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First 2 weeks and my thoughts on P10, Brevida and Dreamwear masks
Hi everyone. Very new to this. Sleep study mid July showed AHI of 70.7, and oxygen dropped to 61% asleep from 95% awake. I'm in my early 50s. Obviously that needed some treatment! Very big snorer.

DME offers a one month trail of machines, and weekly follow up appointments, at which I can try and take home different masks, so I am taking full advantage of it to try some out. Machine is an AirSense 10 AutoSet. Settings are basically default still - 6-20, EPR full time at 2cm, humidifier at 4, no ramp, no smart start. For noting I have a full beard with moustache, though not particularly long.

At the first appointment to collect my machine, they suggested a N20 mask, but I have a very physically large head, and it basically didn't fit. Adjusting the headgear out fully, it did fit me, but tightly, and after removing it 30 seconds later, I already had red marks on my face, so we abandoned that one. Suited me because from reading here I wanted to try the pillow style masks anyway.

Got a P10, medium, and a chinstrap seeing as I know I snore a lot and thought I would struggle with keeping my mouth shut. Worked well. First night I managed to sleep mask on 9:15 hours, AHI 2.7 (bit better than 70!), 1.56% large leak, 95% leak rate 20.4. First time in memory I woke up remembering dreams, and also that I didn't go to the toilet in the middle of the night. Interestingly I haven't been to the toilet overnight since, which I'm told is a good sign.

Anyway, the P10 was OK, and seemed to be working, but it felt quite hard to me, and really felt obtrusive in my nose. That said, for a first time user, given all the reviews here, I was OK with that, I did expect some discomfort and getting used to everything, so pretty happy. Wore it the rest of the week, averaging a touch over 7 hours a night with it. My AHI's were 3.8, 4.7, 3.3, 3.2, 3.6, 2.9. Large leaks dropped as I got more used to the mask, but still getting some each night. Leak rate was 16-20 each night. 95% pressure 17.8 to 15.3.  

Overall happy with things, was feeling very tired, but also less tired, if that makes sense. Hadn't realised how much I had obviously just been pushing through life, and that constant feeling of exhaustion wasn't normal. What was most noticeable was that my "affect" has improved markedly. I had been feeling depressed, but probably wasn't clinically so, but my mood has certainly lightened a lot, I'm less grumpy, and making many more bad dad jokes for the kids than I have in a very long time. 

On the downside, the P10 was making the bridge of my nose sore, did feel like I was shoving something foreign up my nose each night, and was still causing occasional large leaks. By the end of the week it also became obvious from SleepyHead that I had many less events when I was sleeping on my side, but that also did cause some fit issues on my P10 - nothing major, just knew I was adjusting it a bit during the night. I was also getting a strap grove along my cheek on the side I mainly side sleep on. Not a big deal, but still noticeable.

Never used the chinstrap. The horrible feeling caused by having the air in the nose and my mouth open was clearly enough for me to learn to keep my mouth shut. 

First follow up visit, they offered me a Brevida nasal mask, medium size. No changes to settings on machine. Used that for the next 7 nights. No large leaks recorded for the whole week. AHI 3.1, 2.6, 3.2, 2.0, 6 (I had a cold and blocked nose that night), 2.3, 4.3. Overall these were slightly lower. Leak rate 95% immediately dropped to between 6 and 9 down from the 16-20 on the P10. Sleepy head shows the % time above leak rate on the Brevida as 0.01% and on the P10 as 0.6%, so much lower there.

Pressures also dropped, 95% being in the 13-15.8 region. The mask to me also felt both much more comfortable and more secure. It does feel bigger on the nose, which it is, as it sort of wraps around and over the nose, but it is very soft. It feels much like having a bunched up soft tissue being held to the end of your nose. There are little prongs vents that go in each nostril, but I honestly can't feel them, and I no longer have that feeling of having something inserted quite firmly in my nose that the P10 gave me. I also lost that irritation / pressure sore that the P10 had been causing me on my bridge, and can't see any strap marks when i wake up.  

So, very very happy with the Brevida. To me, with the little diffuser they supply, it was a touch quieter on exhaust than the P10, but neither were a problem. Every now and then I would need to tweak the swivel on the front that the hose attaches to. One down side is that it does collect some moister internally, and once every second night or so a drop of water would hit my face at some point. Not a problem, though a bit odd the first few times. I may drop my humidifier settings some time, but it isn't something that is bothering me. Didn't put the P10 back on again to sleep (I now had both) though I did try it on a few more times to compare for comfort, but the Brevida felt better every time. So, no large leaks at all, leak rate halved, pressures down 2cm on average, more comfortable, and band adjustable to fit my head (the P10 was one pretty full stretch and that may be why it felt so forced into my nose?).
Yesterday, I handed the P10 back, and brought home a Dreamwear medium nasal pillow (not the gel one with prongs). Tried a large at the DME, but he said the fit was better on the medium. Used it last night. It is soft, but not as soft as the Brevida - there are much firmer parts that fit around and under the nose, with a soft area that the nose end / nostrils sit in. I like the tube at the top of the head, and that worked well for me. I didn't notice any "conduction" noise along the tubes wrapped around the face, but I didn't like the vent which shot a stream of cold air out - this hit my  arm a few times and woke me. But it felt much leakier, and less secure. And more bulky to side sleep on. Three and a half hours into the night, I woke, took it off and put the Brevida on. I expected my leak rates etc to by bad. 

However, sleepyhead shows it all worked quite well. Comparing the two halves of the night, there were no recorded large leaks in either, and in fact the leak rate on the Dreamwear was slightly better than the Brevida. AHI overall was 2.2. Recorded pressure was a touch more on the Dreamwear, but the SleepHead data shows it all being very similar. To be honest that surprised me. It felt like there was air going out everywhere on the Dreamwear. I'll try it again and see how it goes, but at this time, not as happy with it as the Brevida. If they have them, I will see if I can get the gel pillow mask insert and see how that goes - that may feel less leaky and would move the harder parts of the mask away from pressing on my nose. 

So, that is my first 15 nights. If I can't get the dreamwear gel pillows next week, I'm not sure what else to try out. Open to suggestion. It would be my last week of the trial before I need to buy something. I'm still struggling with head pillows a bit to encourage and make comfortable the side sleeping that gives me better flow rates and essentially no events - my events nearly all occur when i am on my back, which is easy to tell from the flow rate graph (having tried deliberately starting on my back some nights, and on my side, and noting what position I am in when I wake, or if I glance at the clock during the night it is easy to tell what position I am in from the graphs). 

Thanks everyone for the board, and thanks to Mark Watkins for sleepyhead. I'll update my journey with the dreamwear if I try it again this week - I intend to give it another go or two.
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Finding the right mask is one of the most important and difficult issues. If you haven't seen it there is a  good Mask Primer article in the Wiki. Sound like you have a good DME and are adjusting well. Post some data if you want suggestions on getting your settings dialed in.

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Hi JeffT,

WELCOME! to the forum.!
Thanks for sharing this interesting post about the different masks you have tried; the mask is the most challenging part of this therapy so it’s good that you are able to try different ones.
Good luck to you on your CPAP journey and hang in there for more responses to your post.
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Welcome to the forum.

You seem to be doing quite well.  Keep it up.

My first thought was of you describing the P10 as being IN your nose.  It should never be IN your nose, but rather ON your nose.  Your statement implies your P10 was too small and you should have used the large pillows.

Masks are VERY personal, what works for me may or may not work for you.  Simple because each of us has a fairly unique face.

Masks to try, ResMed AirFit N20, or for a full face mask, ResMed AirTouch F20 (which I think will be a go to FFM for most people)

Definitely read the Mask Primer, anso the other links in my signature.

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Thanks both for the welcome. The forum has been very helpful and its great to be in a positive community where everyone is trying to help. I was hoping my posts on the masks may be useful to someone else. The Brevida seems too new to have many reviews yet. 

I'll post an image soon - just need to get my post count up.
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just (for now) post with a space in it (htt p://imgur.png)
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(08-04-2017, 07:08 PM)bonjour Wrote: Welcome to the forum.

You seem to be doing quite well.  Keep it up.

My first thought was of you describing the P10 as being IN your nose.  It should never be IN your nose, but rather ON your nose.  Your statement implies your P10 was too small and you should have used the large pillows.

Masks are VERY personal, what works for me may or may not work for you.  Simple because each of us has a fairly unique face.

Masks to try, ResMed AirFit N20, or for a full face mask, ResMed AirTouch F20 (which I think will be a go to FFM for most people)

Definitely read the Mask Primer, anso the other links in my signature.



Interesting thoughts on the P10. I probably wasn't describing the feeling well - the outside of them was certainly outside the nostril - i.e they didn't go all the way in, but they felt pretty firmly rammed in if that makes sense. I suspect that the headband was possibly applying a bit more pressure than it should (large head issue), and I was probably feeling the harder inside bits rather than having them held away by the softer outers? Either way the feeling was a bit "intrusive". But I appreciate your thoughts. Based on that I will ask to try a large P10 on my next visit and see how that feels. It certainly worked as a mask, and for a first timer I slept well every night, so absolutely a good mask - just a 4 stars out of 5 for me.
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Thanks for the hint on image posting, but I'm there now!

As much as my DME is good, he is only using the standard graphs that are used for myAir from ResMed, i.e. checking my overall "score" and isn't interested in the detail. I figure for the time being I'll just leave things as default and in two weeks when I have my own machine I'll start tweaking if people think it is worth it. He did offer to try a constant pressure setting yesterday. I asked why. He said cheaper machine, and I said no. Want to stay on the AutoSet, even if I eventually run it in constant pressure mode, but for the moment it looks to me like it is working well in full auto.

Here are my event flags, flow rate and pressure graphs from last night. The break in the middle is where I work and swapped masks from Dreamwear to Brevida. I still find it interesting that too me it felt "wrong" when I swapped it out, but in fact the graphs show it was actually doing what it was supposed to.

[Image: sEAR0Hj.png]

I believe the bits with the wider flow rate are when I am on my side, and the bits with the narrower flow rate I am on my back. Reading things this morning on the forum I am starting now to wonder if when on my back I am opening my mouth, but I don't think so?

I'm assuming the pressure (6-20) correlates to the red graph, which suggests I could tighten the range to 8-18 at least if I wanted?
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Welcome to the forum Jeff. I am a Dreamwear user and also wondered how the air got up my nose with the nasal piece they supply. A bit of experimentation shows that it certainly does and I love the freedom of the hose at the top of my head. Their new gel pillows are even better.

I'm looking at your settings and would suggest that you raise the minimum pressure to at least 12. This would mean that your machine should not have to respond as aggressively to apnea events. The 6-20 is far too wide a range and as your 95% rate is running around 15, this move could possibly get that a bit lower.
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Thanks for the thoughts. I'll give it a try when I can. Currently the DME is remotely setting things. I do think I will try the gel pillows on the Dreamware and see how I go if I can get them. I like the idea of the top hose, and it certainly worked well for me. Thanks again.
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