At Max Frustration

[rmh996usa]

I am still going to stay in the program to help myself, but frustration is mounting. Here are the current facts. I have a ResMed S9 VPAP Adapt due to centrals and mixed. Max pressure is 25. I have pulled the card and uploaded the data in the 4.2 version of the ResMed software application. I have confirmed the machine hits 25 very consistently. Due to the pressure requirements and I always open my mouth after falling asleep, I have the Quattro FFM and have been told due to the pressure requirements, that mask is about it for selection.

After reading the large number of posts to explain to new persons to this treatment by experienced people needing these machine to stay alive, I have tried every night to remedy the end results of wearing the mask. My background includes wearing SCBA equipment to enter fire and smoke filled rooms to put out fires and scuba equipment for diving. I have zero issues with being in a mask for many hours. (The SCBA and dive equipment will lock your breathing up if they run out of the air supply where the CPAP machines do not even if they lose power to operate - so wearing the mask in sleep is not an issue.)

That said, I am down to the final result every morning are - puffy and swollen eyelids, under and above eyes, red lines on face, and pounding headache. I was able to use the Gecko device to widen my nose to seal the mask (white people with thin nose problems ). Each night is the same. I put on the mask with the straps loose to meet the recommendation of the manufacturer, the DME supplier and folks on this forum. This is done after laying down on my back. Turn the machine on. It presses up. The mask blows out on the left and right side of my mouth.

I tighten straps just enough to stop the leaks. I drift off in dozing. Mask leak arouses me. I tighten mask a little more on the side the leak happened. Doze again, leaks again, tighten again. This continues until about 1:00 am or so with waking seven/eight times until then. At this point the mask is cranked down very tight and the leak issue is fixed. I wake two to three more times to shift position as the facial pain and headache wake me and I shift to my left or right side to temporarily relieve the discomfort.

After waking a getting up in the morning, my face is swollen, eye lids and areas under and above eyes are swollen, have a headache. Puffiness goes away after 3 to 4 hours. (Note I have a whole house air purifier – Lennox PureAir – which uses a HEPA filter and has industrial UV to kill virus and bacteria and has a catalyst device to break down organic particulates such as cooking odors, etc.) Pollen and other allergens do not exist in my home.

Again, I really do want to use the machine because I choose to stay alive. I just don't know if long term results like this are a trade off and my health will decline anyway. Still feeling tired and fatigued every day, but not quite as much. This does tell me that I am sleeping better and oxygen levels are not dropping to the low 70's many times per hour.

I have a small and medium FFM as mentioned. I have tried the nasal pillow hybrid that also covers the mouth. Result from the 25cm pressure is the pressure “equalized” across my eardrum and pressed up the inner ear. Very painful and that hybrid mask was removed as a solution.

Any suggestions?

[rmh996usa]

Macine and mask information is incorrect. Don't see how to edit my profile. How is the profile edit done?

[herefishy]

Can you try the "mummie look" by wrapping an ace bandage around your head? Or using silicone from ear plugs to stick around the places the leaks occur?

[Pugsy]

Edit equipment by going to the User Control Panel upper left under the darker blue bar.
Then Click on "Profile" tab....then "Edit Equipment" from the menu on the left. Make sure to click on submit after changing the equipment. Not sure if your machine is offered as a choice. All the choices are tied into products that cpap.com (our forum host) offers and I don't think that the S9 Adapt is offered. If you don't see it just omit the machine selection and add the machine to the comments section manually.

I assume you are trying the Mirage Quattro with the forehead brace.
Your pressures are going to be a challenge with any mask.

If the Quattro is comfortable otherwise you might consider Padacheek's anti leak strap or rig up something similar at home. It offers a way to add a bit more stability.
http://www.padacheek.com/PAC_AntiLeak_Strap.html
Also have you tried a mask liner? If not you might consider it. You can make your own out of an old T shirt or again buy one.
Lots of forum members have good success with Padacheek's liners and pressures up to 30 cm.
http://www.padacheek.com/PAC_Maskliners.html
Hers are custom made to actually be anchored on to the mask. Washable and will last months and months.
There are also disposable mask liners like the Remzzz
https://www.cpap.com/productpage/remzzz ... iners.html

Sometimes a mask simply is not suitable for a particular person's face.
There's no reason not to try another full face mask though. You won't know till you try. Any of them can be used with your pressures...the trick is the seal and that problem occurs even at lower pressures if a mask is just not going to fit a person's face no matter what they do.
The DME told you that mask was pretty much all they could think of? They are wrong. There are people using your same pressures with success with just about any of the other full face masks..

[Otter]

Any suggestions?

Read JohnBFisher's post in this thread:
viewtopic.php?f=1&t=59062&p=566558#p566558

He was using 25 cm H20 and managed to get the QFX to work, at least in part, by not following the recommendations about how tight the straps should be. John is a very friendly guy, and I'm sure he'd do his best to help you. I'll PM him for you.

[Denial Dave]

I'm not too far from your high pressures... My IPAP is 20cm and I'm using an S9 VPAP too.

I agree with others suggestion and talk to John about your issues with the APAP part.

2 suggestions for you -

#1 if you haven't done it yet, check out this blog on the Resmed Quattro... it's got some great tips on wearing the mask and adjusting the straps to stop leaks.

http://maskarrayed.wordpress.com/taming ... e-quattro/

#2 The final solution for me was using pad-a-cheek mask liners. They sort of act like a gasket between your face and the silicone cushion.

It absorbs facial oils and can prevent the leaks from happening.

The upper straps on my Quattro mask are extremely loose. When going to bed, the lower straps are slightly tight...But as my facial muscles relax overnight, the straps get looser.

I also get small strap marks on my cheeks, but it's caused by my sleeping on my side, My face with the straps is pressed into the pillow all night. The strap marks are gone after shaving in the AM.

my lower eyelids are a bit puffy in the AM as well, but I attribute it to having them humidified all night. Any puffiness is gone after showering.

good luck

Dave

[rmh996usa]

Thank you to everyone who took your time to kindly answer with suggestions. I will post my findings as I move through the suggestions.

First will be the different method to put the mask on by letting the top control all the way out and concentrate on achieving the cushion effect. The ResMed VPAP Adapt has the mask fit function that will set the max pressure to on to allow me to set the strapping to no leak immediately instead of over time during the night.

I ordered the ¼” thick full face gel device from http://www.cpapseal.com as this concept is the same thing as a custom fit of a mask to follow the contour lines of the face.

My theory is the ¼” full face gel will fill in the cracks and crevices on my face on the face side as the pressure of the mask compresses the gel on the mask side. Thereby should allow the user to lower the overall pressure of the straps and still maintain a no leakage condition.

If that fails, then behind that will be the PadaCheek antileak strap - http://www.padacheek.com/PAC_AntiLeak_Strap.html

Then on to the Padacheek mask liner if that fails. http://www.padacheek.com/PAC_Maskliners.html

[cosmo]

Would one of those work?

Is weight any factor in your pressure?

[rmh996usa]

Weight is of no issue. The full face including the eyes is a step in a future plan as it is the same thing as a SCBA unit and will not bother me. But, I would rather exhaust the variables on the market and user suggestions on the current mask type before moving to a different mask type.

[chunkyfrog]

Mask liners, just a cloth gasket can be a huge help.
I cut one out of a dried out baby wipe, and it soaked up the facial moisture just enough to keep the mask holding several hours longer.
Different mask companies use different shape faces to design their masks, which is good, since no one company offers enough sizes.

[Julie]

Hi - what are the chances that you can learn to sleep on your side (which may possibly make a difference)? My mask is useless on my back also, plus back sleeping is 'the' worst thing to do as it provokes a lot more apneas for a lot of people. Even if you succeed at that (you can buy long wedge cut foam things to keep you from being on your back) it might not help of course, but I think it might be worth a try... you might even find you can lower your pressure if you end up with fewer events.

[cosmo]

Can you go to your DME or see a sleep tech to see if they can help you out?

[DoriC]

I find the forehead dial has to be set right, just turning it once either way makes a difference. I have my husband's dial set to about 9, if I turn it to 10 he leaks and 8 is too tight. It's a finicky mask but once it's adjusted properly it's very forgiving for about 2-3 months then it need a new cushion.

[jweeks]

Hi,

I struggled the same way with the Quattro full face mash when I first started. I was on 14/21 with BiPAP, so not quite as high as you see, but still pretty far up there. I would get mask lines etched into my face so badly that it would develop into a rash. The worst part was the air blowing into my eyes.

The solution for me was the Swift LT nasal pillow mask. I was repeatedly told by my DME that it was out of the question to use nasal pillows due to the high pressure levels. I was also told that I wasn't a good candidate because my nares are not exactly round. Nevertheless, I tried it, and it worked out very well. The lightness and freedom of nasal pillows are worth whatever learning curve and hassle level it is to get them to work. For me, the hassle factor was preventing mouth leaks, which ended up taking a Ruby chin strap and 3M micropore tape. I ran that way for 4 years with AHI numbers that were consistently in the 1.0 to 1.5 range.

I won't promise that this will work, but I will suggest that it might be worth a try.

-john-

[rmh996usa]

Hi - what are the chances that you can learn to sleep on your side (which may possibly make a difference)? My mask is useless on my back also, plus back sleeping is 'the' worst thing to do as it provokes a lot more apneas for a lot of people. Even if you succeed at that (you can buy long wedge cut foam things to keep you from being on your back) it might not help of course, but I think it might be worth a try... you might even find you can lower your pressure if you end up with fewer events.

Thanks Julie. I have one of those pillows with the cut outs so I can sleep on either side. I have been able to reduce the strap pressure somewhat if I compensate by using the pillow to push the mask tighter on the face. The less strap pressure does lower the headache level from the strap tightness.

I am still thinking the mask cannot follow the contours of the face AND contain the pressure. I am thinking the CPAPSeal 1/4" thick gel device that circles the nose and mouth (big triangle) may allow filling in the contours and thereby allow me to lower the strap pressure. But, it is a theory at this time.

Mike