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New CPAP user - mask/air leak/etc questions
#1
So, I have a couple questions.....

A few weeks ago I finally got a doctor to prescribe a sleep study for me (I changed doctors just for this reason). Sleep study came back with an AHI of around 100. Yeah, definitely needed a sleep study, thank you old doctor for ignoring what I was trying to tell you (not).

Fortunately for me, I apparently have it lucky as far as adjusting to treatment and my response to it. AHI's under 1 are typical for me every morning, according to the AutoSet10. Wearing a mask to sleep isn't a big deal, etc., etc., etc.,

So, on to my question:

I'm still going through the whole find the right mask procedure.

I have a Large F&P SimPlus full face mask which actually works fairly well for me. The provider recommended that specific one apparently due to my nose shape which includes a fairly large bridge at the top. (If I understood her correctly). Like I said, it works really well, except that I apparently tend to drool in my sleep a bit more than I should - which on nights that this occurs, tends to accumulate in the full face mask, and besides being annoying also causes the mask to slip around and not stay put, creating major leaks. If it wasn't for this, I'd just stay with this mask and be happy. (I'm definitely keeping this mask for those times when a nasal mask isn't an option).

My provider also gave me the AirFit P10 Nasal Pillows to try. Evidently I have extra small nares. This was a disaster. First the machine was still set without proper relief (and we didn't have it on auto yet, so the therapy pressure was set constant at 15)...so I couldn't exhale (back to the other mask for that night). That got straightened out and I did sleep one night with them. By morning, the nasal pillows had chafed my exterior skin so much that I couldn't even bring myself to try them again. I'm not completely convinced that this wasn't something adjusted and/or set wrong with these (too much relief perhaps), but when you wake up with sores on the bottom of your nose, it's really hard to try again. I'm pretty sure what was happening was that my respiration was creating enough motion between the air pillows and my nose that the pillows were rubbing on my nose all night, causing this issue. Maybe a different type of nasal pillows wouldn't cause this, who knows?

So, after that I swapped the P10 for a F&P Eson Nasal CPAP mask. I slept a couple of nights with it, at which point I discovered I really needed a chin strap (night one wasn't a problem, night two, couldn't keep my mouth shut - it's amazing how much air comes out of your mouth when the machine ramps up to 12 and your mouth opens). So, I finally got a chin strap and slept with it last night.

I'll say this: I definitely like sleeping with the chin strap and a nasal mask much better than the full face mask. However, I'm not convinced this is the right nasal mask for me. The fit issues I'm seeing have to do with the 'pivot' that this mask seems to be doing on my face. Let me explain:

It seems that this mask has three options for me:

1) Sealed well on the bottom, but not on the top. (bad for the eyes)
2) Sealed well on the top, but not on the bottom. (better, but not good for low leakage).
3) overtightened and putting too much pressure on the cheekbones but sealing fairly well. I.E. I've collapsed much of the air cushion against my face to be able to get it sealed.

Even with various iterations of #3, the seal seems quite fragile and it takes a bit to get arranged. If I work at it I can find a good compromise which works, right up until I roll over or otherwise do something which causes the mask to shift, and then I can't get it back non-leaking without a lot of work (I know, some of this is just learning how to adjust a mask).
When it is non-leaking the mask is pretty well compressed in a lot of it's area.

So, I guess what I'm hoping for some input on is where I should go from here. If it wasn't for my excess saliva I'd just go back to the full face mask. I really liked the lightness of the nasal pillows- the nose damage not so much. The nasal mask is good, but may not be the right one for me.

I have some specific ideas of what looks interesting as far as masks go, but it's hard to find information about what things I should really consider in this process.

Ideas?

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#2
A couple of general things I have found:
1. to get these things adjusted correctly it take 1/8" changes, they tend to be very sensitive
2. most people over tighten them and that causes them to leak
3. When I used the simplus it was almost lose on my face, turn on the air, and pull it away from your face and then let it settle back. This lets the seal inflate
4. to get the simplus around my nose bridge I had to do #3 and then pull the mask towards my chin
5. I moved to the Amara View because I can't use a nose only mask because I can't exhale into pressure and they all don't have enough of an air pocket to exhale into (or so that's what I think)
6. the Amara View like all masks I would guess is as tricky or more so than most to adjust correctly, but I stopped looking when I found it

There is a lotion that people use for a sore nose, someone will post what it is.
You can use a chin strap with a FFM also to stop drooling
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#3
(05-11-2016, 01:09 AM)PoolQ Wrote: A couple of general things I have found:
1. to get these things adjusted correctly it take 1/8" changes, they tend to be very sensitive
2. most people over tighten them and that causes them to leak
3. When I used the simplus it was almost lose on my face, turn on the air, and pull it away from your face and then let it settle back. This lets the seal inflate
4. to get the simplus around my nose bridge I had to do #3 and then pull the mask towards my chin
5. I moved to the Amara View because I can't use a nose only mask because I can't exhale into pressure and they all don't have enough of an air pocket to exhale into (or so that's what I think)
6. the Amara View like all masks I would guess is as tricky or more so than most to adjust correctly, but I stopped looking when I found it

There is a lotion that people use for a sore nose, someone will post what it is.
You can use a chin strap with a FFM also to stop drooling

I haven't tried the chin strap with the FFM yet - That's going to be sometime in the next few days. I was wondering if that might be the case.

On the simplus I have the exact same experience as you do. I don't need it very tight - just tight enough so that an inflated mask seals lightly against my face. It took me a while to get the basic technique down - I think I read a post on here or somewhere else on the net which described the air pillow seal, which finally helped me be more consistent with it - except for the moisture issue which most likely lets it slide back upward where it leaks.

When I moved to the eson nasal, I figured it would be the same so that's what I'm trying for - a light mask adjustment with room for the cushions to inflate. The mask seems like that's what it wants - but evidently my physiology isn't quite what they expected - I don't seem to be able to get everything lightly touching my face enough to get the 'pillow seal' at the same time. I think my cheeks (or cheekbones) may be too big/puffy or something like that. I'm kinda hoping that there's another nasal mask which fits a bit differently - you know for those of us who apparently have protuding cheeks.

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#4
I have the SleepWeaver nasal mask that just seals around the nose.
Very low profile, no hard plastic and my glasses fit over it to read.

The seal is made by a soft rubber/plastic fringe around the edge.
I do the same thing when I get a leak, pull the mask out, let it inflate a little, and then set it back down around my nose, leak is gone.

Sometimes the mask will rub the skin between my nostrils and leave a sore. I just started putting a 1/4"x1" strip of medical tape there each night, no more sores.
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#5
(05-11-2016, 06:46 AM)rem52 Wrote: Sometimes the mask will rub the skin between my nostrils and leave a sore. I just started putting a 1/4"x1" strip of medical tape there each night, no more sores.

Get a tube of lanolin from the beast feeding mothers section of your store and put a tiny tiny amount on the spot that is rubbed and sores will no longer be problem.
I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
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#6
I know laughing at typos is impolite, but...hee hee! Too-funny

(05-11-2016, 07:25 AM)FrankNichols Wrote: Get a tube of lanolin from the beast feeding mothers section of your store

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#7
forrestc, I use the Respironics Wisp nasal mask. I'm not having any problem with leaks at 11.0 cm pressure, but that's only so long as I replace the nasal cushion every month. It starts to leak after that. I think it lasts longer for lots of people.

I use the Large headgear and the Large nasal cushion. I liked the fit of the Medium nasal cushion on my nose better, but there didn't seem to be enough space inside it for me to breathe easily.

I don't have a prominent nasal bridge. My nose is large-ish, but my facial bones are just medium and my face overall is the fleshy type. Wearing a CPAP mask is the first time I've ever been glad that I don't have sculpted facial bones.

The only discomfort I've had with the Wisp was 2-3 days of slight soreness of my gums and teeth when I first started using it and some irritation of the skin under my nose that quickly resolved itself.

When you say that the provider recommended a particular mask for you based on the structure of your face, you might ask them which masks they usually fit people with. My bet would be that they have a limited number of masks that they typically use and that they chose the best fit for you out of those.

I started my xPAP therapy last winter and started off with a nasal mask. I am getting ready to try a nasal pillows design soon, because I feel like that will be more comfortable during hot summer weather if I can tolerate the nasal pillows touching my nostrils.

If I had really good air conditioning in my bedroom, I would probably just stick with the Wisp. On the few hot nights here so far, though, I've had the feeling of "eew, I want this plastic off my face".

I think some of the non-leakiness of the Wisp has been due to my apparently learning to adjust my sleeping position to avoid leaks. I used to notice lots more often that I'd switch to sleeping on my side and the mask would start to leak. Since I'm not waking up to find this lately, and I'm not seeing any large leaks reported either by my machine or by SleepyHead, I can only assume that I'm moving in my sleep to stop the leaking.

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#8
The lotion brand people are struggling with is Lansinoh.

I'll make a bet you used too small of a nasal pillow with the P10. A larger size is almost always the cure for the problem you describe. The pillows don't insert, they rest on the outside and seal there. Insertion is a guaranteed sore.

You're doing great getting pressure dialed in for comfort and effectiveness and controlling your own therapy. Even firing your doctor. You'll fit in great around here.
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#9
Hi forrestc,
WELCOME! to the forum.!
Get some HPA Lanolin cream to heal your soar nostrils. A little goes a long way. You can find it in the baby isle of most stores.
Hang in there for more answers to your questions and much success to you with your CPAP therapy.
trish6hundred
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#10
(05-11-2016, 08:57 AM)green wings Wrote: I know laughing at typos is impolite, but...hee hee! Too-funny

(05-11-2016, 07:25 AM)FrankNichols Wrote: Get a tube of lanolin from the beast feeding mothers section of your store

What makes you think it was a typo? That's why they need the lanolin... kids are little monsters!

:die laughing:

Edited to say, Just Kidding, sometimes people take me seriously...
I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
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