Wife is at her wits end

[revelstone77]

My wife is about 1 month into the CPAP and things aren't going well.  She has the Resmed airsense 10 and started with the Airfit f30i mask.  She couldn't keep that one sealed so they moved her to a Phillips Dreamwear which is better, as long as she is on her back and doesn't move.  She has trouble with chin drop and tried taping her mouth, but that freaked her out (claustrophobia).  She's getting less sleep now than she did before the CPAP due to fighting with leaks. Last night she tried the Releaf collar without the CPAP and was able to keep it on, but her O2 dropped to 76 at one point in the night (she wears a Wellue Checkme O2 Max).  On top of all that, she had heart valve replacement surgery 2 weeks ago. I've downloaded her CPAP data into OSCAR but am unsure how to snapshot the data to post here.  When I do a screenshot there is a lot of data not on the screen that isnt displayed. I've included what i could get for a screenshot. She's trying hard, but about ready to give up. I'm wondering if an Airfit N30i w/chinstrap might be better.  Any help will be greatly appreciated.

Thanks, 
Hal

[SarcasticDave94]

Welcome to Apnea Board,

A few suggestions and some suggested reading, then a few questions.

The CPAP/AutoSet requires higher minimum pressure for effective therapy. You're going to need to get it to about 8.3 cmH20 which is the median. We'll call it EPAP Min 8.0.

The use of EPR, requires minimum EPAP to go up as well. If you're using EPR 1, EPAP minimum must be 5, if EPR 2, minimum 6, EPR 3 with min 7.

This is a math thing. The mechanical lowest EPAP is 4 cmH20. EPR reduces EPAP Min pressure by its number value 1, 2, or 3 during exhale. Again physically the AutoSet cannot drop below EPAP min 4. So EPAP at 4 cancels any EPR until events force the pressure to dial up.

There's also some Flow Limits that are occasionally too high, even for EPR 3 to help with.

There's clustered event flags, indicating possible Positional Apnea patterns. This is where the patient is chin tucking, externally kinking off the airway. This needs avoided of physical external prevention.

Then there's higher CA, on CPAP and OSCAR this is clear airway events. The opposite of Obstructive Apnea. The airway is clear, 10 plus second breath pause, CA flag.

Do you have the diagnostic detailed sleep study report? You need this ASAP for your personal health record, and you could post info here about this, specifically regarding CA. Myself, I'm after the table of event type and count, plus the doctor recommendations. This helps define CA events, there in the sleep study CA mean Central Apnea.

If you attach any sleep study, it's preferable to redact your personal info.

Do you live at higher elevation? Again to gauge seriousness regarding CA.

Do read my signature link on Positional Apnea.

[revelstone77]

Not high altitude. We live at sea level
We are working through the Positional Apnea info.  She is going to try the collar with the CPAP tonight.  Mask leakage is still an issue.
I tried to upload the Sleep Study report as requested but it wont let me since I'm apparently not a full member yet.

[revelstone77]

I did change the low end pressure to 8 from 4 and upped EPR to 3 from 2.

[jdougc]

Take pictures of the sleep study with your info redacted and upload that.

[revelstone77]

Here is some of info from the sleep study. However, it reports zero central/mixed apneas.
APNEAS: TOTAL=51, OBSTRUCTIVE=51, CENTRAL/MIXED=0. AVG DURATION=31 SECONDS
HYPOPNEAS: HYPOPNEAS 3%=235, HYPOPNEAS 4%=180. AVG DURATION=20 SECONDS

CALCULATED INDICES: TOTAL APNEA =9.9, HYPOPNEA 3%=45.8, HYPOPNEA 4%=35.1, CENTRAL/MIXED=0.0, MAX DEN 10 RDI=86.2, REI 4%=37.7, AHI 4%=45.0 (O%CENTRAL) AHI 3% (RDI)=55.7 (0% CENTRAL)

CONSIDERATIONS:
If initial cpap is considered appropriate, the predicted initial cpap pressure is 9 cm h20. If auto-titrating, treating pressure will be determined by the device’s internal software.

I will try again to post the actual report.

[revelstone77]

Thanks, I may have to resort to that.

[SarcasticDave94]

Read my signature link on attaching OSCAR charts. Follow that also for other therapy related attachments.

[revelstone77]

I dont have any problem locating and attaching the document. the problem is that the system wont let me upload it because apparently I'm not a full member. I will attempt to take a photo of it and upload that and hope you can read it.

[Sleepster]

My wife is about 1 month into the CPAP and things aren't going well.  She has the Resmed airsense 10 and started with the Airfit f30i mask.  She couldn't keep that one sealed so they moved her to a Phillips Dreamwear which is better, as long as she is on her back and doesn't move.  She has trouble with chin drop and tried taping her mouth, but that freaked her out (claustrophobia).  She's getting less sleep now than she did before the CPAP due to fighting with leaks. Last night she tried the Releaf collar without the CPAP and was able to keep it on,

Welcome to ApneaBoard. At this point I'm sure you're overwhelmed with information and data. It will take awhile for you to absorb all this information, but unfortunately the medical community hasn't caught up to the nuances of CPAP therapy, so you really do have to do this yourself. In fact, that's the real reason this board exists.

I would suggest trying a special CPAP pillow. You can do a search for Papillow at Amazon, and although they no longer offer that particular brand, you'll see many alternatives. I've used many, and the one I'm currently using is the Contour CPAPMax. This will allow her to sleep on her side.

If you are unable to get the leaks under control, you can try a full face mask. Your equipment provider is under contract with your insurance company to allow you to try a variety of masks. If they won't cooperate, contact your insurance company. Your equipment provider has already made the lion's share of its profit from you by selling the CPAP machine, but nevertheless they are required to cooperate with finding you a mask that doesn't leak.

she had heart valve replacement surgery 2 weeks ago.

I'm sure you're aware of the punishment inflicted on a cardiovascular system by untreated sleep apnea. For many of us, we get less sleep, not more, when we start CPAP therapy. Because the pressure and the hose are such a bother. But I assure you that once she gets adapted her sleep will improve, she will feel better than she has in years, and the risk of cardiovascular disease, stroke, and death will all go dramatically down. Once adapted, the mask, hose, and pressure are as normal to sleep as a pillow and a blanket. We just get used to it because we are highly adaptable creatures.

Here is some of info from the sleep study. However, it reports zero central/mixed apneas.

That's good news. The central apneas she's experiencing now will likely subside as she adapts. Her body is not used to getting this much oxygen while sleeping, so her brain doesn't trigger her breathing like it should. Fairly common, and almost always goes away with adaptation.

Stick with it!