Mask Hell: Harness Causes Baldy Headaches

Having had four sleep studies using the WISP exclusively, I assumed that mask selection would be a no-brainer.

NOT!
The prescription called for pressures higher than those used in the titration studies. At pressures above 20CWP my lips are forced open, the WISP floats upward and the musical leaks from the mask seal edge become loud enough to wake my wife.

After failing with a chin strap I've treated the open mouth/lip leak issue successfully with ("hostage"-like) taping. Tightening the mask harness works only up to a point with the WISP; the tightness needed to counter-act the leaks creates discomfort and actually seems counter-productive for the seal.

Nasal Alternative
The DME supplied a ESON nasal mask to try. It was awful! Or I should say the harness was awful. Any tightness of the harness at all gave me a massive headache. There is someting about the shape or position of the headgear contacting my shaved bald scalp that sets off this problem. My record for keeping the ESON mask on is barely eleven minutes so I really can't say anything about its actual fit or seal leak rate.

Full Face Mask Trial
Given that I require a Jack Bauer-level of taping to keep my lips from burbling, there seemed to be no reason to avoid a full-face mask. I am now trying the new-ish Resmed F10.

My first reaction was "wow, this thing seals great!". And the SleepyHead file shows that the leak rate was very low indeed, with no Large Leaks at all.

A bit later it was a different matter. At the pressure I require (23.4CW average) the F10 seal edge lifts and "sings" loudly from the area between my nose bridge and my cheekbone. Worse, the headgear caused headaches near as bad as the ESON rig!

I managed 47 minutes with the F10 before removing it. I took a timeout from attempting to sleep for an hour so the headache could subside. I saddled up the WISP and had a few more hours of Large Leak unpleasantness before giving up and sleeping nude nasally.

Next Up - SImplus FFM Trial starting Monday.
Many here speak of high pressures and mask fit yet very few seem to experience the over-22CW I apparently require. I'd like to get advice from forum members who experience my level of IP, or those who have had the "harness headaches" I speak about.

As always I appreciate any comments members care to offer.

Mask liners, like those sold by Pad-a-Cheek, quiet the face farts,
and reduce the mask-related wake-ups.

chunkyfrog wrote:Mask liners, like those sold by Pad-a-Cheek, quiet the face farts,
and reduce the mask-related wake-ups.

Thank you, I do use a pad-a-cheek liner on the WISP.

When I first started out I was RX's a high pressure, 27 and 20 cms. At the time, I had to use an ST unit in BiPap mode since the "normal" machines didn't go that high. A month later, I convinced my PCP to write the script down since I never sleep on my back which is where they came up with those numbers.

I have always used a FFM. Originally with the Comfortful from PR.

I stopped using ramp almost immediately since it actually didn't help and got in the way. I start out out full pressure before going to sleep and the mask stays pretty much the same.

I've never used liners but would have back then if I knew about them then.

BTW, I resorted for a period of time of tying one of my ties around my head to keep the mask close to prevent leaks for a while. The vents were at the top of the mask. Would have Velcro'd it to my head if I thought it would have worked at the time.

Can you tolerate a single strap that goes around the back of your neck?
If so, take a look at the Oracle link in my signature block below.
If your pressure requirement was less, you could even do without the strap.
If you want to try, let me know if there is anything I can do to help you make it work.

Have you got Sleepyhead setup yet?

Maybe you can see if it is possible to dial back that pressure, at least at first, and still get some effective therapy. Those are some seriously high pressure settings to have to deal with!

JDS74 wrote:Can you tolerate a single strap that goes around the back of your neck?
If so, take a look at the Oracle link in my signature block below.
If your pressure requirement was less, you could even do without the strap.
If you want to try, let me know if there is anything I can do to help you make it work.

This is a very interesting mask alternative JDS74, and you have comprehensively documented your experience with it. I'm very likely to try it.
Thanks!

One other comment. I just noticed that you have ramp set to 20 minutes. That will interfere with mask fit unless you are turning it off as you make your adjustments.

SleepDisturbed wrote:Have you got Sleepyhead setup yet?

Maybe you can see if it is possible to dial back that pressure, at least at first, and still get some effective therapy. Those are some seriously high pressure settings to have to deal with!

Good suggestion regarding the pressure.
I do have SleepyHead working and have attached a screenshot of last night's data.

The pressure was reduced to a maximum of 20cwp, and I snugged up the headgear somewhat. I didn't get headaches but I did get plenty Large Leaks. See attached image:

deforeman wrote:Having had four sleep studies using the WISP exclusively, I assumed that mask selection would be a no-brainer.

...snip...

Welcome to CPAP hell.

Try this.

Since you have an auto bipap machine, change your setting to Auto. There is a possibility that your pressures are too high and by having lower pressures your mask issues will go away. If you don't already know, you don't actually need the same pressures all through the night. The Auto setting is suppose to detect your pressure needs and adjust accordingly. Only drawback to this is that some people are awaken with changes in pressure and have to use a fixed pressure but I think they're in the minority.

Sleep on your side if you aren't already.

Position pillow such that your head/neck/shoulder align. That helps to avoid a misalignment that causes a reduction in airflow which then calls for higher pressures and then the whole mask floating/burping thing.

Best of luck and let us know how it turns out.

look into the pad-a-cheek headgear liners... I've been using them for 3 years now... it solved all headache and neck pain issues for me

deforeman wrote:

SleepDisturbed wrote:Have you got Sleepyhead setup yet?

Maybe you can see if it is possible to dial back that pressure, at least at first, and still get some effective therapy. Those are some seriously high pressure settings to have to deal with!

Good suggestion regarding the pressure.
I do have SleepyHead working and have attached a screenshot of last night's data.

The pressure was reduced to a maximum of 20cwp, and I snugged up the headgear somewhat. I didn't get headaches but I did get plenty Large Leaks. See attached image:

Forgive me because I have a ton to learn and working on my own education but could someone comment on the central apneas in the snapshot which appear to be much more prevalent than the CA index on the sleep study results in the signature, and also exceed the OA at least last night? From my admittedly lack of experience or knowledge I would want to look into this. Especially since they increased the pressure for the Rx higher than they used in the sleep studies? Also it looks like the centrals seem concentrated when you had full pressure and no leaks?

I am just asking for educational purposes so forgive me if I am intruding. I might even be reading it wrong so slap me if I am bringing up irrelevant questions.

In regards to the periods of time with no real event flagging...those were some really massive leaks and most likely the machine was clueless and didn't report much of anything because the leaks were so bad it didn't know that events were happening or it flagged them as UAs (Unknown apneas) because it sensed something was happening but couldn't figure out exactly what to call it.

During the periods where leaks were controlled there was a lot more Centrals (Clear Airway events) than I would want to see unless someone says they were awake during those times when leaks were acceptable but the Centrals were numerous. Awake centrals...we ignore but asleep centrals in those numbers we don't.

I need help understanding SleepyHead results so that I can make progress on mask selection.
Below are last night's SH results shown in two sessions.

1st Session
The first is only 45 minutes long beginning when I first went to bed. I had on the F10 full face mask, I ran "Mask Fit" and snugged the straps up until there were no leaks (while lying on my back with no pillows). At about 22:36 the mask began leaking and I snugged it further. I also moved my head and neck a bit to find a position where the leak diminished. This 1st session ended when I could not stand the harness headache any longer.


With my limited experience this chart seems to indicate that, could I solve the headache problem, the F10 would eliminate my Large Leaks, at least while I'm sleeping on my back.

2nd Session
I swapped the F10 for the WISP nasal mask for this session and employed hostage-level mouth taping. Once again I ran "Mask Fit" and snugged the headgear till there were no leaks. The session was 5hr 23min long and very heavy with LLs. I tried snugging the mask a few times and sleeping in a different position without any improvement. I did wake up while dreaming which I view as something of an improvement; prior to sleep therapy I never used to dream at all.


My conclusion from this 2nd session and several others is that the WISP, even with mouth taping, will never be satisfactory.

A Question: My first session was 45 min and 5.71 AverageHI. The 2nd session was 5hr 23 min and 12.72 AverageHI. When combined in SleepyHead the overall result for both is 18.42. Is this an SH bug or am I missing something important?

With pressures like yours, perhaps a sturdier headgear would help keep your F10 on your face. I frequently see pressures at 25 and the only way I could keep the mask from leaking was to try a headgear that didn't stretch around the back of my head. Here it is:

https://www.cpap.com/productpage/softca ... aQodZhQADg

This has been so successful for me that I will never use the headgear that comes with a mask again! I have used it on the F10, Quattro FX, Hybrid, and FitLife total face mask.