First Night with Hybrid Mask

[Medic1]

Hi all,

Well last night was the first time I tried the hybrid mask. Granted I have only been on APAP a week ago last night. I was using the nasal pillow mask at first. I was finding that my mouth was opening when I went into deeper sleep only to be woken up by the rushing air coming out of my mouth

It took me a little longer then normal to fall asleep last night not sure why( maybe I was excited for the new mask ) Once falling asleep I did not wake to morning. Upper lip area was a little sore. But there was a change in things and not sure why????? With the nasal pillows my AHI was 2.8 to 5.8, Last night with the hybrid mask it was 10.8 . Any idea's on what might be going on???? Thanks for all the help.

Erik

[Bodhi]

Two thoughts:
1. Make sure that you set your S9 Mask Type to Full Face from original Pillows setting.
2. Check your leak rate in your daily data: ResMed claims its machine can compensate for leaks under around 30 L/min.

Edit: You might want to list the name of your hybrid (Liberty?) so that folks who use it may be able to provide some tips.

[Medic1]

Thanks Bodhi

I will change the setting. I was told by my DME it should be "nasal" setting. I thought that was strange and guess they are WRONG
Also for furture referance, yes I do have the Mirage Liberty by ResMed hybrid.

[Pugsy]

Mask setting only affects leak rate reported by machine. Not the AHI.

I suspect that the lower AHI with the nasal pillows and the report of air gushing out of the mouth was possibly not accurate. If leak rate is over 24 L/min ResMed says that therapy AND reporting accuracy can be impacted.

Of course same thing applies to the Liberty. If it was leaking a lot... that elevated AHI might be from leaks affecting the therapy and thus allowing some events to sneak in. You didn't mention leak rate so not sure if it was enough to be a problem or not.

When evaluating the numbers always check leak number also.

[Medic1]

Ok just check leak for last night. Not sure if this is the Info you were looking for.

Maximum was 43.2
95th Percentile was 6.0
Median was 2.4

Does that tell anything?

[Pugsy]

Overall the leak wasn't bad at all.

That 43 L/min max means there was a huge leak at some time but since the other numbers are quite acceptable I suspect the large leak was not prolonged. This would be where looking at software reports might be helpful.
You would see that large leak and be able to see if any events seemed to correlate to it.

Just remember that 24 L/min and if you start seeing that number or close to it in the other parts of the leak numbers, then therapy may be impacted.

Example if that median happens to be close to the 20s. then you have leak problem.
In general if I had Resmed machine I would be happy if I saw 10 L/min or less. Between 10 and 20 I would probably work on leak some. Over 20 and I would really seriously work on leak.

[Medic1]

I did look at the software report. Thats how I got those numbers. Only thing is I am still learning on how to read all the data in the graphs so it is hard to see how long it lastest. I dont know how to get it to tell me how long it lasted

[Pugsy]

How long that large leak lasted? I don't use the ResMed software but I don't think there is a way to see how long the leak lasted unless you can zoom in on that particular graph.

Have you seen the video on how to use the software?
If not, this might help a bit.
http://montfordhouse.com/cpap/resscan_tutorial/

Mostly I just sort of eyeball it and make a mental note if events corresponded with leak or not.

I wouldn't worry about one night though with just starting the new mask. I would give it a few nights to see how things want to settle in. If AHI still wants to run high and leaks can't be blamed then you can consider making some changes but I wouldn't do anything drastic right now.

It is a pretty steep learning curve. Take your time and things will become clearer.

[Medic1]

No I have not seen the video and thanks a million. That should help greatly

I almost forgot it was for one night lol. Your right I need more time. Plus I am still new to CPAP to begin with. I guess this is so unreal to me still. I am also a Firefighter. I wear a SCBA mask all the time.................But I don't have to sleep with that on IDK It was easier for me the first few nights. Seems to be getting just a little harder night by night. Hope this wont change into anxiety.

Wife is very happy no snoring at all anymore keeping her up But now I am up more

[Pugsy]

Wife is very happy no snoring at all anymore keeping her up But now I am up more

Price we pay for good health. Sometimes a blessing, sometimes a curse.

You are brand new at all this cpap stuff. It will get easier and the reports will become more clear to you.

[DreamDiver]

Roster (AKA Rooster) has some very good posts about how to work with the hybrid mask.
wiki/index.php/Hybrid_Mask_Modifications
(While the images on the wiki page show a different mask, the illustrations commute well for the hybrid.)
This may help with leaks, though yours isn't bad as Pugsy points out, and it may also help with comfort.
If you're feeling a lot of pain on the upper lip, consider loosening the upper straps just a skosh.

[Snorzitmucho]

Guys, I'm open to ideas to change my mind about the Liberty Hybrid mask, which sadly seems like ill-designed overpriced junk to me. The large mask fits well and the nasal pillows work fine for me, and the S9 even reports leak rates of less than 24 L/min on average. However, I am frequently awakened by the mask leaking at the sides (my cheeks) because at certain pressures, it creates a 'raspberry' sound effect, flapping my cheeks and making that classic noise while it slaps my face. AHI is OK but sleep is worthless. The mask is tossed aside while I use nasal pillows and tape my mouth. Does anyone have any suggestions? Tightening the lower straps any further results in backward movement of my jaw, which isn't good for OSA as y'all know. Ideas are appreciated!

[LinkC]

I couldn't get the Liberty to work for me either. Mouth cushion was constantly leaking. Then I switched to the "real" Hybrid (by RespCare) and never looked back. YFMV (Your face may vary)

For the record, Rooster's tips are for the Hybrid, not the Liberty...although many will translate nicely, I suppose.

[M.D.Hosehead]

Pada cheek has a strap that might help.

http://www.padacheek.com/PAC_AntiLeak_Strap.html

[pdean44]

The hybrids i have not tried yet. My ears perk up when I see folks commenting on them. i am using a full face quattro right now.

Good luck with your therapy. It sounds like you have a good handle on things for someone new to the game. I am sure you will get it all ironed out soon.

Cheers!