Need a new mask.

[natyprueba]

Hi everybody.

Once more I need your advice.

I am a new bee, but I already walked the break up of the system. I got more than 100 days with the machine. I have learned a lot in the forum. I know my machine and how to change all the settings. I use SH and the meaning of the graphics. I have full filled my initials goals:
1-Sleep more than 7 hours/day with the machine.
2-Got an 3<AHI< 4.
3-Leaks are acceptable.

I don't have any medical knowledge or medical studies and my only place to learn about CPAP is in this forum. I see my DR once in a blue moon and she doesn't got a modern communication system as other Doctors in my town. In this system you write down an email to your Doctor and you got an answer before a week, from the Doctor or the nurse. My sleep Doctor is the old fashion and she doesn't answer the phone calls or fax. I requested a change of settings a week ago and still does not have an answer. I am seriously thinking in to change my settings and fight the insurance is there would be a problem. I have read in the forum all the point of view about the setting changes, but I know very well my insurance guys. I have been with them about 20 years and I know very well that they try to do everything in their reach to deny a payment if you don't go by their book ( they send you every 6 months a new thick book of rules that nobody read).

I think is time to move on.
My new goals are:
1-Got down the mask leaks until 0% of time above the leak threshold/day . Now I got nice days and bad days, I think that is related with my sleeping position. (60% good, 40% bad).
2-Got the 1< AHI < 2.

In order to got this goals I think that I need a new kind of mask, because:
1- I am using a FFM mask. FFM mask leaks very easy when you spin your body, because the set up is critical and you must seal a big area of your face.
2-My skin is very sensitive. When I tight up to much the mask I don't get leaks but I got sores, bumps and irritated skin and even small blisters in my cheeks, forehead and back of the neck. My AHI is lower with lower leaks.
I am thinking in a nose mask, but there are this one with nose pillows and the other one similar to a FFM but only for the nose. As less straps the new mask got, as better for my skin allergies.

My provider changed my mask complete about a month ago. The next mask change (by the book) will be in 2 month.
I don't know if the insure will pay before this 2 months for a new kind of mask. Last time I saw my Dr. she proposed a mask change, and I refused.
I am waiting for your posts.
Ralph.
Ralph.

[martinsr00]

I found that my AHI's are heavily position dependent. When they did my sleep study, I couldn't be titrated when sleeping on my back, and otherwise the pressure was 20/25 (Bipap Machine).

I also have to have a full faced mask. Make sure that it's the right size for you. When I started, I got the wrong size and it ulcerated my nose. Some trial and error here may help you.

Sometimes a good firm CPAP pillow helps when managing the mask. The nice ones have a cutout so that when you sleep on the side, the mask can hang out over the edge while your head is on the pillow.

So, it seems careful trial and error can help. I also found that my pressures dropped dramatically when the machine was set on automatic (not fixed pressure). When looking in the Sleepyhead software, even though AHI scores were very low, the machine adjusted pressures fairly frequently during the night.

Perhaps some of these ideas may be of help.

[kowlooner]

I have no idea why they're not more popular, but I'd really really really suggest the Sleepweaver Advance. Super comfortable, doesn't leave marks, easy to adjust, sleep in whatever position you want.

I'm also new to this, just finished 4 months, and I seriously cannot even remotely relate to the difficulties that others seem to have with finding a decent mask.

I had the regular size at first ("one size fits most") and though it was comfortable, it did take a little adjusting to get it working right. Problem was after a short while it did start to sometimes leak at the bridge of my nose (easy enough to fix though). Also, the leaks seemed to get worse the longer the mask went without washing (so, duh, wash it every couple of days).

My nose has a little bit of a crook in it, but not much, so it's possible that had something to do with the leaks. However, I think the real problem was simply that the mask I had was too large. So, I decided to try to the small Advance as well as the Sleepweaver Elan (newer series, a bit more expensive, mixed reviews). When they came, I tried on the small Advance and haven't looked back. Zero leaks. None at all. From day one. AHI hardly ever goes above 2, usually around 1, and lately under that. Haven't even tried the Elan yet, and it's been a bit over 2 months I guess.

The one thing that I could see maybe causing a problem is if you do auto cpap and if you start with lower pressures. Apparently it doesn't seal very well below 9 or so.

Besides being super comfortable and not leaving marks, they aren't claustrophobic in the least, are easy to clean, are very cost effective (reasonably priced and don't require extra consumables), and will probably solve your problem with the sensitive skin. Have a look on Youtube and you'll find a very good review of the thing.

That said, not everybody likes them. But for me, the mask made me wonder what the difficulty was that so many others seemed to be having in getting used to CPAP.

Just my two cents, but if you follow the sizing instructions, I can't see why you wouldn't be pleased.

Good luck!

[natyprueba]

Thanks for your posts.

As always there are good suggestions in the replies.
I will try with this kind of harder pillows and I read about the proposal mask and liked it.



Ralph.

[FrankNichols]

Beware, our machine can not accurately detect and classify events when you are having large leaks. So, when you say you AHI is lower with leaks what you really mean is the machine is not reporting all of the events, so you don't know how high the AHI is in reality. The first priority should always be to get leaks under control - as well as possible - so you know what is really going on.

I use the F10 FFM and have most got it under control at this point. It doesn't leak (much) below a pressure of around 12 to 14 above that it leaked massively for me. I run now around 18 to 19 - sigh, so I have some experience handling (and solving) large leaks with a FFM.

First, I completely agree it is easiest to just tighten down the hatches and try to weather the storm, but that doesn't really work too well with the F10, for the reasons you mentioned. Two things I have done that help. First is use the Mask Fit Test, it is your friend. Find the least tight adjustment that will work at your pressure. The seal of the F10 works when the silicone "ballon" along the edge is inflated, not when it is fully collapsed by being over tighten. The natural instinct is to tighten more when you have leak. That should instead be the last resort. Also, the angle of the F10 on your face controls where the pressure points are - always tight the lower straps first to rock the mask away from the bridge of your nose, then if necessary slightly tighten the upper straps. Do it very slowly over days - 1/8 to 1/4 inch of strap at a time and try hard to keep the adjustment even around so the mask is not tilted too far in any direction. And lastly, the mask will train you over time to sleep in positions where it doesn't leak.

Second, try using the cloth mask liners (there are gel liners, but they are EXPENSIVE and I have not tried them). The liners don't so much stop the leaks, they more like smooth them out so the leak rate grows slowly and doesn't just spike up when you roll over. Since the FF10 seal doesn't always recover once it blows out, if you stop the big leaks from a bump you can avoid some of the leaks altogether, since the balloon seal will deform to compensate for the mask shifting position - but only if the mask is floating, if it is tighten down to the point of collapsing, then the seal no longer works. The liners also greatly reduce the noise the mask makes while leaking so you get more uninterrupted sleep.

A combination of those two (and I have mostly stopped using the liners now) over a period of several months of focusing on it, and I now have the F10 floating (slightly) on it's silicone seals at a pressure of 19 and only get a red face maybe once every couple weeks - and that is usually when I failed to wash my face to get the oils off.

It isn't easy, but it can be done, Like I said, I would have nights with 90% of the time I was in major leak when I was running at 13 or 14, but now with a lot of work, and patience I have got it to work up to 19 with few major leaks and my AHI is now down to around 2.5 regularly and occasionally below 1.

BTW, I flop around a LOT in my sleep, I sleep every way possible except on my stomach. So, I can sympathize with your side sleeping knocking the F10 around. Second I also have a P10, and have tried and tried to get it to work, but I am a serous mouth breather and have found nothing that can stop it. It also causes me to swallow air, which when enough is swallowed causes a day of serious abdominal discomfort. If you can stop the mouth breathing (some can) and not swallow air, I highly recommend the P10. It is worth trying to get it to work.