[Diagnosis] Helping Father in Law Get Started on xPAP

[R and R]

Hello folks, what a great haven of help this is. 

We are facing huge delays with our public and private sleep clinics here so we are looking get this started our selves. 
Initial issues are mask leak, active / side sleeper.  The mask test comes up good but we may need to ask him to shave the edges of his mustache. 
We only have 3 hours of data so far with him taking it off after the leaks proved too distracting.
He is a mouth breather due to adenoids so using a full face mask. 
He is 85 but very fit and moderately adaptable but hoping to get this dialed in and comfortable quickly.
He says he never sleeps and from the chart I think we can see why.

Any tips on helping him become familiar, should we switch to a nose pillow, do we need to set the max pressure to 20 etc.

   

[Narcil]

Am not familiar with the ibreeze so not sure it has all of these but if you can show us these graps: event flag, flow rate, pressure, leak rate, flow limit, snore.

i think he needs a higher min pressure 7-8cm, 4 is usually too little for adults. but the first priority is leaks. the events seem to correspond to leak events a lot of the time so hopefully his numbers go down once he receives adequate (not leaking) therapy.

Maybe someone else can provide more info cuz his breathing pattern a bit odd, i don't know if that is just Periodic breathing or not.

Nose pillows would probably work better with the moustache but he would need mouth tape, a chin strap or a soft cervical collar if he is a mouth breather.

[HalfAsleep]

What mask is he using? There are different types of full face masks.

[staceyburke]

I have never helped with the type of machine you are using but to me it looks like Positional Apnea.  

.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

This may NOT be the cause but I would not rule it out...

[Phaleronic]

Lots of good advice so far from our members here-I would add that you should set the machine to cpap mode and turn it up to 15.5cm this should help immediately, also please turn up iPR to 3 instead of two (exhalation pressure relief). Have him try these setting changes during the day for 30 minutes to an hour or before bed to see how it feels to him.

[Sleeprider]

R and R your father's breathing pattern has persistent periodic pattern and hypopnea or apnea at the nadir of the cycle. This individual may require a more advanced ventilator like ASV or ST-A to maintain respiratory volume. We really need to know more of his health conditions, and you might be able to use a chart like this to expedite a clinical evaluation as this appears to be a fairly serious condition that can be treated. CPAP cannot cure this problem. Even if leaks are resolved, your FIL needs adaptive pressure support to even out the respiration. Take a look at the Resmed Sleep Lab Titration Guide to understand more about periodic breathing or Cheyne-Stokes and how the ASV or ST-A may be appicable depending the medical issues that cause this pattern. https://www.resmed.com/us/dam/documents/...er_eng.pdf

[R and R]

show us these graps: event flag, flow rate, pressure, leak rate, flow limit, snore.

i don't know if that is just Periodic breathing or not.

Here is a zoomed event cluster.  Note the class 6 late peak flow rate contours toward the end of the breathing periods.
He also claimed to be awake during this time so this could be wake / periodic breathing. 

   

What mask is he using?

BMC F5A
   

it looks like Positional Apnea.  

Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  

He is usually a side sleeper no changes recently, though we may need to get him a side sleepers pillow to help with the leaks?

Lots of good advice so far from our members here-I would add that you should set the machine to cpap mode and turn it up to 15.5cm this should help immediately, also please turn up iPR to 3 instead of two (exhalation pressure relief).  Have him try these setting changes during the day for 30 minutes to an hour or before bed to see how it feels to him.

Will do thanks, indeed some great advice.

[R and R]

Sleeprider,  great info, I was just reading about CSR on the Apnea Board Wiki "Beyond AHI: Apneas and hypopneas in the Flow Rate graph"

His cardiologist is saying he has intermittent AF.  He has had sleep apneas for about 40 years so we suspect the heart conditions are probably caused by the sleep disorder.  What a crying shame this wasn't looked at earlier.

Thanks again everyone, a bit of a learning curve for all of us for sure.  This is the most help we have had so far and all in the space of one day, bless you.

[Sleeprider]

With those results, it would be work a quick EKG to check if he is in AF again. As long as you're certain no heart failure is present, particularly with left ventricular ejection fraction less than 45% ASV won't be a problem. I hope you can check additional nights to see how common the periodic breath pattern is in his results. If it's ubiquitous, then please inform his cardiologist whom may be able to prioritize him for an advanced PAP evaluation. Just to be clear, you are not dealing with simple obstructive sleep apnea, and need to address this medical issue which may be secondary to other issues.

[R and R]

Thanks will do, 

We did some position work and mask leak testing yesterday removed the ramp, set IPR to 3 and upped the pressure to 9/16. 
He seemed comfortable but was not able to sleep with the full face mask on so took it off after 2 hours then said he was able to sleep, possible due to additional sleep pressure but had a dry mouth so likely snoring, apneas etc.  The device did not record any data unfortunately so we still don't have any true sleep data.

Any tips for help with adaptation or should we look at taping (mouth breathing) and moving to a nose pillow?

We gave him some coaching on nose breathing - deep and slow belly breathing which is helping but very early days still there.