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[Diagnosis] BiPAP and MAD not working, please help
#1
BiPAP and MAD not working, please help
Hi everyone,

Two years ago, I underwent a second septo- and rhinoplasty, and since then, I've been experiencing various sleep-related symptoms (red eyes, impotence, fatigue, headaches, and so on). Recently, I had a DISE, which indicated a 100% blockage of my throat caused by my tongue.

Unfortunately, despite using both my Mandibular Advancement Device (MAD) and BiPAP for a year, they haven't been effective. My symptoms remain the same. 

Could anyone help me interpret my sleep data? I’m trying to determine if this truly appears to be a tongue-based issue or if my nose could also be involved. Or if it is even a breathing-related issue?

Thank you very much.

Best, 
Daniel


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#2
RE: BiPAP and MAD not working, please help
I myself would not be able to determine what causes your airway blockage.

I do see 2 things you need to change for success. One, your leak rate is high. You need to try getting the mask to seal better, which does not include making the mask tighter. If the mask doesn't keep leaks down with moderate tension, then it's a poor choice for you.

Second, your settings are not ideal. The Min pressure of 4 is too low for adults typically. I'd go to about 6 or 7. Also Max pressure probably needs to go up about 3. Then PS should be raised to about 3.

I'm thinking the pressure was edited down to prevent leaks, and that's the wrong way to fix it. Leaks just need addressed, while using proper therapy settings.
Mask Primer

Positional Apnea

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: BiPAP and MAD not working, please help
Here are some tips for mask leaks as well:   Mask Primer             
Download OSCAR
OSCAR Chart Organization
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Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.  
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#4
RE: BiPAP and MAD not working, please help
Thank you very much for the advice. I seem to have solved most of the leak issue with my current mask, while I wait for a new one. 

However, I still don't feel much better, and I have previously also used these settings for six months, while having a low leak rate, without feeling much better. 

Do you have any idea why this could be?


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#5
RE: BiPAP and MAD not working, please help
This leak rate is perfectly fine from this chart.

Is the mask cushion, or other parts, worn out? How old they are can affect leaks. Any physical damage obviously will make it harder to control leaks.
Mask Primer

Positional Apnea

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