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Requesting Advice for Elderly Mother
#1
Requesting Advice for Elderly Mother
Good morning,

My mother was hospitalized two weeks ago for delirium and exhaustion.  It was discovered that her Carbon Dioxide was extremely high (CO2 Total > 50 mmol/L, pCO2 Art > 121.9 mmHg).  We were told she needed to be on a BiPAP every time she slept.  The BiPAP treatments corrected the delirium and gave her more energy, and she was sent home after 12 days in the hospital.  We were provided an Astral 150 BiPAP for home use, which connects to her home oxygen concentrator.  She's a complicated case, with both emphysema and severe scoliosis, and suspected depressed breathing during sleep.  She's also on 2 liters of oxygen during the day.

While she seems to be getting stronger physically and remains mentally sharp, the BiPAP has been nothing but a nightmare.  With zero leakage detected by the Astral 150, we are able to keep her oxygen in the low 90's by setting the oxygen to 4 liters.  Once leakage reaches 5+, her oxygen plummets to the 70's.  I've been forced to wake her multiple times for the past two nights to take her off the BiPAP and place her on the cannula, which gets her oxygen saturation back into the 90's within a few minutes.  She doesn't seem confused or disoriented when I wake her, which I find odd.

The problem is we're having a very hard time getting a proper fit with her Air Touch F20 mask (memory foam).  There's no leak at first, but it eventually starts to creep in.  With the medium mask, she opens her mouth past the bottom of it, and with a large, there's too much space at the bottom.  I even went so far as to use surgical tape over her mouth to keep it closed while using the medium mask, but a small leak still developed.

We've had companies come out to look at both the concentrator and Astral 150, and they insist that both products are working fine.  I reached out to the pulmonologist and didn't receive a helpful response, and now it's the weekend.  I'm not sure what to do at this point.  I have none of my mom's data since no sleep study was performed.  She needs the BiPAP to deal with her extremely high CO2, but we may be creating a hypoxic state in the process.  Should I look into another style of mask to prevent leaks?  Or getting a concentrator that can reach 10 liters?  Her recovery has been faster at home, so I'd hate to take her back to the ER, especially since the doctor told us that any respiratory pathogen would kill her right now.

Any advice or knowledge is appreciated.
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#2
RE: Requesting Advice for Elderly Mother
It's the norm that you will have to try different masks to find one that fits well. You need to find out from the hospital who is providing her CPAP supplies. Call them and tell them that the mask doesn't fit and she needs a different one.
Sleepster

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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#3
RE: Requesting Advice for Elderly Mother
(10-22-2022, 09:44 AM)Sleepster Wrote: It's the norm that you will have to try different masks to find one that fits well. You need to find out from the hospital who is providing her CPAP supplies. Call them and tell them that the mask doesn't fit and she needs a different one.
Thanks.  Is zero leak achievable for most people?
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#4
RE: Requesting Advice for Elderly Mother
Hello Matt.  I agree with Sleepster - get a new mask.  I have had the same problem (my mouth used to drop wide open when I relaxed and slept and caused major leaks).  But one thing that worked for me was getting a soft cervical collar and having it just tight enough so that my jaw stayed closed and leaks all but disappeared (if the soft cervical collar is positioned right underneath the jaw, it will prevent the jaw from dropping when in a relaxed state and sleeping - at least it did for me personally.)  A chin strap could possible work also (can purchase from one of the suppliers listed here or amazon, etc.).
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#5
RE: Requesting Advice for Elderly Mother
You actually have an advantage in that you are doing this for someone else -- for the rest of us it's really hard to figure out what's going wrong while we are asleep because, well, we're asleep! LOL

Mask fit is a very personal thing, in that everyone's face is different, and then there's lots of different things that can go wrong with the fit while you're unconscious and not able to fix it.

There are same excellent resources on this site on mask fit. The basic problem is that there is a lot of Goldilocks going on here -- a fine difference between too loose and too tight, too big and too small, and all going on in 3 dimensions.

There's also a bunch of different general things that can be going wrong. Maybe the mask fit is very sensitive, and anything changes and it's blowing like crazy. Or your mom moves in a certain way and the hose gets caught and now the weight of the hose is pulling the mask off. Or she rolls over and knocks it ajar. Here is where you have the advantage of being awake and able to see what's happening.

Something that got me at one point with a new mask is that there are really three states not two. There's perfectly sealed. There's making trombone noises that you can hear across the house. But then there's also almost-but-not-quite sealed with a gentle hiss that you can hardly hear (especially if you have tinnitus!) I had a Dreamwear for a couple of weeks before I realized that silent was achievable and I should be aiming for it.
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#6
RE: Requesting Advice for Elderly Mother
(10-22-2022, 10:36 AM)cathyf Wrote: But then there's also almost-but-not-quite sealed with a gentle hiss that you can hardly hear 
This is what we're experiencing (well, except when her bottom lip hangs out, that's a much more obvious hiss).  I'm not sure if all devices come with a standard leak rate, but hers is in the single digits, a very gentle hiss, but it's enough to drop her oxygen by 10 points.  The hospital BiPAP had a minimum leak rate of 20, and often exceeded 100, yet her oxygen remained stable.  A new mask definitely seems to be necessary, but I have a feeling we need a stronger concentrator as well since some leaks seem to be inevitable, though setting the oxygen higher without leakage could be a bad idea as well.  Sad

It's all very stressful because we were initially given news to plan for possible intubation and/or death, and she somehow pulled through and made it home, and now every night and every nap is met with me repeatedly waking her because we can't keep her oxygen up while using the machine.
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#7
RE: Requesting Advice for Elderly Mother
You can fit the mask over oxygen canula, a small amount of air will leak but the oxygen won't saturate down
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#8
RE: Requesting Advice for Elderly Mother
What people say here is totally true; mask fit is a very individual thing. I would have a couple quick thought re leaks: The headgear sizing can make a big difference as well. Myself, I need a small headgear, or any mask shifts too easily. Another tip is that the fit should be optimized for when the mask is at pressure.

A more powerful oxygen concentrator may be a help, but if her saturation dives with any leaks, it sounds like the pressure support aspect of the BiPAP is more critical. Yes, minimal (I won't say zero) leaks are definitely doable.
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#9
RE: Requesting Advice for Elderly Mother
I wear the AirTouch F20 mask and I have found, like others that it must be worn pretty snug to do it's job. I wear a small size and it works best when pulled down just to touch the dimple in my chin. When it slides up it is nearly bothering my eyes. Mind stays well sealed even if it does slip up and the cushion ends up squashing my lower lip into my mouth. Hopefully you will be able to solve the problems she is having!
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#10
RE: Requesting Advice for Elderly Mother
We have a wiki on the site that discusses the use of an Oxygen Bleed with CPAP or a ventilator. http://www.apneaboard.com/wiki/index.php..._with_CPAP There is considerable dilution of oxygen in any positive air pressure circuit and this lowers the fraction of inspired oxygen (fiO2) when PAP is in use. The presence of leaks makes this dilution much greater, making it harder to raise FiO2. It is very important to reduce leaks, and you probably need to get a different mask for your mom. We have some members on the forum that need two oxygen concentrators and a bleed rate of over 6 LPM to maintain adequate oxygen levels. Read the wiki to better understand the effect of dilution of the oxygen bleed, and discuss getting a different mask or prescription for a higher bleed-rate with your doctor.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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