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#31
Thanks Evpraxia, the Lincare rep mentioned a full face mask for mom because she has a tendency to breath thru her mouth. We also talked about humidifiers because it gets very dry here in winter. Apparently the humidifier is a heated humidifier that is built into the ResMed AirSense Autoset 10. But nothing was said about whether the hose was heated. I'll look into that. It's cold in the mountains in the winter!!

I love your long post! It's hard for me to write a short post. So much has happened to mom in the last 3 months, it would fill a book. Her fall, her surgery and having a rough time post general anesthesia...from what I read, that's a given with sleep apnea and the anesthesiologist should have picked up on the fact that there was a breathing problem.
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#32
Sue,

Glad I can help!

Some mouth-breathers find they can do fine with nasal pillows and a chin strap. Sometimes they find they can dispense with the chin strap after a month or a year, as their body "learns" that it does not have to breath through the mouth in order to breath. My hubby went from a nose mask to nasal pillows and a chin strap with no problems.

Doing a search on this board will show lots of discussion on mouth breathers, what works and what does not.

Heated hoses are a Wonderful Thing! Also, I have my hose in a "hose cozy", which helps retain the heat and keeps the hose from making noise on the wood headboard. Hose cozies can be bought from most CPAP websites, bought from Etsy or made at home: socks cut at the toes and sewn together to make a long tube, polar fleece or knit or cotton sewn together in a tube wide enough to accommodate the hose connections when it is slipped over the tube, or the same fabrics sewn onto a long separating zipper for ease of putting on the tube.

Also, there are numerous ways to manage the hose: some folks pin it to their night clothes so the hose stays under the bed covers, others buy or DIY a hose stand and others, like me, drape it over the headboard.
Evpraxia in the Pacific Northwest USA
Diagnosed: 44 AHI when supine, O2 down to 82%
Treated since 20 Sept 2014:: 0.7 AHI, Settings 7-15, EPR on Full Time at Level 3
Better living through CPAP/APAP machines!
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#33
Rethink the full face mask Sue. Mom's 85? It's probably a sure thing she'll freak a little over that mask. Try the pillows. They're much less invasive and in my not-so-humble opinion much easier to learn to use and get a good seal than a full face mask. As far as being a "mouth breather" is concerned? Yeah, we all are, until we aren't.

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#34
Hi suedanem, welcome to the forum!

See if you can get the doctor to write on the prescription "AutoSet For Her" treatment algorithm.

The A10 AutoSet For Her model is better (for both men and women) than the standard A10 AutoSet model, at same cost.

The A10 AutoSet For Her model has three therapy modes (three machines in one): standard CPAP therapy mode (like the Elite, with full data), standard AutoSet therapy mode, and the new AutoSet For Her therapy mode. (More chances to find an optimal therapy mode for your mother.)

Also, the A10 AutoSet For Her model reports RERA (Respiratory Effort-Related Arousal) events in all three of its therapy modes, which none of the other models do. It can be helpful to have some indication of how many RERA events are occurring.

You might be successful simply telling the DME that you are looking for a supplier who will supply your mother with the A10 AutoSet For Her model. Again, the A10 AutoSet For Her model costs the supplier the same as the A10 AutoSet model.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#35
The A10 AutoSet will detect if your mom is having central apneas and you can read the info off the display.

Get the setup manual from the link at the top of the page. You may need to turn on the "sleep quality" function before it will show you the count of central apneas.

There is a free "SleepyHead" program you can download and look at the data on your computer. Be sure to follow the right links and get the "testing version" because that is the only version that will do the A10 machines.

http://www.sleepfiles.com/SH/index.html?TestingVersions

You can also get the manufacturer's official program, ResScan from here:

http://www.apneaboard.com/forums/Thread-...ht=resscan

You can check the results and see if she's having central apnea. With the setup manuals, you can adjust the pressure to tame the autopap.

Too much pressure can cause central apnea or make it worse. The APAP will "try" to not adjust the pressure in response to centrals, but you can manually turn down the maximum pressure and help prevent central apneas that way.

Sometimes you have to strike a balance between too much pressure causing centrals and not enough pressure to fix her obstructive apnea.

Good luck and keep after it. There's a good chance you and your doctor can make this work with the AutoSet, or at least provider her some help. I nothing else, you can figure out a lot about what kind of therapy she needs long term.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#36
As for an actual pulmologist being there during the sleep study? Don't count on it. Most likely it will be techs who collect the data then give it to the sleep doc the next day or so.

Mom may prefer the full face mask to the nasal or pillows with a chin strap.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#37
(11-14-2014, 10:03 AM)suedanem Wrote: Her doctor said, last night at 5:30, that just going ahead and using an APAP could possibly make things worse because mom had both central and obstructive apnea. (Can someone make a comment on this possibility?)

Hi suedanem,

Ask for copies of the full sleep reports (not a one-page summary), including data and event graphs, for both sleep studies (not just for the most recent).

The doctor is correct.

A few people have both obstructive apneas and central apneas when sleeping without CPAP therapy. This is called Mixed or Complex Sleep Apnea. When being treated with CPAP, although the continuous pressure is needed to prevent obstructive apneas, the CPAP therapy will sometimes cause the number of central apneas to increase, perhaps worsening the overall AHI.

Some people have only obstructive apneas when not being treated with CPAP, but when being treated with CPAP the continuous pressure causes central apneas. This is called CPAP-emergent central sleep apnea or Mixed or Complex Sleep Apnea. Although the CPAP therapy is needed to prevent obstructive apneas, CPAP therapy will sometimes cause the number of central apneas to increase, perhaps worsening the overall AHI.

So standard CPAP or APAP treatment may make things better or worse, but usually makes things much better, at least if the pressure is limited so it does not go too high.

Oxygen Therapy (supplemental O2), in addition to raising the amount of O2 in the blood (which is important), tends to decrease the number of Central Apneas. I think there is more than one cause for Central Apneas, but one cause can be too little CO2 (carbon dioxide) in the blood. Supplemental O2 tends to increase the O2 content of the blood, which, as the O2 is used and is turned into CO2, tends to increase the amount of CO2 in the blood, helping to avoid the type of central apnea which is caused by too little CO2. However, any time we are using supplemental O2, we should at least occasionally (monthly?) wear a recording Pulse Oximeter at night, to verify we are not getting too much O2, which can cause many very serious health problems, such as rendering prescription medications ineffective, and accelerating Coronary Artery Disease, and generally increasing oxidative stress on our whole system.

The gold standard for treatment of Obstructive Sleep Apnea is CPAP/APAP/BiPAP, and the gold standard for treatment of mixed or Complex Sleep Apnea is a CPAP bi-level machine having an ASV (Adaptive Servo Ventilator) therapy mode. Several members of the forum need and use ASV machines.

The presently-available ResMed ASV machine is named the S9 VPAP Adapt. The presently-available Philips Respironics ASV machine is named the System One BiPAP autoSV Advanced.

The ResMed VPAP Adapt and the PRS1 BiPAP autoSV Advanced are similar to the AutoSet, which can automatically slowly raise the EPAP (the pressure during exhalation) to prevent obstructive apneas. (My own ASV machine is a 2012 model of the S9 VPAP Adapt which cannot automatically adjust EPAP, but the more recent models can.) The EPAP pressure is not raised by the AutoSet during an apnea, but is raised a little after each apnea or hypopnea ends, and is not raised if the apnea type is Central Apnea. The EPAP pressure is also slowly raised if the machine detects snoring or Flow Limitation.

The key additional feature of the ASV machines is that when a central or obstructive apnea or hypopnea begins, the ASV machine will act as a ventilator, by rhythmically increasing and decreasing the pressure, so that we naturally inhale and exhale, with the changing pressure doing for us some or all of the work of breathing. The amount by which the inhale pressure (IPAP) is higher than the exhale pressure (EPAP) in order to aid or cause inhalation, is called the amount of Pressure Support.

Typically, when the Pressure Support is raised up to 10 cm H2O, this is usually adequate to do for us all the work of breathing. For example, if the ASV machine has raised EPAP (the pressure the machine produces when it senses we are exhaling) up to 8 in order to prevent obstructive apneas from occurring, and if a central apnea suddenly starts, and if the machine raises Pressure Support to 10, then the machine would be cycling back and forth between an EPAP pressure of 8 (for exhalation) and an IPAP pressure of 18 (for inhalation). When we once again start breathing normally, the ASV machine reduces the amount of Pressure Support to whatever normal amount of Pressure Support is most comfortable for the user, which is usually between 1 and 5.

There are also non-ASV standard bi-level (VPAP or BiPAP) machines which can produce Pressure Support to help us inhale and exhale, but the amount of Pressure Support is fixed or very slowly self-adjusting, and these standard bi-level machines do not attempt to interrupt or treat central apneas.

Most ResMed CPAP and APAP models, such as the Elite and AutoSet and AutoSet For Her models, are able to use a limited form of bi-level which is named EPR for Expiration (meaning Exhalation) Pressure Relief. EPR is limited to amounts of 3 or lower, and EPR is the amount by which the EPAP pressure is lower than the IPAP pressure.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#38
(11-15-2014, 12:13 AM)archangle Wrote: The A10 AutoSet will detect if your mom is having central apneas and you can read the info off the display.

Get the setup manual from the link at the top of the page. You may need to turn on the "sleep quality" function before it will show you the count of central apneas.

There is a free "SleepyHead" program you can download and look at the data on your computer. Be sure to follow the right links and get the "testing version" because that is the only version that will do the A10 machines.

http://www.sleepfiles.com/SH/index.html?TestingVersions

You can also get the manufacturer's official program, ResScan from here:

http://www.apneaboard.com/forums/Thread-...ht=resscan

You can check the results and see if she's having central apnea. With the setup manuals, you can adjust the pressure to tame the autopap.

Too much pressure can cause central apnea or make it worse. The APAP will "try" to not adjust the pressure in response to centrals, but you can manually turn down the maximum pressure and help prevent central apneas that way.

Sometimes you have to strike a balance between too much pressure causing centrals and not enough pressure to fix her obstructive apnea.

Good luck and keep after it. There's a good chance you and your doctor can make this work with the AutoSet, or at least provider her some help. I nothing else, you can figure out a lot about what kind of therapy she needs long term.

Thanks for the info. I will look at the setup manuals and ResMed. I knew about SleepyHead, but not that I had to use the "testing version"
I have no choice but to keep on keeping on.
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#39
Vsheline, WOW! you know your stuff. Right now, we are stuck with, lucky to have the A10 Autoset until mom's sleep study (that hasn't even been set up yet.) So I hope that will help her a little.

I got the CMS 50D+ several days ago. Have not tried it out on mom yet. The first several nights I tried it on myself. The first night it would be off when I woke up and I'd put it back on. The next night, I put a rubber band on it to make it stay on. That didn't work either. So last night, I TAPED it on good. And it stayed on. So, I'm ready to try it on mom now.

I'm not looking forward to that. Just because I know her nighttime 02 levels are very low (from looking at the first sleep study and from doing spot checks in the middle of the night.)

Paula02, no I don't expect a pulmonologist to be there for the sleep study. That would be asking too much. But, I expect him to read the data and probably recommend the equipment Vsheline told me about. I'm off to look up the equipment. But, I also have to go to work today because I missed so much during the week.

Thanks everyone for your input.
Edited to add: My O2 levels on the oximeter recording dropped to 90 once for a second but most of the time it was round 95%. My heart rate was mostly stable except when I got up in the middle of the night to check on mom. I couldn't tell if she was breathing at first (she was). My heart rate shot up to over 100 then but went back down.
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#40
(11-15-2014, 10:07 AM)suedanem Wrote: I got the CMS 50D+ several days ago. Have not tried it out on mom yet. The first several nights I tried it on myself. The first night it would be off when I woke up and I'd put it back on. The next night, I put a rubber band on it to make it stay on. That didn't work either. So last night, I TAPED it on good. And it stayed on. So, I'm ready to try it on mom now.

I would never use a rubber band, because it would make the Pulse Ox tighter on the finger.

Very very important to not allow the tape to cause more mechanical pressure on her finger.

Put the tape ONLY along the sides, so as to stabilize the Pulse Ox so it won't fall off as easily, without making the Pulse Ox any tighter, not even the least little bit. And change to another finger when one finger gets sore from the Pulse Ox.

Recording Pulse Oximeters are used commonly all night, but manufacturers, I think to guard themselves from legal liability, somehere in the user manual will caution against using for longer than a few hours at a time on the same finger, although commonly it is worn all night on one finger.

The type of Pulse Ox which is worn like a watch, with separate finger cup, applies less pressure and is more comfortable and is less likely to come off. But even with that type it is not recommended to wear too long, although it is commonly worn all night.

For months I used to wear one every night, but I now I wear one a night or two every few weeks or months.
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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