CPAP for a 15 years old

[Pierrec83]

Hello

As we tend to do things in family, my 15 years old son has been diagnosed with an AIH of 15
As he is still growing, the only release which can be brought to him is a CPAP.
So he started with a Resnet Autoset S10 and the new Resmed mask Air Fit F30 (which we will change today against an Air Fit 20 as he has issues at the nose level)

Using the avises you gave me for my own case, I have worked on adjusting :
-I progressively for the max pressure from the initial 6 to a 9.6
-the min pressure is at 5.2
-the EPR is at 2 and full time

Is AIH ranges from 2.3 to 3 when he manages to keep the mask all night long. His total time in Apnea is always around 4 minutes
I copied screenshots from last night which was complete and where Pressure Med is at 8.54 and AIH at 2.28

I notice that the machine is hititng the Max pressure quite often, but would like your advises before increasing the max pressure again

Thank you

Attached full night, 15 mins zoom and 2 mins zoom

   
   
   

[Sleeprider]

From what we can see of your son's data, it looks pretty good. It appears there is a fairly short ramp set that starts from 4.0 and it appears the pressure is capped at about 10. My best guess of the minimum pressure is 6.0 with EPR 2. The most noticeable thing about the events is that the obstructive apnea are clustered together. This is usually the result of using a pillow that lifts the head and causes chin tucking. This can cause obstruction that the CPAP can't quite clear. This is a very common problem, and when it is severe, we often recommend the use of a soft cervical collar. This is a pretty minor as it presents here, so be aware of it and see what you can do with his pillow or sleeping position to mitigate it and keep things comfortable. If he uses multiple pillows, limit to 1. Read the Positional Apnea section of the Optimizing Therapy wiki to get some ideas http://www.apneaboard.com/wiki/index.php...onal_Apnea I think we are going to move minimum pressure to 7.0 and EPR to 3 to reduce the flow limitations, but let's focus for now on the sleep position.

We see a number of pediatric CPAP users on the forum and some have had severe problems with more complex apnea. The use of CPAP by a 15 year old is not unusual these days, and getting ahead of the obstructive apnea will pay off in long-term health. With the kids, we like to make the machine theirs, and focus on comfort. Some things to consider (optionally) is to locate the CPAP inside a bedside drawer with the tube and power routed out the back through a 2-inch hole. This allows the CPAP to be concealed during the day and prevents it from being pulled off a nightstand if he is an active sleeper. The use of an inexpensive tube cover like the Snugglehose from Amazon makes the tube more comfortable on skin, prevents condensation and again looks less medicinal. I use a lanyard attached to the headboard or wall to hold the tube above the bed, and this helps with freedom of movement as well. Put your son in charge of the care and cleaning of his own equipment, but keep an eye on it.

We do want to see the left column Daily Sidebar information from the screenshot as it gives us important respiratory statistics, settings and other information. Please be sure to include it on future charts, and read the Organizing Your Oscar Charts from the links in my signature.

[Sleeprider]

You are using a full face mask. If you have never tried nasal therapy, ask for a trial with the Resmed Airfit P10 nasal pillows. If he can avoid mouth-leaks, it is far smaller, lighter, quieter, and even allows the user to talk. Unless he really needs a full face mask, I would avoid it.

[Pierrec83]

Thank you Sleeprider

Sorry for notposting the left bar

The data which I did not paste (left side bar) is here in text format

Don't you also think, beside position, that I should increase the max pressure? Now it is at 9.6, and the 95% is 9.6 (see below). Ands I see on the curves that the pressure hits the maximum a big number of times during the night

Thx

Large laks : 0.03%
Clear Airways : 0.57
Unclassified Apnea : 0
Obstructive : 1.59
Hypopnea : 0.11

Statistics
Channel Min /Med / 95% /Max
Pressure 4.06 / 8.54 / 9.60/  9.60
EPAP 4.00 / 6.54 / 7.60 / 7.60
Minute Vent. 0.00 / 4.38 / 6.75 / 10.88
Resp. Rate 0.00 / 13.60 / 20.20 / 28.60
Flow Limit. 0.00 / 0.00 / 0.14 / 0.27
Leak Rate 0.00 / 0.00 / 3.60 / 9.60
Snore 0.00 / 0.00/  0.00 / 0.00
Insp. Time 0.04 / 1.94 / 3.18 / 4.85
Exp. Time 0.10 /2.36 / 2.88 / 3.48
Tidal Volume 0.00 / 320.00 / 440.00 / 560.00
 
Total time in apnea 00:04:16
Time over leak redline 0.032%

[Sleeprider]

With the flow limitations, whatever you set as a maximum, will become the median pressure, or close to it. The obstructive sleep apnea problem is not a big problem at these levels. I was avoiding pressure changes in the first go-around because many parents are reluctant to get into the settings at first. If you are comfortable with that, then yes I recommend a minimum pressure of 7.0, maximum pressure at 12.0 and EPR at 3.

[Pierrec83]

Thank you

Having been thru these settings for myself, guided by you guys, and with successful results I am comfortable to go for it
Thanks