Here I go again...mask issues 4 nights in with new treatment.

[Plmnb]

Latest situation:

1)Downloaded OSCAR onto my MacBook Pro.  Need to buy SD card reader this Thursday.  So at the moment I only can go by the MyAir reports.

2)Saw RT yesterday because I am exhausted and she fit my mask for me.  She said my leaks were high and she thought it would help to show me how to tighten the mask.

3)Woke up this morning not feeling any better and leak report still not good.  Called my doctor’s office and they said based on info so far I need to switch to a different type of full face mask.  This is what I was afraid of.  The types they have shown me look very much like the types I tried 7 years ago.  (I tried all styles back then).  The doctors office told me that the part of the mask that goes under my nose on my current mask is not good to use with the pressures I am having.  She also said there could be an issue with this mask with side sleeping.

4)On top of everything else I am having trouble with mouth soreness being even worse than my usual discomfort.  I have very unhealthy gums and am working with a dentist to address this.  But the air from the CPAP is aggravating the pain.

I know I need to be patient and work through everything.  That I need to give things time.  I just am trying to get everything going correctly as quickly as possible because mentally I don’t know how much more I can take not getting a decent night of sleep.

Regards,
Plmnb

[harrywr2]

Having recently been to my dentist and gotten a report that my gum problems had improved dramatically I can only put down the reason being my Sleep Doctor insisted I make a 'best effort' to use a nasal pillow mask(p10 or p30i) instead of a full face mask in order to cure me of my lifelong habit of mouth breathing(Mouth breathing leads to gum disease among other things).

[SarcasticDave94]

Assuming you have decent fit on mask size, and that the headgear permits proper fit there as well, as best as I'm aware most modern masks handle CPAP pressures. I'd call that kinda bogus info from Dr. Duck.

On side sleeping, you might consider a different head pillow, maybe one with the mask cutouts or a buckwheat filled type that you can shape it a bit to accommodate the mask. My 2 cents for the day.

[Sleeprider]

Have you ever tried a truely small lightweight nasal therapy like the Resmed Airfit P10 pillows mask? It only covers the bottom of your nose and comes with 3-sizes of nasal pillows. The for-her model has XS, S and M, and the regular model is S, M and L. If you can learn to use nasal therapy, you will be much better off for comfort and leaks.

What Dave is saying is that making a mask tight does not make a good fit. A properly fitting mask can float on the face, and strap pressure is minimal, s sufficient only to hold the mask in place. Anything else is not a good fit.

[Gideon]

I'll suggest taking a different tact,  A pillow mask, such as ResMed P10, and a different means of managing Mouth Breathing.
From the Mask Primer Wiki.

Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With OSCAR look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In OSCAR right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, does not happen overnight, but it works for some. The tongue trick is where you want to be but it takes a lot of time and some people just cannot get it. Place the tongue on the roof of your mouth and breathe with your mouth shut. Breathing thru your nose, right? Now leaving the tongue where it is open your mouth, you should still be breathing thru your nose. Now that you have that down move your tongue, breathing thru your mouth right? OK, put your mask on, under pressure, and repeat the above. Expect to need to turn your machine off when you start to repeat. Add talking while under pressure, It takes a while to get any of this down. It took me months. The exercises above are to help you understand the positions that cause the issue and how to correct it. For all this to become automatic will take a while.
Cervical Collar. A "soft" Cervical Collar (Releaf is popular). This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occurred when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues. An Anti-Snoring collar, which has a small strap in back (Dr. Dakota is popular)
It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw-dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, the Ultimate Chinstrap, Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose is to maintain a proper head and neck alignment while allowing for the mask maintaining the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks/mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask.

• Many users use a product called Biotene to get relief from this symptom.
  

[SarcasticDave94]

I may not have said it in a way that makes sense, but yes on the mask tightness. Tight isn't right on these masks. I've fallen for that mentality myself when I was a newbie. Bonjour was very helpful in correcting me on that mistake in my noob stage.

Best wishes you get successes on this xPAP journey. Feel free to post us on the Dr. Duck soap opera anytime you'd like to fact check.

[Plmnb]

Oh wow, so much info and help, I really appreciate it.

harrywr2:  It is so strange because I had given up smoking for a month earlier this year and switched to Paradentex (?) toothpaste and a special mouthwash by Crest that helped my gums tremendously within a day or two.  Unfortunately I started smoking again and stopped buying that particular toothpaste and mouth wash.  The toothpaste became so expensive and I couldn't find that particular mouth wash again.  So my gums had really been in trouble just before starting with the CPAP again.  About a week before starting CPAP I tried a new toothpaste and mouth wash but they have not worked as well.  I just stopped smoking AGAIN, with hopes that would make the difference but it has not, so far anyway.  7 years ago when I first tried CPAP therapy, a nasal mask was tried.  It did not work at all.  It ended up on the floor beside my bed just like all the other mask styles I tried.

SarcasticDave9:  Lol, Dr. Duck.  Good name for him because I don't really like him.  I have met him 2x.  Once to see about having the new study done and once to get the results.  He spent maybe 5 minutes with me each time.  He did not physically examine me either time.  Maybe that is normal for most but I don't like it.  Both my prior sleep doctors at least examined me and spent more time with me.  I questioned his staff and they said this is just the way he is.  I mentioned it to my machine provider and they said they had heard the same complaint from other patients.  I called the doctor's office today and in order to see me quickly they have suggested I see a different doctor in their practice which I want to do.  As to the information about the nasal portion with high pressure, this statement came from the machine provider's office.  Your suggestion though about a head pillow with cut outs for cpap users is something for me to investigate.



Sleeprider:  As I have mentioned, just nasal pillows has not seemed to be a likely solution for me.  In the past I have had to use a chin strap to keep my mouth closed and it did not work.  The mask would end up on the floor and the chin strap would just stretch upon mouth falling open.  I have tried starting with the lightest tightening of the head gear, all of them, working my way up to as tight as I could stand...nothing works. (So far anyway).  The RT showed me where to position the bands and such and the tubing, but this has not helped.

bonjour:  Well, as I have said the pillow mask does not seem to be the answer.  But, your suggestions on managing the mouth breathing by using a cervical collar is very intriguing.  The full face mask without that soft nasal pillow area that is on my current full face mask may have to be the way to go.  Hopefully they have had improvements on them since 7 years ago.


I promise to update in the forum once I get the OSCAR system up and running.

Warmest Regards,
Plmnb (Phoebe)

[SarcasticDave94]

FWIW there is a chin strap that may actually help, if you find you need to reconsider one. Google Knightsbridge dual band, a cap and dual strap combo. I'm considering it myself next year sometime as a probable buy after I finalize a new machine.

PS Dr. Duck so named as he says quack.