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Should we get him a full face mask?
#1
Should we get him a full face mask?
Hi!

My father has a Respironics PR System One BiPAP Auto with Bi-Flex from 2013.
The doctors says his apnea has to be treated better, because it's getting worse day by day, his average AHI is currently 30-40.
They say his general health is affected very badly because of this. He is currently 66 years old, have a stage 5 kidney desease, and diabetes. He had several strokes too. I can imagine how bad is this severe sleep apnea for his health.
He has a fixed 14-24 Bi-level setting now.

Last month we were at the doctor, and he suspected a mouthbreathing problem (which we confirmed as we saw and heard it everyday), and he got a full face mask (comfort gel blue) for testing for three weeks.
When we went back to the doctor, they thought this is not helped at all, so he got an appointment for polygraph examination for 9th aug. As I understand, they try to find out if it's CSA or OSA.

I couldn't wait for a whole month doing nothing, so as every geek like me woud do, I downloaded the data from the SD card, installed OSCAR and I started to examine the data back until 2013.

My findings so far:
  • I dont know how they calculate the average AHI, but it seems like its more like 50 in average than 30-40.
  • His AHI jumped up when he (probably) had a brain stroke in the end of this january. He was in the hospital for a week, but the doctors are not sure about the stroke.
  • I also see a quite clear jump when they switched from Auto Bi-Level to Fixed Bi-Level mode. I don't know if it was a great decision back then.
  • When he used the full face mask a few weeks ago, his AHI is fallen to a relatively good interval (like 15-25 Shy ) but the Large Leak numbers got worse. Also this is the same week he got thiogamma and trental treatment for his kidney desase and neuropathy. I'm not sure if it's related.
I think I'm starting to lose my faith in the doctors a little bit, so I'm asking for an advise from you:

- Do you think we should get back the full face mask? Is it possible that it helped that much?
- As I understand, if he has CSA, he will probably get an autoservo machine. Is this new mask will be good for that machine too?

I'm attaching the graphs, too.

   

   

What do you think? 

Thanks
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#2
RE: Should we get him a full face mask?
Hi tolnaiz - Welcome to Forum!

Please post a screenshot of the Daily screen that best displays his problem.  Please review the OSCAR Chart Organization link below for the best way to display this information. It will help in seeing his problem.
Crimson Nape
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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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#3
RE: Should we get him a full face mask?
(07-12-2019, 08:55 AM)Crimson Nape Wrote: Hi tolnaiz - Welcome to Forum!

Please post a screenshot of the Daily screen that best displays his problem.  Please review the OSCAR Chart Organization link below for the best way to display this information.  It will help in seeing his problem.

Okay, here is the daily screen from yesterday.

   

Thanks
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#4
RE: Should we get him a full face mask?
Your father shows indications of complex sleep apnea with significant number of central events. The leak rate is NOT out of control and the data by the machine going back a considerable time shows that complex apnea has been present. Your father should be scheduled for evaluation on ASV (adaptive servo ventilation) which can treat this condition. His current BiPAP is strictly to treat obstructive sleep apnea, and he has suffered enough.

A major reason for this problem is that the BiPAP Auto machine is set to fixed pressure at 24 IPAP/14 EPAP which is a pressure support of 10 cm. This has washed out his CO2 and caused the extremely bad AHI. I recommend that you immediately switch the machine to Auto BiPAP mode, wth EPAP min at 12.0, IPAP max at 24.0 and PS min 3.0 and PS max at 5.0. This will give him auto titrated pressure to prevent obstruction and will immediately relieve the central apnea. His settings on the current BiPAP look like a medical error and should be corrected immediately!

If you are not comfortable making the changes suggested above, he had better efficacy on CPAP than BiPAP. The added pressure support has increased the treatment emergent central apnea. Please discuss with the doctor, switching back to CPAP mode until the ASV titration can be arranged or his BiPAP setting corrected.
Sleeprider
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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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#5
RE: Should we get him a full face mask?
(07-12-2019, 09:52 AM)Sleeprider Wrote: Your father shows indications of complex sleep apnea with significant number of central events.  The leak rate is NOT out of control and the data by the machine going back a considerable time shows that complex apnea has been present.  Your father should be scheduled for evaluation on ASV (adaptive servo ventilation) which can treat this condition.  His current BiPAP is strictly to treat obstructive sleep apnea, and he has suffered enough.

A major reason for this problem is that the BiPAP Auto machine is set to fixed pressure at 24 IPAP/14 EPAP which is a pressure support of 10 cm.  This has washed out his CO2 and caused the extremely bad AHI.  I recommend that you immediately switch the machine to Auto BiPAP mode, wth EPAP min at 12.0, IPAP max at 24.0 and PS min 3.0 and PS max at 5.0.  This will give him auto titrated pressure to prevent obstruction and will immediately relieve the central apnea.  His settings on the current BiPAP look like a medical error and should be corrected immediately!

If you are not comfortable making the changes suggested above, he had better efficacy on CPAP than BiPAP. The added pressure support has increased the treatment emergent central apnea.  Please discuss with the doctor, switching back to CPAP mode until the ASV titration can be arranged or his BiPAP setting corrected.

This post is worth repeating !!!
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#6
RE: Should we get him a full face mask?
I want to simplify my previous post. Someone setup the BiPAP auto wrong! The span of 14 to 24 cm should have been implemented in BiPAP Auto mode with a lower pressure support range. No one can use BiPAP with 10 cm of pressure support and not have serious problems. Tell the doctor and DME you have a serious problem and find out if the prescription was written incorrectly, or if the settings were input incorrectly. One of those two things is wrong.
Sleeprider
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____________________________________________
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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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#7
RE: Should we get him a full face mask?
(07-12-2019, 09:52 AM)Sleeprider Wrote: Your father shows indications of complex sleep apnea with significant number of central events.  The leak rate is NOT out of control and the data by the machine going back a considerable time shows that complex apnea has been present.  Your father should be scheduled for evaluation on ASV (adaptive servo ventilation) which can treat this condition.  His current BiPAP is strictly to treat obstructive sleep apnea, and he has suffered enough.

A major reason for this problem is that the BiPAP Auto machine is set to fixed pressure at 24 IPAP/14 EPAP which is a pressure support of 10 cm.  This has washed out his CO2 and caused the extremely bad AHI.  I recommend that you immediately switch the machine to Auto BiPAP mode, wth EPAP min at 12.0, IPAP max at 24.0 and PS min 3.0 and PS max at 5.0.  This will give him auto titrated pressure to prevent obstruction and will immediately relieve the central apnea.  His settings on the current BiPAP look like a medical error and should be corrected immediately!

If you are not comfortable making the changes suggested above, he had better efficacy on CPAP than BiPAP. The added pressure support has increased the treatment emergent central apnea.  Please discuss with the doctor, switching back to CPAP mode until the ASV titration can be arranged or his BiPAP setting corrected.

Thank you for your detailed answer. That is exactly what I thought. Is there any circumstance which could justify using the fixed Bi-level pressure? Or the numbers just speaks for themselves? I can't belive he is getting the wrong therapy for 3 years and nobody noticed it.  Huh

I'm afraid I cannot reach the doctor until august, but I can definitely change it to auto bipap mode and watch for the results.

Thanks
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#8
RE: Should we get him a full face mask?
Use the settings I suggested:
Mode: BAuto
Max Pressure: 24
Min EPAP: 12.0
Min PS 3.0
Max PS 5.0

I guarantee you put this into the machine and his AHI drops to less than 10.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


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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#9
RE: Should we get him a full face mask?
Sorry, I just missed your previous post. Now I understand. I will try the settings you suggested. Thank you
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#10
RE: Should we get him a full face mask?
Extremely bad results, his strokes might have been avoided if he had been treated properly from the start. Sadly you're not based in the US, you'd have a potentially viable million dollar lawsuit. Anyway ASV regulations in Europe are slightly better then the US, if it were germany you'd get an ASV just based on your fathers machine data, additional sleep study would be required only AFTER he got his ASV to make sure its working.

If you're buying out of pocket then its Resmed Pacewave CS you want to get.
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