CPAP questions

[crispy91]

Hey everyone,

I'm not sure if this the right thread, but I have a few questions about CPAP. Specifically, the home model F&P Icon. I'm staying at a shelter until graduation with a few other people. One of the guys asked if I could help with his CPAP. Here's the issue: he says at night, the air pressure increases and litterally blows the mask off his face. I was thinking maybe there was a way to adjust the pressure, or maybe it was the PEEP valve, but when I looked at it, it didn't have a place to adjust anything. It's got a radio, alarm clock, everything; just nothing to do with that. So I was thinking maybe it was the mask seal. Aparently, it gets so bad, it's overwhelming the pop-off valve. So I looked in the instruction manual, and there was nothing about it under trouble shooting. Anyone know anything at all about this model?

 

[BLS Systems Limited]

Most of time, the pressure setting is done at the place where it was purchased, to prevent people from playing around with it. In order to qualify for these devices, tests are performed before and after to diagnose for sleep apnea. The second test (and sometimes even a third) titrates the pressure to achieve the desired result. I would question when the last time the device was serviced and calibrated (and check the filters as older machine are usually ridiculously dirty).

Another possible cause is that the mask harness isn't securing properly. These machines have the feature to ramp up the pressure gradually to allow the person to get to sleep before the full effect hits. As the machine ramps up the pressure, it could blow off before hitting the target. There may also be a leak compensation aspect where the pressure keeps increasing if the mask leaks, actually exacerbating the problem until it gets to windy to continue.

It is very common for people with CPAP devices to need a followup check to see if the setting is where it should be and whether the mask still fits as it should. Where CPAP works well, people start getting better sleep, better attitudes and even lose weight. The physical morphology actually changes such that the initial settings no longer apply.

 

[gw812]

Good answer, BLS. I am in this same situation - got a BiPAP myself 2 weeks ago and my pressure setting is pretty high. I've had 'hurricane-mask syndrome' as well. Too bad he didn't get something in the ResMed S9 series, they're smaller and IMO better machines. I'm thinking he's new to his machine too. Layman's terms for the guy you are speaking to:
1. "What's your ramp set to?" If it's not 45 minutes tell him to set it to that. It's getting to full power before he's really down. If he doesn't know what the ramp is tell him to call his resp therapist. They didn't teach him properly.
2. "What kind of mask do you use?" Find out the actual brand and model, then together check out the maker's website. Again, I defer to ResMed here, their newest mask line has documents and videos to help set it right. Sometimes logic does not apply to them - the cure is not always to TIGHTEN the straps as the seal comes from an air cushion. I had to learn that the hard way and experience it before believing.
3. "Do you have your prescription?" If he doesn't have a copy of the Rx tell him to demand it. The machines won't allow you to CHANGE settings without a bit of hacking h34r: but most will DISPLAY them. Check the pressures for accuracy.
4. "Remember, I'm an off-duty EMT and I learned all this stuff from another off-duty EMT on the Internet. Only your doctor can give you good answers!" Obvious...

Now, I have learned some things during my time as a hose-face that are worthy of relating to him:
- Mask-fitting is not a 'one-and-done' proposition. It took 2 weeks to get mine close and I'm still working on it. Takes experimentation.
- Only decrease the ramp settings once used to the machine and airflow.
- Take advantage of a mask-fit feature on the machine, and only fit the mask while LYING DOWN. It makes a difference.
- Learn the way to sleep with a mask. Supine, with just a touch of head elevation seems to be the best. Left-lateral recumbent often requires a special plllow.
- Straps must be played with BILATERALLY. If you mess with one side with simultaneously messing with the other you'll never get a fit.
- Speak up if something doesn't feel right. Make the resp therapist work for you. Make the MD work for you. Self-advocate, and don't take no for an answer when you need something changed.

Give him this address for a wealth of info: http://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html
Finally, if he has an iPod or iPhone using relaxation audio or relaxation/ASMR videos on YouTube go a long way in helping you get used to the machine. Takes your mind off of the thing strapped to your head.

I'm now going to go plug myself into mine...

 

[crispy91]

Actually, what BLS sugested really worked. I think the seal wasn't quite tight enough, so adjusting the harness helped immensely. I actualyl did ask him about his doc, though. He said he had gotten the machine three years ago in another state, and hasn't seen his doctor since. He needs to go back regularly, but at least this issue's been taken care of.

 

[BLS Systems Limited]

What gw describes above is bang on as nothing beats clincial knowledge more than being a user as well. He made a great point of not making the seal too tight (a very, very common mistake, even by clincians...something we see with BVMs as well).

Three years is a bit long between visits. Because of the large number of CPAP users, there should be a fair number of forums specifically for his machine and mask. Although I don't recommend playing around with the settings, he may find more information on finding the best mask fit and/or machine care to optimize the device. I would start with the link given above.