Continued difficulty with mask fit

Hi Again:
After starting off on nasal pillows and developing major congestion (nose, sinus, middle ear). Switched to FFM (am a mouth breather). The day I went to the DME to exchange masks (I am in first month of APAP), my sinuses were so congestion that I couldn't even imagine anything on the bridge of my nose - even my glasses felt too heavy!

Came home with Amara View. Have been tweeking ever since. I am petite (5'3" - 110#) with a thin face - however not such a petite nose (thanks Dad!). While AHI numbers have been good (last night .69), I have been having major issues with leaks - last night alone - 19 large leak events - one of these eventually woke me up with all of the noise and squeals. Leak average was 30L/min. The majority, if not all of the large leak events were in the first part of the night when I did NOT wear my oral appliance and happen when the pressure on the machine gets up toward 12. Average pressure has been running around 13, but not sure if that is because I need it or if the machine is trying to compensate for all of the leaking.
After waking up, I put the appliance in (the appliance helps bulk out my mouth so that the seal is better around the mouth without making it too tight under the nose) and had no major leaks the rest of the night. I have watched many, many videos on adjusting this mask and have tried everything I can think of.

I called my DME about this and she thinks my numbers are great and I know so much about this!! - I am not going to be getting much help from her - both of the two "fittings" I had for the masks I have used so far have been a joke (sitting up in a straight back chair and told to lean back! - I am a side-sleeper - didn't know enough to take my pillow along and try the floor.)

I am wondering where to turn next. Thinking of ordering the medium cushion insert for the Amara (right now I have small) to better fit my nose and see if I can get a good seal around the mouth if the nose isn't so squished. Or - what style of FFM would be a good fit for a thin face?? Considering ordering some from an online supply source that offers free returns (at least on some models).

Additional difficulty with the Amara headgear - the back strap is very wide and rides lower on my neck which puts pressure there that gives me a stiff neck in the morning. I did adjust the top head strap and put a 3/8" or so pad of microfleece between my neck and the headgear last night which did help with the pressure. I have also made my own pads for the top straps which come across the temple as the pressure on these for a side sleeper was uncomfortable.

Any help appreciated!
xcountrygal

xcountrygal wrote:Hi Again:
After starting off on nasal pillows and developing major congestion (nose, sinus, middle ear). Switched to FFM (am a mouth breather). The day I went to the DME to exchange masks (I am in first month of APAP), my sinuses were so congestion that I couldn't even imagine anything on the bridge of my nose - even my glasses felt too heavy!

Came home with Amara View. Have been tweeking ever since. I am petite (5'3" - 110#) with a thin face - however not such a petite nose (thanks Dad!). While AHI numbers have been good (last night .69), I have been having major issues with leaks - last night alone - 19 large leak events - one of these eventually woke me up with all of the noise and squeals. Leak average was 30L/min. The majority, if not all of the large leak events were in the first part of the night when I did NOT wear my oral appliance and happen when the pressure on the machine gets up toward 12. Average pressure has been running around 13, but not sure if that is because I need it or if the machine is trying to compensate for all of the leaking.
After waking up, I put the appliance in (the appliance helps bulk out my mouth so that the seal is better around the mouth without making it too tight under the nose) and had no major leaks the rest of the night. I have watched many, many videos on adjusting this mask and have tried everything I can think of.

I called my DME about this and she thinks my numbers are great and I know so much about this!! - I am not going to be getting much help from her - both of the two "fittings" I had for the masks I have used so far have been a joke (sitting up in a straight back chair and told to lean back! - I am a side-sleeper - didn't know enough to take my pillow along and try the floor.)

I am wondering where to turn next. Thinking of ordering the medium cushion insert for the Amara (right now I have small) to better fit my nose and see if I can get a good seal around the mouth if the nose isn't so squished. Or - what style of FFM would be a good fit for a thin face?? Considering ordering some from an online supply source that offers free returns (at least on some models).

Additional difficulty with the Amara headgear - the back strap is very wide and rides lower on my neck which puts pressure there that gives me a stiff neck in the morning. I did adjust the top head strap and put a 3/8" or so pad of microfleece between my neck and the headgear last night which did help with the pressure. I have also made my own pads for the top straps which come across the temple as the pressure on these for a side sleeper was uncomfortable.

Any help appreciated!
xcountrygal

Watch these videos for help.
https://video.search.yahoo.com/search/v ... k&fr=yfp-t

I've never used the Amara View mask, so I'm speaking a bit off the top of my head, but my general rule of thumb is to leave the part around the nose VERY LOOSE. The idea is to let the air cushion fully inflate and hug the nose--the tighter the upper straps the less you let the air cushion do what it was designed to do. But looking at the Amara View photo, it does look a little more like my DreamWear as far as the shaping around the nose, and it can take a bit more tightening than the Quattro around the nose. Be sure when you are fitting it you are lying down with the mask at the 13 pressure (use the mask fit feature) to be sure to get a fit that will hold when the pressure goes up. (See my link for Taming the Mirage Quattro, even though it's a different mask the general ideas will help).

BUT, you have to compensate somewhat by making the lower straps tighter, and this is already giving you problems because of the way the lower strap sits on the back of your head. I had this issue with the Mirage Quattro and my solution was to get out the sewing machine and alter the back so the straps were a bit higher on the skull in the back rather than low and pulling on my neck (it also annoyingly kept bending the bottom of my earlobe!). I had to shorten the vertical pieces that connected to the back strap (sort of a triangle configuration) by a good 1 1/2" each--this slightly changed the angle of the straps. You might try with safety pins first to see if that helps, then if you have the skills you can sew it in to place.

I know a lot of us have felt your frustration. Mask fit can be hard. Keep up the hunt. You're worth it!

I've tried the Amara View and just couldn't get a good seal. So I went back to my full face mask AirFit F20. Its sister mask, the AirTouch F20 uses the same headgear, just a foam cushion which gives a better seal for some. The only drawback of the foam cushion (AirTouch) is its special cleaning requirements.

I agree with previous poster. I got an Amara View but couldn't get it to seal at all. I use the AirFit F20. Tried the AirTouch at first (foam) and it was super comfy, but the silicone seals better for me. I use a Padacheek liner with it - helps the comfort immensely. This mask does put pressure on my nose bridge, and as a glasses wearer, I'm bummed that I have something on my nose bridge all day and all night. But I will say that over time the mask has felt much better on my nose bridge and the pressure only occasionally bothers me. So,masks do get more comfortable with steady use.

I used the Amara View mask for several months before switching to the ResMed F20. The Amara View can be difficult to get a good seal. Where are you getting the leaks, and how bad are they?

Hello to All:
Thanks for suggestions.
I am getting the leaks on the lower part of the mask near the side of my mouth to chin - both sides. I have watched the fitting videos numerous times, but it isn't as easy as they make it look. I also have a longish thin face so nothing like the "model" fitter.
However, based on recommendations and thinking more about what was uncomfortable for me, I rolled the lower back section of the headgear (the part that goes on the nape of your neck) and used one of my homemade strap pads to hold it in the folded position.
This did two things, raised that piece up so it didn't bother my neck - no stiff neck today, yeah!
It also repositioned those lower straps upward which fits my face better.
Last night average of 6L/m leak. I have yet to download the night into Sleepyhead, so not sure about major leaks. I did wake up several times to leak noise and had to tighten the lower straps a bit more. Still a work in progress.
The noise from the exaust vents also seemed to be really loud last night. Pressure at the time was running near my top limit of 14 and even when I layed there awake for a bit, the machine didn't ramp down - shouldn't it do that? I ended up disconnecting the hose for a few minutes and then hooking up again to get the machine to reset to the lower pressure so I could go back to sleep.
Thanks again for all suggestions and thoughts. So grateful you are all out there to help.
xcountrygal

When I wake up during the night to the sound of higher pressure, I just turn the machine off for a moment. It serves two purposes: 1) it will go back to the minimum set pressure when I turn it back on, and 2) on Sleepyhead I'll be able to find that moment because it'll show me where the machine was off. This allows me to see what was happening then.

Thanks rainmom! I will try that.
xcountrygal

I went to a plastic surgeon and had them remodel my face to fi my face mask.

Ha ha! But it does seem as if that is what one must do to achieve a good fit. So many users so few size options