(03-11-2015 07:18 PM)suedanem Wrote: Her CA index is a fairly consistent 5. Once in a while it goes up to 7 or so or as low as 2. One night several weeks ago, I turned the max pressure down to 13 cm H20. Her AHI went up to 33.3. OA index = 27.4, CA index = 4.8, unknown = .6 and H = about .4
She has been sleeping with a backpack full of towels and tennis balls so that she can stay on her side. She does pretty well on her side. Definitely, if she rolls over onto her back, the OA goes up.
She tried pillows (P10) a couple of times and really hated them. She uses the full face mask because she is occasionally a mouth breather. She uses a homemade chin strap.
One of the problems we have had is that her head and face are very small (she is 5'2" and weighs barely 100 lbs). My feeling is that the F10 just doesn't fit her face. But, given the cost of full face masks, it's been hard to figure out which ones to order. Can any of the ladies that have very small heads/features make any recommendations for a small mask/headgear?
A bi-level machine will definitely make it easier to breathe in and out.
It is common to prescribe bi-level machines when the patient needs pressures higher than 14 or 15 cm H2O.
There are manually-adjusted bi-level machines which use "S" (which stands for "Synchronized to patients natural breathing rate") therapy mode or Auto bi-level machines which automatically adjust pressures to eliminate obstructive events, similar to how an APAP self-adjusts its pressure.
Similar to APAP versus CPAP machines, an Auto bi-level machine will allow choice of the "S" (manually adjusted, with fixed EPAP and fixed IPAP) therapy mode or the "Auto" (self-adjusting) mode, but an "S" machine can only be used in "S" therapy mode or (like all CPAP machines) in basic fixed-pressure CPAP mode.
I think your mother needs a bi-level Auto machine, such as the Philips Respironics System One BiPAP Auto with Bi-Flex (ask for the version with Heated Tube).
Compared to ResMed machines, the PRS1 BiPAP Auto raises the pressure more gradually. It also has more adjustability than the ResMed AirCurve 10 Auto has.
With bi-level machines, the higher the Pressure Relief (Pressure Relief is the amount of pressure difference between EPAP and IPAP), the easier it is to inhale and exhale.
A likely issue with bi-level treatment, however, is that bi-level treatment can cause a higher number of Central Apneas to occur. For example, many have reported that their Central Apnea Index is much lower when they lower the EPR setting or Pressure Support setting.
What is waking up your mother when the pressure gets to 20? Is it mask burping/fluttering/leaking, or is it just that the high EPAP is too hard to breathe out against?
I use a mask liner from RemZZZs with my ResMed F10 FFM, otherwise I cannot sleep because the without a liner the mask needs to be uncomfortably tight in order to stop mask burping.
Everyone hates mask liners because the liner tends to touch the eyelashes, with is very bothersome, but after being put on (and the mask put on) one can gently push or pull or fold the liner away from the eyelashes toward the bridge of the nose, so the liner will not touch the eyelashes. Also, it is always important to install the liner so that the portion on the nose bridge curls slightly toward the mask, not toward the face (and eyelashes).
Use of a mask liner allows the straps to be less tight without bothersome leaking. A small portion of the leaking is still there (only a little) but it is not bothersome, because there is no mask burping.
RemZZZs recommends using a fresh new liner every night, but I have no problems using one liner for a week, as long as I do NOT follow manufacturer's directions to pull and stretch out the liner so that it will curl away from the face (and eyelashes). I minimize pulling and stretching and merely gently move the liner away from my eyelashes. But after about a week the liner has become too stretched out to use again without laundering and pressing. To wash used liners, one should use a small mesh laundry bag meant to hold small or fragile items which otherwise may get eaten or damaged by the washer if not put in a containment bag.