Getting a good seal

stages3n4 · Post by **stages3n4** » Mon Apr 23, 2007 1:09 pm

Wow...is this ever more difficult than I thought it would be! Is it this hard for everyone?

I started out with the Swift Nasal Pillow, and had no problem with seal unless I moved too much. Mouth breathing was a problem, so I decided to try the Hybrid.

Have been working with that for the last 5 nights, and it has been rough. Had a terrible time getting seal around the nasal part (just love that high pitch air escape). Finally got that pretty much worked out, and now can't seem to get the face part sealed right.

I can get both to work right if I hold the mask in place, but can't seem to replicate the placement with strap adjustments.

Trying the Hybrid because of the mouth breathing. Taping worked, but I have terrible ragweed allergies, so not being able to breath through the nose and having my mouth taped shut seems like it could be a tad inconvenient come July, August, and September. (Yes, I am using meds for this, I don't know if I build up a tolerance to them and effectiveness drops, but there are times in ragweed season where I swear TNT wouldn't open my nasal passages).

I'm thinking I'll go back to the swift for a couple of nights to try and get some good sleep, and then have another crack at the Hybrid.

I know there have been some other similar posts, and now I'm finally to the point I started out to make for other Hybrid users; because of my size, I started out with the Large mouth and nasal units. Switched out last night to Medium just for giggles, figured there was no way I would be a medium, but the Medium did work better than the large. My point: don't assume what size you should use, if one isn't working, try another.

bdp522 · Post by **bdp522** » Mon Apr 23, 2007 1:26 pm

In case you haven't already read this;

Hybrid Mask Adjustments: Just One Man’s Opinion at One Point in Time (updated 12/28/2006)

If you are a mouth-breather or mouth-leaker and don’t like mouth taping or chin straps or traditional full face masks, then the Hybrid mask may be the solution for you.

Three critical things to do: watch the manufacturer’s video, watch the manufacturer’s video and watch the manufacturer’s video.

I am 95% convinced that the Hybrid will fit most people and provide appropriate therapy if you can get the right combination of:

• Chin flap or no chin flap. I cut the chin flap off. The rest of the discussion assumes the chin flap has been removed.
• Mask size. In my case the large appeared to be the correct size. After some trial and error, I finally got the medium to work. It is barely wide enough to cover the corners of my mouth but it works and is not uncomfortable.
• Pillow size. The medium pillows “appear” to be the correct size and some trial and error confirmed that they are.
• Pillow height. Pillow height depends on the mask size and the distance between the top of the mask when it is in place and the nose openings. Select a pillow height that will provide a snug fit to the outside of the nostrils. When in place between the outside of the nostrils and the top of the mask, the pillows should be compressed about 50% of their normal height.
• Top strap of headgear. This strap should be adjusted fairly loose. It is to provide some upward stability to the headgear.
• Top side straps. These straps provide stability of the mask on the upper lip and pull the pillows against the nostrils. They should be adjusted evenly on each side to assure the mask is centered on the face. The top side straps are critical to preventing leaks between the pillows and the nostrils. They should be adjusted snugly.
• Bottom side straps. These should be adjusted snugly to provide stability of the mask on the chin. They should be adjusted evenly on each side to assure the mask is centered on the face.

Adjust the headgear in this order:

• Place your xpap on a counter with a mirror.
• Place the pillows in the mask and twist them into the openings so that they align well with your nostrils.
• Place the mask (with pillows already attached) into the hard shell. Make sure the rim of the mask is inserted completely into the groove all the way around the shell.
• Attach the top side straps to the shell.
• Slide the headgear onto your head and place the mask on your face in a position that appears to be leak-free and comfortable.
• Attach the bottom side straps to the shell.
• Make sure the mask is centered on your face. As noted above each set of side straps should be adjusted evenly on each side of your face.
• Check that the pillows create a seal with the nostrils that appears secure. Use thumb and forefinger to adjust each pillow into the opening of the nostril.
• When everything looks and feel “right”, turn on the xpap machine to the maximum pressure you will be using. Check for leaks. You can place your two index fingers over the exhaust ports and listen for leaks elsewhere in the mask. Don’t do this too long because you aren’t breathing fresh air when the exhaust ports are blocked.
• The pillows should not be separated (cut apart) unless you have two very different sizes of nostrils. I know many patients cut the connector between the nasal pillows. Personally I think this is a mistake. I find the connector adds considerable stability to the pillows, particularly preventing them from flaring out to the sides of the face. The pillow openings are not round; they are oblong so you may need some adjustment (reorientation) to align the axes of the oblong openings with the axes of the nose openings. Place the pillows in the mask and twist them into the openings so that they align well with your nostrils. In my case the pillows both need to be twisted slightly inward so that when adjusted the connector is no longer straight but forms a slight arch out toward the mask shell.

• If you get the adjustments right, there should be no need for dental floss or rubber bands to hold the pillows.

• When you arise in the morning only unclip the bottom side straps. Leave the rest of the headgear as is.

• I remove the mask from the shell every morning and wash it briefly in warm soapy water. Rinse well and leave it in a safe place to air dry during the day.

It took me about five nights to get an adjustment that works very well. I find that the headgear only needs readjusting about every 10 days or longer. I am not sure if this is because the headgear is stretching or the velco slips slightly. I am using the original headgear and apparently I am the only person on the planet who likes it. It is lightweight and cool and holds the adjustments for 10 days or more. When the new headgear is out, I hope to be even happier.

I have used the Hybrid Mask 3 months and 16 days. It is trouble free most of the time. For the litmus test, I am beginning to feel better and have had some wonderful dreams most nights for about two months. It has been ten or more years since I had dreams like this.

Don’t forget three more things: watch the manufacturer’s video, watch the manufacturer’s video and watch the manufacturer’s video. Call their customer service number if things don’t work well for you immediately.

Good luck.

This post was from Rooster, Jan 2006

Brenda

SleepySandy · Post by **SleepySandy** » Mon Apr 23, 2007 1:32 pm

Yes, finding the right mask is difficult for many people. I'm on mask #6.

I envy that you can use nasal pillows. I've been trying to evaluate the Hybrid for my RT and my nares just can't handle the pillows - they hurt like crazy. Combine that with the fact that my leak rate with the Hybrid is high (though I can't feel any leaks) and I'm pretty sure it's not the mask for me.

You said you switched from large to medium and I'm not sure if you were talking about just the mouth part or the nasal pillows as well. You may not know this but you can use any size nasal pillow with any size mouth part. And, you can cut apart the nasal pillows and use 2 different nasal pillow sizes if you need to.

stages3n4 wrote:I can get both to work right if I hold the mask in place, but can't seem to replicate the placement with strap adjustments.

Can you think of another way to replicate that placement? I'm actually finding the same thing with my current mask and I'm trying to figure out if I can add a headband or something around the mask / my head to keep it in place the way I do it with my hands.

Hopefully successful Hybrid users can give you some suggestions you can try.

If the Hybrid just won't work for you, there are other FF masks you can try. The most popular seems to be the Resmed Ultra Mirage Full Face (UMFF). This mask didn't work for me, but it works for tons of posters here. I use the Respironics ComfortFull 2 (CF2). It does work for me - my leak rate is so stable it's amazing. Since it's April and allergy season for you starts in July, you have some time to find the right FF mask .

WearyOne · Post by **WearyOne** » Mon Apr 23, 2007 1:50 pm

My best seal for me came when I cut the chin flap off. BUT, I only did that after I acquired two backups of the size I wear. Before that, I got so irriated because, same as you, if I held it in place, it was fine! The reason I kept trying is because I don't like taping and I haven't been able to find another FF mask that doesn't give me more problems (especially around the eyes) than the Hybrid did.

I am still not 100% satisfied with the pillows, as sometimes I wake up with a hurting nose, but it's not so bad that I'd ever stop using it.

Most nights it's like I don't even has a mask on. I have actually found myself waking up to scratch my nose or mouth, and rammed my hand into the mask because I forgot I had it on!

I hope you can get it to work for you. It did take me some time, though, and reading a bunch of information here!

Pam

stages3n4 · Post by **stages3n4** » Mon Apr 23, 2007 1:54 pm

So, I'm thinking that I should watch the mfg's video.

I did try, but now I'm thinking about something, I put it in a DVD player, is it solely a CD and needs a computer? Hadn't thought about that.

Thank you for posting the written take by rooster, definitely some good ideas in there!

SleepySandy · Post by **SleepySandy** » Mon Apr 23, 2007 1:57 pm

There's a Fitting Guide video on-line. I'm not sure if it's the same one on the CD, but it seems pretty complete:

http://www.respcare.com/hybrid/video_index.htm

Just remember that rooster's instructions assume you've cut the chinflap off.

I hope you can get it to work!

roster · Post by **roster** » Mon Apr 23, 2007 5:02 pm

[quote="SleepySandy"]There's a Fitting Guide video on-line. I'm not sure if it's the same one on the CD, but it seems pretty complete:

http://www.respcare.com/hybrid/video_index.htm

Just remember that rooster's instructions assume you've cut the chinflap off.

I hope you can get it to work!

stages3n4 · Post by **stages3n4** » Tue Apr 24, 2007 7:29 am

Wow, followed rooster's written instructions posted above by bdp (thanks to both of you!), lo and behold, achieved a much better seal last night.

Leak rate was 33L/min, which if I'm understand the chart that came with hybrid, is within standard range at a 10 pressure (new model shell).

The chin flap, if I moved in a certain way, like tucking my chin down a bit, did seem to cause the lower seal to break, is this what others have experienced?

The one bit of advice I'll give is just to stress that it seems like the upper part of the mouth piece needs to sit well above one's upper lip, and then work the lower part so it is under lower lip.