My son whom is 8yrs old was just diagnosed with sleep apnea...when he was 4 he was diagnosed with OSA and we had his tonsils and adenoids removed well here we are again. He will be getting his CPAP which is a Resmed airsense 10 on Tuesday. Any tips or tricks or anything possibly helpful would be appreciated. Thank you!
At an age of 8, getting a mask that fits well may be a bit of a challenge. I would make sure that your provider spends enough time to ensure the mask fits well without leaks using the expected treatment pressure. There are some masks made for kids that you may want to ask about if they only have adult masks. Here is a link to an article on CPAP Masks for Kids. They list some available masks near the end of the article.
The other issue will be ensuring the machine is set up for good comfort. This ResMed AirSense 10 has some good comfort features. When you put a CPAP mask on and you are awake it can feel like it is restricting the air flow. One way to address that is to use the ResMed EPR feature which increases pressure on the inhale, and decreases it on exhale. EPR can reduce treatment effectiveness so it is best if the machine is set to use it on the Auto Ramp feature only. Say for example the expectation is that a treatment pressure minimum may be 8 cm. I would ask for a Ramp Start pressure of 7 cm, with an EPR of 3 on ramp only. This will give 7 cm of pressure on inhale, and 4 cm (machine minimum) on exhale. This tends to be very comfortable because you get pressure assistance to breath in, and the very lowest available pressure to breath out. When the machine detects you have gone to sleep, then it will switch the EPR off and go to the 8 cm treatment pressure. Now if the expected treatment pressure is lower than that, then you will have to scale back those pressures. The ramp start pressure can't be set higher than the treatment minimum pressure.
Make sure you get a heated hose, which I believe ResMed calls the ClimateLine. It allows the machine to automatically control humidity and temperature for maximum comfort.
So, I think those may be a couple of key things to get right; mask comfort, and going to sleep pressure settings. A good sleep tech should take the time to do this, but some may just take the machine out of the box and leave everything at default settings.
If you have any questions, just ask. I use the same machine, but am just a little older than 8 years!
Thank you for all the helpful info. For the sleep study we used a philips dreamwear full face mask...the only issue we had was we had to put the mask edge over his nose a little but other wise he did well with it. He sleeps all over the place so we figured with the hose on top was his best bet. But we have the Philip's respironics amara gel full face mask they sent us home to practice with. I'll have to see if his insurance will cover the climate control hose, if not it'll be something I'll have to save for. This stuff isn't cheap. I definitely think the autoramp will be good for him because I remember when he did his sleep study at first the air coming on made him want to take the mask off until he sat there for a minute and tried breathing. I'm hoping once he's home and we're set up and he's comfortable he'll be a happier kid. Hes having a rough time but he says hes happy hes getting his machine. I'm sure I'll be back with more questions once we get this thing home.
APRIA is who is providing our stuff...anyone know how good this company is? I've already had issues with them. Thank you Sierra
The secret with the AutoRamp feature is to get the start pressure high enough to feel comfortable, and have the EPR (Expiratory Pressure Relief) set at 3 cm and for the Ramp Only. Most like about 7 cm but 6 should be fine too. Out of the box it will default to 4 cm.
If you really want to monitory progress closely there is a free software program called SleepyHead which combined with a PC or Mac with a SD card reader allows you to track and graph all the data that the AirSense machine captures. From the factory the AirSense comes with a 4 GB SD card, but some suppliers are pulling the card out. Someone must have a drawer full of cards! I would ask that the card be included. If they refuse, you can buy an SD card and put it in yourself. Or you may have one lying around from use in a camera or tablet. The machine will format it when you put it in. Some links for SleepyHead:
Apria is the company Kaiser contracts with for sleep apnea stuff. I haven't had any problems with them so far. The ClimateLine is not very expensive. If you have to pay for it yourself it is about $40: https://www.cpap.com/productpage/resmed-climatelineair-tubing-airsense-aircurve-10
Thank you forthat... the issue I've had is his doctor sent in his order and they would call and I would return their call only for them to tell me someone would call me back in 24-48 hrs...I got sick of this when they told me that his order went thru and we needed to set up an appt, I refused to get off the phone until they put someone on to finish our stuff. I told them my son needed to sleep and this was ridiculous. Needless to say his appt got set up for 3 business days later than God.
I would say a heated hose may not be necessary. I don't have one, and have only had condensation and a sprinkle hose is when I'm camping in very cold weather. That said, I do have a heated humidifier, and that may make a difference. I only had one problem with Apria. Knowing I would be on the road for a month, I ordered supplies in plenty of time, only to receive the wrong size. They said they would send it right out via Golden State OVERNIGHT. Turns out GSOvernight is only the name of the shipping company they use, and has nothing to do with getting your package overnight. Couple days to process order, couple days in transit. . . .trip was delayed. Wishing you and your little guy all the best.
Yes, the heated hose is a nice to have in most areas, and not essential. It lets you run the humidity a little higher without risk of condensation and rainout in the hose. It is a convenience feature as well. The machine goes into automatic humidity control mode when you connect the heated hose.
Oh geeze that's ridiculous. I hope I dont end up having more issues with them.
Well follow up when your kiddo gets on therapy. My advice on the DME (durable medical goods) is to FIRST find out which ones in your area your insurance company will allow you to use and SECOND, do some research; google their ratings and BBB and you will find there probably are almost none in your area that have good ratings or have not had a bunch of BBB complaints filed against them. DMEs seem to frequently have troubling business practices and customer service issues are rampant!
So lil mans pressure is set at 7 and his auto ramp pressure is at 4. So tonight is night 1...wish us luck.
With that pressure setup I do wish you luck but I would feel short of air while going to sleep at 4 cm pressure. If your son feels that way, I would ask your provider about changing the the Auto Ramp Start Pressure to 7 cm, with the EPR set at 3 in Ramp Only mode. When setup that way, it would feel easier to breathe in (with 7 cm of pressure), and easier to breathe out (against 4 cm of pressure).
If the Ramp Start is set at 4 then it will hold at that pressure until he falls asleep. It will depend on how comfortable he feels with that very low pressure.
Note that with either setup the treatment pressure will be 7 cm, and treatment effectiveness would be the same. The only benefit in using the EPR during ramp is for comfort. It does not change treatment.
I dont remember what the other number was but I know it's set so when he breathes out the pressure is lower...I'm still trying to understand all these terms so bear with me
An auto CPAP normally has a minimum pressure and maximum pressure, unless they are set to a single fixed pressure. When you turn the machine one, there will be a brief display on the machine. In the middle of a circle the current pressure (usually Ramp Start Pressure) will be displayed. Above that and to the right the minimum and maximum pressures will be displayed. During the night the machine will automatically adjust the pressure to what it thinks is needed, but is forced to operate between the set minimum and maximum.
The ramp is just the short period of time intended to maximize comfort to go to sleep. When the Ramp is set to Auto, it does not actually ramp the pressure up. It simply holds the pressure at the Ramp Start Pressure. Ramp start pressure has to be set at the minimum pressure or lower. The machine monitors breathing and when it decides you are asleep it then ramps the pressure up to the minimum.
EPR lowers the pressure on exhale and can be set to off, 1, 2, or 3 cm. It can be set to be on full time or just during the ramp period.
So, say for example the Ramp start is 4 cm, minimum pressure is at 7 cm, and EPR is full time at 3 cm. The machine will go to 4 cm when you start it up. However the EPR can not reduce pressure on exhale because the machine will not go below 4 cm. So the pressure will be a fixed 4 cm on inhale and exhale. Then when it ramps up on sleep onset to the 7 cm minimum, the EPR will start to function and inhale will be 7 cm and exhale will be 4 cm.
If it is set up this way, it can cause two issues. First as I said before trying to go to sleep with a fixed 4 cm of pressure can leave you feeling short of air with a suffocating type feeling. And the second issue is that if EPR starts cutting back pressure after going to sleep then the treatment effectiveness can be reduced. Apnea can occur on exhale as well as inhale and the exhale pressure is reduced. If the machine detects apnea due to the reduced exhale pressure it will push up both the inhale and exhale pressure to compensate. This results in higher average mask pressures which may be uncomfortable or cause mask leaks.
In any case if you turn the machine on, you will see these pressures on the display and it will confirm where it is actually set at.
Ask your son how it feels though. 4 cm might be enough for him. I find when the ramp start pressure is set right it feels like you are not wearing a mask at all. Breathing is as free and easy as having no mask on at all.
Well he did awesome last night...he only got up once last night to go potty so I only had to reset his mask once. The mask didn't mess up at all while he was sleeping. The sleep report said he had 2.9 episodes per hour...it said his mask had a 7ml leak, I dont know how horrible that is but we got the green face so I'm guessing it's not bad. He slept over 9hrs which was wonderful. I'm excited about this now...I was expecting to be up 2500 times last night. And as for the display, I moved the dial and it lit back up and didnt mess with any settings.
The green happy face for mask leaks is a very low bar. It will be green if 70% of the time leakage is under 24 L/min. 24 L/min is quite high leakage. The leak rate reported on the advanced sleep report on the machine (just before AHI, Total AI, and Central AI) is the 95% leak rate. In your case 95% of the time leakage was less than 7 L/min. I assume you meant L not ml. 7 L/min is a very low leak rate and is excellent.
And if you got a pressure value just before the Leak number it would be the 95% number too. 95% of the time pressure was equal or less than that value.
Yes I meant L...sorry. It says the pressure was 7.0 and that's what they had set it to so I'm assuming that's good? HOURS=9.2 AHI= 2.9 TOTAL AI =2.8 CENTRAL AI =0
Is your machine the AutoSet version? It will say AutoSet on the front near the bottom beside the humidifier reservoir. The AutoSet is capable of adjusting the pressure during the night between a preset minimum and maximum limits. If you don't have the AutoSet then the pressure will be a single fixed value, which is 7.0. It is also possible to set the AutoSet version to CPAP mode and then there is only a single fixed pressure. They could have done that. The actual setting should be displayed in the top right of the display when you start it up. If it is not an AutoSet or is an AutoSet in CPAP mode there will only be a single number, not a minimum and maximum.
The AHI is OK, as anything under 5.0 is considered acceptable treatment. However, most will try to get the AHI lower than that. With no central apnea that is usually possible. I struggle to get my AHI under 3.0 as I have significant central apnea frequency, which is a clear airway event. CPAP pressure does not resolve them. Obstructive apnea is resolved with pressure, and your son appears to have nearly 100% obstructive apnea. AHI can be very variable from night to night, so I wouldn't get get concerned until you have at least a week of data. If it is averaging 3.0 or so after a week, that may indicate a pressure change is required. It doesn't hurt to limit the pressure a bit at first until your son gets used to it.
If the EPR is active during sleep it will be reducing your effective pressure as well. Turning EPR off would likely reduce AHI without increasing the 7 cm set pressure.
Hope that helps some,
So I thought I would update...lil man has been doing this for about 10 days now...hes doing amazing. He falls asleep within 5-10 mins now instead of the 30+ it use to be and hes sleeping thru the night with the occasional potty break unlike before where he would be up 3+ times a night telling me he couldnt sleep. Our mask leak has been up and down but I think we've pretty much figured out how to get the mask leak very low and hes comfy...it definitely took me a few days to figure out the way to set the mask on his face without having to adjust 40 times. Lol But I'm really happy we made this choice and I'm glad hes finally sleeping well.
As a teacher and CPAP user of 20 years I will offer this advice:
Make sure his face is clean to prevent mask leakage. I wash my face nightly before the mask to remove oil and clean my mask with good mask wipes. (link below) Also, a little hanger for the air coil helps to prevent tangling as he moves in the night. (link below) I'm assuming that you track his progress with the sleep app for the airsense 10 daily....if not, you can download it for ios, not sure about android. You can also use the sim card for even more details using a program (link below). Finally as a teacher, give him encouragement. Tell him that there are so many kids that have apnea but don't use a machine and are grouchy and don't learn as well. He has an advantage over them!
I'm pretty sure that I've been apenic all my life, even in my young skinny years. I wish that I could have the advantages you are giving your child. I applaud that your taking these steps to help your child succeed!
https://www.amazon.com/gp/product/B0753KMW66/ref=oh_aui_detailpage_o08_s00?ie=UTF8&psc=1 https://www.amazon.com/gp/product/B003UAHWOE/ref=oh_aui_detailpage_o04_s00?ie=UTF8&psc=1 https://sleepyhead.jedimark.net/
I believe those specialty CPAP mask wipes are a con. Your mask doesn't need to be sterile, just clean. Your face is not sterile, the air is not sterile, your pillow is not sterile. Plain ordinary baby wipes (they should be alcohol free but almost all are) will do just as good a job at a fraction of the price. Also, any antibacterial agent in wipes will usually damage the rubber of the mask cushion.
