart on for him, if it were me.

archangle wrote:On the PRS1, I can enable Auto On without enabling Auto Off. Does the S9 not allow you to do that?

The ResMed S9 doesn't have separate settings for that.


SU, on page 21 of the Provider manual for the S9 AutoSet (and Elite) it says this:

"If you enable SmartStart, the patient’s device will start automatically when the patient breathes into the
mask and stop automatically when they remove their mask."

Every ResMed machine I've used, including the S9 AutoSet, is extremely sensitive to picking up on airflow coming from the person. I doubt the machine would have any difficulty sensing your ten year old son's breathing.

You asked about the implications of the machine turning off and the person continuing to sleep... person is wearing a nasal mask (not a full face mask) and a chin strap. I'd think the person would begin breathing through the mouth (even with chin strap on) when they felt a need for more air than they were getting through the vent holes of the nasal mask. And/or wake up, as your son did.

I'd turn SmartStart on for him, if it were my child... so the machine would have a chance to sense airflow from him and start blowing again.

msradar65 wrote:I was thinking about you and wondering how your son was adjusting.

Thank you. Until last night we haven't had any incidents of the machine being off, and thankfully he doesn't remove the mask. However, there are sometimes leaks, and in the 3+ weeks he's been on CPAP, he's woken up in the middle of the night with stomach aches. Sometimes he wakes with other complaints, like sore throat. He has a fair number of centrals on his data, and I don't know how many of those are arousals. So I don't know how disruptive it may be to his sleep. In short, while not perfect, his adjustment is pretty good considering what we could be dealing with. Unlike his CPAP-failure-of-a mother, we have him at his prescribed pressure. He probably needs 10cm, but they wanted us to use 9cm so that he'll tolerate it, and he is tolerating it. He's such a trooper. He never argues about it, and *I* know it is not fun to strap on a chinstrap and a mask, and yet, he doesn't complain. He is really a great kid.

Ask the doctor about the auto on auto off. See if the the Auto On responds to your son's inhalation.

Look for ways of protecting the on - off button from your son by covering it: for instance, find a way of hiding the button with a paper cup which is strapped down with velcro whatever it is the machine is sitting on.

Ask an electrician if s/he can can create an a alarm system that will go off when your son turns the machine off - one that goes off in your room, and can be turned off by yourself in the morning.

We have a sports water bottle with a spout by his bed so if he is thirsty, he can get a drink without taking the gear off. I think between the overhead fan and whatever air comes out of the mask just from him breathing, he got confused and thought the machine was on and went back to sleep that way. I guess we'll wait and see if it happens again. Meanwhile I've enabled Smart Start on my machine and I'll mess with it myself, hold my breath, etc. and see how it works. If there's something wrong with his machine, how do I request one that doesn't have data skew?! Both his and mine have that problem.