Getting my first Mask

[DenG]

Re: the Elan - I used it for 3 months and just recently replaced it with a Mirage FX, which is a standard nasal mask.
The Elan is very comfortable, particularly for a side sleeper such as myself.
There were nights when I would wake up and not even be sure I was still wearing it, it's that light and comfortable.

The problem for me was the leaks.
It's very fussy and seems to change with wear over time so that, in my experience, it required constant adjustments.
The leaks were constantly waking me up and/or keeping me from falling asleep.
I'd mess with the straps and get it to a point where it was stable, but then over time it would start to leak again and I'd have to readjust.

It was just too much fuss and trouble for me and was costing me too much lost sleep.

I'm keeping it as a back-up, because it is nice when you can get it to seal and stay sealed, but just not reliable enough for me.

I've tried a Wisp and it was no good for my side-sleeping. It pressed against my nose to the degree that I felt like if I used it long enough I'd end up with my nose bent off to the side.
I also had leak issues with it and it gave me a pressure sore on my nose. That could've been down to just getting it adjusted properly, but it was too uncomfortable for me to work with.

I tried nasal pillows - Opus 360 - and, despite the consensus that they're best for side sleepers, I found them uncomfortable and painful.
Again, it was a matter of sleeping on my side putting pressure on the mask and pushing it into my nose causing pain.

Finally decided to try the Mirage FX because it's what I used in the sleep lab and I didn't remember it being uncomfortable.
It's sort of counter intuitive, because it is bigger and bulkier than anything else I've used, and I'm never going to wake up wondering if it's still there like with the Elan, but it is actually quite comfortable.
I can sleep on my side, with my face buried in the pillow and it doesn't leak or press on my nose or cause me any discomfort at all.

So, now I no longer feel the need to get a special pillow because it's no longer an issue with the Mirage FX.

One thing everyone seems to agree on is that the hardest part of this whole process is finding the right mask for you.
There are as many different preferences as there are shapes of faces and you have to just keep trying until you find the right one.

I think I may have finally found the right one, but I've only had 3 nights with it so far, so keeping my fingers crossed.

Luckily for me, my DME lets me return and exchange masks within 30 days with no penalties or questions asked.

Edit to add: For anyone using the Elan and probably any of the other cloth masks from Circadiance, one thing I learned early on is that there is a minimum pressure required to keep it inflated sufficiently to get a good seal.
I'm using auto-titration with a prescribed range of 5-15 cm/h20.
What I discovered is that the Elan required a minimum of about 7cm in order to fit properly.
My average pressure each night was 10-11 so there didn't seem to be any harm in raising the minimum - I think I ended up keeping it at 7.6 or 7.8.

[countryboy]

I have some general questions I was hoping someone could answer for me to better understand how things work. I also thought it could benefit my brother who’s getting ready to have a sleep lab.

1. Are Sleep doctors also sometimes DME’s? One reason I ask is because if yes then I could see where they wouldn’t want to give you a copy of your prescription.

2. Medicare has certain guidelines pertaining to providing CPAP equipment one being you can get a new mask every three months and in the first 30 days exchange it for another. For people who have regular insurance like my brother do they have similar guidelines? Do they give you a choice of machines?

3. When the DME delivered my CPAP machine I had no knowledge of the machines in general or what I was getting… it ended up being a PR System One REMstar Pro C-Flex Plus. What is the most desired or recommended CPAP machine for those who don’t have one yet?

4. I don’t know a lot about my machine and have been too afraid to mess with the Menu/settings. My DME said she can tell if I have a big leak like taking my mask via the remote antenna attached to my machine, but can’t tell if there is a small leak. Is there a way for me to tell if I’m having a lot of leaks during the night?

[Pugsy]

2. Medicare has certain guidelines pertaining to providing CPAP equipment one being you can get a new mask every three months and in the first 30 days exchange it for another. For people who have regular insurance like my brother do they have similar guidelines? Do they give you a choice of machines?

Actually it isn't the insurance companies or Medicare that do anything about any exchange of mask within the first 30 days of getting a mask or starting cpap therapy.

It's the mask manufacturers that offer the 30 day mask swap thing....insurance has nothing to do with it.
DMEs often make their own in house rules though and often will tell a person that it is their insurance that only allows so and so.

You might want to read this
http://maskarrayed.wordpress.com/what-y ... me-part-i/
It explains how machines are normally billed out...by HCPCS billing code and not by model...and some DMEs will allow some user input in selection of model/brand and some won't.

Most private insurance companies will either mimic exactly or come close to Medicare rules and regulations.
For your brother ...for specifics a person would need to contact the insurance company directly to find out how they do things. Never rely on what a DME might say...go directly to insurance company.

Some sleep doctors will also have their sleep lab facility act as a DME supplier...there is always a potential for conflict of interest when this occurs and Medicare specifically prohibits this relationship...the doctor (or member of the docs family) cannot have any financial interest in any facility supplying equipment.
Private insurance....most often won't have a similar rule like Medicare does in this instance.

Is there a way for me to tell if I’m having a lot of leaks during the night?

Yes, software is easy to obtain and use that will offer leak details. There is even some general leak information on your machine. It will flag any time spent in large leak and show it as a % of time in large leak on the LCD screen...if you don't have any time in large leak...then leaks are unlikely to be negatively impacting therapy (assuming that leaks aren't waking you up).
To see the onscreen data you just have to turn that setting on in the clinical menu...do you know how to get to the clinical menu?
if not
http://maskarrayed.wordpress.com/what-y ... me-part-i/
you might want to watch the little video too

Check out my signature line for links to software, how to use and and what to do with what you see.

[countryboy]

Pugsy thanks for explaining all this and especially the link "WHAT YOU NEED TO KNOW BEFORE YOU MEET YOUR DME Part I" I wish I had read this before I got set up with a machine.

. To see the onscreen data you just have to turn that setting on in the clinical menu...do you know how to get to the clinical menu?
if not
http://maskarrayed.wordpress.com/what-y ... me-part-i/
you might want to watch the little video too

No I've never been in the clinical menu nor do I know how like I said I'm a little afraid I could screw something up. Where is the video you linked to?

No I'm not having large leaks but I'm not entirely sure if I could be having small ones during the night. I am waking up usually once during the night but I'm attributing that to needing to go to the bathroom surely I would know if a leak woke me up.

[Pugsy]

Oops....I didn't give you the right link the second time (gave you a copy of the first one). I didn't pay attention.
Try this
http://www.apneaboard.com/pr-system-one ... structions
and the little video is at the bottom of the page

[countryboy]

Well going on my 3rd week now with the Wisp mask and only a few days left to try a different mask... I can count on one hand how many good nights of sleep I've had.

Since I seem to be incapable of adjusting my mask as well as the RT I keep having to drive a distance for her to adjust it. I had her adjust it 2 days ago and the first night no air leaks or nothing but last night all I had was air leaks and my chin strapp loosened to the point my mouth kept opening. I'm getting pretty frustrated to say the least.

Do I understand correctly that if I tried a FFM the therapy would work with my mouth open but I would still get the terrible cotton mouth (maybe even worse) that I occasionally get now if my chin strap slips? By the way there is no way I would consider wearing a chin strap with a FFM.

Also don't you have many more issues with air leaks with a FFM than a nasal mask just because of the larger coverage area?

I am a side sleeper but with the Wisp mask I've almost had to give up sleeping that way due to air leaks it seems any pressure is not tolerated and I have tried a couple of different pillows.

[HerbM]

Since, I asked for a special order mask, my DME told me the 30 day exchange rule was NOT allowed.

It will be 3 months before insurance will let me have a new one (they said.)

I really want the Oral Mask and no one yet has told me that is a foolish choice

[Pugsy]

Also don't you have many more issues with air leaks with a FFM than a nasal mask just because of the larger coverage area?

Yes, just think of the surface areas involved...the greater the real estate touching the skin...more area to have to seal.
Though it isn't impossible. Lots of people successfully use FFM and not have major issues with leaks....but as a whole it takes more work.

Do I understand correctly that if I tried a FFM the therapy would work with my mouth open but I would still get the terrible cotton mouth (maybe even worse) that I occasionally get now if my chin strap slips? By the way there is no way I would consider wearing a chin strap with a FFM.

Using a full face mask and the humidity it delivers to the mouth sometimes is simply not enough to overcome the drying effect of the air moving through the mouth. It likely is going to depend on multiple factors like starting hydration level in the mouth as some people just have a dryer mouth than others...then pressures used...just how much mouth breathing is actually done...bedroom humidity level and humidity level on the machine (may help and may not even at maximum setting).

[countryboy]

Thanks Pugsy your answers are kind of what I expected.

Keep in mind this is all new to me but I find it so strange I can have a good night with none or hardly any leaks with my mask and then the next night I fight it all night long... maybe this is all normal I don't know. I guess I do know it's possible to wear the Wisp successfully if that means anything.

On the other hand as a side sleep I'm having to sleep on my back way too much and with my bad back it's something I can't keep doing. What I'm finding out with the Wisp mask is when I try to sleep on my side any pressure (from the pillow) on the side straps is breaking the seal.

Do you think there might be other Nasal masks more suited for side sleeping? Could you or others recommend some to try?

[Pugsy]

Do you think there might be other Nasal masks more suited for side sleeping? Could you or others recommend some to try?

Sure, there are lots of nasal masks that people use successfully and sleep on their sides and even sort of on their stomach.
I am a side sleeper...I will tell you that your bed pillow is going to affect the mask placement and seal. If the bed pillow pushes on the mask....well, the seal gets broken so you may want to investigate different bed pillows too.... yeah, I know that's something else you really wanted to have to mess with.

There's a reason those cpap pillows are everywhere... The right bed pillow can make or break a mask.
Cpap cutout...buckwheat hull where you can make a nest for the mask....and a recent experiment that has been successful with one of those Chiroflow/MediFlow water based pillows.
For the cpap cutout pillow....just get a cheap memory foam from Walmart and cut out some holes on the sides where your face/mask would be resting so no gets put on the mask.

I have always preferred nasal pillow masks and the ones with the least amount of "stuff" on my face and I have had great success no matter what sleeping position I use and even when traveling (so don't have my normal bed pillow).
I don't remember...did you have issues trying the nasal pillow mask?

I nasal pillows are out....you might think about the Swift FX Nano cushion..it's similar to the Wisp in size but I found it to be a little more stable. The other older nasal (over the nose masks) with gel and plastic frames and just larger in general...I have no experience.

Oh...the Sleepweaver cloth nasl mask....if you can get it to seal (seems like some do well and some never master it) you can use any bed pillow you want. I have no experience with it...too much "stuff" on my face.

I can successfully use any number of nasal pillow masks...some I like better than others.
I couldn't successfully use the Wisp because it caused my nose to become congested but I was able to successfully use the Nano (big surprise as I thought it would cause the congestion issues I have with anything across the bridge of my nose)...and I like the headgear of the Nano SOOOO much better.

Do look at your bed pillow though.....it really can make or break a mask being successful.

[countryboy]

Actually I chose a nasal pillow mask for my sleep lab and found it to be fairly comfortable for my first experience with a mask. I did think it was kind of noisy but more so I couldn't tell if I had a leak that probably wouldn't be an issue now.

My reluctance with trying a nasal pillow mask up to this point (besides the noise) is I've been afraid I would have more trouble with leaks than a nasal mask or just keeping it in place as a side sleeper. Do I have this wrong what are the advantages/disadvantages?

Could you recommend some nasal pillow masks?

Do nasal pillow masks in general seem to be noisier than nasal masks?

I looked at the picture of the Swift FX Nano and it sure look similar to the Wisp?

Yeah I have been researching bed pillows and so far have just bought a different regular pillow which hasn't helped. I've also thought about the Regenesis Pillow http://www.pur-sleep.com/products/produ ... ategory=14 but couldn't decide if it would be too hard to sleep on. I'm not sure a memory foam pillow would be that comfortable but maybe worth a try doing what you suggested.

[Pugsy]

Actually nasal pillows are the easiest to get a good seal and maintain it with movement.

Without knowing which one you tried..can't comment on the noise factor because some do have more noise on venting than others.

Give the new ResMed AirFit P10 a look (and a try IMHO)...best of both worlds...easy to fit and vent noise is non existent.
From cpap.com ...comes with free return insurance....if you hate it you have 30 days from time of purchase to get it returned and you get full refund...they even give you a shipping label to print off so that you don't have to pay shipping.

Or look at the Tap Pap I use. Those nasal pillows absolutely won't move no matter how much tossing and turning and even sleeping with my face in the pillow that I might do.

[Pugsy]

I used the Regenisis buckwheat pillow for years (till the cat did something bad on it and I just decided to try the MediFlow) and absolutely loved it. It is firm but you can add or remove some of the hulls to make whatever adjustment is needed.

[Pugsy]

Some nasal pillow masks that I think are a good fit for newbies to try.

The Swift FX, F & P Aloha, ResMed's new AirFit P10, Pilairo, the Tap Pap that I use, Respironics Nuance gel nasal pillow....
No particular preference order above but I suppose if I was going to rate preference

Tap Pap
AirFit P10
Swift FX (but this one you can also use the headgear with the Nano cushion so if you buy it..you can get by with just the Nano cushion)
Nuance
Aloha
Pilairo

But that just my personal preference and really doesn't mean much because there are masks out there that I absolutely hate and wouldn't use if someone gave it to me...that others just love.
With masks...one man's treasure is truly another man's trash and the ONLY way to know for sure what will work well for you is to keep trying them.

[countryboy]

Pugsy I have no idea what nasal pillow mask I used in sleep nor did I even know what brand/model of nasal mask I ended up with until later on. if only I had been aware of this forum earlier I would have been much better informed.

Since I can still exchange my Wisp what are the chances my DME will have some of the nasal pillow masks you listed do they normally have on hand several of each type?

I would have no problem using cpap.com to order masks to try out but when I had them request my prescription for me my sleep Dr didn't respond. I have a feeling he's not going to easily comply I know in the past if I asked about something they always brought up Medicare restrictions.

Any problems using nasal pillows with chin straps?

It sure looks like the mouth piece with the Tap Pap mask would be uncomfortable how do you keep your mouth closed/teeth clinched with it?