Dreamwear Full Mask (M) Whistling during Trial.

[MBix]

Hi folks,

I really do hope I'm doing the right thing posting this, I've viewed many threads over the past 48 hours and have read as much as I can on many different websites and simply cannot find a solution. I've just started my CPAP/APAP trial this past Friday using the Dreamstation with the Dreamwear Full Face Mask Medium. I'm still very green on this stuff, so I will try provide as much info as possible, so far during the trial the therapist has set the machine to Auto with a range of 8-20cmH20.

A short run down of things. Friday night everything seemed okay, a little bit uncomfortable, but according to my DreamMapper app I hit 7.03 hours of usage with an AHI of 7.9 and mask fit 96%. I believe I was told during my sleep study my AHI was 140+ (but this may be something else I was told!) however since that first night where I thought everything was looking peachy and only going to improve I've absolutely had a nightmare. Sat/Sun/Mon night I'm hitting around 2h 30m of usage per night, mask fit ranging from 70% to 99%, and AHI upwards of 20, finally last night I narrowed down the reason.

WHISTLING! Once the machine increases it's pressure to 13+ I start to get a very audible whistle and I narrowed it down to the fact it's coming from the right face tubing that connects to the mask itself, I've inspected it, there are no holes or anything of the sort I just cannot pinpoint why this is the case everything looks correct, everything connects correctly, yet still I will wake up with whistling. The only thing I can think of is currently the right hand side of my nose is blocked so I'm only really breathing through one side, but I wouldn't think this would cause such a sound.

I know there are threads and a multitude of posts about whistling, and these masks, but I couldn't find one directly mentioning the fact it was coming from the right tubing where it connects to the full face mask. I've left a message with my therapist also, but really thought I'd double down and try find some help for this one.

Thanks for reading folks and if I've failed to mention something important or I've done the wrong thing by posting please do let me know.

Matt

[Pugsy]

Welcome to the forum.

Let's see if the whistling leak shows up much on the software report.
Will look to see if it is consistent all night vs intermittent. Also need to check your AHI...it's way too high.

Get OSCAR
https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation

[MBix]

Thanks for the reply Pugsy!

Will definitely download and set up Oscar when I arrive home later today, looks like a great tool to use. As for the leak/whistling I did a little bit of testing yesterday and it's only really noticeable once the pressure increases 13+, if I applied some pressure to the join where the face tube (not the tube from the machine to the top of the mask) then I could at times stop the whistling, or even by pinching the tube (assuming less air was coming through when this happens).

In regards to AHI it's definitely sky rocketed since Friday night's first trial night, I'm unsure if this is attributed to the fact I've been playing around a lot with the mask since then trying to stop the leaks/whistling when the pressure increases. I've ordered some Remzzz liners to hopefully seal up anywhere else, but even with these I fear the leak/whistling will remain as it's not coming from where the mask meets my face.

Anyways, thanks again for the tip, I will report back with some Oscar findings later today!

[Pugsy]

If there is a consistent leak in the circuit somewhere (something not attached properly or completely or even a hole in something) then it makes perfect sense that with higher pressures there is a greater chance of it whistling.

My first thought is something isn't quite perfectly connected and leaks a tiny bit at lower pressures but at higher pressures the force of the air causes the whistling. A little air going out a poor connection creating a leak isn't going to be all that annoying but the higher pressure creates more air going out that little leaky area...and you get a whistle.

[gv280z]

The Dreamwear Full is a nice mask but it can be finicky to get adjusted correctly. My guess is that the area around the nose is leaking and producing the whistle, which only perseverance and experimenting with adjustment can solve. If you under tighten, it will leak, if you over tighten, it will leak because of the mask being smooshed and deformed against your face. Aim for snug to a little past snug on the upper and lower straps. Also, make sure nothing is blocking the exhaust holes on the front on the mask. Unless you just happen to have a defective headgear or mask, it won't always be like this. It does get better.

Also consider this, it's entirely possible that's just not the mask for you. Apparently, and I've only learned this through being a member here...in my opinion, there is very little science in dealing with what works for any given cpap'r and what doesn't. Some people do really great with some particular masks that I myself as an accomplished cpap user absolutely cannot abide and I would be in trouble if my therapy depended on said masks.

You, your mask, headgear and machine are now 4 members of a new relationship, another wedded spouse if you will. You may love your machine but hate your mask, or vice versa...you and your mask will cast shade on the machine, I once had a mask I loved but hated the headgear and had to find a way to hybrid in a new headgear, (from a different mask altoghether!!!...I'm in a mixed relationship cpap wise)....out with the old. You will sleep with your new partner every night, you'll clean and care for, and spend much time lamenting over...and you'll tell others about how well your new Sleeping/Breathing life is going. No two relationships are the same and neither will your journey to cpap'lightenment be the same as anyone else's.

JUST DON'T QUIT.

[MBix]

My guess is that the area around the nose is leaking and producing the whistle

I definitely thought this was the case at first but the mask actually sits perfectly around the nose (confirmed with a lot of testing) the whistling is definitely coming from the face air tube where it connects to the mask itself which is away from the nose, I was able to replicate it by disconnecting the air tube from the mask (not the main machine tube) and squeezing it together and hearing the whistle somewhat when the higher pressure is present. But as has been mentioned it couid be a poor connection but I really don't know how to get the air tube that goes over the face to connect into the mask any better than it does. It clicks into place nicely like the other side. I have the humidity set to 3 but I did play around setting it to 5 and 0 hoping for some relief but nothing really happened.

[gv280z]

OK, connect the headgear to pressure and spritz a little soapy water on the suspected leaking air tube and see if you can locate a pinhole somewhere. According to what you've described, it does sound like you have a good connection on both sides of the mask and headgear.

[MBix]

Thanks again for the replies everyone

So just an update, I applied soapy water and just couldn't replicate where it was coming from, so I gave the mask a really good clean, and the face tubing as well. This seemed to solve some of the issue as the whistling subsided for awhile. I had another horror night with it the following evening however as once more when the machine increased it's pressure to around 16, there were leaks left right and center, whistling again, and apparently at one stage in my sleep I took the entire mask off without realising. Obviously this is all about learning and adjusting which is keeping me from frustration at this point. Anywhoo, I gave everything another clean and tested earlier in the afternoon, set the machine to CPAP and 16.5 which is roughly where the first night of 7 hours use said 90% of my time was spent. The mask was whistling away, and I couldn't get a good seal so I really adjusted the straps this time to make them fairly tight, to the point where it was a tad uncomfortable around my face, however the seal remained great, no whistling, maybe this was the key finally.

Latest Update: So I went to bed last night, strap tight, set back to APAP with 8-20 being the range, and managed to fall asleep in a position I've not been able to goto sleep on in years. (FYI: I've only ever been able to sleep/fall asleep the last few years nearly face down in my pillow on my stomach, head to the RIGHT hand side, all other positions I'd wake myself with a snore even before being asleep)

So while I did wake up a few times with some leaks and whistles, the straps a little painful, the DreamMapper app reported back 7:18 hours of usage, mask fit 99%, however an AHI of 11.6 (Clear Airway: 1, Obstructive 27, Hpopneas 57) so still some work to be done obviously, but getting the mask on and sealed was the first step. I was however told that I was having 140 per hour originally, so if this has gone from 140 to 10 average per hour then that's surely going to show a marked improvement for me?

I don't have an SD card reader handy so haven't been able to utilise Oscar as yet, but I have one arriving today, so hopefully will help with some more information and help me here.

[MBix]

Hi once again guys and gals,

Just wanted to come back now I have an SD card reader with some updates. Firstly I've attached (I hope I've done that right) two nights worth of Oscar screenshots, one was from the Monday when I originally posted the other from a Friday where I managed to have a complete 180 almost with results. As I mentioned on the Monday night I had horrible noises, whistles, leaks and a bad time. This continued for a couple nights and even a night where I just felt panicked with the mask on so couldn't wear it. Enter Friday evening. I decided to absolutely rule out certain things I would tighten the mask right up and lo and behold this stopped almost all leaks and whistles for the most part. I found that starting the pressure on the machine at 8 was working against me, as the pressure would rise and that's when the leaks/whistles would occur. So I decided to hunt in the machine and found the setting and found a comfortable starting point of 12. *Please tell me if this is not recommended, as I'm still in my CPAP trial, and returning to the Sleep Scientist this coming Friday, I just felt the change was absolutely needed for me to get any benefit with mask/treatment.*

Anyways, you can see the difference in the two nights, and I really don't know if it was a placebo effect but I felt SO AMAZING and just clearer on Saturday than I have in years, I don't know if I'm just imagining it, but it was such a nice feeling. The down side, is that I wake up and it feels like someone has been palming my face some of the night, especially around my mouth, but I really can't stop the leaks or whistling unless the mask is really tightly applied. The liners didn't really help at all unfortunately. Maybe this will be just about getting used to the mask, maybe trying different masks will be beneficial. But the fact I had a decent result really gave me great confidence.

The two nights proceeding we had some really hot days here in Perth, Australia and I really struggled through the night with keeping the mask on, I feel this will just be a learning curve for me, and maybe even the most experienced of CPAP users find sometimes its just too uncomfortable, or maybe as time goes I'll just deal with it.

Any suggestions/thoughts would be great. So sorry for the lengthy posts.

[Pugsy]

Please review this thread for image format hints.
viewtopic/t158560/How-to-post-images-for-review.html
Hide the calendar and turn off the pie chart (Preferences/Appearance tab and remove check mark for show pie chart) so that some useful statistics below the pie chart will move up into view.

To keep from having such a big blank space scrunching the data into small areas you can turn off short sessions or naps so they won't be in the way....scroll down on the left side below the statistics until you see sleep sessions. If you click on them they will change from green to red and be turned off so you can see your data more easily on the events graph. Once done you can click on it again to turn them back on. It's also a good way to omit known wake sessions...just leave it turned off. Awake stuff doesn't count.

Based on your night with minimum of 12...and a better result both in numbers and how you feel....I think you probably need a little more than 12 minimum starting point. Hard to say how much because I can't see the statistics but I suspect around 14.

[MBix]

Based on your night with minimum of 12...and a better result both in numbers and how you feel....I think you probably need a little more than 12 minimum starting point. Hard to say how much because I can't see the statistics but I suspect around 14.

Thank you so much for your help here mate. I've uploaded an updated screenshot of the Friday nights results, hopefully it has all the correct information this time around. As for going up to 14, I will give that a shot tonight, it's good to know I didn't do the wrong thing in increasing it myself, and hopefully the sleep scientist I see this coming Friday will appreciate the fact I've been able to seek help and guidance from much more educated users than I. Really do appreciate it.

[Pugsy]

About the time over red line statistic.
OSCAR/SleepyHead both default to a red line number that is suitable for a ResMed machine.
It doesn't work so great for Respironics machine red line reporting though because the 2 brands report leak differently.

I don't see any large leak flags on the Events graph and if you really had some large leaks they would show up there.
See the LL line....that's large leak.

You can alter the red line default number to bring it closer to where your machine's red line threshold is but it's just a "close" number because the red line threshold varies as the pressure varies.
Go to Preferences/CPAP tab and either turn off the red line reporting and use the LL line on the events graph for leak evaluation...or change the 24 L/min default threshold to something around 70 L/min. It's a nice conservative number and with your pressure needs the actual threshold for large leak territory is likely higher.

Were you for sure asleep at the 08:00 time frame???

[MBix]

Were you for sure asleep at the 08:00 time frame???

Sorry mate, I actually missed this question at the end, I'm not exactly sure if I was asleep at the time.

Just to update, I've found somewhat of some better results lately, getting 7+ hours per night with my AHI ranging between 4-10 (from where it was at 140, I'm pretty stoked with that) sadly I'm still struggling some night with the masks. The whistling of the Philips mask can be annoying with the whistling but I have a portable air conditioner in my room which is clunky and loud so I can drown it out (currently some pretty hot nights here in Perth!)

The sleep clinic gave me a Fisher and Paykel Simplus Full Face Mask to try also which has been interesting, in some ways it's been better, in other ways it seems to be causing a few other problems, especially in regards to my eyes being blurry of a morning. They've adjusted my pressure to a straight 18 now, no APAP, which seems to be helping a lot. The masks however both seem to have their positives. Some nights I find one better than the other however both need to be tightened fairly well due to the way I sleep nearly face into the pillow on my stomach and having the pressure fairly high.

Philips FFM
Pros: Less invasive on my face
Cons: Any sort of mouth movement causes some leaks at times. Sore teeth/jaw in the morning due to tightness

Fisher & Paykel
Pros: Seems to be more secure, so not as many leaks caused by my movement.
Cons: The sheer tightness of it I think is causing my eyes to be blurry of a morning. Not sure if this is something I'll get used to though.

Cons for both: Since using the CPAP I've noticed a few random tooth aches, I dunno if this is due to having dry mouth some mornings, going to start using mouth wash in the mornings and before bed more.

[LSAT]

Masks with silicone cushions are not made to be worn tight...If they are tight the air cannot expand the cushion...that's what forms the seal. I use the Simplus and never have leaks..my cushion is at least 5 months old and still going. Try gently putting the mask on while the machine is running and the cushion is filled with air.

[MBix]

Masks with silicone cushions are not made to be worn tight...If they are tight the air cannot expand the cushion...that's what forms the seal. I use the Simplus and never have leaks..my cushion is at least 5 months old and still going. Try gently putting the mask on while the machine is running and the cushion is filled with air.

Have just given that a whirl and find it doesn't form a decent enough seal with my face it seems unless the bottom straps are a fair bit tightened, at a lower pressure it definitely does though, the top straps however I've been able to loosen, but am getting a weird sensation in my eyes every now and then like its leaking from the bridge of my nose, but when putting hands there I certainly can't feel a leak. The mask is definitely expanding however, even when the straps are rather tight. Thanks for the tips however, hopefully loosening the top straps will help the blurry eyes (I felt as if that top part being tightened was one of the culprits possibly)