Advice Requested on Mirage Quattro Face Mask

I request advice concerning my Mirage Quattro full face mask. I had sleep apnea 15-20 years ago, had a full surgical cure, and recently suffered a recurrence due to an extreme dry mouth & throat condition which my family physician believes is caused by some sort of auto-immune disorder. I have always used a full face mask because surgery for a partially deviated septum went very wrong and turned me into a mouth breather.

I have resumed using my 1994-vintage Healthdyne Tranquility model 1700 Bi-Pap, with its 1994 settings of either 7 or 10 cm pressure. This is without a prescription as it has taken months to get a first appointment with a new sleep specialist. I won’t see him until next week, and a subsequent sleep study will go through the same interminable insurance review.

I bought an HC150 heated humidifier, a Flexifit HC431 full face mask, and a Mirage Quattro full face mask based on the reviews here. I got return insurance for the two masks, and have been using those for 2-3 hours a night for the past four nights.

The Flexifit HC431 does not seal as well as the Mirage Quattro. This is a problem because cold water dribbles out of the Flexifit down my neck after 2-3 hours, and wakes me right up. I am using the recommended setting of 2 on the humidifier. Less gets my mouth dry in an hour – much faster than if I do nothing at all. The Mirage Quattro seals perfectly, but exhalation is a major issue. The mask interior fills with warm moist exhale air. It seems like the exhale valve is not working properly. I can’t fall asleep with the Mirage on. Some fear and/or anxiety is involved.

This was not a problem with the oxygen-style full face mask I had used before, which had inflatable cushions to provide a complete seal. Its exhale valve worked well, as does that of the Flexifit HC431.

But there seem to be problems with the Mirage’s exhale valve. I request comments as to whether this is really a design/personal preference issue, or whether there might be some defect in my particular mask.

And if you feel I should not even try to use my 15 year-old Bi-Pap, with either mask, until my eventual first appointment with a sleep specialist, please say so and, if possible, give your reasons..

My previous treatment for my new sleep apnea has been to take two Benadryl at bedtime and irrigate my nostrils with 12-hour Afrin (really 8-hours). I am aware that the Afrin use has a limited effective period. I’m coming up on four months of such use.

And it has been effective. I can sleep at night if I can breathe through my nose, though my mouth and throat are still bone-dry in the morning. I can even sleep in on weekends. I know I am still suffering from some sleep deficit, but it is manageable and I can recover some of the deficit on weekends. I just can’t sleep during the day. Sleeping ten hours or so on weekends, by sleeping in, is possible.

I tried going without the Afrin on the second night with the Flexifit HC431, and that was a major error. My sinuses totally filled with snot and whatnot due to irritation from the Bi-Pap overpressure. I took the mask off and cleared the sinuses with a whole lot of Afrin which eventually worked, and I slept the rest of the night.

I checked the Resmed site and it mentioned that Mirage Quattro masks have "settings" which can vary from one CPAP/Bi-Pap machine to another. This indicates that it may well be possible that the Quattro is incompatible with my old, obsolete, Bi-Pap, and that I am right to be concerned about using the Quattro on it with a non-functional exhale valve.

Tom Holsinger wrote: ...using the Quattro on it with a non-functional exhale valve.

Welcome Tom,

I don't know how the exhale valve can fail to function unless it is taped over. The exhale valve on the Quattro is nothing but the holes in the shell near the top angle of the mask.

Are you possibly thinking about the relief valve in the elbow that allows you to breathe in when the machine is turned off? When the machine is running, the flap on this valve should close and not allow air to exit. Under normal conditions, air will also not enter this valve.

Please join and fill out the equipment profile. Select "text" option for equipment, not "icons".

After you do this, please also post a link to the ResMed instructions about "settings" that you are referring to.

Regards,

You might want to take my comments with a grain of salt, as I'm too new to know much yet, but I feel like I'm starting to get the hang of this CPAP thing. I've got the same mask -- it is quite popular -- and I had an occasion to take it totally apart and put it back together recently. I don't think there is an exhale valve, as such. It just has an exhale vent, always open. The vent takes the form of several rows of small holes over the nose. I suppose these could be missing or blocked on a defective mask, but if the mask is working right, you can feel air continuously venting from these. There is nothing mechanical to malfunction.

Since there is always pressure to work against, even on a BiPAP machine, exhaling seems like work at first. It kept me awake for hours during my sleep study (or maybe I should say it competed with a whole range of weird sensations to keep me awake). Of all the many surprises so far using CPAP, this biggest, I think, is how quickly one gets used to this. I wake up in the morning and I am totally unconscious of the pressure. At my setting of 17 cm, the pressure is toward the high end, but I feel completely normal, breathing gently in and out. I know the out part must take more effort than without the machine, but I barely notice it at bedtime now and truly can't feel it in the morning. Turning the machine off feels feels oddly like having the breath sucked out of me for a second.

PST wrote: ........ Of all the many surprises so far using CPAP, this biggest, I think, is how quickly one gets used to this. I wake up in the morning and I am totally unconscious of the pressure. At my setting of 17 cm, the pressure is toward the high end, but I feel completely normal, breathing gently in and out. I know the out part must take more effort than without the machine, but I barely notice it at bedtime now and truly can't feel it in the morning. Turning the machine off feels feels oddly like having the breath sucked out of me for a second.

PST,

You are the man of the day. Four days in with a FFM and pressure of 17!

Way to go champ!

PST, I used to turn the machine off before taking off my mask, so I know what you mean about "having the breath sucked out of you." I recently set the machine to auto on/off, and now I just put on my mask and breathe to start the machine, and then I just take the mask off to stop the machine. It works great, especially when I get up in the middle of the night. The machine does blow for a couple seconds before stopping, but I really like this feature.

rooster,

If those little holes are the exhale valves, they are working. It seems, however, that those produce more exhale pressure when my Bi-Pap is turned off. That may be simply that there is a greater pressure differential between no pressure at all, with the unit off, and exhale pressure, than between BiPap pressure before and during exhale.

The Resmed links (both *.pdf files) which mention mask settings:

http://www.resmed.com/us/assets/documen ... er_eng.pdf

http://www.resmed.com/assets/documents/ ... sa_eng.pdf

twokatmew,

I use an old surge protector with both my BiPap and my heated humidifier, so I can turn both off with a click of a single switch. That minimizes the chances of accidentally leaving my heated humifier on.

rooster wrote:You are the man of the day. Four days in with a FFM and pressure of 17!

Rooster,

Thanks for the kind words, but although I only joined this group a few days ago, I've been using the CPAP machine almost four weeks now. It's really made a difference. Other than working to find the mask sweet spot between leaking and hurting, I've had a pretty smooth time of it.

Twokatsmew,

Thank you for the auto-on suggestion. I had forgotten about that capability. I will give it a try.

Tom Holsinger wrote: ........My previous treatment for my new sleep apnea has been to take two Benadryl at bedtime and irrigate my nostrils with 12-hour Afrin (really 8-hours). I am aware that the Afrin use has a limited effective period. I’m coming up on four months of such use.

And it has been effective. I can sleep at night if I can breathe through my nose, though my mouth and throat are still bone-dry in the morning. .......

IMO, that Benadryl and Afrin are each nasty critters and you are abusing yourself by using either one of them.
Please check out this discussion between Dr. Falcon and myself -> viewtopic.php?f=1&t=36483&start=15 .

What I currently use to keep my passages open is one Zyrtec (generic version) each night before bed and a neti pot saline rinse once or twice per day. Sounds like you will need a little more than that, so I would add a cortisone nasal spray (.g. Flonase) (prescription needed) each morning. All of these treatments are thought to be safe in longterm use.

When you discontinue the Afrin you will likely get horrible rebound congestion. The solution some have used is to first discontinue it in one nostril and after it clears up in about a week, you can discontinue it in the other nostril. The downside is you are breathing from one nostril for maybe two weeks.

Of course those are my opinions (but they are ideal advice, IMO ), so suit yourself.

Tom Holsinger wrote:...... it may well be possible that the Quattro is incompatible with my old, obsolete, Bi-Pap, ......

I am not familiar with the machine you have, so I can't comment.

Rooster, thanks for the suggestion about discontinuing the Afrin for one nostril at a time. I know about the Afrin rebound congestion. Keep in mind that my county's health insurer waits months to approve anything, and I needed something fast.

I am told by a friend that investigation of my autoimmune disorder will take years.

rooster wrote:When you discontinue the Afrin you will likely get horrible rebound congestion. The solution some have used is to first discontinue it in one nostril and after it clears up in about a week, you can discontinue it in the other nostril. The downside is you are breathing from one nostril for maybe two weeks.

Of course those are my opinions (but they are ideal advice, IMO ), so suit yourself.

Tom, see if you can get your family phyiscian to give you an Rx for a BIPAP -- you can then use it to buy an automatic, data capable bi-level online. cpap.com - hosts of this forum - are a reliable online source, and will do price matching if you find a lower price. Have the doc write the 2 pressures you're using in your old machine - I think they have to be part of the Rx.

I would also suggest you buy a heated hose, ("heated cpap tube") - they originally come from http://www.sleepzone.com.au that will let you get more humidity into the system without condensation in the mask.

Your pre-surgery pressure on the old machine my be much too high for your present condition.

I read your post to giantred -- you have done so much to make you life better! I was touched by your decision to make sure you had time to spend with your twin sons -- how are they doing (I assume they must be in their 30s by now)?

O.

Rooster,

Thanks for the kind words, but although I only joined this group a few days ago, I've been using the CPAP machine almost four weeks now. It's really made a difference. Other than working to find the mask sweet spot between leaking and hurting, I've had a pretty smooth time of it.

Twokatsmew,

Thank you for the auto-on suggestion. I had forgotten about that capability. I will give it a try.

PST, I have the same mask and my setting is 16 cm. I have been struggling for a week trying to find the same balance you are talking about. I don't want to hijack Tom's post, so I will be making a new one. Any insight you can give me about how you figured out the right adjustment would be terrific!