high pressure = leaky mask

[froggie66]

I need the help of this awesome board!! I was recently increased from 11 on CPAP to 19 on Auto Bi-PAP. My favorite mask while at 11 on the CPAP was the Mirage Liberty (size small for my small face). My nose is super sensitive and gets pressure sores with ANY nasal mask I tried. The Liberty seemed to solve all of those problems and I loved it.

Here's my problem: ever since I went to 19, the mask leaks!!! I have to snug it down waaayyy tight when I go to sleep, and make sure I have the nasal prongs PERFECTLY settled and NOT MOVE for it to be OK. Then, somewhere around 3:00am, the nasal prongs start leaking like crazy and I cannot seat them properly anymore. Also, the sides of the membrane on the mouth pillow will bow out and leak then, too.

I did try increasing the size of my nasal prongs, also "customized" them by cutting the prongs apart and using a different size for each nare because my mostrils are two different sizes. I settled on medium prong on left nare and large prong on right nare. Really, on the 11 pressure setting, the small size prongs were perfect and my nares really are smallish! My whole head is kind of smallish.

I have, also, tried using moisturizer on my face....and NOT using moisturizer on my face. Neither situation seemed to matter much. It worked exactly the same whether I used moisturizer on my face or not.

So, my question is: what mask works best at this high pressure (on Bi-PAP)????? Any solutions that will make my Liberty work?? I cannot afford to keep getting new masks because of this. My DME won't take them back once they give them to me and charge my copay. They say it has something to do with the fact that the insurance company has already paid for it and so they cannot take it back. This after only a week of trying out whichever is my latest mask. I have 5 masks now, and have only been under treatment for two months.

I am relying on the combined experience of this board. Y'all are the experts, as far as I am concerned!!!!!

Kathleen

[SleepyDragon]

I started out on CPAP at 19 and now use BiPAP at 19-17 cmH2O, myself. I use a full face mask instead of a nasal mask. The only one I've found that has a good seal without being too tight is the one I use now, the Comfort Gel FF. You'll have a problem with it if you have a sensitive nose, though. I have to put two layers of medical tape on the bridge of my nose because at our pressure the seal gets stiff and stands out - cutting into the skin. Even with the tape I occationaly get a painful pressure point if the mask slips too low on my face.

[Wulfman]

Which masks have you tried so far?


Den

[froggie66]

I have been told that nasal pillows do not work at higher pressures, but I love my Liberty. I wish it would work effectively at this higher pressure.

I have used the Resmed Mirage Micro nasal mask, the Fisher-Paykel FlexiFit 406 nasal mask, and the Liberty I now have (I guess I've only had three masks, but the number of fittings and treks to the DME to get the kinks worked out made it feel like a lot more!) Both of the nasal masks, even at lesser pressure and with the mask not too tightly fitted to my head, I STILL got terrible pressure sores on the bridge of my nose. I now have a scar on the bridge of my nose from the wounds they caused. One night with a nasal mask can make me end up with sores. I am sure that the full face masks that sit on the bridge of the nose will create similar problems for me. My DME agrees. I have not yet gone to them to see what I can do about the leaky Liberty, because I cannot afford to buy another mask right now, and I am sure that is what they will recommend. Their recommendation when I was set at the higher pressure was to snug it down a little tighter.

Soooooo....any suggestions?!

I appreciate your advice!

Kathleen

[Goofproof]

Did you find 19 CM to be the magic number from Encore Pro, or did you Doctor just pull it out of his hat? Jim

[froggie66]

No....I had another sleep study and they gradually increased my pressure in the study until it got to the point that it caused me the minimal amount of apnea events. 19 ended up being the pressure it finally took to give me the relief I needed.

However....I saw the doc today and told him what was going on and he has decided to pull my pressure down a bit to 16 and see if that alleviates the leaking. If so, they'll then increase it another level and then another level and see at what point it becomes too leaky. If my AHI stays low enough, and the mask stops leaking, we'll stop at that point. In other words, it is going to take trial and error to resolve this.

At the same time, I am going to have my DME show me all the full-face mask options they offer and try them and see if there is another that will be more effective, less leaky, and doesn't cause pressure points on my nose. I will know as soon as I try it on if it will push too hard on the bridge of my nose. If so, we'll try putting my pressure back up.

We even talked about the fact that where the hose attaches to the mask can influence where the pressure is greatest. My Liberty has the hose attaching so that it lays flat against my chest when I sleep so it doesn't tug and shift my mask on my face. That may be important in the mask I get for this higher pressure.

It is really the sensitivity of my skin that seems to be the biggest factor here. I tolerate the pressure very well and it is very effective for me. It is the leakiness and pressure sores that make or break a mask for me.

K

[OutaSync]

Kathleen,

Do you have a hose hanger? Have you tried pad a cheeks nose bridge protector? These items have helped me a lot.
Bev

[froggie66]

Thanks, Bev!

I don't think I'd hang my hose, since I keep the machine on a stool next to my bed. It keeps is low enough that it does not disturb hubby, and it prevents rain-out. The hose doesn't really seem to be the problem, anyway.

However....the pad-a-cheek suggestion may be a way for me to go. I haven't tried that. If I get a FFM that sit on the bridge of my nose, I will DEFINITELY try that!!! Maybe I'll get one now and try it with one of the nasal masks I have used in the past and see how effective that will be for me. The nasal masks don't work for me because my mouth drops open when I sleep (chinstraps are useless....I have tried all variations, including a cotton headband), but for a night or two I could use one of my nasal masks and tape my mouth shut and see if the pad-a-cheek works.

Good suggestion!!! Thanks Bev!

K

[rested gal]

Kathleen, please check your Private Messages when you get a chance.

[wadeh]

I have a 20 cm setting. I use a nose mask made by RESMED called the Activa that has a membrane that floats on you face, no leaks gauranteed. It saved my butt for sure,I was going nuts with the exact same problem. Good luck.

[OutaSync]

My Activa leaks everytime I move my head, requiring me to adjust it 10 to 20 times a night. The only advantage that the Activa has over the others that I have tried, is that the Activa leaks more quietly, and if I can get to sleep I can sleep through some of the leaks. As with any mask, it all depends on your face shape.

B

[froggie66]

I am finding that all masks have their pros and cons at these higher pressures. It is the amount of cons I am willing to live with, I guess, that will determine my outcome. The thing that stinks is that I am STILL waking up at night, just not from the apnea! Now it is from the treatment for the apnea failing!!!!! Grrrrrrr....

I am still exhausted and feeling like I could drop at any moment by the time the afternoon comes. Driving home from work is brutal when all my body wants to do is sleep. And once I am home, I can only think about sleep and NOTHING ELSE!! My kids have even gotten used to it being "mom's nap time" as soon as I walk in the door. I get a "hello, how was your day?" out and then hit the hay. They are missing so much of their time with me because of this stupid apnea!!!!!

I need to get this mask thing resolved asap.

K