CPAP Newbie -- Mask Questions

Sleepy Shelley · Post by **Sleepy Shelley** » Fri Aug 19, 2005 2:54 pm

I'm so glad I found this site. I'm newly diagnosed with OSA and very confused.

When I picked up my CPAP machine from the home health place, I tried on several styles of masks but finally settled on the Nasal Aire II — mainly because the masks made me feel suffocated/claustrophobic. I also really hate anything touching my face or head and the NAII seemed the least obtrusive.

But, when I went for the CPAP adjustment two days ago, the otherwise friendly & seemingly knowledgeable technician took one look at it and said it would never work. She said it would leak too much and once she adjusted the pressure up from the lowest setting it would be too much air blowing directly up my nose. She brought in a couple different masks but agreed to start out with the NAII and only switch "if" there were leaks.

I couldn't have been asleep for more than 15 minutes before she was waking me up to switch to a mask — a ComfortGel. She proceeded to strap it so tightly to my head that it hurt. It was so tight I could feel my pulse throbbing against it. I protested but she said it had to be that tight or it would leak. Somehow dispite the throbbing pain in my face, I managed to fall asleep. At one point I rolled over and knocked the machine off the night stand. When she came in to fix it, I insisted we try a different mask. Through the rest of the night, she tried at least three different masks. Each time she said she had to switch because I was still snoring. Each time she cranked the straps as tight as she could. A couple of times I woke up to find her yanking on the straps, trying to tighten them even more. My upper lip is still swollen from the masks pressing against my teeth. Finally she found a full-face mask that seemed to satisfy her. (Sorry I don't remember the name.) Luckily, in addition to taking home the full-face mask, I also got to keep the NAII that I started with and the ComfortGel since it had been used. So even though she told me to use the full-face mask, I intend to try them all. I haven't started yet because I don't think I'll be able to sleep at first, but I'm going to this weekend. Here are my questions.

1 - Is it really necessary to strap the masks on that tight? Surely some leakage is ok? There is no way I can wear it as tight as she had it. How do I know how tight is tight enough?
2 - How concerned should I be about snoring? I thought it was apneas I was worried about?
3 - I think the full-face mask she gave me is too big. The top overlaps my eye sockets. I can't open my eyes or it feels like it's going to poke me in the eye. But if I pull it down lower, it leaks around the chin. I told the tech it was too big and asked her to give me the next smaller size, but she refused because the big one was the only one that stopped my snoring. How should a well-fitting full-face mask feel? How do I know if it's too big?
4 - How long should practice with each one before I'll know if it's right for me?

I'd appreciate any advise to help me make a smooth transition. I know how important it is that I make this work.
Thanks,
Shelley

yawn · Post by **yawn** » Fri Aug 19, 2005 3:24 pm

Sleepy Shelley wrote:I'm so glad I found this site. I'm newly diagnosed with OSA and very confused.

1 - Is it really necessary to strap the masks on that tight? Surely some leakage is ok? There is no way I can wear it as tight as she had it. How do I know how tight is tight enough?
2 - How concerned should I be about snoring? I thought it was apneas I was worried about?
3 - I think the full-face mask she gave me is too big. The top overlaps my eye sockets. I can't open my eyes or it feels like it's going to poke me in the eye. But if I pull it down lower, it leaks around the chin. I told the tech it was too big and asked her to give me the next smaller size, but she refused because the big one was the only one that stopped my snoring. How should a well-fitting full-face mask feel? How do I know if it's too big?
4 - How long should practice with each one before I'll know if it's right for me?

First of all, WELCOME!!!! You've found the perfect place to ask your questions and to learn more about OSA than you ever thought possible.
I don't usually make very bold comments but I'm going to make an exception here: Your sleep tech was a JERK!!! You poor thing. I think all sleep techs should be required to do a sleep study with a mask strapped tightly onto their faces so they can understand the torture they are inflicting.
With that said, I'll try and help you with your questions.
1) No, it is not always necessary to have the straps pulled tightly. As a matter of fact, some masks work better if you don't tighten them. Your main goal is to make the mask fit comfortably and not "leak" (I'm referring to leaking air out of the sides of the mask..) If the mask is leaking, you aren't getting the intended treatment. You need to have all the air directed into you. There is a mask, Mirage Activa...it's a mask that covers your nose but not your mouth. It's VERY comfortable, almost never leaks, and the straps are supposed to be loose. I felt very claustrophobic when I first tried a nasal "mask" too but I overcame it very quickly. It was a "mind over matter" thing for me.

2) You're right...apneas (or eliminating them) are your focus. I honestly don't know if it's bad to snore...I'm guessing it's an indication that your airway is being compromised which isn't a good thing. Hopefully somebody else can give you a better answer.

3) It does sound like the full face mask is too large, but again, I honestly don't know because I've never worn one. In my opinion, you should be able to tell if it's comfortable or not and the fact that the tech. didn't care about your comfort or your opinion makes me think she doesn't know what's she was doing. I think you should consider filing a complaint about her...you weren't treated well at all.

4) there is no clear-cut answer to "how long" you should try a mask. Your ultimate goal is to find a mask that is comfortable for you so that you'll wear it. It's all about wearing the mask and getting the treatment.
You are embarking on a very difficult and frustrating journey but you've found the right place to hang out and ask questions. We've all been in your shoes (some of us very recently) and we all struggle. You're welcome here and no question is a stupid one (I really mean that).

Hang in there and ask us whatever you want.
Amy

chrisp · Post by **chrisp** » Fri Aug 19, 2005 5:02 pm

The sleep tech wasn't a jerk. She was an ignorant IDIOT ! If she did that to me the mask would be crushed in my hand and perhaps her fingers with it .

Too much air going into your nose ? Where does she think it is supposed to go ? I know where I'd tell her to stickit if she tried that stuff with me. Why do we put up with these people ? I'm sorry you had a bad experience.

Get a copy of your Rx so you never have to go thru this again . Just buy a new auto online from Johnny in a few years when your cpap wears out .

No the mask isn't supposed to be tight and it shouldn't hurt .

I'll bet she doesn't like the activa either. Thats the mask that should hang loosely on your face before the cpa is switched on. Make it tight and it WONT work .

:twis ted:

_________________

lindas88 · Post by **lindas88** » Fri Aug 19, 2005 5:59 pm

Sleepy Shelley I agree with both yawn and chrisp...I think the Mirage Activa Nasal Mask it a great mask. I use that one and had great luck with it. You wear ir really loose and that is so much better then the tight ones I tried. I think you should give it a try.

Janelle · Post by **Janelle** » Fri Aug 19, 2005 6:04 pm

Sounds as if she has never read the instructions that came with the masks, if she thinks making them tighter will make you snore less, much less changing masks. The PRESSURE she is supposed to be titrating is what makes you stop snoring, not the mask!

You might want to write the manufacturers of these masks and see if they can send you the instructions on how to adjust them. I imagine all she gave you was a bag with the masks in them and not even the box they came in or any other accesories.

Sleepless on LI · Post by **Sleepless on LI** » Fri Aug 19, 2005 6:52 pm

I would also find out who I could write a letter to about this SOB witch who put you through the torture she did, when these RTs should be caring, compassionate and informed professionals who are there to help you get through a very stressful and unfamiliar situation in your life. I don't understand some people and why they choose to be in a profession where you are supposed to show, and have, at least an ounce of caring, yet their behavior is just the opposite and they seem to get a perverse thrill by putting poor people through hell. Someone should make sure she never pulls that garbage on anyone else again. Shame, shame, shame on her. And you poor person for having to endure that.

Sleepyman · Post by **Sleepyman** » Fri Aug 19, 2005 7:07 pm

Each time she cranked the straps as tight as she could. A couple of times I woke up to find her yanking on the straps, trying to tighten them even more. My upper lip is still swollen from the masks pressing against my teeth.

Where do they find these people, "Masochist are Us"
I can't believe how incompetent and cruel some clinians are. You need to report to your states medical board. Don't give up there are some remarkable and caring individuals here who will guide you.

yawn · Post by **yawn** » Fri Aug 19, 2005 7:32 pm

Shelley,
The Activa really is a comfortable mask but if you really can't stand the idea of a mask, look into nasal pillow masks. Many of us LOVE the "Swift" mask. The nasal pillow sits at the entrance to your nostrils (not jammed inside your nose) so you don't have alot of "stuff" on your face. It's comfortable, effective, and it's great if you like to sleep on your side. If you click on the Search icon and search for Swift, you'll find lots and lots of conversations about this mask.
Amy

rested gal · Post by **rested gal** » Fri Aug 19, 2005 8:31 pm

Hi Shelley,

It was your misfortune to have fallen into the hands of a "tech" who was dreadful.

It's your great good fortune to have found your way to this message board.

As the other posters have said, the treatment doesn't have to be like that at all. Not at all. The "treatment" you got during the titration shouldn't have been like that, either.

Hang on and keep reading.

WAFlowers · Post by **WAFlowers** » Sat Aug 20, 2005 2:26 pm

Ask any scuba diver (and any hosehead here) and they'll all say the same thing: if you tighten the straps too much you'll deform the skirt of the mask and cause leaks, not prevent them!

"Ignorant idiot", "jerk"; I couldn't have said it better. I won't try to improve on what was already said.

Amy's advice on masks is right on. The Swift isn't the only nasal pillow system, but many here (myself included) are having great success with it. And the Activa has been highly touted; I might try on in the future for the rare times I don't want to use the Swift.

OldSeaRock · Post by **OldSeaRock** » Sat Aug 20, 2005 7:28 pm

The Mirage Activa is the shizzizzle...... great mask!

I wear mine rather loosely with great results.

Your "tight strapping" tech probably has a pointed head.

ahujudybear · Post by **ahujudybear** » Sat Aug 20, 2005 8:10 pm

I'll add my $.02-worth here

That tech is sadly replicated far too often in the sleep centers across the country: ignorant, uncaring and heedless of the purpose of the study to begin with.

As has already been said, the masks should be fairly lose at first. During the night as the seal warms up, the leaks will lessen. My F&P FlexiFit 407 nasal mask fits with minimal (almost none) leaks when I put it on and by AM the seal is so tight that the forehead cushions are not even touching my forehead and my upper lip is almost sucked into the mask. The straps do NOT have to be tight - just comfortably snug.

Your bed pillow is also important. it needs to absorb the headgear while supporting your head, otherwise it will press the headgear against your head and ears, making them sore. The pillow I use is the "shapeable" pillow from Target - very soft, but very supportive. it even supports the Swift nasal pillows without dislodging them or suffocating me. (c. $13.00 from Target stores)

Everyone has trouble with face or nasal masks. It takes a couple of weeks or longer for some people to get accustomed to wearing them at night. What might help is wearing the mask during the day - while watching TV or reading, or at the computor. Just the mask. Many people find themselves removing the mask during the night. This is a natural response to having something on your face. Just give it some time and you'll get used to it.

it is very important to wash the mask every AM and your face just before you put it on. This is to remove skin oils which will interfere with getting a good seal. My RT recommended using BABY SHAMPOO (plain) for the equipment. Others have recommended NEUTRAGENA Facial Wash (Liquid), but that's kind of expensive, so I use the baby shampoo for the equipment and Neutragena for my face. These products are the best that are easily available because they will remove the oils without damaging the equipment (or your skin) and will rinse without leaving a residue.

Hang in there, be patient, and good luck to you!

yawn · Post by **yawn** » Sat Aug 20, 2005 9:53 pm

Hey Shelley...I just noticed that you're from Indiana too....Welcome Hoosier! I'm originally from Connecticut. My hubby and I moved out here 8 years ago (wow...has it really been that long??!! )

Amy

Sleepy Shelley · Post by **Sleepy Shelley** » Mon Aug 22, 2005 1:44 pm

Thanks everyone for the feedback & encouragement. I don't feel so all alone.

CPAP Newbie -- Mask Questions

CPAP Newbie -- Mask Questions

Re: CPAP Newbie -- Mask Questions

Thanks!!