A few questions for DreamMask users

[Dancers Need Sleep!]

I started out with a DreamMask, medium frame and small cushion. I am a side sleeper and I found that laying on my side was dislodging the cushion and causing leaks. This became a vicious cycle - the machine kept ramping up because of the leaks, which was making them worse. The pressure got up to 16, at which point the mask was sort of levitating slightly away from my face.

I went back to my DME, who ordered me a small frame for the DreamMask and gave me a Wisp to try in the meantime. As I posted elsewhere earlier, I'm having leak troubles with that one too. My cheekbones are prominent and the creases from my nose corners to mouth corners are fairly deep, so that is a leak point. Plus I'm really not crazy about the elephant hose.

The small DreamWear frame came today and it's way too small. I want to give the medium frame another chance before I give up; it would be by far the most comfortable option if I can get it to work. With that in mind, I have some questions for those who have succeeded with this.

1.
When the mask is on and air is flowing, there is a lot of air noise and I can hear my own breathing. I can feel air swirling around in the cushion, but that seems like it would be normal for this design. It is difficult to tell whether I have any leaks at this point, due to all the air exiting the exhaust port, but if I run my fingers around the edges I don't feel air moving. Does this sound like a normal functional state, or does the noise already indicate a problem?

2.
When I lay down, the cushion moves upward and is no longer centered under my nose. Then I have a leak next to the uppermost side of my nose, and i can't seem to get it to stay centered under my nose again. Is there a trick to getting this adjustment right?

3.
I think it would help if the frame was a little snugger, but the small won't even fit around my head. Has anyone had success with something like putting a small towel between the top of their head and the frame to tighten it up a little?

I've looked at all the fitting videos I can find, but they are all from Philips and all regurgitate the same images that are not at all helpful if you're having any issues.

Thanks for any suggestions!

[Thatgirl]

I find the Dreamwear isn't noisy as long as that square exhaust port on the front isn't blowing on a sheet or pillow or anything- otherwise it's quite noisy. You can try tightening the frame on with the Velcro tabs. I've found switching to a buckwheat pillow to bed very helpful in not dislodging the mask as I roll around. Hose management may also help. I added as extension piece to my hose and run it up over my headboard.

[DeniseR7]

I started out with a DreamMask, medium frame and small cushion. I am a side sleeper and I found that laying on my side was dislodging the cushion and causing leaks. This became a vicious cycle - the machine kept ramping up because of the leaks, which was making them worse. The pressure got up to 16, at which point the mask was sort of levitating slightly away from my face.

I went back to my DME, who ordered me a small frame for the DreamMask and gave me a Wisp to try in the meantime. As I posted elsewhere earlier, I'm having leak troubles with that one too. My cheekbones are prominent and the creases from my nose corners to mouth corners are fairly deep, so that is a leak point. Plus I'm really not crazy about the elephant hose.

The small DreamWear frame came today and it's way too small. I want to give the medium frame another chance before I give up; it would be by far the most comfortable option if I can get it to work. With that in mind, I have some questions for those who have succeeded with this.

1.
When the mask is on and air is flowing, there is a lot of air noise and I can hear my own breathing. I can feel air swirling around in the cushion, but that seems like it would be normal for this design. It is difficult to tell whether I have any leaks at this point, due to all the air exiting the exhaust port, but if I run my fingers around the edges I don't feel air moving. Does this sound like a normal functional state, or does the noise already indicate a problem?

2.
When I lay down, the cushion moves upward and is no longer centered under my nose. Then I have a leak next to the uppermost side of my nose, and i can't seem to get it to stay centered under my nose again. Is there a trick to getting this adjustment right?

3.
I think it would help if the frame was a little snugger, but the small won't even fit around my head. Has anyone had success with something like putting a small towel between the top of their head and the frame to tighten it up a little?

I've looked at all the fitting videos I can find, but they are all from Philips and all regurgitate the same images that are not at all helpful if you're having any issues.

Thanks for any suggestions!

I am not new to CPAP, had a Wisp, am trying a Dreamwear again. Last time I tried one, it was not small enough,this new one seems to fit better( is smaller).

I poked around on this site and found places where there was info about how various folks keep the Dreamwear on their face. I am a side sleeper and that seems to dislodge it sometimes too. I have read, on this site, that some women make a pony tail that the strap fits under to keep it in place better.
and there were other adaptations too.

[Dancers Need Sleep!]

I poked around on this site and found places where there was info about how various folks keep the Dreamwear on their face. I am a side sleeper and that seems to dislodge it sometimes too. I have read, on this site, that some women make a pony tail that the strap fits under to keep it in place better.
and there were other adaptations too.

You must be a better searcher than i; I have poked around too, and just did so again, and I find lots of people saying they adjusted the fit of their DreamMask but most don't mention how. I heard about the ponytail trick from my DME and I do that but that's not the part I'm having trouble with.

Last night I tried the DreamMask again, and found that I could improve the fit if I stretched it out to the side a little and hooked it over the outer edges of my cheekbones. That plus friction on my skin was enough to get it to stay in place for a while. This greatly improved the fit; my breathing was still noisy but the shifting and leaking were much improved. However, that's not a good long term solution. I need some way to add another strap, lower on the frame than the current strap, without cutting off airflow. I'm not sure that will be possible, but that seems to be what it would take for it to really fit me.

[Michelle-OH]

Can't help you with the mask fit, but if you manage to get it right and the sounds still bother you , I would suggest using a sound machine to block out the mask sounds. You can try the noise of a fan before investing in a sound machine to see if that constant white noise will work for you. I use a Dohm https://www.marpac.com and love it.

[Jay Aitchsee]

I started out with a DreamMask, medium frame and small cushion. I am a side sleeper and I found that laying on my side was dislodging the cushion and causing leaks. This became a vicious cycle - the machine kept ramping up because of the leaks, which was making them worse. The pressure got up to 16, at which point the mask was sort of levitating slightly away from my face.

Have you tried a larger cushion?
I found I had to snug the strap more than I thought should be necessary (but not uncomfortably so) to get the cushion to stay in place over night. I am using a medium frame with medium cushion and straps fairly tight at the back of the head. Even so, there is still about a finger's width of room under the frame at the top of the head, but that doesn't seem to matter in keeping the mask in place. To me, the strap seem to be most important in the fit, aside from the proper cushion size.
Unfortunately, I find the strap rides up on the back of the head which allows the cushion to become dislodged and leak.
I really like this mask, but the inability to keep the rear strap in place has caused me to go back to the ResMed P10, which for me, runs a really close second as far as comfort.

[Sonnyboy]

Jay's idea of trying a different cushion size is a good one.
I can not remember if your DME provided you with a fit pack?

I tried each configuration of the small & medium pillow with the medium frame and then with the small frame.
Medium frame, small pillow works best for me.


We come in different shapes and sizes and perhaps this is why the fit pack comes with multiple pillow sizes?

Also, one forum member posted snapshots of himself wearing the mask--front, back, & side.
You might consider doing this and seeing if anyone here can spot the problem.

[Dancers Need Sleep!]

Sadly no, I did not get a fit pack, and last time I talked to the DME he didn't seem to think it was worth trying a larger cushion. I emailed him this morning but he hasn't gotten back to me, so I'm going to spend a few more days tinkering with the masks I have. Next week I'll have to get pushy about getting something else to try if I don't have success.

[Dancers Need Sleep!]

Ok, so last night I did a couple of new things - I put the back strap all the way under my hair, which pulls it down quite a bit, and I put a few pieces of folded up fabric (waxing strips for those who know what they look like) between the top of my head and the frame, where there is a small gap. This tightened up the fit considerably and reduced the breathing noise, as long as the pressure stayed reasonably low. There is still a small leak in one place; I was very tempted to plug it with a cotton ball, but ultimately I went with learning to ignore it. I don't think it's necessary or possible to get to 100% leak free, as long as I can learn to sleep through it.

Looking back over the last two weeks worth of data, there's a pretty clear pattern - regardless of which mask I'm wearing, every time the pressure ramps up over about 9, I wake up shortly thereafter. There's also a pretty strong correlation between the pressure going up and leaking getting worse - sometimes the pressure goes up first, other times the leak starts first. At least part of the time, the leaks are fooling the machine into raising the pressure, which only causes more leaks, and then the leaks wake me up.

I think I'm going to try reducing the max pressure and see if that helps keep the mask comfortable. I'm recording mostly CAs; if I count only OAs my AHI for last night would have been only 2.9. So i don't think I really needed the pressure to ramp up the way it did, the machine is just not handling very well the fact that I'm still not sleeping with the mask on, and in fact is making everything worse.

One good thing about having a DME who doesn't seem to want to do much - he doesn't care at all if I tinker with the settings. Less work for him, I suppose.

[bryansong]

I started out with a DreamMask, medium frame and small cushion. I am a side sleeper and I found that laying on my side was dislodging the cushion and causing leaks. This became a vicious cycle - the machine kept ramping up because of the leaks, which was making them worse. The pressure got up to 16, at which point the mask was sort of levitating slightly away from my face.

Have you tried a larger cushion?
I found I had to snug the strap more than I thought should be necessary (but not uncomfortably so) to get the cushion to stay in place over night. I am using a medium frame with medium cushion and straps fairly tight at the back of the head. Even so, there is still about a finger's width of room under the frame at the top of the head, but that doesn't seem to matter in keeping the mask in place. To me, the strap seem to be most important in the fit, aside from the proper cushion size.
Unfortunately, I find the strap rides up on the back of the head which allows the cushion to become dislodged and leak.
I really like this mask, but the inability to keep the rear strap in place has caused me to go back to the ResMed P10, which for me, runs a really close second as far as comfort.

I'm finding out what Jay found. My Medium frame was too small so I bought a large frame and also found when I switched to the extra wide nose interface I had less pressure on my upper lip (I was starting to get a sore there).
I pull the straps back until it stays put and doesn't leak while not getting it so tight that it cuts off blood flow to my brain and I do alright. I agree with what others have said about the slack in the top. There is an awful lot of space between the top of my head and the frame where the swivel meets the hose. There is so much slop there that last night I started out with my medium frame again only this time using the extra wide interface to see if that combination would work better. It didn't. I find the medium frame just runs up my cheeks too high, it's more uncomfortable for me. It did fit the top of my head better but it didn't feel better on my face. I got out of bed and swapped the frame back.

Something else that helps me is draping the hose at the Head of the bed. When I have it of to the side it pulls on the top of my swivel too much.

Best wishes.

Bryan

[Sonnyboy]

Re: Sadly no, I did not get a fit pack, and last time I talked to the DME he didn't seem to think it was worth trying a larger cushion. I emailed him this morning but he hasn't gotten back to me, so I'm going to spend a few more days tinkering with the masks I have. Next week I'll have to get pushy about getting something else to try if I don't have success.

The Dreamwear Mask comes with a starter pack specifically so you can experiment with the cushions to help determine the correct fit. The starter pack includes all size cushions and the fabric wraps. The starter pack is priced the same as the frame and cushion purchased separately. Shame on the DME for not starting you out with the starter pack.

My first DME gave me the Airfit P10 starter pack after removing the medium and extra small pillows. Turned out I needed the medium pillow and they actually tried to charge me for this. In my opinion this practice is not ok but Medicare does not care. I complained enough that the DME finally sent me a medium pillow. Demand a starter pack today. If they say no, pm me your address and I will send you a new packaged medium cushion.

Re: I think I'm going to try reducing the max pressure and see if that helps keep the mask comfortable. I'm recording mostly CAs; if I count only OAs my AHI for last night would have been only 2.9. So i don't think I really needed the pressure to ramp up the way it did, the machine is just not handling very well the fact that I'm still not sleeping with the mask on, and in fact is making everything worse.

I feel you need to post more charts so the experts here can review your data and help you decide on pressure changes.

[Dancers Need Sleep!]

Thanks for the offer, Sonnyboy, I will let you know if I can't get my DME to send me a medium cushion.

Here's last night's data: http://imgur.com/vtDZx8i

I have it set to auto ramp between 7.4 and 8.6 - a very narrow range, I know. I'm not trying to determine a final setting here; I'm trying to get to a point where I'm comfortable enough to sleep through the night, and see how things look then.

Last night was the best so far - I lowered the max from 9.6 to 8.6 because I was still waking up with so much air escaping that both the sound and the cold breeze were a problem. I made it almost 7 hours with the mask on, which is a first. Although the AHI is marginal at 4.5, there were only 7 OAs and 1 Hypopnea in those 7 hours, which is pretty good. The rest were all centrals.

You can see at 6:40 (which was really 3:40) that the machine detected an OA and ramped up the pressure, which caused a whole cluster of CAs and then woke me up. That's exactly what I'm trying to avoid by keeping the max pressure low. At least it only happened once last night instead of once per hour like it was doing before I started lowering the max.

The other two times I woke up were both due to me becoming aware of the sound of my own breathing. I'm not sure if this is worse with the DreamMask or not. I'm not noticing the sound being carried through bone like some people talk about, it's just loud, lots of air rushing sounds. The last couple of nights I have been sleeping with earbuds and my phone playing rain sounds, which is what I used to use to help drown out my husband's snoring; that has definitely been helping me sleep, but sometimes even that is not enough. I'm not sure I can do anything about this, though.

I might drop the max slightly more tonight and see if I can make things even more restful.

As an aside, I would like to fix the time, but the ResMed clinical manual warns about possible data loss if you do that. Does anyone know how to do it safely? i suspect that my DME did not set up this machine at all, just took it out of the box and gave it to me (it was also set to Pillows for mask type, when he had set my husband's machine to Nasal for the DreamMask).

Feedback welcome!

[Sonnyboy]

Try posting your graphs in a new thread with a title something like:

Need help optimizing treatment

and this will help you get the attention of
members who can best help you evaluate your pressure, leaks, and centrals.

[Janknitz]

I just started the DreamWear mask this week and found that if it's good and snug there's very little leakage or noise. I find that it has to be just slightly less than uncomfortably tight. I am suprised at how quiet it is. When I was wearing it too loosely, it was very noisy.

I push the straps back pretty far down on my head. And I use a homemade hose hanger, which seems to help as well as the hose is suspended, there's no weight pulling down on the headgear.

[Dancers Need Sleep!]

I have it as snug as the strap will allow... I can't pull it any tighter. I'd have to cut the strap so more of it would fit through the slots. Which would probably help.

Last night I slept fine for 2 hours, got up to pee and then just could not get fully back to sleep; I was too aware of the mask and the sound of my own breathing. After 2 more hours I finally took it off and slept the rest of the night. I don't think it was really the mask's fault; it wasn't any leakier or noisier, it was just my brain refusing to block it out.

I emailed my DME to ask him for a medium cushion and to tell him what I've been up to. We'll see if I hear anything back; the last email, wherein I told him I wasn't sure my humidifier was heating up correctly, never even got a response.