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Unable to find the right mask [Looking for advice]
Unable to find the right mask [Looking for advice]
I'm about to GIVE UP!

Approximately 1-1/2 years with CPAP:
ResMed -- good unit and was using a great mask but the headgear straps cut into my cheeks
I've changed masks and headgears (F&P Vitera) -- love the mask but still have to over tighten the straps
- if I don't tighten my straps, I get air leaks (feel like the mask has been glued to my face)
- red bridge of nose due to the mask being so tight (I put band-aids on my nose nightly)
- my scores show I've readjusted my mask throughout the night; too frequently!!
I sleep with a cervical pillow so I stay in one place rather than constantly roll around all night -- the pillow keeps me on my back or side (my preference is side sleeping)
I use tape for my mouth (being a mouth breather) -- I have to use a full-face mask (small may have been tight, so I went to a medium -- leaks were worse so I went back to the small)
I use an app on my phone to detect snore sounds - from very light to EPIC (this was the BEST indicator of snoring or not --- everyone should try it)
I get up tired most mornings (and yes, I take a mild sedative to get me to sleep and still awaken every two hours)  And HATE waking up so frequently -- doesn't do well with feeling refreshed the next morning -- most mornings, I just get up between 4-5 a.m.

I don't go to a gym but I do walk outdoors almost on a daily basis; I'm not a 'couch potato'; I'm not overweight; I don't eat late; I don't use caffeine late; I sleep in a quiet, cool room.  I try to follow tips provided by others!

No need to go on -- it's a struggle!  Living alone, I shouldn't care but taking a case full of equipment and supplies on a family vacation and then to continue with issues of snoring -- just not worth it!

Not a good day -- sorry to complain!
Dont-know Annoyed-and-disappointed
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Unable to find the right mask [Looking for advice]
Sorry to hear of all your struggles. I have to think that some of these issues may be improved upon with a different mask choice. Do you have any type of insurance to cover cost of masks? Or are you 100% out of pocket like me?

~ Self-Treatment - via ApneaBoard experts.
~ Self-Pay - no help from Kaiser other than getting my script, then a pat on the butt and out the door.
~ Self-Educated - via ApneaBoard experts, its many users, and posted reference material.
~ Complex Apnea - All Night AHI=34.2/h, Supine AHI=45.5/h
~ Using a 2021 16" MacBook Pro M1 Max, 32 GB, 1 TB, macOS Monterey V12.6.
~ Pay no attention to the dog behind the cup, he ain't a docta, and does not give medical advise.
~ Woof, woof.

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Unable to find the right mask [Looking for advice]
I hope my experience can help you.  I have been on a long quest for the right mask.  I am a 68 year old male with modest facial hair.  Facial hair was one of my challenges.  I landed on the Vitera and I thought it was going to be the answer.  I got the medium and large mask.  The medium didn't work at first and the large seemed like it would be the answer.  I felt like I was a "large" because that was what I used with other masks.  But I struggled with the large.  

By accident one night I used the medium and it worked really well.  I decided to experiment with it and now I'm sold.  Here's why:  It feels just a little too small, but because the bottom sits right in the cleft between my lower lip and chin, it tends to act as a chin strap oddly enough.  That was my biggest problem with full-face masks.  If I moved, my jaw tended to open and break the seal.  Overall the medium seems a little small, but I'm not getting any appreciable leakage – most of the time.  So maybe it's not too small.  Maybe it's just right.

Recently I got a haircut and for two nights I had a maddening leak.  I didn't think about the haircut until after the second night.  But now I realize that the change in circumference of my head had changed just enough that a leak developed.  I tightened the lower straps on the third night and it was back to a good night's sleep.

They say that you shouldn't tighten the Vitara's upper straps super tight and I agree.  I have a finger-width between the plastic and my nose.  I've read in this forum that the Vitera is the only full-face mask that does better when it is lower on your nose vs. higher.  That's my experience.  The medium mask sits lower on my nose than the large and I think that suits me.

My experience is that I have to cinch up the lower straps tighter than I would like, but that's what it takes.  The upper straps have to be taut but not tight.  The way the lower part sits between my lip and chin works well with my facial hair.  

I've experimented with my pressure using OSCAR as a reference (sorry Doc...) and have found a sweet spot at 10.8.  I'm going to experiment with 11 one of these days.  The approach above works well at that pressure.

I hope this helps.
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Unable to find the right mask [Looking for advice]
THANK you!  I think the air coming from the Vitera mask (as it's intended) throws me off somewhat because I can hear and feel the air.  Thinking it's a leak, I keep tightening the straps.  

I'll experiment more tonight but it gets frustrating.  I know everyone's face size and shape is different but when I hear 'just snug' doesn't get it for me.  I have to go to 'tight'!

Sleep deprivation is wearing me down!

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Unable to find the right mask [Looking for advice]
The Vitera mask has a grid of holes in the front and there is a detectable amount of air that comes out of the front – by design.  You can feel it with your hand and you can hear it.  This is not a leak.  It is the way that F&P designed their mask to allow the user to exhale without building up pressure (as I understand it).

I use the ResMed Airtouch 10 machine. It has an app for your phone.  It provides daily summary of how your night went, including a rating of "Mask Seal".  Last night I got a score of 20/20 – no leaks.  I use OSCAR which takes the ResMed data and gives a display minute by minute for key variables including leaks.  ResMed has a threshold value it calls "Time Over Leak Redline" (TOLR) that it uses to report leaks.  It reports TOLR as a percent of your total night on your device.  

I had a very brief spike of a leak last night that OSCAR reported as TOLR = 0.009%.  In other words a few seconds of a leak.  That's why my phone app gave me a 20/20 score – the vast majority of the night there was no "leak".  OSCAR reported that my median Leak Rate was 6.00 and the 95th percentile Leak Rate was 7.20.  The max was 10.80.  I've been watching OSCAR for six months and I can say that this was a fantastic night from a leak perspective.  

Bottom line, it was one more night that made me feel that I now have a mask, mask placement, and headgear adjustment that is working well for me.  Unless the mask is glued to my face or surgically implanted, I have to think that sometimes my movement during the night will result in a momentary leak.  But with numbers like last night, I feel really good.

I encourage you to take a data-based approach to understanding mask fit, pressure, etc., to "dial in" the right fit.  I think ResMed gives you a lot of tools to do that.  I'm not sure about other CPAP machines and vendors.  But one thing I know for sure – don't worry about the airflow coming out of the holes in front of the Vitera.  It's not a leak.
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RE: Unable to find the right mask [Looking for advice]
I have requested that this be split into its own thread on the main forum.
I am certain that your mask, the Vitera, does not properly fit you. A mask for you to try is the Mirage Activa Nasal CPAP Mask. It was my goto mask for years. Will it work for you? I don't know, but it has what I call a "bellows" and because of it will tolerate a wide range of movement up to about .5 inch in any direction, The mask is totally loose until it is pressurized. I now use the P10 pillow mask, extremely quiet, so much so my wife kept waking me up to see if I was still breathing.

Download OSCAR and post your nightly charts. This gives us data that we will use to provide very specific advice for you.
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RE: Unable to find the right mask [Looking for advice]
I can sympathize, too. So far, Resmed F20 airtouch (foam cushion) seems to work best for me (not good in all respects, but best so far.) I use
a size medium CUSHION with a SMALL HEADGEAR. (Sometimes it is difficult to obtain these- "-they" seem to think that we should use small cushion and small headgear together.) I think the " For Her " headgear IS size small headgear. For me, I need a shorter/ and wider mask. ( Is anyone from Resmed listening?)

For awhile, my husband was heating then stretching in width --size medium cushions for me. That seemed to help, unless it didn't work well.
Size large cushion was too large.

I have simplus masks--a small and a medium . I understand the need for venting after reading explanation somewhere (Sleep Apnea.com?). However, the venting sent the air straight onto my eyes. Yes, my eyes were closed, but it is still annoying. I plan to try to send the air AWAY from my eyes, with a silicone cupcake liner and superglue---when the simplus mask turns up again. (Cardboard and tape didn't work very well. )

Please keep trying, and let us know what helps and doesn't help you.
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RE: Unable to find the right mask [Looking for advice]
If you still want to try the Vitera again, I can go over the steps I found to adjust it. I find it acts like the bellows as well, like Gideon mentioned on the Activa. F&P calls this RollFit.

I'll check back this evening and post my suggested adjustment.

Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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RE: Unable to find the right mask [Looking for advice]
I have only swept quickly though this thread, so forgive me if I have missed a key 'something'.

Have you considered ear plugs?  Think in 'systems'.  Or, systems-thinking.  You are a system, but you have added a system.  You have conjoined systems; it HAS TO make a difference of some kind or another.  Apparently, your systems haven't wedded well.  Thinking-about

With each change in system, or in merely arrangements, your ears, your senses in general, will feel unsettled.  The different sounds will sound....well....different, and you alert level will be heightened.  

Apart from finding convenient fixes for other problems, consider using ear plugs to reduce the impact of noises, especially different noises.  I have been using silicone ear plugs for years.  If nothing else, they reduce the noises made by the vent at the end of my mask, but wife is a bit of a noisy sleeper as well.  She needs PAP therapy, but she and her physician aren't 'there' yet.  Meanwhile, I can't fall asleep if I hear what she's going through 1 meter away.  Oh-jeez  Maybe, just maybe, good ear plugs/sound/noise attenuation will help a wee bit for you.  Go to the drug store or grocery-with-drug section, and look for the small package with silicone pucks.  They can be divided, in case it doesn't occur to you.  I have to pinch them in half, but that means one plug will do for a while.  Cheap, like borscht.
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