New CPAP user - is high pressure causing leak?

[Fragman]

I've been looking around as a guest. What a great forum. Did some searching around, but really haven'tseen my specific question. So apologies if it has been asked before, but here goes.

I have had sleep apnea for years. Finally bit the bullet, did the sleep study and picked up my BiPap machine 6 days ago. I have a Respironics BiPAP auto, running at 25/20, 15 minute ramp with heated humidifier, hooked up to a Quattro full face mask. Hope that covers everything!

My issue is that I just CANNOT get it positioned so that it does not leak. Wheile I was checking out the manual for adjustment etc, I noticed that the tech specs say it is for 5-20 cm/H20. My prescription is for 25 IPAP, 20 EPAP. I'm told this is on the high side.

If I fiddle around enough, I can get it to seal, but as it ramps up, it just starts leaking, eventually to the point where they turn into 'raspberry's'.

Well, I called the DME after day 3 and they said that because the Dr was so specific in his mask prescription, there was nothing they could do. So, I called the Dr's office and they sent me to their inhouse DME tech. She looked at the mask I had been prescribed and said that it was pretty much as good as a mask gets. She then took off the 'skirt' and held it up to my face and said that the mask was too big. She lent me a medium to try, but I am still getting leaks as the pressure ramps up. I've tried tightening the straps but it does not seem to help and everewhere I have looked has said not to over tighten.

My questions are these:.
1) Does anyone else run at this high a pressure with a full face mask?
2) Does anyone think that the pressure being at 25 may be too high for the mask?
3) Any other suggestions?

I really want this to work.

[Janknitz]

Full face masks tend to leak more simply because there's more surface area where leaks can occur. I find it very hard to control the leaks when there are wide variations in pressure with the Quattro.

One of the problems is your ramp. When you turn the machine on to fit the mask, the pressure is lower. As the pressure climbs it blows out the seal. You need to reset your machine TEMPORARILY at a steady CPAP pressure of 25 to fit the mask in your usual sleeping position. Once you have that done (see my signature for tips "Taming the Mirage Quattro", then restore the normal settings and it might be better.

And, you may want to duke this out with your doctor, but I'm not too enamored with the idea of a doctor telling you what mask is best. The mask that's best is the one that works for YOU, not the one the doctor thinks is best. You're the one who has to sleep in it and spend 1/3 of your life in it. Every face is different and if you cannot control the leaks with the Quattro it is NOT working for you. You should be free to try other masks and find the one that's best for your face in your sleeping conditions.

[rested gal]

Welcome to the forum, Fragman.

Well, I called the DME after day 3 and they said that because the Dr was so specific in his mask prescription, there was nothing they could do.

What an unhelpful DME. And/or stupid one. They should have asked you to come in to check the fitting of the mask. But since they gave you one that was too big for your face in the first place...

So, I called the Dr's office and they sent me to their inhouse DME tech. She looked at the mask I had been prescribed and said that it was pretty much as good as a mask gets. She then took off the 'skirt' and held it up to my face and said that the mask was too big. She lent me a medium to try

Now, THERE was a helpful doctor's office and inhouse DME tech. Smart tech.

but I am still getting leaks as the pressure ramps up. I've tried tightening the straps but it does not seem to help and everewhere I have looked has said not to over tighten.

Check out some fixes for leaks that don't involve tightening straps. The Lab Rat page has many fixes and mods. Check out any that seem the least bit like what you're looking for -- even if it's about a different mask than the one you have, a mod that works for one can often be adapted to another.

Sometimes simply hanging the main air hose overhead can help prevent some mask leaks -- especially if the air hose is apt to tug the mask a little out of place when a person turns over or even just shifts their head position on the pillow:
LINKS to Hose hangers and methods of managing the air hose
viewtopic.php?t=10640

My questions are these:.
----
2) Does anyone think that the pressure being at 25 may be too high for the mask?

Pressure of 25 is a lot for any mask to try to seal against...not just your present mask, which is a very good one.

It might be that another FF mask would do better for you. What works for one person and not another person sure can vary according to the anatomy of each person's face. If I were going to try a different FF mask, I'd try these two: ResMed's older (pre-Quattro) Ultra Mirage FF. Or the Hybrid, which uses nasal pillows and a mouth cushion.

Sometimes, using a separate chin strap (not the so-called chin straps that are built in to some FF masks) can help reduce leaks with a FF mask. If the jaw relaxes wayyyyy down too far when a person is sleeping, that can change the shape of the lower face, change the contours around the mouth and flatten the cheeks. All that "anatomy" change can interfere with the fit of a mask cushion that was fine when the jaw was closed, but is not a good "fit" anymore on a longer, thinner, drop-jawed lower face. A dropping jaw can also pull the mask downward, too...changing the "fit."

Several people have posted about using REMzzz liners, or similar homemade liners to help a mask cushion seal better -- cut down on the slipperiness that can develop during the night.

3) Any other suggestions?

Well, if it were me... I'd get this mask:
Aeiomed's Headrest. It's not a FF mask. It's a nasal pillows mask. I've tried it (just to see how it would do) at a pressure of 20. Handled that so well with no leak at all, that I expect it would do equally well against pressure of 25 or even 30. I didn't use it at 20 long (gosh, that was almost impossible for me to breathe out against) -- the machine I was using for the experiment had only C-Flex for exhalation relief. C-Flex didn't put a dent in that pressure for me, but that's a whole other story. The highest pressure I usually ever need is 14.

So, why would I even suggest a nasal pillows mask for someone using very high pressures and posting about trying to make a FF mask work for him?

Here's why.

The biggest benefit of using a nasal pillows mask for high pressure needs is that there is a LOT less "cushion" perimeter to have to seal against leaks. A lot less to try to tweak and keep in place.
Oh, and if any DME (including the very nice inhouse doc's DME) says, "you can't use nasal pillows at high pressures" -- t'ain't so.

I am someone who absolutely mouthbreathes during sleep. No chin strap, no "training" the mouth to stay closed, or "training" the tongue to maintain a leak proof seal inside, can prevent that for me. I've tried practically all the Full Face masks out there, including the hybrid types (Liberty and Hybrid), ResMed masks including the Quattro, F&P FF masks, Respironics FF masks, Hans Rudolph, and even the Oracle oral mask. Used several different sizes with most of them. None of them suited me. Even with "fixes", all of them sprang leaks as the night went on and were uncomfortable against my face for side-sleeping -- even when using two different cpap pillows.

So, in order to wear masks that were far more comfortable and leak proof for me than a FF mask, I chose to start putting tape over my mouth to prevent breathing through my mouth during sleep. I've been taping my mouth for almost 6 years. No problem. Has let me use my favorite nasal pillows mask (Headrest) all that time.

I do have to use a homemade soft stretchy strap (leg cut off a pair of pantyhose tights -- needs to be "tights" material, not regular pantyhose) to cradle and nestle the nasal pillows against my nostrils for better stabilization of the pillows for my toss'n'turn sleeping style. I used the homemade strap during my "20 cm H2O" experiment too.
Using one or two homemade straps with the Headrest nasal pillows mask.
http://www.tnlc.com/Lara/laura/osa/aura-strap6ways.jpg

The solution that works for me might not be at all the solution for you, Fragman. Just something to consider. Some other nasal pillows masks to consider if you decide to go the tape route are the ResMed Swift LT, Swift FX, and the Respironics ComfortLite II. For that matter, "taped mouth" would open up a whole new world of regular "nasal" mask (covers just the nose) to try.

There are sooo many pieces to the puzzle of getting effective, comfortable CPAP treatment, aren't there?

And the mask is the #1 key to being able to "do it."

LINKS to: Mouth leaks - Air Leaks - Tape - DIY Guard
viewtopic.php?t=8011

LINKS to HeadRest nasal pillows mask topics (same mask has had other names: Aeiomed Aura, then Headrest, then Invacare Twilight NP, then back to Headrest again.)
viewtopic.php?t=3098

I really want this to work.

I can tell that you do. You have the right attitude, you've found this message board, you posted very clearly about your problem while asking for help, you have a doctor's "inhouse DME" who sounds sensible and helpful. It may take trying a lot of things and putting up with a lot of frustration while working out the mask issues.

Judging just by your very first post, I'm betting you do get it to work, eventually. Hopefully very soon.

[Fragman]

Thanks for the replies.

I forgot to mention in my first post that I tried fitting the Quattro with the ramp turned off. It just never seemed to work. I might eventually get it to stop leaking, but reall any movement at all and it was blowing out the sides again. I reckon that it just isn't designed to a 25cm pressure.

What I also forgot to mention (I was trying to keep the post shortish) was that the DME tech at the Dr office also loaned me a nose mask. Not sure of the model, but pretty aure the manufacturuer is ResMed as it has that forehead dooda. It also kind of telescopes out a little when innflated. A little skeptical of it as I know I was a mouth breather (due to the horribly dry mouth several times a night) but it occured to me that that might just be because of the apnea. So, I gave it a go last night. Very minor leak that I am confident will disappear with fine tuning. No large leaks. I actually tried it without the chin strap. My logic was to see if I could do without it at first rather than put it on and then not realize that I don't need it. Seemed to go pretty well. I don't have software yet, so I cant really post any figures. What I do know is that was the first compliant night!

[OntarioKevin]

Your last post sound promising - congrats on at least getting one night under your belt!

25 sounds like a crazy high pressure, but I'm fairly new to this myself.

What I might suggest is trying a lower pressure, just to see get a few nights of semi-compliance under your belt. More than half of the struggle for me was just getting used to having this big plastic thing on my face.

And I agree with the general sentiments on this board about doctors. They're a valuable source of information, but they're not with you at 3am. You need to be able to tinker with all the different elements of this therapy.

[FoxNewsFan]

Fragman, Two suggestions-

#1 Listen to Rested Gal. She is one of our most knowledgeable and helpful forum members.

#2 Try to get the software as soon as you can. I was misdiagnosed in a very expensive two night sleep study with pressures of 24/18. I too had major leaks. I didn't have dry mouth, I had TORNADO MOUTH. With the help of members of the forum I got the software and soon had wonderful results at a pressure of 11.

Good luck,

Ed