Wish me luck...

[John S]

I've been on CPAP for just over a week and tonight I am trying my fourth mask. The first, a Comfort gel nasal would not work since I tend to mouth breathe once I fall asleep and relax. The flexi fit 431 just would not seal at the pressure level I use (19cm) and the Comfort gel full face would seal but after two nights I had a blister the size of a dime on the bridge of my nose and it was tender as he**.
Tonight I will try the Mirage Liberty hybrid. I worked with it a few times today getting the nasal pillows just right and I still need to cinch it tight to get it to seal at my pressure but there should be no discomfort, especially on the bridge of my nose. Hopefully tonight I can get a full nights sleep "on air".
I'll let everyone know how it turns out tomorrow.

[rubymom]

Are you sure the issue is the mask and not the pressure? I couldn't tolerate my pressure (20) when I first started using the CPAP machine. I had to "fail" on the CPAP and get a Bipap before my treatment really became successful.

[mars]

Hi John S

I know it is a lot of reading to do, but it might save you a lot of unproductive messing about if your did a search on mask fitting e.g. fitting a mask or How To Fit A Mask.

There was a brilliant post on this a couple of months ago, which I cannot find. Maybe someone else will recall it, and direct you to it.

cheers

Mars

[John S]

Actually I believe that the problem is compounded by the pressure. But so far the DR. is convinced that I need to be under the high pressure and will not lower it. The machine I have ramps up the pressure and at the lower pressures the masks work fine. Since I am locked out of the machine I can not change any settings even if I wanted to.

Also, I have been though dozens of posts and a lot of time on the net regarding mask fitment. Wearing a mask is not something new to me since I also wear masks for work and as a firefighter. True, different masks, but I am quite comfortable fitting and wearing masks.

[Muse-Inc]

If you can't get the Liberty to fit well/not leak, see if you can try the other hybrid-sytle mask, the RespCare Hybrid. I have both and they feel quite different; the Hybrid works for me so I haven't tried sleeping with the Liberty yet. Good luck on getting some good sleep!

[rested gal]

Hi, John. Welcome to the message board!

The others have offered good suggestions about the mask. So, I'll elaborate a little (well, a lot) on what rubymom mentioned -- the pressure and the possibility of switching to a bilevel machine.

19 cm H20 is quite a blast of pressure. Despite what your doctor says:

so far the DR. is convinced that I need to be under the high pressure and will not lower it.

It might very well be possible (most likely is) that you could get equally good treatment as far as holding your airway open, by using a bilevel machine. Bilevel machines are commonly called "bipap" machines although "BiPAP" is actually one of the manufacturer's trademark name for their particular bilevel machine. Kind of like calling all facial tissues "kleenex", or all lip balms "chapstick."

The reason I say that a bilevel would probably do fine for you, is that a bilevel is set for two steady, separate pressures. A lower pressure for exhaling, and a higher pressure for inhaling. The EPAP (exhale pressure) is set first, and should be set to a level that will prevent all apneas right from the get-go. Then the IPAP pressure (inhale pressure) is set usually 3 or 4 cms higher, to prevent all other events -- snores, flow limitations, hypopneas (partial closure.)

EPAP is the most important pressure to set "right" on a bilevel. It's the lower pressure -- it handles the apneas. I know that sounds counterintuitive. One would think since apneas are complete (or nearly complete) collapse of the airway, you'd need the higher pressure to handle apneas. But it's the other way 'round. The lower EPAP pressure on a bilevel (if set right) is to prevent full apneas. And most likely would be quite a bit lower than the 19 you've been prescribed for "cpap."

When you think about it this way, it makes more sense: if "some" pressure (the lower exhale pressure) can keep the airway resonably open, even if not completely open, while you're breathing out, the airway will be open "enough" for you to actually start to draw in a new breath when you're ready to inhale again. Starting to breathe in triggers the higher higher IPAP pressure to come in. Then IPAP does its job -- splinting the airway completely open so you can draw in a good full breath.

A bilevel machine can be not only much more comfortable to use -- feels more like natural breathing -- it can also help with mask leak problems since you don't have one single steady high pressure blasting the mask all night. The lower EPAP might allow whatever mask you end up with to seal a little better.

It might be that you could do very well with EPAP of 15 or16 and IPAP 19 on a bilevel.

Your doctor really shouldn't object to the idea of putting you on bilevel. Your insurance might require that you complete one month on plain CPAP and "fail" CPAP before it would reimburse for a bilevel machine. Putting in a couple of calls to the doctor's office during your first month, complaining of not being able to breathe out well on the CPAP machine and asking, "Is there any kind of machine that would lower the pressure each time I breathe out? I just can't handle this steady pressure."

Even better, but I doubt you'll be able to convince your doctor to do this, since he hasn't mentioned bilevel to you already, would be to get a bilevel auto machine. Not an "autopap." A bilevel auto is first and foremost a bilevel machine (and can be set for just "bilevel"), but it also has another mode that can be selected, that would vary both the EPAP and IPAP pressures as needed during the night. In "auto bilevel" mode it wouldn't use IPAP 19 on you unless/until it sensed from your breathing that that much pressure was needed. Which might not be very often during the night. There might even be some or many nights that 19 wasn't needed at all.

At your sleep study they wanted to see "worst case scenario." Worst case scenario is usually when a person is sleeping on their back (supine) and is in REM (rapid eye movement..."dreaming" sleep. Apneas and hypopneas usually hit most people hardest and in the greatest number during that "worst case scenario."

You cycle through stages of sleep with REM usually happening about 3 - 5 times during the night. A normal total amount of REM is 25% of your sleep time. So you really aren't in "worst case scenario" most of the night. Especially if you don't usually sleep on your back at home.

But the pressure that is prescribed for straight "CPAP" needs to be set to handle "worst case scenario" even if considerably less pressure would keep the airway open perfectly during the majority of the night.

If it were me, and I'd been prescribed straight CPAP at 19 (even if it were a CPAP that had some type of exhalation "relief" like C-Flex or EPR) I'd move heaven and earth to get the prescription changed to a bilevel machine with separate EPAP (exhale) /IPAP (inhale)pressures. Ideally I'd get a bilevel auto machine, but I'd at least get a bilevel machine.

The two main manufacturers of bilevels and bilevel autos are:

ResMed -- the VPAP III bilevel, and the VPAP Auto 25.

Respironics (now Philips Respironics) -- the BiPAP with Bi-flex bilevel, and the BiPAP Auto with Bi-Flex.

Please check your Private Messages, John. Click the phrase "One new message[s]" just below the Search box at upper right of this page.