[Pressure] BiPap air pressure question

[AmbitiousCut0]

Ambitious, I think the frequent sleep disturbance could be sufficient to explain the centrals, but we're not really going to know until he is in therapy at home and able to put in some hours in a more comfortable environment.  If we can sort out the positional, central and obstructive issues, then he will win the night.

Absolutely I would love for it to be a success. I went ahead and picked up a SCC for him to help with his chipmunk cheeks but he feels uncomfortable while laying down on his back/side. He says the medium mask feels claustrophobic for him but we tested the large one and the store owner said the medium would provide a better seal.

I think he has anxiety putting the mask on with the collar and he has trouble breathing through his nose. His doctor gave him a couple steroid sprays to open up his nostrils but we haven't used it since he mentioned that it might've made his breathing worse so I want to go visit his ENT to have them take a look at his insides as I think it could also be an anatomy problem.

The thing is we're identical twins so it's not that we're exactly the same but genetically I would be the closest so I kind of know how he feels. I tried the mask on myself with the BiPap running and it felt kind of relaxing actually. I'm not sure why it's so uncomfortable for him so for those reasons unfortunately we're not able to start treatment yet. Quite honestly I'd really like him to just try it for at least one night, and I'm not trying to push him too hard since he's very stressed from his leg surgery but as soon as I have data I'll make sure to post it here.

[Sleeprider]

It sounds like the nasal spray is just something like Flonase (fluticasone propionate) and I think if you research the side-effects they are minor, rare and not related to respiration. The best way to adapt to therapy is the way you trialed it while awake and relaxing. The biggest obstacle to overcome is attitude, and it's a lot easier if someone has an optimistic expectation of an improved outcome.

Interesting you are twins and don't share this issue. It could be predominately positional, and if there was a way for him to view what happens in his sleep (night camera), it might be motivating and help show how he gets into trouble with his airway and learn to avoid that. In many cases it's very obvious.

[AmbitiousCut0]

It sounds like the nasal spray is just something like Flonase (fluticasone propionate) and I think if you research the side-effects they are minor, rare and not related to respiration.  The best way to adapt to therapy is the way you trialed it while awake and relaxing. The biggest obstacle to overcome is attitude, and it's a lot easier if someone has an optimistic expectation of an improved outcome.

Interesting you are twins and don't share this issue. It could be predominately positional, and if there was a way for him to view what happens in his sleep (night camera), it might be motivating and help show how he gets into trouble with his airway and learn to avoid that. In many cases it's very obvious.

Yeah I might have him try the nasal spray to just have him practice nose breathing but he said he reverts to mouth breathing during sleep so that's another issue to tackle. I want him to start just wearing the mask with no hose during the day then add the hose and finally the machine running while he's awake but he's being stubborn/anxious about it saying he'll do it later so that's where attitude comes into play.

One thing I noticed he doesn't like the smell of the mask (silicone) I didn't wash it because he hasn't worn it for more than 10 minutes but it might have that new product factory smell or perhaps he might be allergic, whatever the reason is it's just another hinderance.

The thing is i've watched him sleep and I've asked him to sleep on his side and he does but sometimes he rolls onto his back, I personally sleep on my side or stomach and I suspect it helps for me since I recently have been waking up with dry mouth on my side but not my stomach. Regardless I've read that side sleeping will reduce the pressure the machine will need to use compared to supine sleeping. I saw a video where this person put something under their mattress to gently add an incline to the bed to open airways so that was another idea.

The main thing is I have to help him get over the anxiety, he's promised to wear the mask today to get used to it but I was also thinking of purchasing the large size F20 or possibly a different full face mask to make him feel less claustrophobic. The thing is it might be very obvious but I'm not sure because it seems like sleeping on his back/side still produces the apnea, and he can't sleep on his stomach (anymore) because less there's rooms for his lungs. He loved to sleep on his stomach before so that may have helped with his apnea by pulling the tissues that direction but I'm not sure. 

The catch 22 is he gets chipmunk cheeks because he breathes through his mouth but when he wears the SCC it restricts his mouth movement. When I was wearing it I got a bit of chipmunk cheeks too but it wasn't a problem once I kept my mouth shut and inhaled/exhaled through my nose. He states the the full face mask is meant for both nose and mouth breathing and our supplier said we should just breathe how we normally do but I'm trying to get him to just breathe through his nose. It doesn't sound stuffed when he lays down but it seems he has trouble perhaps because he's missing a sinus? I'm not sure. I may be digressing here but I'm just writing all my thoughts down to get more details down if there might be a solution to them. Apologies for the long replies.

[Sleeprider]

You have TBRS (Twin Brother Resistance Syndrome). He is simply resisting this and there is nothing either you or I can do until there is an attitude change. Either he takes the first step, or everything gets tossed out the window. His therapy will be revoked, the sleep study wasted and he will suffer whatever health effects his apnea imposes on him. It's really his choice.

[AmbitiousCut0]

Hi guys, great news we got him a different full face size mask that helped with his claustrophobia and he was able to sleep with it for ~5 hours. He said his mouth was a bit dry so I might turn up the humidifier and possibly some air in the tummy but nothing too bad I'm quite relieved!

Here's a screenshot of the OSCAR data and an excel export he's going to wear it tonight again. There were more charts there so let me know if I need to post more but it seems his AHI has dropped significantly; still we haven't had him get a proper full night's rest so we'll go from there.

I was thinking of changing the PS back to 6 since that was his prescription, but I may just leave it on 4 for the time being while he gets used to it. I also noticed his IPAP didn't get anywhere close to 25. He didn't take the mask off though so that's a win in my book, again I appreciate all the feedback this was a big burden lifted off my shoulders.

[Sleeprider]

Let's try to reduce CA events. Reduce PS to 3.0 cm and be sure trigger sensitivity is very-high.

[AmbitiousCut0]

Let's try to reduce CA events. Reduce PS to 3.0 cm and be sure trigger sensitivity is very-high.

Some more data.

I noticed his AHI is lower but he doesn't seem any more well rested. He will usually sleep with it for 4-5 hours on and afterwards sleep without it. He wakes up with a dry mouth (I have climate control on auto so I will change it to manual to add more humidity.) He states that he's still tired and that the mask seal says it's "good" but he feels there might be some leaking on the underside so I might purchase an extra large mask because he keeps saying he wishes the mask was slightly bigger. Says it might be CSA but I thought the BiPap should fix that too? His chest did feel a bit tighter and he removed it 30 minutes after because it was "annoying to breathe" and he couldn't tolerate it, he's also yawning a lot.

My concerns are that he's not getting proper rest and I read in the user manual that there could be excess CO2 so maybe he's inhaling CO2?
I was thinking of reverting his settings back to the prescription to try that since he hasn't slept with those settings yet.

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Couple more files.

[Sleeprider]

The entire ramp period from 06:00 to 06:45 looks pretty chaotic and respiration does not settle until ne is at 10+ cm pressure and PS 4 Other than a brief OA at 09:00 things stay right around 13.5/9.5 cm pressure. Maybe it's a sign. From 7:30 to 10:30 things look pretty good. My takeaway is his ideal pressure is 10 cm with PS 4, and his ramp detracts from efficacy. You need to get ramp on Auto or shorten it. Other than that, you're expecting a lot out of less than 6 hours of therapy where over an hour is spent flailing on ramp.

He is not inhaling CO2. That would cause high reparation rate and flow. The solution for hypercapnia is more pressure support, and I'm not seeing any indication it is necessary. I think he needs to expedite getting to his therapy pressure of 10 EPAP, 14 IPAP and spend a lot less time in ramp.

[AmbitiousCut0]

The entire ramp period from 06:00 to 06:45 looks pretty chaotic and respiration does not settle until ne is at 10+ cm pressure and PS 4 Other than a brief OA at 09:00 things stay right around 13.5/9.5 cm pressure.  Maybe it's a sign.  From 7:30 to 10:30 things look pretty good. My takeaway is his ideal pressure is 10 cm with PS 4, and his ramp detracts from efficacy.  You need to get ramp on Auto or shorten it. Other than that, you're expecting a lot out of less than 6 hours of therapy where over an hour is spent flailing on ramp.

He is not inhaling CO2. That would cause high reparation rate and flow. The solution for hypercapnia is more pressure support, and I'm not seeing any indication it is necessary.  I think he needs to expedite getting to his therapy pressure of 10 EPAP, 14 IPAP and spend a lot less time in ramp.

Alright i'll turn off the ramp for tonight, should I still leave the trigger sensitivity on very-high? It was originally on Medium.
Also any clue on what to put the humidity level on? Auto isn't cutting it and manual starts at 4 (0-8)

[cmpman1974]

Gideon took the words right out of my mouth. No one could use EPAP 10, IPAP 25 (PS 15).  

Your brother might be able to use nasal pillows. They are much easier to seal, and more comfortable. As long as he keeps his mouth shut and tongue on the roof of his mouth to exclude the air pressure, he will really like it.  I use the Resmed Airfit P10 nasal pillows, and Gideon has a magnificent beard and also uses the nasal pillows.

Well maybe. lol.  My sleep doctor titrated my BPAP S a couple years ago to 24 IPAP / 14 EPAP.