How to overcome if you breath with mouth and nose same time when wear mask

[Walla Walla]

It depends on the cause of the flow limitations. It can help with the flow limitations that are caused by tucking the chin down to the chest.

[luckydxx]

HI, could you help me understand what is clear airway events? 

thanks

[luckydxx]

Last year i was just wanted to get cpap for my mom to start therapy ASAP, and thought full face mask would be safest to her if she breaths through mouth and nose, But she is not able to handle it at all.

Now i am thinking whether i was started at wrong direction. How would you determine which type to use? 

thanks

[Walla Walla]

The only way to know for sure is to try either a nasal mask or a pillow mask. I like the ResMed Airfit P10 pillow mask, but there are others that are also good.

[luckydxx]

I have another questions:

A. if the automode for her can only deal with apnea up to 12, and my mom's mostly are OA events and not flow limit and snore (not sure what are these limit will cause it increase to 20),  so why the pressure each night can max to 15?

B. Do you know what are the flow limit and snore number will cause the pressure continue up to 20?

C. also just a thought, would you think a mask for asian type face will be different sizing compare to American size type?  (just like clothes, small is different concept in China than in here).

A. It is the lowest limit that applies. If it is in the For Her mode and the events are OA type, then it will not go above 12 cm for pressure, and events may continue to happen. If at the same time there is flow limitation or snore then it may try to go higher based on those. However if you have the maximum pressure set at 15.6 like the last SleepyHead chart indicates, pressure will not go above that setting, regardless of what happens with OA, flow limitation and snore.  My suggestion is to set your maximum at 20 cm and put the mode in the standard setting, not For Her. That will give the best chance of having the machine fix the problems. If it does, then you could also try it in the For Her mode to see if it gets worse again.

B. No I don't. What I see in your chart however is that the machine is responding up to the maximum 15.6 setting, and it must be the flow limitation and snore that is doing it. So the short answer is that what she has is enough to drive pressure up. 

C. Your most recent chart shows a very low leak rate from her mask. It is all under 8 which is excellent. It makes me wonder if the mask is adjusted too tight and may be uncomfortable. If she thinks that mask tightness is a problem, you may want to try backing it off a bit to make it more comfortable. But this suggests to me that the size is fine. If you want to check to see what Resmed suggests for size, do a google search for resmed airfit f20 sizing guide pdf. You should find a pdf document to print and cut out to check for size. Just be careful with the scale. You may have to manually adjust your printer setting to get it to print out at the correct size.

Hi Ron, could you help me understand what is clear airway events?  I saw you have some posts about it, but i don't quite understand what is it and what does it relate to EPR. 

thank you

[Ron AKA]

Hi Ron, could you help me understand what is clear airway events?  I saw you have some posts about it, but i don't quite understand what is it and what does it relate to EPR. 

thank you

An obstructive event occurs when the airway is blocked because there is not enough air pressure to keep it open, or the position of the neck is forcing it closed. A clear airway event is when there is no blockage and no flow. The A10 does a test to see if the airway is blocked or not, and then classifies the event as obstructive or clear airway. It is technically called a central apnea. It essentially happens when the body's breathing control system does not signal the body to take a breath. A CPAP machine like the A10 does not respond to these events by increasing pressure. There is no point as the airway is already open. There is not much you can do about them, except monitor them. If they become excessive then a more sophisticated machine may be needed to treat them. Some believe that EPR may cause the frequency to increase, but I am not in the camp. I might change my mind though... I don't recall that your mother's CA events are excessive, but it would help to post a more recent chart.

[Walla Walla]

A clear airway event is not always central apnea. The machine sometimes will count a CA event when your holding your breath while rolling over. The machine can't tell the difference. As far as EPR it does not cause central apnea. Central apnea is when the body doesn't get the signal from the brain to breath when it should. EPR can cause clear airway events by reducing the amount of CO2 in the lungs. An excess of CO2 signals the brain to breath to bring in more Oxygen to replace the CO2. It's not that the brain can't send the signal to breath it's a lack of CO2 that stops the breathing. By reducing the EPR your reducing the amount of CO2 that is lost on each breath. This prevents a shortage of CO2 which results in clear airway events.

[luckydxx]

Dear friends,

Thurs and Fri 4/12-4/13, i had mom make sure use a right pillow and with good neck support when on the side sleep. No collar use yet. All the settings remain the same.

So last two nights she come up good number and Friday also had good hours usage.

So my questions are: 

a. on Friday report, she said she almost no sleep during all thess 6 hours, so i don't know whether that's the reason events are less. Can you tell by looking at chart did she fell into sleep?

b. How can you prevent mask leak when you are a side sleeper. She did said she feels there is leak sometimes.

c. Do you think I should still let her try the collar?

Now what i want is let her remain in right pillows etc and continue this until I get the new nasal mask to try. My goal is get her use cpap long hours and be able to sleep as well.   Any other suggestion?

thank you for being with me.

[Walla Walla]

It looks like the pillows are working well. I'd stick with that. Also the leaks aren't bad as far as numbers. So if it's for comfort I guess you just have to keep trying small adjustments until you get the pillow mask.

[Ron AKA]

a. on Friday report, she said she almost no sleep during all thess 6 hours, so i don't know whether that's the reason events are less. Can you tell by looking at chart did she fell into sleep?

b. How can you prevent mask leak when you are a side sleeper. She did said she feels there is leak sometimes.

c. Do you think I should still let her try the collar?

Now what i want is let her remain in right pillows etc and continue this until I get the new nasal mask to try. My goal is get her use cpap long hours and be able to sleep as well.   Any other suggestion?

a. Telling when one goes to sleep is not easy. But from a distance I think she may have fallen asleep at 23:50. We breath deeper and in a more irregular pattern then when we are sleeping. On the flow chart you may be able to see this if you expand out the scale. Put your cursor in the 23:50 area, and repeatedly press the up arrow key to expand the scale. You may have to left and right arrow to keep it in the right area. Keep expanding it until you can clearly see the wave pattern. Then look as I say for when the waves become very regular and perhaps of lower amplitude. The other clues are snore as people don't usually snore when they are awake. And flow limitation will be more likely to occur when sleeping because the airway becomes more relaxed. Thursday is harder to tell, but actual sleep may have started at 22:30.

b. Her mask leaks look very good. This is much better than I get with my P10 pillow type mask.

c. I have no experience with the collar and will leave that advice to others.

I think you have a reasonable setup based on those two nights, but I still think she could benefit from changing the mode to standard instead of For Her. And increasing the max pressure to 16 may help. It was not a limitation in those two days, but it could be especially if you switch to standard mode.