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New Bipap user at 92 years old
#1
New Bipap user at 92 years old
Hello all.  I'm looking for some advice for my 92 year old mother in law who was diagnosed with severe apnea in April and received her equipment in May.
She is a mouth breather and is on BiPap and the pressure peaks at 20.   I'm a long term cpap user and use a nose mask and have no experience with a full face mask.

She desperately wants to have a good nights sleep. She was given a Resmed AirTouch F20 each time for two separate studies at the lab.  Those initially worked fine
but then leakage problems started.  It was suggested that she try a nose mask with a chin strap and she was then given an Eson2  (which I use).  This proved more difficult for her to put on at night as she uses trifocals and also had significant leakage problems.

As a side note she still drives, does daily walks, uses her iphone and ipad.

After this they switched her to the Amara mask, which was the worst of the bunch for her.  There were notes in the packaging about what medical conditions that mask was not a good match for and she has several of these conditions.

I purchased an F20 silicon mask (airfit to swap with the foam one and this did not work as it caused significant pain at the bridge of her nose.  That was also a failure for her due to the pain

Last week we bought he the Resmed AirTouch F20 for Her (pink / gray head gear) and this has less leakage than the regular F20.  The mask itself is indeed slightly smaller that the normal F20 AirTouch

The leakage is never present when she lies down and starts out.   It usually happens after one or two hours of machine being on.  It takes her an average of over an hour to fall asleep.

We have had the tech lower the pressure (at least temporarily) and set the ramp as high as possible.  Oh - of course it's a DreamStation 1 and we are well aware of the recall.  It was odd the the display on the DS1 advised her of the recall one morning recently to further add anxiety to using the machine for her.

Given the masks she has already tried does anyone have any other suggestions for us to try for her.  We've are not able to try another one through insurance for three months.

Note that she sleeps partially elevated with pillows as she has a hiatal hernia.   Thanks for any suggestions.
Wayne
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#2
RE: New Bipap user at 92 years old
Take a look at the ResMed F30 or F30I. Both have a nose cradle so no problem with a sore nose. Mine does not leak and does not need to be tight to work.
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: New Bipap user at 92 years old
Some CPAP users adjust the mask too tight in order to attempt leak control. Consider going a bit lighter on the strap adjustment. See if leaks are controlled. By the way, leaks do not need to be zero from the mask, just low enough to be consistent in control, and minimal sleep disruptions.

I myself use a Fisher and Paykel Vitera full face. I can get away with it being fairly loose. When the PAP pressures up, the mask inflated a bit, completing a decent seal.
Dave

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Dealing With A DME
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: New Bipap user at 92 years old
Hi and welcome!

Definitely keep an eye on the bridge of her nose if she's using a full face mask, as I'm only in my 40s and I'm struggling to heal a pressure sore there, too.

My tips for tightening the mask are to make sure you're doing the fitting in the sleep position, not sitting upright. Be sure to test it in every position that she tends to sleep in and turn her head on the pillows to see if the mask leaks while awake.

If she tends to mouth breathe, make sure to test the mask with her jaw dropped a little as well. I struggled at first (and still do sometimes) getting a good fit because of a) a small face and jaw and b) I'm a huge mouth breather. I would fit the mask while awake, with my mouth closed, and then as soon as I fell asleep, my mouth opened and the mask would leak. So that might be part of the problem. Those leaks were the worst for waking me up, because they were the noisy vibrating leaks.

I've also found that sometimes when you leak in a spot, it's not obvious which strap to adjust. Sometimes if I'm leaking on the top left, I need to tighten the bottom right strap instead. and so on. I definitely found the F20 memory foam masks a lot more comfortable but again, if they tight enough, they create pressure points (hence the sore spot on my nose and swapping between masks right now to give it a rest and help it heal). I also have an F30 and when that works, it's wonderful. But when it doesn't, I find it shifts and slips around, and sometimes the nose seal ends up blocking my nostrils which is unpleasant. But it's definitely better for the bridge of the nose!

If her chin dropping is the cause of the annoying leaks, she may also find a chin strap might be enough to combat that too.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#5
RE: New Bipap user at 92 years old
Do you know which size of the Airtouch for Her she got? I started with a medium and then I got a small and it helped a lot. I still start getting leaks at the bottom sides of the mask in the night when I roll over onto my back. Thanks to some threads on this board I got a cervical collar pillow, and it keeps my jaw in place and stops those leaks. 

I am brand new to all of this, but that's what has worked for me so far.
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#6
RE: New Bipap user at 92 years old
Thanks for all the responses  - the Airtouch F20 for her is a medium.  Has anyone found the replacement foam mask module for that "her" model?  All the ones that I see are the larger normal F20.  We always set her up in bed so the straps are good in the starting position.  It's a good idea to have her drop her mouth during the bedtime setup as we have not been doing that.   She lives on her own about 1 mile away and given the daily naps (usually in a recliner with no cpap) she goes to bed much later than the rest of us.
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#7
RE: New Bipap user at 92 years old
+1 for the AirFit F30. 

I started out using an AirFit F20 and I did well with it. When the F30 came out, I ordered one and it's great!  like
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#8
RE: New Bipap user at 92 years old
Looking at the Resmed store here in the UK, it looks like they use the same size inserts for both the regular and For Her model. I'm thinking that the size differences are probably more to do with the headgear than the inserts (at least for the AirTouch). Definitely go with the small, the difference between them for me is that the small (while still possibly a little large for me) fits between the dip between my chin and lower lip and just below my eyebrows, whereas the medium can tuck down under my chin if I'm not careful. Which while I can make that work with the Airfit, the Airtouch is a disaster!

They have a mask sizing guide on their website - if you can't find it from the product page for the Airfit or the Airtouch, then Google "AirFit F20 Fitting Temp Web Inch Eng" and scroll past the Google adverts, and you have the option of a version in inches or millimetres, which you can print out if you don't have one already.

Hopefully, once she's doing well with the BiPAP, she won't need to take as many naps during the day, because any sleep without the PAP can affect how well it works. I know that if I take just an hour or so nap without it, I will have a screaming headache for the rest of the day (though some people can cope with the odd sleep off). But the more often she can wear it, the faster she'll be able to tolerate it.

There's also the option of Gecko Pads or similar too if she continues using an FFM that covers the bridge of the nose. They're a gel pad that sits over the bridge of your nose to help spread the pressure and reduce soreness, so that might be worth a try too, if she doesn't get on with an F30 or an Amara View maybe.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#9
RE: New Bipap user at 92 years old
Thanks you - I've actually measured the medium for her mask against the normal f20 and the shell of the 'for her' is slightly smaller - both are medium.
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#10
RE: New Bipap user at 92 years old
Hi, I also use the Airtouch F20 for her mask in a small size. If I am not careful I also will wake up with a sore nose. To alleviate this, I put my mask on in front of the bathroom mirror to make sure the mask is resting correctly on the base of nose bridge. If I have it too far down, I will usually wake up with a sore nose. After securing all the straps, I get in bed and move my mouth all around while checking for leaks. Most of the time this works.
I hope this helps.
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