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Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
#1
Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
I did some searching but didn't find this question. If I missed it please point me to the discussion or the best search terms and feel free to delete this thread.

My father is in his nineties and has snored as long as long as I can remember. He has also always taken a nap in the afternoon and fallen asleep in the evening in his recliner. He also was often up at all hours. 

Is seems ridiculous that it didn't occur to me earlier that he may have sleep apnea. I have been using an AirSense10 every night for several years now. With COVID19 and his age I'm not eager to encourage him to go anywhere. Both my parents have been staying home for months.

I'm wondering if it is a reasonable idea to loan him my AirSense10 with it's Autoset function just as a diagnostic test? If it indicates that he does infact have sleep apnea we would go about figuring out how to get him evaluated in the safest method.


I understand that sleep apnea is serious and there is very real danger is self treatment but that is not what I'm suggesting. There is also real danger in both him being untreated and him potentially getting exposed to COVID. 

1) Can the AirSense 10 Autoset be set to just measure. For example can it be set to zero or very low pressure. 

1.A) If it is set to zero does it compensate for the slight increase in back pressure that is cause by the mask it's self?

2) Should we just set it up for while he is taking an afternoon nap? So we can watch him? 

3) If something goes wrong what would it be? Would be stop breathing (which he may have been doing every night of decades) 

4) Couldn't we just wake him up?

5) IIRC wasn't the Autoset feature on the AirSense 10 studied and found effective and safe?

Thanks in advance for any advice.
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#2
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
You can set it for 4 (lowest it will go) and 20. Use OSCAR and see if there is apnea detected. It may be helped by the 4 setting but if it is very minor apnea. It will show the increase in pressure when he needs it and that would show apnea. He will have no problem (any more than normal sleep) using the cpap. The settings will not do a lot to help him if he has significant problems and Centrals but it will record them.

Again no problem with him using the auto cpap. Just be sure you have a card in the machine and download the results to OScAR. If you don't you will know nothing other than what he says about the nights sleep.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
First, there exist these days take-home sleep study equipment that is not terribly expensive. They're not as good for finding the unusual types/causes of sleep apnea as a study in a real sleep study center, so many sleep therapists don't like them, but others do. For your father I'd bet that such a take-home sleep study might be just the ticket. And then the interview with the sleep specialist can be virtual, so maybe he won't have to leave home at all.

You can also use your Autoset for the titration, although it won't be as effective as equipment designed for a sleep study. I don't think it can be set to just measure; when it is on it always blows some air. If you do use your Autoset, I would recommend setting it to its minimum and maximum pressures (4cm - 20cm H2O). And you can use OSCAR to view the results.

But you also need a mask, and for that you can just use your mask or if you have more than one mask lying around take them all to him so he can see what he likes best, with your assistance, of course.

And I think that doing the sleep study during his afternoon nap might be a good first step. If it indicates no sleep apnea, then you're done. If there are events then you can move up to a longer time or overnight. During my first sleep study in a full sleep lab I actually slept only an hour (hard to sleep away from m own bed), but it was enough for the therapist to diagnose me with severe obstructive sleep apnea. Longer times might be useful for diagnosing causes of arousal (fragmented sleep), among other issues.
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#4
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
Personally, I would not "test" him. I would set it up at therapeutic pressures, look at the results, but ask him if that was better and more comfortable. That should tell you every thing you need to know. I really don't endorse using a CPAP as a diagnostic, and as JJJ said, there are home test machines. Just start in Autoset mode, at a minimum pressure of 7.0, maximum pressure 14.0 and EPR 2 or 3 and see where it takes you. Our job is not to diagnose, it is to find what works and provides better sleep. The EPR will make his breathing easier, and the auto-adjusting pressure will prevent apnea and hypopnea. Chances are this will motivate him, but if not it's okay. By the way, the information from that session will tell us everything we need to know. Also, please take "no" for an answer. 90s isn't a bad run, and sometimes our parents are not into changing things up at that point.
Sleeprider
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#5
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
even if your father doesn't have apnea, cpap can be used to reduce or eliminate snoring, if that's desirable in his case. I asked my ex sleep doc about this for my wife. he said no until I told him I was willing to self fund his fees and the equipment, at which point he said "make her an appointment with me", implying insurance was the only obstacle. despite the conventional wisdom that snoring in the absence of apnea is not harmful, I think at the very least in many cases it's not good.

in addition to using cpap, which can't be set just to monitor without at least 4 centimeters of water pressure providing treatment, you can observe him sleeping or use a phone sleep app with sound activated noise recording or a video camera to witness apnea indicators, like pauses in breathing, choking, coughing, gasping, rousing, etc.
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#6
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
(01-01-2021, 05:55 PM)Sleeprider Wrote: Also, please take "no" for an answer.  90s isn't a bad run, and sometimes our parents are not into changing things up at that point.

Good point. He is interested at least at this point. Once he wears a mask that my change
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#7
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
The pressure it takes to treat apnea is independent from the severity of the apnea. For example, I was diagnosed with moderate obstructive apnea (AHI 23), but I am successfully treated with an pressure on exhale of just 5. So if you see little or no apnea even with a low pressure, that won't tell you whether or not your father has apnea.

Many people initially find using the machine disruptive to their sleep, so that's another variable to take into account.

Several other suggestions sound sensible: have someone observe your father during a timed nap, counting the number of pauses that are 10 seconds or longer, along with any snores. Or have him try a home sleep test.

All that said, if he's game to try the machine, then go for it. If he shows an AHI over 5 while using it, with mostly obstructive events, then that would be a good reason to think he does have obstructive sleep apnea and would benefit from PAP therapy with optimized settings.
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#8
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
Wanted to give a follow up. He was happy to do a test during an afternoon nap. OSCAR showed several events and he is scheduled for a sleep study. Thanks!
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#9
RE: Father in his 90's. Staying at home b/ COVID, Diagnose/Treat with APAP?
That's good news! Thanks for letting us know.
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