newbie with Amara View mask

[astrodeb]

Hi folks,
Thanks for all the great information that you folks have available!. I have read through some of the stickies and recent threads. My husband and I just started with CPAP last Friday. While he is yet to fall asleep at all using his mask, I have been using mine every night. However, I appear to have some leakage issues, since I have woken up each night with air blowing into my eyes. Last night was the first night that I successfully refitted the mask (after swallowing a good bit of air) and returned to sleep for a total of 8 hours on the device! I have installed the Sleepyhead software and produced the attached screenshot from Monday night.
Two of the last four nights had large, long-term leaks in the plots, but two did not. I note that my sleep periods ended on high pressure spikes, so I suspect that the top of my range (20mmH2O) is more than my mask can handle. I also note that I am using a mask which is apparently quite new, so there doesn't seem to be a previous knowledge base to draw upon. The "Amara View" has a nasal hole in the cushion on top of the mouth hole rather than pillows, so it is probably very susceptible to sliding down as the sleeper moves around. I need to make a decision as to whether to request a new mask. Do you think this is just an issue of finding the right fit before going to sleep or should I bail on this mask? Thanks again for being willing to share your accumulated wisdom.

Cheers,
Astrodeb

[Janknitz]

I can't find anything on the Amara "view" mask, so I can't help you there. But if you are having all that leakage, the mask is not working for you. It may not be sized correctly, it may not be fit correctly, or it just may be difficult for your facial structure to work with a FF mask.

Full face masks are exceptionally tricky--I think they are the HARDEST masks to fit, because there's so much surface area of face where a leak may occur. If you see my "Taming the Mirage Quattro" blog post in my blog below it may help. Note that over the years I never got the Quattro to be entirely leak free and had significant leakage I just learned to put up with.

Some things may help--a mask liner or an anti-leak strap (see Padacheek.com). You can jury rig your own liner from a cut up T-shirt and tie the leg of a pantyhose around the mask to mimic an anti-leak strap. These did NOT particularly help me, the anti-leak strap ended up putting a lot of painful pressure on my jaw and teeth.

I have yet to hear of a FF mask that is easy to fit or keep from leaking, though some people have better experience than others.

If you can give either a nasal mask or hybrid mask a try, perhaps with taping, you might have a better time of it. Less surface area equals less leakage. I went from very high percentage "large leaks" with my Quattro to ZERO with the Wisp mask. It's incredibly comfortable, too.

[Pugsy]

Your machine looks like it is set pretty much wide open and if you are fitting it for the starting pressure of 4 then it isn't going to work when your pressure goes up into the teens. It needs to be fitted at the higher pressure.

Is there a reason for the wide open range....like are they trying to find a more suitable range once you have been on the machine for a while?
You would probably have better luck with the starting pressure around 8 cm instead of 4 cm and you might get lucky and find out that the machine doesn't need to go quite so high.

The Amara (I also couldn't find anything about a new Amara "View") has been around for quite a while now...and wasn't one of Respironics greatest success stories. There is a choice of "gel" and "silicone" cushion available.
http://www.usa.philips.com/healthcare-p ... -face-mask

Personally...I wouldn't spend a huge amount of time with it if you can't get the leaks under better control and still be able to sleep well with it.
You probably have a 30 day window to swap masks (ask your DME exactly what their mask swapping policy is) so I would be making use of any mask swapping time I might have and not spend all my 30 days on a mask that may not ever work for you.

Do you have significant nasal congestion issues that mandate a full face mask like this because you simply can't breathe through your nose? Or are you a "sometimes" mouth breather?

[astrodeb]

I have unilateral nasal congestion when lying down which puts me into the "sometimes mouth breather" category. I like to fall asleep on my side, but often roll onto my back and start snoring. The Amara View "just arrived" according to my DME (which probably should have been a red flag). It was fitted in the office using the "Mask Fit" function of the machine at full pressure, but not on the floor with a pillow. It does not resemble any of the other masks that I have seen and is good for wearing glasses since it has no nose bridge. Obviously, that is a minor factor for a sleep device! The DME says we are allowed to switch masks within 30 days. The 4-20 "wide open setting" was the prescribed range; I'm not sure about the reasoning behind it. Many thanks!

[coolbranch]

I read that the Amara is not a very popular mask. I have one. For me, the Amara created the worst nose bridge damage of any mask I have used. I quit using it after 2- 3 days.

[astrodeb]

Here's the Phillips Amara View mask. It won't hurt the bridge of your nose, but leakage is an issue for me.

[hyperlexis]

Here's the Phillips Amara View mask. It won't hurt the bridge of your nose, but leakage is an issue for me.

Wow!!! This is really something new! Thanks for sharing this. I wonder if they are testing this mask out now and may plan to release it later or if its definitely a go for sale.

The only other mainstream mask similar to this is the Liberty hybrid mask that has nasal pillows. This new Amara has some other structure like a slot or opening for the nostrils to rest atop -- how you fit it, I suggest reading the instruction manual. That would best explain how to stop leaks. No one here aside from you has ever mentioned this mask's existence, so we cant really advise about fitting it.

Can you scan and post the instruction manual here or on dropbox? I would be interested in seeing it.

Did the DME say they are also releasing a new Amara FFM that just had no forehead bar, similar to the ResMed F10 or Quattro FX designs? I would probably go with a true FFM like that, before a hybrid. But I have never tried the Amara View so maybe if fitted properly, it could be great.

[Pugsy]

That mask does look interesting. Last night I searched high and low for information about it and couldn't find a thing.
I suspect that it is still in promo stages and you got one because your DME was part of the promo.
I wish I had seen it earlier yesterday as I was just in my DME office to get my once every 6 month new mask. If I get back over that way anytime soon I will try to catch them open and ask if they have one...they sell Respironics machines so maybe they will have that new mask.
Though most of the time when it comes to new masks...I have to tell them that so and so is available.

I don't think it would suit me personally long term because of the lower straps and my neck but I would like to play with it to see how it compares to the Hybrid.
It's really interesting how nothing at all goes across the bridge of the nose which makes me think "hybrid" type.

[astrodeb]

I'll scan the instruction manual for the mask tonight or tomorrow. It is pretty comfortable, just frustrating when the pressure spikes and leaks wakes me up. I will try elevating the starting pressure to 7 as suggested. Possibly the "no leak" strap might help, but I am a bit wary about potentially covering the vent holes. My husband is getting nowhere with his F&P Simplus FFM (too hot even at 70F, feels smothered but dries out too fast when humidifier off) so we might try a second one of these Amara View masks if I can manage the leaks on mine a bit better. His sleep has been dreadful for months since before his kidney transplant.

[Pugsy]

Unfortunately one of the problems some people have with auto adjusting pressures is that the wide range can make anticipating and fitting for a good seal difficult. What works well at 5 cm doesn't work so great at 15 cm. There is a mask fit feature with your machine that will do some calculations internally and give you a slightly higher pressure for fitting with but that's a crap shoot since you really haven't had that much time on the machine.

Often when people use a more optimal starting pressure to give the machine a better head start we find that the machine doesn't need to go as high as often...so that's what I am hoping will happen with you. If we can stop those big pressures spikes and not compromise therapy maybe the big leaks will also stop. Certainly worth trying.
I can't guarantee it though...wish I could.... because some people just have short periods of time where higher pressures are needed despite the minimum being quite optimal. Let's cross that bridge if/when you see it.
But might as well try it because there's a good chance it might work for you and enable you to use a mask that you otherwise are satisfied with.

Don't know what to tell you about hubby's problems. Is there any way he could use just a nasal interface mask or does he also have significant nasal congestion issues that pretty much mandate a full face mask?

[astrodeb]

Many thanks! My husband tends to breathe out through his mouth while sleeping, so we thought a FFM would be necessary. However, that may well be related to his struggling to breathe during apneas (moderate). Nasal congestion is not a big issue for him.

[Pugsy]

I thought I was a mouth breather also but it ended up being habit from struggling to breathe with the apneas.
Took me a little bit of time to unlearn the mouth opening habit but for the most part I keep it closed now and don't worry about minor short lived mouth openings.

He might do better with a nasal interface mask and worry about potential mouth breathing leaks later if needed.
Besides...even a little mouth breathing leak would be better than no therapy or no sleep.
Worth at least trying.
The nasal pillows are probably the least intrusive and less likely for that "air too warm" sensation to be a problem.
The nasal cushion mask covers the nose and the "warmth" is going to be felt more with it.

[hyperlexis]

Many thanks! My husband tends to breathe out through his mouth while sleeping, so we thought a FFM would be necessary. However, that may well be related to his struggling to breathe during apneas (moderate). Nasal congestion is not a big issue for him.

First, like Pugsy said, your machine is set wide open -- bad. Ask the DME's respiratory therapist to look at your data and tailor a tighter pressure range for you. Wide open is definitely not the way to stay on the machine. I assume you had not had a titration study. If you can get one then definitely do so. Otherwise tighten up the pressures as soon as there is enough data history to look at.

Second, I think your husband (and you) would benefit from watching the training videos from the lankylefty27 on youtube. Can be very helpful to learn techniques to reduce anxiety from using a ffm, etc.

The Simplus is actually one of the best rated, quiet, and slimmest profile new FFMs out there -- your husband may be complaining of things like 'heat' simply because he really doesn't like the claustrophobic feeling of a FFM, etc. Don't like heated air, then shut off the humidifier completely and let run on unheated mode. Easy.

There are multiple other FFMs out there that are even less bulky, including the ResMed F10 and the Quattro FX. Both do not use a forehead bar and are quiet and comfortable. If you have mouth breathing and are just starting, then a FFM is a very good means of getting acclimated to CPAP. Otherwise with a nasal mask, if you have jaw drop or mouth breathing, all the air will come out while in REM sleep and then likely wake you up, or reduce the therapy. Then you end up needing a chin strap or tape on the mouth or something to stop the mouth breathing. That's a whole other mess.

Tell dear hubby to be a brave boy and try to acclimate to the Simplus, or, possibly the Amara View. If absolutely nothing works after trying for a few weeks at least, then by all means try an alternate mask. The videos should really help. Definitely try them.

Good luck!

[Pugsy]

Check with your DME about their mask swapping policy...find out exactly what it entails.
If it's a strict 30 day thing and then you can't swap anymore without added expense....don't spend all the mask swapping time on one mask trying to make it work. Try others...you can always go back to the first choice.
Now some DMEs have more of a liberal mask swapping time frame but many don't. Find out exactly what your options are and then make your decision as to how long to devote to one mask.
Especially true with your husband's situation. If all that is available is 30 days...don't spend 24 of those days on the Simplus..try something else.

[astrodeb]

I think I have the leaks under control for now. AHI < 2 for the last two nights!