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High pressure Bipap 28/24 need mask ideas
#1
High pressure Bipap 28/24 need mask ideas
I have been on a cpap (several different machines) a long time since 1994 (the very 1st test done at Keesler AFB in MS) and it was set at some low pressure like 8 or 10 using a nasal mask and chin strap. During this time, I was within body standards for the military and maintained the standard through the beginning of 2004 when I retired. I went for another sleep study at the VA and they set me up with a Respironics Remstar Auto System One with a pressure of 15. I have always been a mouth breather so when the pressure increased I moved to a full face along with a chin strap. Slept on this thing until I started always feeling tired again and continued this for about a year. Finally went to a Neurologist and had 2 sleep studies and they found several sever sleep problems including night terrors and such. Plus, like most folks I have gained lots of weight over the last 4-5 years after having neck, back, both shoulder rotator cuffs, knee replacement and 3 stints after a small heart attack. They have put me on a Resmed S-9 BIPAP UPAP COPD with a pressure of 28/24. I am having problems a mask that does not leak. I have tried the following: Fisher & Paykel Forma Full face small, Resmed Airfit F 20 medium Resmed Mirage Quatro small and a med. And all leak bunches and wake up and find the bottom of the mask in my mouth. Cut/bruises my nose ect…Thinking about trying a FULL FACE MASK like firefighters use. I do have a few extra masks here that I tried one or twice with my old machine but did not like. I have a F&P 431 med, Resmed Ultra Mirage med, Respironics Amara View med, and a Respcare Hybrid full face with small, med and large gels. All the masks I have tried so far I have to over tighten which hurts and always leaking and it runs the wife out to a spare bed room. Also use cheek pads and Gecko nasal pad to no avail. Anyone have any ideas or experience with this high of pressure. Any ideas for masks? Any tricks? Oh yeah saw video about using a karate mouth guard so ordered several, heated in water and formed for mouth but still did not keep my mouth shut.
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#2
RE: High pressure Bipap 28/24 need mask ideas
There's a FitLife Mask that's like you described as a firefighter mask. You might want to check on that. I've never used one so can't say if it's what you need.
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#3
RE: High pressure Bipap 28/24 need mask ideas
The Fisher & Paykel SIMPLUS full face mask will withstand high pressures - I've tested it with IPAP above 25 cm h2o and the seal held, although you have to tighten the straps quite a bit. It's relatively comfortable at higher pressures - I've never had any skin breakdown or sores at least. I don't find that it digs into the bridge of my nose or anything like that.


Side discussion:

I'm not necessarily doubting your doctor, or the sleep techs, but I am highly suspect of those pressures...very high on both IPAP and EPAP which leads to very minimal pressure support. With COPD and/or obesity, you could be suffering from sleep related hypoventilation (being underventilated), because of the extra weight your chest wall becomes restricted and effects your breathing at night. Plus with COPD your actual airways are effected. In a sleep study, they could be mistaking diaphragmatic hypopneas, meaning shallow breathing/ineffective breathing efforts, as OSA events, and are trying to "titrate them away."


If anyone cares to chime in that would be swell. I think we would all love to see some data from SleepyHead to see what is going on.
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#4
RE: High pressure Bipap 28/24 need mask ideas
yes please sound off on the side note and the original post. I too am not sure of the testing.
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#5
RE: High pressure Bipap 28/24 need mask ideas
If you have a ResMed S9 it should tell you your AHI on the screen when you wake up and turn the device off. If you go into the clinical menu on the device (hold down the rotating dial/joystick looking thing and the little button next to "setup" on the screen for a few seconds to unlock it) and you can enable Sleep Quality and change access to full. That should you tell you more information like leak rate, tidal volume, minute volume and respiratory rate for a given night of sleep (on your screen). 


Have you installed SleepyHead and imported the data from your SD card? 

Since you were using a CPAP for a long time, if it were me, I personally don't think it would be a bad idea to use minimal pressures for a night or two to simply see what is happening, and maybe make adjustments from there. 

Idea: Changing your pressure isn't illegal. I would do something drastic and try out something like IPAP 10 / EPAP 6 for a night, to see what type of events you are having. Then, generally, you raise IPAP for hypopneas, flow limitations, and snoring, and EPAP for obstructive apneas. It sounds like you had been sleeping with inadequate support for quite a while so I personally don't see the harm.


Note: Wait until others chime in, I'm just talking out loud and am not any kind of expert. I just want to get you up and running. AFAIK no mask is going to withstand IPAP 28 / EPAP 24 without being cinched down so tightly that it hurts/causes facial breakdown. That's why I am discussing what I am...not to derail.
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#6
RE: High pressure Bipap 28/24 need mask ideas
Matt, my first impression is someone titrated using pressure as the hammer for nail called apnea or hypopnea. Pressures that high would be unusual and oppressive. As you properly note, pressure support should be the criteria. If dfellow55 gets a copy if the titration tables from his study, we could certainly verify at what EPAP pressure OA events are resolved, then help him to properly use pressure support to achieve the ventilation target needed. Not only did they put him on a VPAP COPD, but other options like ST or iVAPS exist that would make more sense for obesity hypoventilation. I'm very curious to see the study, and perhaps our biggest value would be to offer some insights on how to discuss that study with his doctors, as well as how to use its findings going forward in therapy.
Sleeprider
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#7
RE: High pressure Bipap 28/24 need mask ideas
(03-10-2018, 09:21 AM)Sleeprider Wrote: Matt, my first impression is someone titrated using pressure as the hammer for nail called apnea or hypopnea.  Pressures that high would be unusual and oppressive.  As you properly note, pressure support should be the criteria.  If dfellow55 gets a copy if the titration tables from his study, we could certainly verify at what EPAP pressure OA events are resolved, then help him to properly use pressure support to achieve the ventilation target needed.  Not only did they put him on a VPAP COPD, but other options like ST or iVAPS exist that would make more sense for obesity hypoventilation.  I'm very curious to see the study, and perhaps our biggest value would be to offer some insights on how to discuss that study with his doctors, as well as how to use its findings going forward in therapy.

Yeah I think this is just a case of we need more information. No one should have to be up all night fighting leaks, and having their wife sleep in another room!

They may have just picked the S9 COPD machine since it can go to 30cm h2o on the IPAP. AFAIK it doesn't have a backup rate though.
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#8
RE: High pressure Bipap 28/24 need mask ideas
Thanks for the info will look into that. Also guess I do need to get the different types of software and do I need a special card reader? Though I have been on C pap for many many years I have never really studied it. Guess I treat it like medicine the Dr prescribes, I just do it. But with the new Bi-pap and super high pressure it is very painful stopping leaks. Plus my sleeping has been terrible for years.  During the week go to bed 830 and get up 430 for work. Monday thru Friday. On weekends if I do not set my alarm and the wonderful wife doesn't wake me up I will go to bed at 9 and sleep till somewhere between 12-pm and 3-pm . Way too much! And STILL TIRED! Sleeping way too much. Maybe something else going on with this problem.  Thanks for the info and will continue taking advice and reading/learning because I need to get this fixed for wife and Grandchildren's sake.
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#9
RE: High pressure Bipap 28/24 need mask ideas
According to the C pap techs they had to order this machine because none they carried went above 25. As far as COPD I had 2  Pulmonary Function Tests by the VA and was told it was fair but they put me on Symbicort 160/4.5 for maintenance only they claim though they did give me a script for rescue inhaler which I do not use it. Just like the Heart Dr He gave me Nitro patches, Nitro pills and though I had 3 stints put in one are about 5" long there is still a 80% blockage on the backside of the heart so they have me on max doses of blood thinners and other meds that opens the arteries. The tried to open it one time in the cath lab but could not punch thru and were scared they would have to open me up to fix it. But they claim I was to young to do that they thought (53). I am taking loads of meds daily for different things so that may have something to do with all this. I can list if needed. I do take Norco 10/325 1-2 times a day for knees, back and neck pains. I know that Norco  causes supression of breathing or lowers heart rate somewhat so this may have an effect also. Sorry about writing a book on this stuff but I don't know if any of this stuff makes a difference but am trying to give all the info to you folks tecause you never know what will help.
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#10
RE: High pressure Bipap 28/24 need mask ideas
SleepyHead is a free program that is awesome and works with the ResMed S9 series.

You just need an SD card reader. Some computers come with them already, or you can buy a adapter if necessary. Something like this: Search online


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