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My dad, who is extremely stubborn, finally said he would try a CPAP machine, but doesn't have diagnosis/sleep study.

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TheBulgarian +0 points · almost 2 years ago Original Poster

The issue with my dad's sleep has been going on for many years. Time and time again he has refused to go to the doctor and treat his sleeping problem. He has no formal diagnosis but it seems almost obvious that he has sleep apnea. He snores constantly, takes numerous naps throughout the day, is easily aroused from sleep, and has numerous periods where he doesn't breathe during his sleep/naps.

The big thing is that he has finally agreed to try a CPAP machine. I've been lucky enough for someone to actually give me the ResMed Air Sence 10, but I feel like this is out of my league. I work in the medical field but I am not a doctor, nor am I really familiar with sleep apnea. I've been researching if I can/should set up the machine for him and see how it goes. However, it's starting to seem like it may be unsafe for me to do so. It seems like you have to have specific pressures set on these machines and too high/low may not be beneficial or can be even dangerous.

We have insurance, but it is not the best, our family is not in a great financial situation and my dad constantly avoids going to the doctor. My question is what do I do? Should I research more on how to set up this machine for him? What can happen if I do it wrong? Should I even consider doing this? What if my dad agrees to a study, can we still use this machine that I got as a gift?

Thank you for any help that you may provide.

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Biguglygremlin +0 points · almost 2 years ago Sleep Enthusiast

Hi TheBulgarian

It really isn't that complicated. I don't understand half of the stuff these guys go on about and I live in a perpetual fog with only a few worn out neurons to work with but I manage to get my machine working. (without reading all of the instructions of course)

I figure you can do it easy! :)

Park the machine on the kitchen table, just add water, and turn it on. It's not that scary.

Tinker with a few settings check out how it operates and how it feels.

Manual

If your dad wants to try the machine I would suggest that you set it up with a maximum pressure of 10 and then adjust it over a number of nights based on feedback from the machine and your father. Others in this forum can advise you better than I could if you can understand all the technical jargon. :P

If you are concerned or have serious doubts try it yourself for a night or even just for half an hour with a good book. If it becomes uncomfortable take it off.

I think an auto machine should be safe for just about anybody larger than a child but reducing the maximum pressure is probably a sensible precaution initially.

If it's any consolation you would probably end up having to figure out the basics and adjust the machine at some stage anyway even if your dad went down the 'normal' path first.

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TheBulgarian +0 points · almost 2 years ago Original Poster

Hello!

I really appreciate this information and how to start my dad off. I didn't even considering doing it just for a little while and see how it feels. How do I know that the pressure is too little for him? Like for example, if I set the pressures to be 4-10 initially, what can I notice during his sleep that will show that it is doing its' job? When should I be increasing the pressure, and what would be a good range for an adult?

Again, thank you so much for the information, it has put me at ease on trying to figure this out for him!

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Biguglygremlin +0 points · almost 2 years ago Sleep Enthusiast

I am just an observer and not really familiar with the functions of the auto machines but it seems to me that most men who are snoring would be improved at 10 but it would not be enough. Your father would probably take the mask off after a short while. It wouldn't do harm but it wouldn't deliver noticeable results either.

Most men would begin to notice real benefits at 11 or 12 and I suspect that in most cases the sleep specialists would specify starting at 12 or thereabouts and with the auto machine it should figure out for itself what to do.

I only suggested a low max so you would feel confident that it couldn't do any harm and because when high pressure can do harm it seems silly to trust the machine unreservedly.

Perhaps 7 - 15 would have been a better suggestion for an auto machine.

Once he has used it for even a few hours the machine will give you data that you can use to set it up properly.

Up to that stage it is still quite simple and well within your ability to manage.

The machine also collects extensive data on the SD card and that's where this forum can be really helpful.

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bonjour +0 points · almost 2 years ago Sleep Commentator

It would be extremely unlikely for a CPAP, even at max pressure, to hurt your dad. It may not help him but if he did as you said "has numerous periods where he doesn't breathe during his sleep/naps" he has Sleep Apnea and the question is how bad.

I'm sure we can help you thru this but my first question is which ResMed AirSense 10 machine do you have? There will be words on the front of the case. What I want to here is that it says "Autoset" or "Autoset for Her" which would mean that you have the best CPAP (Auto-CPAP) to use to accomplish what you would like to accomplish.

Like all (alright most) here I am not a medical professional but I do have some experience with Apnea. That said either I, Sierra, or others here can help you to understand the results and what your next actions should be. That said ...

You will need an SD card in the CPAP machine. The access door in the upper door on the left side of the machine. If one is not there (or even if one is) you can buy one almost anywhere. The OEM size is 2GB but it is very unlikely that you will find one the important thing is that it is 16GB or smaller. Assuming you have an AutoSet set the range to Min = 6 and Max = 20 and for the test I would suggest EPR is off. 4 is the min that the machine will go but it is not uncommon for an adult to feel that 4 is not a high enough pressure. The next step is you say "goodnight dad, see ya in the morning." What we just did is set up your dad to be auto-titrated over night. That means to find which pressures to start him off with. This is an option that is frequently provided by a Sleep Lab (except without our help) only with a pressure range of 4-20.

To do this you will need to know how to set the pressures. Perhaps someone here (Sierra) can provide that.

Sleepyhead Software (free) is the best software to view the results so download Sleepyhead and Post his nightly charts here. Which charts? That would be *Event Flags -- This will show us what Apneas and Hypopneas occurred and when. Apneas and Hypopneas are also a trigger for an Auto-CPAP to increase pressure *Flow Rate -- Can provide valuable info on exactly what happened *Flow Limit -- This is another cause of both discomfort and or arousals and is also a trigger for an Auto-CPAP to increase pressure *Snore -- This too is also a trigger for an Auto-CPAP to increase pressure *Pressure (not Mask Pressure) -- To let us see how the machine responded to all your dad and everything through the night *Leak Rate -- this can indicate issues such as mouth breathing

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TheBulgarian +0 points · almost 2 years ago Original Poster

Hello! Thank you so much for the detailed responce. The CPAP machine says "AirSence 10 Autoset". I looked around and found how to change the min and the max pressure. It also already has an SD card to record the information. What advice would you give on what kind of mask to buy? I was considering this one for him, https://www.footit.com/products/resmed-quattro-air-full-face-cpap-complete-mask-with-headgear

It will take a few days for me to get the mask and for him to try it, so I will update whenever possible.

Again, thank you very much for the information!

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bonjour +0 points · almost 2 years ago Sleep Commentator

Masks are very personal, what fits one person may not fit another. The Quattro is frequently the first mask tried by many clinics. You may find better prices online on sites like Amazon (note: technically a mask purchase in the US requires a prescription) I wrote a well received WIKI article about masks in general callte the Mask Primer.

[http://www.apneaboard.com/wiki/index.php?title=Mask_Primer]

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Sierra +0 points · almost 2 years ago Sleep Patron

I can see you are in a difficult situation with your Dad. There are some legal issues and forum issues that need to be addressed first. One is that it is not legal in the US (Is that where you are?) to buy a new PAP machine without a prescription from a doctor. It is also not legal to buy a new PAP mask without a prescription (in the US). I think the mask rule is a bit silly but there is some logic to the rule that you cannot get a CPAP without a prescription. Obviously it is to ensure the prospective patient is diagnosed properly and the machine is appropriate for the needs. And even on a practical basis these machines are expensive to buy, and the potential consumer needs some protection from wasting their money on something that is not going to work. The other issue is that as bonjour mentioned most here are not medical professionals, just PAP users. I am included in that category and as such cannot give you medical advice. All I can do is tell you what my experience has been using these machines, and you will have to decide how applicable that experience is to you (your Dad).

So with that warning I will also say that the rule against buying a PAP machine in the US does not apply to used machines. It sounds like that is your case, and you already have it. And the work around to the prescription for a mask is to buy the mask parts. The vendors in the US are well aware of this somewhat silly (In my opinion) rule, and almost all of them will sell the mask in two parts -- i.e. as mask replacement parts, that are easily put together.

I use the same machine as you have. BUG has provided a link to the Technical Manual for the machine, but I could not get it to work. Here is a link that may be better. I would suggest you read the manual thoroughly so you understand how it works.

Technical Manual

The first thing I would do with the machine since it is used is to delete all the data on the SD card and the machine so it does not get mixed up with your Dad's data. See page 17 in the manual and use the Erase Data command in the Configuration section first. Then set the date and time, and Restore Defaults.

Here is how I would set this machine up if I was going to use it for myself, knowing I probably have apnea, but not knowing to what extent. In short I would be conservative with the settings, but also set up the features it has for maximum comfort. At the end of the day the biggest issue with using a PAP machine is compliance. Will your Dad actually use it? If he rejects it, and does have apnea then all is lost... So, the settings in order they appear on the machine:

  • Mode: AutoSet
  • Min Pressure: 7 cm
  • Max Pressure: 10 cm (this may be too low and after viewing results in SleepyHead you may have to increase it)
  • Mask: This has to be set to the type of mask you choose. Here is a ResMed Compatibility Table that tells you which type. If you buy a non ResMed mask then just use the generic mask type; Full Face, Nasal (covers the nose), Nasal Pillow (under the nose).
  • Ramp Time: Auto
  • Start Pressure: 7 cm
  • EPR: On
  • EPR Type: Ramp Only
  • EPR Level: 3
  • Climate Control: If you have the heated ClimateLine hose (has heating wire in it) it should default to Auto. Otherwise set to Manual.
  • Tube Temperature: Only if you have the ClimateLine, set to 27 C or 81 F.
  • Humidity Level: Only if you have the standard hose, set to 4
  • Essentials: Plus (Gives you access to a bit more control and sleep data from the User Menu)
  • SmartStart: On (this will start and stop the machine by just putting the mask on and taking it off. I find it convenient, but your Dad may or may not.)

The rest of the stuff you can leave in the default setting.

I would highly recommend using SleepyHead to monitor the results so you can further adjust the machine. The maximum pressure is most likely to need adjustment after you see the results. To use it you need a Mac or PC and a SD card reader to get the data from the machine to your computer. Here are some links. When you get some results then post back for some help on how to post the SleepyHead results here and some help in understanding the results.

SleepyHead Download

SleepyHead Basic Manual

As for the mask that is difficult. As I mentioned before, you will likely have to buy parts and put it together if you do not have a prescription. That is easy. Choosing one is difficult. Most who get a machine from a sleep clinic will be offered various masks to trial, and that is the best way. It is a very personal thing. So far I have tried 6 masks. Of the ones I have tried I would recommend the ResMed Swift FX. It is a nasal pillow mask and they tend to be the most comfortable to use if they fit and work for you. See this link for what you would need:

Swift FX Replacement Parts

Of these items it would be best to get the whole fit pack version which includes three nasal insert sizes for $98, but that requires a prescription. Without one you need:

  • Mask Assembly Kit - $67 ( I would choose the large size of insert)
  • Silicone Headgear Assembly - $31

And if you wanted to be safe for fit, I would suggest also ordering the Nasal Pillows insert in the Medium size for $19, or just go with the large and order the medium if it ends up being too big.

Hope that helps some. Post back if you have questions or need more help.

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bonjour +0 points · almost 2 years ago Sleep Commentator

I will add that my 6-20 recommendation is for one night only. The data from that first night would be used to better dial in your dad. I can guarantee that I would change it. Thus the upload the charts after. Either Sierra's settings or mine will provide info that likely will require adjusting after you/we see the data from night 1.

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Sierra +0 points · almost 2 years ago Sleep Patron

Yes, 6-20 would work too. I like 7 cm because the EPR of 3 on ramp will cut it back to the machine minimum of 4 cm to give a very comfortable feel while going to sleep - especially for new users. Lots of air on inhale and easy exhale. It is possible after review in SleepyHead that the minimum will need to be reduced, but not likely. On the max end, yes many machines are just handed out set at 20. I think mine was originally. The only issue is that I gathered that Dad is a reluctant user, and I worry a bit about souring him on the PAP machine treatment if the machine really went up to 20 cm on the first night. I thought it might be better to under treat a bit until some results are gathered.

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bonjour +0 points · almost 2 years ago Sleep Commentator

Thanks Sierra, that is a good point. You reminded me that I did not address that the first night is just a trial and the real treatment would start after the adjustments from that. My only thought on your studies was that 10 cm may be low, then that was OK because either of us would adjust that based on the data from the first night.

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Sierra +0 points · almost 2 years ago Sleep Patron

"Should I research more on how to set up this machine for him? What can happen if I do it wrong? Should I even consider doing this? What if my dad agrees to a study, can we still use this machine that I got as a gift?"

I jumped in and gave you a sermon and a solution but did not really answer your questions. My thoughts:

  • Read the Clinical Guide for the machine. It gives you a good basic understanding of what the machine is capable of.
  • The most common mistake in setting up an Auto machine is having the starting pressure too low. That can give a suffocating feeling and users sometimes just want to rip the mask off and throw it out the window. Depending on the severity of the apnea, if he in fact suffers from it, the pressure to treat it can be high. The machine can go from 4 cm to 20 cm. When you start to get up into the 14-20 range depending on the mask, it can feel uncomfortable when you are a new user. That is why I suggested starting with a lower maximum pressure. It does mean however that you will likely have to adjust it from the initial settings.
  • I can't give you medical advice, but I think if I were in your situation I would do it. I saw my father in law suffer from fairly obvious in retrospect undiagnosed apnea and probably diabetes too, and he suffered quite a bit for it in his later years.
  • I don't see a problem if he has a study later. You now own the machine and they can't force you to buy a new one, if the one you have is suitable. By the way I think in the Auto PAP category you have the best one on the market. It it turns out he needs more pressure or a specialized machine, then you may be in for buying a new machine. However if he uses the AirSense 10 AutoSet now, you will pretty much know that from monitoring the results with SleepyHead.
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TheBulgarian +0 points · almost 2 years ago Original Poster

Thank you all for such detailed responces. It really means a lot to me. I will post updates as soon as I can, but my family still has to buy the mask first. I will then take all your advice and tinker with it while using the app to gather data. Again, I really appreciate everyones help, once I gather more information I will post again!

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