Needs help choosing the right mask. Adjusting to CPAP.

[samurai3005]

Hi all. My dad is diagnosed with OSA with an AHI of 25.5. He's 71 and he generally doesn't surf English forums so I'm speaking on his behalf. Also because I'm his main caretaker in the family.

We were given a Remstar SystemONE with A-flex and a Pico (all Philips Respironics) and were told to use it for 4 to 7 days and then the clinic will collect the machine and analyze the data and then provide my Dad's recommended starting pressure. They say this is a standard "calibration process".

However, when my dad put the Pico mask on (without the hose attached yet!), he said he felt suffocated. I'm wondering is this normal? I asked him multiple times how he felt and he said he felt suffocated as if something was blocking his nose. Could it be that the Pico mask structure is not fit for my dad's face? Does this normally happen?

So I began to loosen the mask but it only made him feel slightly better. Then we attached the hose and began with 4cm H2O pressure. After a couple of minutes he said he felt terrible because he couldn't breathe out with his nose and he had to open his mouth to breathe, which leaked the air from his nose and made his mouth very dry.

My dad is South East Asian and he typically has a short nose, with small face structure. My best bet right now is to change the mask but I don't know which one will work. Which mask would you guys think will work for my dad, given all the data I provided above? I did some research and found a mask called Dreamwear that doesn't go over the nose bridge. Did anyone have success with this mask?

Looking forward to some help here! Any help is much much appreciated.
Sorry for my bad English.

Nam.

P.S: Sorry if it offends any of you to spot a similar thread of mine over apneaboard. I just want to get all the help I can get.

[palerider]

However, when my dad put the Pico mask on (without the hose attached yet!), he said he felt suffocated. I'm wondering is this normal? I asked him multiple times how he felt and he said he felt suffocated as if something was blocking his nose. Could it be that the Pico mask structure is not fit for my dad's face? Does this normally happen?

It *can*. he can be having a bit of a panic attack, (we all want to breathe). having the machine connected, when he puts on the mask, so that there's more air would *probably* help.

It would be better if the minimum pressure were set to something like 6cm water pressure, instead of the 4 that the clinic probably set it for... some people feel like 4 is too little. btw, the pressure is referred to as "cm h2o" or centimeters of water, the pressure it takes to force water up, or down a tube by that many cm.

You can get a good example of how tiny that pressure is by sticking a straw 4 inches (about 10cm) into a glass of water, and blowing through it, the pressure it takes to get bubbles to come out of the end of the straw in the water... that's 10cm h2o pressure, even 20 isn't nearly enough to blow up a balloon.

So I began to loosen the mask but it only made him feel slightly better. Then we attached the hose and began with 4cm H2O pressure. After a couple of minutes he said he felt terrible because he couldn't breathe out with his nose and he had to open his mouth to breathe, which leaked the air from his nose and made his mouth very dry.

My dad is South East Asian and he typically has a short nose, with small face structure. My best bet right now is to change the mask but I don't know which one will work. Which mask would you guys think will work for my dad, given all the data I provided above? I did some research and found a mask called Dreamwear that doesn't go over the nose bridge. Did anyone have success with this mask?

Looking forward to some help here! Any help is much much appreciated.

Finding the right mask is often a difficult task. Can y'all go back to the provider and get another mask to try?

Sorry for my bad English.

In my experience, people who apologize for their 'bad English' usually have nothing at all to apologize for, nor do you.

P.S: Sorry if it offends any of you to spot a similar thread of mine over apneaboard. I just want to get all the help I can get.

No worries, mate.

[samurai3005]

Thanks a lot palerider.

About selecting the mask. Due to the ongoing pandemic, I couldn’t let my dad go out to a provider store/clinic to try out different masks (that’s why they gave us the machine to self-tiltrate at home) but rather ask a technician to bring a few masks to my house for my dad to try out. And because of that, I want to have a few models on my mind beforehand so that I can inform the technician to bring exactly that (you know, because they can’t bring the whole store with them ).

So I tried to bring the starting pressure to 7cm H2O. He said he was able to breathe in easier but still “couldn’t breathe out, had to open my mouth. It’s so uncomfortable!”. So far what I’ve read is that people normally SHOULD be able to breathe out at this pressure (like you said, even 20cm h2o couldn’t fill a balloon). Could it be what he experience was just his mind denying the treatment?

I’m from Viet Nam (a 3rd world country, mind you) so the OSA service is not as good as the U.S (but what else is, right) so seeking professional help on this matter in my area is close to hopelessness, especially when it comes to individualization therapy like CPAP.

Again, I really appreciate your help, Mr palerider.

[Julie]

Did he specifically complain about too much pressure on trying to exhale, vs 'just' difficulty inhaling or finding the mask did not fit his face? That machine's an old model among other things, so may not have a feature to lessen exhalation pressure like the newer ones do, but at the low starting min. of 7 cm, it shouldn't be an issue... much more likely is that the mask is pressing on the sides of his nose and blocking air - see if he can be specific about where it feels wrong. Often Asian faces have flatter, but wider nose bridges and air may leak in one place, but be blocked in others as a result (not Asian here, but do have a similar nose so it took a long time til I found ones (none perfect) that were ok and got used to them. It is a trial and error thing, not an instant one.

[Pugsy]

There's a feature to help with exhaling on the machine. It's called AFlex....is it turned on? If not go turn it on...3 settings available...try all 3 choices to see if one seems to help your dad with the exhaling issue. Use the one that he likes the best no matter what the setting.

Also make sure that just the pressure of the mask on the nose isn't causing difficulties breathing. When I wear any mask that puts the least little pressure on my nose in the area of the nasal turbinates (where eye glasses rest) I get immediate congestion and can't breathe in or out.

There are more popular masks (and newer) than the Pico out there.
Are you limited to just Respironics brand or can you get other brands?

[samurai3005]

To Julie and Pugsy, thanks a bunch for replying!

After a while, I managed to get my dad feel “the most comfortable attempt so far since you forced this thing on me” (though these were just 2-minute attempts) while on 7cm H2O starting pressure and A-Flex 3 setting. He said he felt fine breathing in (which should exclude any physical obstruction caused by the mask ridge, right?) but he didn’t like the fact that he had to exhale a bit forcefully, and that he had to “pay alot of attention to my breath”. By my calculation, the pressure he had to exhale against was only 4cm H2O, which gave me great doubt that he would tolerate a higher pressure once the machine increases the pressure in the deep phases of his sleep.

He hasn’t agreed to try out a full night sleep with a Pico mask using the above mentioned setting CPAP yet. He wanted to try out a new, more comfortable mask.

To Pugsy: Because my clinic is sponsored by the Respironics so I think it’d be easier for me to get a Respironics mask. However, there’s still a Resmed distributor in my city. Although I don’t know anyone who had purchased from them. Which mask do you think I should get?

Another problem is that, although my dad doesn’t normally breathe with his mouth, during the deep phases of his sleep, he’d unconsciously open his mouth. Would this affect the effectiveness of the continuous positive pressure, aka keeping the airway open? I’m worried that he might have to resolve to a full face mask, which I read that isn’t very ideal.

[Pugsy]

I don't envy you at all. Sounds like dealing with your father is what I would be going through if my mother was in the same situation.
She could come to the situation kicking and screaming all the way and throwing up every road block she could think of because she doesn't really want to embrace this whole therapy. My mother doesn't have sleep apnea but she does have some other health issues...and she's 87 years old and very stubborn...and we talk every day about what she NEEDS to do to reduce her problems and all I get is lip service and sometimes blatant lies about actually doing what she needs to do. Frustrates the hell out of me but I have to keep telling myself that short of physical force which wouldn't be very easy anyway.....I can't really make her do what she doesn't want to do.

Until your dad wants to make it work....he's not going to do much to help himself or you, make it work. So don't beat yourself up too much right now when he throws up road blocks.
.
First thing to do is try to find a mask he is okay with. Ask him what he wants...show him pictures of his choices...get him involved in the decision making process if you can.

As for the possibility of him opening his mouth enough to be a negative impact on his therapy...my personal opinion is that we have to first start with getting him to do the therapy in the first place and not worry so much about the need for a full face mask right now.
I can tell you right now he probably will throw up a big full face mask road block. Until there is an urgent proven need to use a full face mask don't even bring it up. He's got to be sleeping with any mask first before we even know if mouth opening is that big of an issue or not. Put that thought on the back burner for now.

Take a look here at the most commonly available nasal masks...and be sure to include nasal pillow masks in your review.
Lets start with Respironics masks since that is what is going to be easier for you to get your hands on right now. Save ResMed for later if we strike out with Respironics.

https://www.cpap.com/cpap-masks/nasal-cpap-mask#:::1:::::

https://www.cpap.com/cpap-masks/nasal-p ... -mask#:::1:::::

I have no idea what to offer as a suggestion beyond my own personal experience so that's what you get.
I would try this mask
https://www.cpap.com/productpage/pr-dre ... k-fit-pack

Much less of a footprint on the face...very comfortable...no pressure on the nasal turbinate area...and if you want to try a nasal pillow version all you have to do is buy one little part as they are all interchangeable.

Encourage your dad to just wear the mask and have the machine on while reading or watching TV and to try to tune out his focus on his breathing. It's a common problem...people zero in on the machine and breathing and find it difficult to relax and just breathe normally.
The more he uses it...the more it will become second nature.

[RPDM]

Samurai
I can only relate my experience to you regarding masks.
I started with full face mask (Resperonics Dreamwear, see link below). I found that to be working for me right away. HOWEVER in the first couple of minutes it does give the a bit of a claustrophobic feeling. Even the reminder or statement 'breath normally' does not really sink in until one is able to truly 'relax' (as in release "over tensed") all muscles.
Recently i tried a nasal mask, which works well for me some of the night, but in some sleeping positions i open my mouth and air leaks from my mouth, it was the first night i took off my mask in the middle of the night.

As noted in other posts the CPAP materials are more geared towards the big European / North American faces like mine

The above description of experience to illustrate what the knowledgeable in this forum already shared, it is trying to find what works. I hope you can encourage your father to keep trying to get comfortable.

[DreamDiver]

Welcome!

You would not be the first person to act on behalf of a relative on this forum. Your father is very fortunate. Thanks for caring.

Masks are a pretty personal thing. Some people like nasal masks. Others like full face. For some reason, full face gets a bad rap. I keep wondering if it's because people think you're supposed to breathe through your mouth with full face masks. This is a misunderstanding. Having a full face mask allows the pressure between your nose and your mouth to remain equal, regardless of the pressure applied to your breathing column. It makes it easier for some to keep their mouths closed and to reduce mouth leak, dry mouth, and large leak.

That said, you may find it difficult to find a mask that fits in general. More than one person of Asian descent has remarked that most masks are not ideal for Asian faces. This may affect both nasal and full face masks.

You may have already done this research, but if not, here are a couple previous threads just on CPAPtalk alone started by Asians about mask fit:

Best Masks for Asian Faces

Asians! Any full face mask suggestions?

I hope you are able to help make sleep therapy better for your dad!

Chris

[Julie]

I prefer FF masks (at least the ones that fit) because when going to sleep it's a bit like zoning into a special sleep space... however nutty that sounds.... the plain nasal ones (not pillows or prongs) feel too light, not strong enough, if that makes any sense.

[Janknitz]

Samurai,

Is your dad in the US? The titration machine he was given is an older model machine. I had one for 6 years and it does make you feel as if you are being forced to breathe in it's rhythm, instead of normally--that made it very hard to get used to. Hopefully after a titration he will get an up to date machine. Newer machines have nicer algorithms (I now have a ResMed Autoset and it's wonderful). I hear even the updated PR machine has a better algorithm than that old "dinosaur" of a machine.

Whether the clinic is "sponsored" by Philips Respironics is a question. In the US, at least, clinics cannot be "sponsored" by a particular manufacturer. That would be a huge conflict of interest. However, a particular clinic may choose to use a particular manufacturer's machines, mainly for convenience, so they don't have to have multiple versions of the clinical software to determine pressures for the in home titartion or to check on patient progress. However, that does not mean your dad is limited to PR masks. Any manufacturer's mask that works for him should be available with a very limited exception in the US that some HMO's like Kaiser have limited "formularies" of masks and may not cover every mask ever made. But even Kaiser does not restrict masks to a certain manufacturer even though they favor one company (currently ResMed in my region) for PAP machines.

If your dad lives in another country, that may be a different matter. ResMed, I believe, does not sell in certain countries.

In any case, you are doing a great job trying to help your dad and we will help with whatever we can to guide him to a successful titration.

[samurai3005]

Thanks everyone. I’m very glad I came to this forum. To be honest I did not expect to be welcomed in such a helpful and warming way. I cannot be more grateful.

After a couple of “tries” and consultation with Respironics, I changed his current XL Pico mask (the one the clinic gave) to size L pico mask (which is the appropriate size for him according to the sizing guide). The Respironics guy also left us a Dreamwear Full face mask as back up plan when I mentioned my dad habit of unconsciously opening his mouth in his sleep. We agreed to first try a full night sleep with the size L Pico mask first. And if things go bad (I’ll explain below), we’ll have to resort to the notorious full face mask.

I got him to practice using it in his midday nap but he only got it on for 45 minutes then went on to sleep without CPAP for another 15mins before waking up. He told me his throat felt very dry and he had pain swallowing, which I had to get him a glass of water immediately.

Right now he’s through the first hour of this night sleep. I changed the humidity from 2 (which was the setting in his midday nap above) to 4 (System One humidification on but Tube heating off) and I also turned off the fan function in our air conditioning (which also happened to direct to his face - I figure this could also have contributed to his mouth drying). Fingers crossed nothing went horribly wrong this midnight!!! I know for sure he’ll go into unconsciously-openning-mouth mode again but I hope his mouth won’t be too dry to wake him up. Really really hope I could get a full OSCAR report tomorrow morning to show you guys.

FYI: the machine we’re having is REMSTAR AUTO SYSTEM ONE A-FLEX, which the clinic gave us for tiltration at home. If this tiltration process goes well, I’ll buy a Dreamstation later for long term usage.

[samurai3005]

Samurai,

Is your dad in the US? The titration machine he was given is an older model machine. I had one for 6 years and it does make you feel as if you are being forced to breathe in it's rhythm, instead of normally--that made it very hard to get used to. Hopefully after a titration he will get an up to date machine. Newer machines have nicer algorithms (I now have a ResMed Autoset and it's wonderful). I hear even the updated PR machine has a better algorithm than that old "dinosaur" of a machine.

Whether the clinic is "sponsored" by Philips Respironics is a question. In the US, at least, clinics cannot be "sponsored" by a particular manufacturer. That would be a huge conflict of interest. However, a particular clinic may choose to use a particular manufacturer's machines, mainly for convenience, so they don't have to have multiple versions of the clinical software to determine pressures for the in home titartion or to check on patient progress. However, that does not mean your dad is limited to PR masks. Any manufacturer's mask that works for him should be available with a very limited exception in the US that some HMO's like Kaiser have limited "formularies" of masks and may not cover every mask ever made. But even Kaiser does not restrict masks to a certain manufacturer even though they favor one company (currently ResMed in my region) for PAP machines.

If your dad lives in another country, that may be a different matter. ResMed, I believe, does not sell in certain countries.

In any case, you are doing a great job trying to help your dad and we will help with whatever we can to guide him to a successful titration.

Hi Janknitz,

We’re living in Viet Nam. The clinic we went to had a Respironics poster up in front of their door! I think I might be tied with Respironics in the long term since the guys at this distributor are very helpful and friendly. So far what I’ve researched is that the Resmed’s Airsense (the new one) is superior to the Respironics Dreamstation so I’m really having two minds about this. But I guess what I have to worry now is to get my dad through this tiltration process using the machine the clinic gave. Plus I have to convince him that this won’t go away any time soon and that we’ll have to try very hard. I hope he understands!

[palerider]

I'm glad you're liking this, and that your dad is becoming acclimated to the machine.

I have to say that full face masks aren't really "notorious" at all, many people prefer them, especially with the newer ones that don't have the forehead brace like most of the old ones had, the newer styles are more comfortable and less obtrusive.

I'm a big proponent of the Resmed machines, their auto algorithm is much more responsive and normally results in better treatment and thus rest for the user, they're also easier to 'get set right', because they do more of the work for you.

Only you can determine whether it is worth the extras effort to get a Resmed AirSense 10 Autoset (the "Autoset" part is important, there are four different "AirSense 10" machines) or not.

[samurai3005]

Anddddd he just removed it! After turning from right-position to supine, he just straight up removed it without saying anything. I didn't bother asking him, knowing that I won't be able to get an answer anyway once he's gone into full sleep mode.

So this is the OSCAR report I managed to pull out for this 1,5-hour-attempt. I don't really know how to interpret this result but I don't think it looks very promising. I think I'm going to have to try the Dreamwear full face mask tomorrow.

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