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How do they decide which mask you should use?
(08-20-2012, 12:11 PM)Masked Man Wrote: When I recently went to my dme for a new machine, they asked what masked I had been using. When I told them I was using a profle lite or a FP flex-fit, she immediately started pushing various ResMed masks. The only masks they had on display were ResMeds. When I asked her about other brands she told me they didn't work as well with my new S9 Autoset. When I told her that was bs, she said they could get some others in (none on site). I had originally asked for a different APAP brand based on what I had read about them but they gave me the ResMes S9. When I asked her why she said the S9 was a much better machine (also way more expensive). I distinctly got the feeling they were pushing ResMed products. I never got that feeling with my previous dme. Although truth be told i've spent around $2k looking for the "perfect" mask.

I too am a mouth breather and tried several full face masks all of which leaked like sieves. I found that using a chin strap pretty much solved that problem. I've seen some of the newer full face masks with a get seal but don't know if they work any better.

I guess it all depends on the DME and the RT who is assigned to you.
My DME seemed to push Respironics when it came to the machines. It isn't surprising considering most DME's in the US pay less for Respironics equipment, than they do Resmed. They charge the insurance company the same price regardless of what machine they give you. I had to insist on an S9 Autoset to get the machine I wanted.

When it comes to the breathing itnerface, I think the therapists have their own biasis about masks, pillows, etc. I was given a nasal mask at my first visit, but when I returned, complaining about bridge of the nose pain, a different therapist couldn't understand why the first RT didn't give me nasal pillows to begin with, since my pressure setting weren't all that high. However, it took a longer for the second therapist to experiment with different size pillows to get my right fit, so perhaps the time elelemnt entersed into the first RT's choice.
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Heh, my DME took one look at my face, and the beard and moustache, and said "You want a medium sized ResMed Mirage Active LT..." and handed it to me to try on, with a machine.

He was bang on.

There were other issues, that led me to use a different DME, ultimately, but as far as pointing me to a mask that really worked for me, this guy was awesome. Of course, he showed me other options, let me test a few, but even the ResMed Softgel, which is just a different cushion on the same frame, never seemed as comfortable or leak free.
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In Switzerland it has to be done through the hospitals, where there is a pretty big staff of specialists and for the most part they are very good about finding you the right fit and adjustment. After you get your mask and compressor, you try it out for a month - if it works then they'll stick with that fit, and if not, adjust accordingly until the right fit is achieved - only after that can you go to the LungenLiga for your own machine (you get to keep the mask form the hospital if it is the right fit (hygiene, I guess). The compressor is rented from the LungenLiga for a year (usually paid by your insurance) and then you have the option of buying it as a used model. Some people opt to remain on a rental plan, others buy - the insurance obviously prefers that you buy it.

Every three months for the first year the machine and mask are checked, and adjustments are made at the hospital, and then that is tapered off to twice a year and eventually once a year for long term wearers. New masks are regularly tried out as they come on the market, and no one brand is preferred, although patients of the Unispital in Zurich tend to get a Philips compressor and a ResMed mask combo, based more on lots of experience fitting the masks, but most major brands are in the selection, and some unusual ones as well.

In my case, a nasal pillow was chosen because of the tendency of my nasal walls to collapse, making the efficacy of an over the nose mask less likely.
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(08-20-2012, 12:11 PM)Masked Man Wrote: I too am a mouth breather and tried several full face masks all of which leaked like sieves. I found that using a chin strap pretty much solved that problem. I've seen some of the newer full face masks with a get seal but don't know if they work any better.

Have you tried a hybrid mask?
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I actually believe it is a case of $$$ return. My HMO has a set list of pharmaceuticals, durable medical equipment, procedures, etc. at a set price. You can chose one item from column A and one item from column A and, oh, a choice from column A! I am lucky because I have been with them for so many years that I can make whatever they throw my way, work for me! I would love to try other masks, I have been having leak issues lately, but I know better than to go find something because I will be on the hook for it myself. I know this sounds very dismal, but it is the way it is. I asked about a decent machine that was data capable, and I was told "not as long as this one is still working". My choice was to either "break" my current machine, which is borderline at best on my ethics scale, or just spend the money for a decent machine on my own. I went to Supplier #2 and got a machine that I am very happy with. I just have to live with the offered mask or not. Since I cannot afford to replace whole or parts of a mask on a regular basis, I made do with what they had to offer. I hope you have great success!
As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
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Sleepster -- I've got 3 of them. Two had been laying around in my mask collection for a while. When my profilelite died. I pulled out a Respironics ComfortGel. After some serious playing around I got the ComfortGel to work well. When the gel component died I started using the Flexfit. Again after some serious adjusting I got it to work.. Then when I got the S9 the dme tried to pitch me some of the ResMed masks. Despite liking both the ComfortGel and The Flexfit, I got a ResMed Mirage SoftGel. (You can never have too many masks) I've found it to work pretty well and have been using ever since, 2 weeks. I really liked the ProfileLite because after the initial boiling they always fit great. However that said I've decided the hybrids are for me. They're much lighter than the profilelite and you don't have to replace the whole thing each time. Replacing the seal, gel, or foam components is much cheaper than a whole new mask. I was trying to be a prudent medical consumer. Silly me. DMEs and Insurers don't seem to much care.
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Sometimes the doctor or sleep tech makes the choice. Sometimes the DME makes the choice. Sometimes they take the time to do it right.

I think in most cases, the DME makes the choice based on what's best for him, based on profit, least amount of work, etc.

For instance, I believe a FFM should always be a last resort choice. They tend to leak, and they may push your jaw back, making your apnea worse. You can't drink water, take pills, talk, etc. without removing the mask. You should always try a nasal mask first, unless you have a known problem with FFMs. Then, if necessary, switch to a FFM if you have mouth leaks or problems breathing through your nose.

Unfortunately, since some nasal mask users have to switch to FFMs, lots of DMEs (or doctors or sleep techs) don't bother to do the right thing and try a nasal mask first.

I think a lot of other DMEs honestly prefer a particular mask because of personal experience, but are still wrong. They tend to get a mindset that mask X is good or bad because they had a particularly good or bad experience with it. Other DMEs honestly come to the opposite conclusion. i.e. even an honest opinion may be wrong.

Nationwide corporate chains make the situation even worse.

Sometimes they DO know what they're doing and make the right choice for the patient. That's the way it's supposed to be.
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If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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The experience ins Switzerland seems to be nasal mask first, then get more aggressive, unless the tests show you need something bigger. but then again, there's no profit motive here - no one makes money off of one mask product over another - only the LungenLiga and the hospitals give them out, you can't easily or cheaply buy them otherwise.
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I am a little upset and embarrassed at the lack of care many of you seem to have received in your lab and with your DME. The first thing I do is bring in a FF mask (usually a Mirage Quattro), 2 nasal masks (I'll bring in a Zest and a Micro Mirage), and some pillow masks (a Swift FX and a Swift LT). I will then explain the benefits of each one and the negatives of each one. I will let my patient try each mask on a CPAP pressure of 5 for 5 to 10 minutes each. We have more masks that than and I let my patients know that. The masks I bring in are ones that have worked very well for a huge majority of my patients. I normally do not like hybrid masks at ALL because they leak like crazy for many people. I have even brought in an entire face mask called a FitLife (which is actually really good despite the intimidating size). Usually, the sleep lab should give you many mask options and, as a patient, you will choose the one you like best. I tell all my patients that they can change the mask as many times as they want during the course of the study. As a personal rule, I tend to avoid FF masks if possible. They DO NOT make apnea worse. They do, however, have a higher leak and are more uncomfortable to wear than other masks. They usually require a slightly higher pressure. On the flip side, they are the easiest to breathe with because the air has more surface area to surround before it blows in. I tend to go nasal mask or pillow, and if necessary, an adjustable tiara chinstrap.
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Dakota, you have discovered one of the problems that many of the members here have to suffer with, inadequate care from their, docs, labs and DMEs. Personally, I refer to my doc as an Ear Nose and Wallet Doctor. Fortunately, his techs are good and caring.
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