Mask issues with high pressure...

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
joeljjk11
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Mask issues with high pressure...

Post by joeljjk11 » Fri Jul 10, 2015 6:32 am

So I have finally found the correct pressure to use on my machine. I have it set to 20/20 which is actually the highest my machine goes. My AHI numbers have been consistently low since I have made this change, like last night it was 3.1. This is great compared to what they were before, they were usually over 10.

So this is good but I have noticed that my leakage numbers are creeping up and I am waking a lot in the middle of the night. The mask is making farting noises almost in the middle of the night and is not that comfortable. I have to constantly readjust my mask in the middle of the night and this is becoming annoying.

What is the best mask to use when high pressure is required? I thought it was a full face mask but I was thinking of trying my nasal pillows (Nuance Pros) and see how that goes. I also have EPR set to 3.

Joel

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Pugsy
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Re: Mask issues with high pressure...

Post by Pugsy » Fri Jul 10, 2015 6:53 am

Give the nasal pillow mask a try. We have several members who use pressures above 20 cm (using a bilevel machine) who are totally successful with nasal pillows. I see pressures over 20 fairly often myself but there are people using bilevel machines at 24 cm inhale and 20 exhale and they are doing just fine.
I think that the less surface area involved can make keeping a seal easier.
It's always a bit more challenge with any mask at higher pressure and the more surface area of the mask touching the skin the more challenge there is.

If you can normally breathe through your nose just fine there is no reason to not at least try the nasal pillow mask. The old myth about high pressures and people not being able to use nasal pillows because of the pressures is just that...a myth or old wives tale. I don't know who started it but they were wrong.

As to "which mask is best at high pressures" question. The one that works for you the individual is the best.
I use the ResMed P10 nasal pillow mask...someone else might use the Swift FX or the Respironics Nuance...there are pros and cons to all of them. You just have to find the one that has more pros than cons for your situation.

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JDS74
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Re: Mask issues with high pressure...

Post by JDS74 » Fri Jul 10, 2015 8:18 am

Do you have the ramp function turned on? Fitting a mask while the pressure is reduced by the ramp function can lead to later night leaks. Some machines do have a mask fit function so that the ramp is off while you fiddle with fitting so, if yours does, you might try that.

Fitting the mask should be done in your bed, lying in the position in which you normally sleep, and at the maximum pressure your machine is set for. Lower pressures won't leak if the max pressure doesn't.

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library lady
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Re: Mask issues with high pressure...

Post by library lady » Fri Jul 10, 2015 8:51 am

You might try mask liners; my pressure is lower than yours, and when I started this journey, I had face farts up the wazoo. Mask liners were a game changer for me! I rarely get into large leak territory anymore, and when I do it usually means my cushion needs replacing. Three options: http://www.padacheek.com, or RemZzzzs available at most DMEs or from forum sponsors at https://www.cpap.com, or, you can make your own from an old t-shirt. Pattern can be found by googling "CPAP mask liner pattern".

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joeljjk11
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Re: Mask issues with high pressure...

Post by joeljjk11 » Fri Jul 10, 2015 9:46 am

Thanks for the help and suggestions everyone. I will try the nasal pillows and see how it goes. I have found my F10 to be more comfortable than the nasal pillows but we will see. I will purchase the liners if I find the nasal pillows to be uncomfortable .

Also ramp is turned off on my machine.

joeljjk11
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Re: Mask issues with high pressure...

Post by joeljjk11 » Thu Jul 23, 2015 7:19 am

I have been breathing through my mouth alot with the nasal pillows. Last night my AHI was 16.1 and it seems like this is because of mouth breathing. Ugh!

I just purchased the pad-a-cheek liner for the Airfit F10 and I am hoping it works well.

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Sheffey
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Re: Mask issues with high pressure...

Post by Sheffey » Thu Jul 23, 2015 7:39 am

joeljjk11 wrote:I have been breathing through my mouth alot with the nasal pillows. Last night my AHI was 16.1 and it seems like this is because of mouth breathing. Ugh!
It always irks me when Pugsy recommends a known mouthbreather switch from a FFM to a nasal interface.

I use the Innomed Hybrid mask. My pressure runs as high as 18 and 20 at times and the mask doesn't leak. My leak rate for the last 30 days is showing 2 l/min (very low). I also occasionally check the leak line where the pressure is up at 18 or 20 and the leak is holding very low or zero.

The Hybrid has a very small footprint and the design of nasal pillows on mouthpiece makes the nasal pillows very stable.

Make sure to get the Innomed Hybrid - https://www.cpap.com/productpage/RespCa ... -Mask.html

ChicagoGranny can give you some very good tips on adjusting and use fixes for this mask if you decide to try it.

One caveat - not everyone will like this mask. Or any other mask for that matter.
Sheffey

joeljjk11
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Re: Mask issues with high pressure...

Post by joeljjk11 » Thu Jul 23, 2015 8:09 am

Thanks for the help.

I have also noticed it seems like other things like caffeine can worsen my AHI/mouth breathing. I've noticed I can't really have it past noon or so but yesterday I had it later. Bad idea.

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Pugsy
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Re: Mask issues with high pressure...

Post by Pugsy » Thu Jul 23, 2015 8:18 am

Well it always irks me when people tell someone that they should or just have to use some sort full face mask because of mouth breathing without even bothering to look at the leak data to see how bad the mouth breathing is for people who are WANTING to use a nasal interface mask. Geezzz...not everyone wants to use a FFM and if they don't want to I am sure as heck going to at least look at the data to see just how bad the leak data is before I say "sorry dude if you can't keep your mouth shut you have to use a full face mask"

and high pressures don't preclude using a nasal pillow mask....I use a nasal pillow mask and see pressures of 22 every night...sometimes not much leak and sometimes a little but nothing horrible. Any mask is going to be more of a challenge at higher pressures and especially masks that have more skin contact areas.

To Joel...how bad was the mouth breathing leak last night? Your AHI is ugly anyway and it might not be related to leak or mouth breathing leaks. How much time was spent in large leak?
Sorry, can't help with full face mask and liners...they are the greatest thing since sliced bread for some people and for some people no help at all. It's just something you have to try yourself.

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joeljjk11
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Re: Mask issues with high pressure...

Post by joeljjk11 » Thu Jul 23, 2015 8:24 am

I am at work so I can't look at Sleepyhead but the leakage was pretty significant on my machine. I am going to try the nasal pillows again tonight and not have caffeine late today. I bet this will improve my AHI and help with the leakage and mouth breathing. If things do not improve I will try out the liner with the F10.

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Sheffey
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Re: Mask issues with high pressure...

Post by Sheffey » Thu Jul 23, 2015 8:32 am

Pugsy wrote:Well it always irks me when people tell someone that they should or just have to use some sort full face mask because of mouth breathing without even bothering to look at the leak data to see how bad the mouth breathing
You are hoping the leak line obscures the actual experience ->
joeljjk11 wrote:I have been breathing through my mouth alot with the nasal pillows. Last night my AHI was 16.1 and it seems like this is because of mouth breathing. Ugh!
-----------------------------------------------------------------------------
Pugsy wrote:people who are WANTING to use a nasal interface mask
WANTING to use??

He has succumbed to your anti-FFM propaganda.

Pugsy, I'm sorry you never figured out how to use a FFM. Plenty of us did and I'm glad there was no one around to discourage me when I was learning.
Sheffey

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Pugsy
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Re: Mask issues with high pressure...

Post by Pugsy » Thu Jul 23, 2015 8:45 am

Sheffey wrote:He has succumbed to your anti-FFM propaganda.

Pugsy, I'm sorry you never figured out how to use a FFM. Plenty of us did and I'm glad there was no one around to discourage me when I was learning.
You are incorrect. I have figured out how to use a full face mask...I just don't want or need to use one. I could use your hybrid if I had to. I cannot wear anything across the nose bridge area as the tiniest of pressure causes immediate nasal congestion and I can't simply can't sleep with my nose congested. Also I have severe DJD in my cervical spine and I have a metal plate in the spine and because if that the lower straps needed for almost all FFM cause a problem with my cervical spine and a bad pain issue. I have found the the Hybrid could be used if I absolutely had to by moving that back strap upwards a bit.
I have slept with the hybrid...so I have figured out how to make one work but I don't need to or want to use it all the time..
When it comes to this therapy "want" plays a big part IMHO.

I am NOT anti FFM...
My job is to try to help someone use the mask that THEY want to use and not decide for them which mask to use.
If you were to look at Joels reports in other threads....his leak isn't bad at all and if he is mouth breathing it sure isn't enough to show up on the report making a negative impact on the therapy in that regard.

It's not like FFM don't present their own challenges at higher pressures and not all mouth breathing means the therapy is in the toilet. I have a graph where I was awake and mouth breathing for sure because I wanted to see just how much of an impact it made. See the last 15 minutes of this report where I have it circled in red.

So what's so hard about asking to see the graphs before shoving a full face mask on someone if they don't want one?

Image

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joeljjk11
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Re: Mask issues with high pressure...

Post by joeljjk11 » Thu Jul 23, 2015 12:44 pm

Has anyone else noticed that caffeine late or other factors like this can worsen their apnea and AHI/numbers?

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Pugsy
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Re: Mask issues with high pressure...

Post by Pugsy » Thu Jul 23, 2015 12:53 pm

I have never noticed caffeine intake affecting the numbers but it will affect my ability to go to sleep.
I pretty much try to avoid caffeine after around 6 PM for that reason but on the occasion that I do cheat and have some (like a soda at 8 PM last night) it didn't change my numbers and I was so tired from cleaning house that it really didn't hurt my going to sleep all that much.

Some people are just super sensitive to caffeine and others, like my husband, could drink an expresso double shot and go right to sleep. I would be wired half the night. Now I can take my daytime pain pill that comes with a "may cause drowsiness" sticker and it wires up up so I can't take it in the evening at all or else I would be up cleaning house at 2 AM. Go figure that one. I have to take something different in the evening to help with the old arthritis stuff or else the pain would keep me awake. Damned if you do and damned if you don't.

It wouldn't surprise me to see caffeine impacting the numbers especially if the increase was in CAs/centrals because it is a stimulant which might impact sleep quality itself and with more awake time on the machine we have more chance of having those awake/semi awake (SWJ-sleep/wake/junk) events get flagged.
I don't see it impacting the airway tissues themselves though. Can't think of how it might do that unless if they are more "awake" they are more stubborn and harder to hold open.

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joeljjk11
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Re: Mask issues with high pressure...

Post by joeljjk11 » Thu Jul 23, 2015 1:05 pm

It seems like last night was a combination of me having caffeine later in the afternoon and just poor sleep overall. I guess it happens, and the caffeine most likely just worsened everything.