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[CPAP] Strange flow patter and results
All I know is that her sleep study showed and AHI of 98. I don't want to make any changes to her clinical settings, only what is available in the user menu. Here are a couple of more close up shots. The reason I am per suing it is because at one stage she was able to only get up once a night for the toilet and now has to get up 4 times. She has a F&P Eson 2 mask.

[Image: Dor6.jpg][Image: Dor7.jpg]
Do you have any idea what her cardiac health is? That second figure is Cheyne Stokes Respiration. It's interesting stuff, but she really needs a BiPAP that provides pressure support for inspiration, and low pressure for exhale, to take the work out of breathing. She may well have had an AHI of 98, but if was central apnea, the CPAP won't do a thing. This is an individual that needs a respiratory assist, and fixed pressure can't provide that. It can improve oxygenation if she is breathing, but I suspect if you put an oximeter on her it would be alarming.
Let's try another tack. I have a 93 year old mother in law who is remarkably healthy for her age, but as one gets into their 90s there is not much expectation of long term health, and doctors accept results that they would not accept in younger people. If her primary physician is more of an advocate for her health, then these results could be shared with him at her next appointment. You mentioned doctors that thought this was better than nothing, and I don't know if that was a sleep specialist or what relation to her healthcare that person has. This needs to be presented and discussed with a physician who is an advocate for her health. With no improvement whatsoever, I would still think adding supplemental oxygen to her CPAP is likely to be beneficial. Her CPAP results are not acceptable, even for the small fraction of the night that the machine cannot detect breathing. Those blackout periods are so acute in terms of lack of respiration and volume that it just should not be ignored. The typical sleep doctor takes the minimal information transmitted electronically through the DME to judge the efficacy of the results...he's not seeing this. His opinion was based on very incomplete information.

I did have a good look at the mask yesterday and the diffuser looks quite dirty. The carer has not been following the recommended cleaning process. Could a semi blocked diffuser cause any of these problems? I have spoken to the provider and he says the problem is how she wears the mask. I had a good look at her before she went to sleep and the mask seems well fitted. A lot of the problems arise from the fact that these machines are provided by the health dept for $50 a year. But they are short of money and resources. Some of the work is provided by a commercial cpap provider, but I suspect they get next to nothing from the government so they are not too interested. The 3 specialist doctors are extremely overworked and it is hard to get an appointment in under 2 months. She has had a history of heart problems. One of them is that she has a bovine valve that has a life expectancy of 10 years and has been in there for 18. She is only a friends mother, I will pass on the recommendations. I was hopping to find a easy solution. I greatly appreciate the input here. Thank you.
You can always offer to clean the mask and tubing. It's no different than offering to dig the ceruman out of a hearing aid. Older people cant see well and often need help with these maintenance tasks. I don't see anything that points to the diffuser as a problem, nor the way she wears teh mask. There is no evidence of a large leak in the data provided, and I think the specialist or supplier is misinterpreting the BND as a leak...it's not. I gave you as easy solution as possible with the limitations of her equipment. Her problem is abundant central apnea and periodic breathing. As a very old woman with a weak respiratory system to begin with, her pressure is too high. A lower pressure would hold her airway patent without the exhale breathing resistance that may be contributing to the centrals. Keep in mind, she more resembles a pediatric patient than an adult. Change the pressure to 6 and observe if things are improved or not. Bilevel would be better as mentioned before. Otherwise, assisting with hygiene would be a huge help, and I'm sure appreciated.
Bruce, I think this has got to the point where this forum really can't offer you much more advice. Your friend is a very old, very sick lady. If the machine outputs are to be believed, she needs urgent proper medical intervention. We can give general advice about sleep apnea but this case goes far beyond that, as SleepRider has pointed out several times.

We don't know her particular circumstances, but perhaps a referral to the Tasmanian Health Service department of gerontology would bring together the necessary experts to review her situation and prescribe an appropriate course of action.

I'm going to close this thread now, as it has gone well beyond what we can offer as an apnea self-help group.
Apnea Board Moderator



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