I am angry at my masks. (leaks, neck pain, severe agitation)

[breakfast]

Relevant details:
AHI 140+, APAP pressure 4-16, mouth breather, side sleeper, septum deviated bilaterally, Contour 5" CPAP pillow, overbite

I have two masks I use: one a Mirage Liberty hybrid, the other a Quattro.

I have been back on PAP therapy for a week. My data looks good-- AHI is down to 1, mostly centrals, I'm not snoring, and when I actually can sleep, I sleep well.

I am not sure what is different this time-- the mask might be sized incorrectly, the straps too loose or too tight, but I am quickly losing patience with therapy. I have switched back and forth between the Liberty and the Quattro. I've tried using larger nasal pillows. I've tried using the CPAP pillow. I've tried wearing a sleep cap, making my own strap pads, everything I can to be even just a little more comfortable and I am failing miserably. I wake up with a minor leak in my eye, or a nostril that I can't unblock, or a twinge of pain in my neck from headgear pressing on my vertebra and I end up taking off the mask and staying awake. I will not let myself lie down without it, but I cannot stand having it on my face.

On therapy, I have trouble falling asleep, and some weird sleep paralysis-- I'm falling asleep but then I am awake, I can't move, and I panic. I have some Ativan and some Ambien but those are not easy to come by (my PCP will only give me 10 of each every month). I did not have this problem before I used the machine and I did not have this problem the other times I have used the machine.

I think the Quattro (XS) is too small, and the Liberty (S) is probably too small too. But I still feel like I need to have it very, very tight against my face so that it seals. If my jaw drops even a little, the mask is off. I can't get it to sit right on my face. I have no curve to my neck, so the headgear sits in an odd place and puts pressure on the nerves-- and the pillow doesn't really seem to be "right".

I am so agitated by all of this that I don't even want to sleep anymore (and since sleeping is one of my favorite things, this is a sad development).

I have a call in to my RT to see what else we can do. I am thinking of trying a different pillow to alleviate the neck pain, but that's going to make the leak worse. I am willing to try a different full face mask. I'm almost even willing to try total face (although if I dislike the eye leak from the Quattro, I'm sure I'm going to LOOOOVE that).

At my wits end. I know it is worth it in the end. But I cannot seem to make it work. What am I doing wrong? What questions do I need to ask, what else can I try, has everyone else been here?

[SleepWellCPAP]

I would suggest narrowing your APAP pressure spread to numbers that are closer to your 95% pressure. Starting at 4 cm H2O seems a little low.

As far masks, I have had clients try literally a dozen before they found one that works well for them. You say you have a Quattro, if it's the FX, you might try the Air instead. I have had many many people say the Quattro Air is the best of the full-face masks.

It sounds like your AHI data isn't as relevant as your mask issues. I would encourage you try other masks and hopefully not lose patience with your equipment in the meantime. A lot of people end up giving up before they realize benefit. By the way, on the masks, the Liberty has so far been the most unsuccessful mask I have observed people using. I would either try continuing on the Quattro path or try a nasal pillow/cushion mask with a chinstrap.

Hope that helps, good luck!

[breakfast]

I would suggest narrowing your APAP pressure spread to numbers that are closer to your 95% pressure. Starting at 4 cm H2O seems a little low.

As far masks, I have had clients try literally a dozen before they found one that works well for them. You say you have a Quattro, if it's the FX, you might try the Air instead. I have had many many people say the Quattro Air is the best of the full-face masks.

It sounds like your AHI data isn't as relevant as your mask issues. I would encourage you try other masks and hopefully not lose patience with your equipment in the meantime. A lot of people end up giving up before they realize benefit. By the way, on the masks, the Liberty has so far been the most unsuccessful mask I have observed people using. I would either try continuing on the Quattro path or try a nasal pillow/cushion mask with a chinstrap.

Hope that helps, good luck!

Thank you! I used to LOVE my Liberty, but something must have changed. I was thinking I would try something without headgear (Bella, TAP PAP) but the chinstrap and the fear of needing to resort to taping both scare me a little. When I started CPAP as a teenager the DME-issued nasal mask was definitely not to my liking, and I logged a total of 3 hours on that machine the first go. I will give something different a shot, mask-wise.

My pressure usually holds pretty even at 15 or so during the night. I thought 4 was low too, I will ask the RT about setting the minimum higher. (I know how to do it, but I am in the 90 day Big Brother period and apparently my insurance company knows what my pressures are set for.)

[robysue]

Relevant details:
AHI 140+, APAP pressure 4-16, mouth breather, side sleeper, septum deviated bilaterally, Contour 5" CPAP pillow, overbite

What is the 90% or 95% pressure level reading? It could be that starting at 4cm is aggravating things because when you first settle down and try to go to sleep, the pressure is so low that it triggers a feeling of not enough air coming through the mask.

I have two masks I use: one a Mirage Liberty hybrid, the other a Quattro.

I have been back on PAP therapy for a week. My data looks good-- AHI is down to 1, mostly centrals, I'm not snoring, and when I actually can sleep, I sleep well.

Sounds like you were on CPAP once before and that when you were on CPAP the last time, it didn't seem so bad ...

What mask were you using the last time round? Was CPAP the last time round not quite so miserable?

I am not sure what is different this time-- the mask might be sized incorrectly, the straps too loose or too tight, but I am quickly losing patience with therapy. I have switched back and forth between the Liberty and the Quattro. I've tried using larger nasal pillows. I've tried using the CPAP pillow. I've tried wearing a sleep cap, making my own strap pads, everything I can to be even just a little more comfortable and I am failing miserably. I wake up with a minor leak in my eye, or a nostril that I can't unblock, or a twinge of pain in my neck from headgear pressing on my vertebra and I end up taking off the mask and staying awake. I will not let myself lie down without it, but I cannot stand having it on my face.

So there's a lot of sensory issues involved. The straps bother you. Small leaks bother you. Not being able to unstop your nose without taking the mask off is an irritant. Neck pain from the headgear bothers you ...

All of which points to: Neither of these masks in the current size is the right mask for you.

It's time to try a different mask or at least a different size in one or both of these current masks.

It's also worth making sure that you have the headgear properly fitted.

And for the small leak problems? One problem with such a wide pressure range (4-16cm) is that a seal that's fine at 4-8 cm may easily spring some leaks once the pressure gets up above 12 cm. So you may need to increase that minimum pressure setting.

On therapy, I have trouble falling asleep, and some weird sleep paralysis-- I'm falling asleep but then I am awake, I can't move, and I panic. I have some Ativan and some Ambien but those are not easy to come by (my PCP will only give me 10 of each every month).

Was this problem happening before you started CPAP this time round? At any rate, the sleep paralysis problem is serious enough to report to both the sleep doctor and the PCP.

I think the Quattro (XS) is too small, and the Liberty (S) is probably too small too. But I still feel like I need to have it very, very tight against my face so that it seals. If my jaw drops even a little, the mask is off. I can't get it to sit right on my face. I have no curve to my neck, so the headgear sits in an odd place and puts pressure on the nerves-- and the pillow doesn't really seem to be "right".

More evidence that you need a properly fitted mask. The headgear should NOT be putting pressure on your nerves and you absolutely need to get the DME to spend some time properly fitting the mask.

You might also want to read through JanKnitz's Taming the Mirage Quattro. The tips she gives for fitting the Quattro apply to all FFM with air cushions.

I am so agitated by all of this that I don't even want to sleep anymore (and since sleeping is one of my favorite things, this is a sad development).

I remember that feeling all too well from my first six months of PAPing But it will get better if you find a mask that is genuinely comfortable and then stick with it long enough to get used to sleeping with the mask.

I have a call in to my RT to see what else we can do. I am thinking of trying a different pillow to alleviate the neck pain, but that's going to make the leak worse. I am willing to try a different full face mask. I'm almost even willing to try total face (although if I dislike the eye leak from the Quattro, I'm sure I'm going to LOOOOVE that).

The thing about that total face mask is that if it is well sealed, the pressure inside the mask is pretty constant and so you don't actually feel a breeze in your eyes. So you might like it---if you can get it to seal properly.

I do think you need to call the RT and say that neither of the current masks is comfortable enough for you to get to sleep and stay asleep. You need to describe exactly how the headgear is pressing on your neck in an uncomfortable way and that you can't seem to get either mask to seal without tightening things down to the point of discomfort.

As for bed pillows: Is the problem that current Contour 5" CPAP pillow is too thick or too thin? Or is the problem something else? What kind of a pillow were you using before starting CPAP and is there any way you can make your old (favorite) pillow work?

At my wits end. I know it is worth it in the end. But I cannot seem to make it work. What am I doing wrong? What questions do I need to ask, what else can I try, has everyone else been here?

I don't think you're doing anything wrong. I think the problem is that the masks you have are simply NOT the right masks for your face and neck. The mask is critical part of the system: If the mask is not comfortable, then CPAP will be uncomfortable and you won't sleep well. It's important to get a mask that is comfortable. That's the only way you have a fighting chance to make CPAP work for you.

[star444]

Did you allow yourself some awake time to get used to the process? My sleep doctor told me that I should start out using the CPAP while watching TV, reading, or surfing the web. This gives your brain time to learn to trust that thing stuck on your face and understand that it is a good thing.

I bought a "Save My Face Le Grand" pillow on Amazon (they offer some with "minor imperfections" at a discounted price). It has the 'cut out' area for the mask, and has a low profile. Sometimes I use it all by itself, and other times I put it on top of my favorite bed pillow.

[library lady]

Breakfast, I'm 2-1/2 weeks in from beginning my journey with cpap; I have a Quattro Air FF mask that I couldn't stand sleeping with, it sounded like a whoopee cushion all night long... it is the only mask I was given, and amazingly, it is extremely comfortable. I couldn't tolerate the noise of the contstant leaks... then, I discovered mask liners, and my problem was solved. The last 10 nights I have been able to sleep all through the night with the mask, and the difference is remarkable - no more leaks and face farts! There are several brands, RemZzzz is one, Pad-A-Cheeks is another... You might give those a try, and if you try one you don't like try another. Some people make their own out of old t-shirts.

[mellabella]

If you otherwise like the Liberty, or the idea of the Liberty, I'd encourage you to look at the Innomed Hybrid (linked in my equipment below)--3 sizes of mouth cushion and 3 sizes of nose pillows come free when you buy your first complete mask. I happen to need the large mouth cushion with the medium nose pillows, and if that hadn't worked, I would have had all sorts of combos to try beyond that at no extra investment cost.