Choosing a mask

[Steerpike58]

I raised this in another thread but it was suggested I was hijacking that thread so I'm posting this as a new topic.

Mask selection is an essential part of the CPAP solution; a great CPAP machine with perfect settings is not going to help you if the mask doesn't fit. As a newbie, It's not clear how one is supposed to acquire the best mask, both initially and long term. I'm eager to learn from others how they arrived at their ideal masks. A slight detail on this is that for a given 'mask' model, there are typically 3 sizes of 'cushion' (sometimes called a 'seal') that is the 'business end' of the mask - the part that goes up against the skin.

In my case, I was given a 'trial' CPAP machine by the sleep clinic, and they gave me two masks - one nasal, one full face. I had to give up on the nasal due to mouth leaks, so focused on the full face. After a few weeks using that FF, I noticed I had severe 'trumpeting' ('mask farts') plus air blowing into my eyes and determined the mask (actually, the 'cushion') was too large. I called the clinic, and they gave me a smaller cushion for the mask I had, plus a different mask design AND both a small and a medium cushion for it (the clinic initially said their readings didn't show significant leakage, but when I mentioned the noise, they acquiesced). So now I'm up to 5 masks/cushions- 1 nasal, 2 F&P Vitera (small, medium cushions) and 2 Resmed Airfit F20s (small, medium cushions). Then when I showed up for the in-clinic sleep study the other night, the clinician didn't like the fit of any of my masks and gave me yet another - an F&P Evora Full Face (which felt amazing!).

So far, for me, this hasn't cost me a penny (over and above the co-pays for the clinic visits, etc). These mask kits (headgear, frame, seal) seem to cost in the $100-200 range, with the 'cushion' alone costing around $50. So experimentation isn't cheap. Plus, there are 'hygiene' considerations with a face mask, so I presume a vendor can't just let you 'try' one and return it without 'someone' footing the bill.

Some questions:

• Is it normal / expected that the sleep clinic will continue to give you different masks/cushions until you have the ideal solution? I see so many posts from people who seem to be given a mask as part of their purchase without any 'fitting' being mentioned.
• Over time, as new masks/seals become available (or as your own face changes, perhaps due to a beard, etc), how does an established CPAP user get to try a new / different mask/seal? Are you expected to buy any new mask? Are you allowed to 'trial' masks before committing to a purchase? I just saw a post here on the forum where a user said they were a long-time CPAP user and some new mask was the best thing that ever happened to them.
• CPAP machines are 'prescription only'; are masks similarly controlled or can you just buy a mask without restriction (in the US, specifically)? EG - can I go to CPAP.com and buy a mask?

Thanks for any insight.

[zonker]

[*]CPAP machines are 'prescription only'; are masks similarly controlled or can you just buy a mask without restriction (in the US, specifically)? EG - can I go to CPAP.com and buy a mask?
[/list]

Thanks for any insight.

getting the right mask is, imho, the most difficult thing to acquire in this whole apnea journey.

yes, cpap.com offers a return policy. but check that closely as i'm not all that certain that is for every mask. so check with them.

you'll need a prescription. and cpap.com doesn't accept insurance so it will be out of pocket.

also, while there, you read customer reviews of the masks. might be a little bit of help.

good luck!

[Craig H]

Mask selection is an essential part of the CPAP solution; a great CPAP machine with perfect settings is not going to help you if the mask doesn't fit. As a newbie, It's not clear how one is supposed to acquire the best mask, both initially and long term. I'm eager to learn from others how they arrived at their ideal masks. A slight detail on this is that for a given 'mask' model, there are typically 3 sizes of 'cushion' (sometimes called a 'seal') that is the 'business end' of the mask - the part that goes up against the skin.

.....

Thanks for any insight.
[/quote]

Your experience is similar to mine and I am also a newbie. In fact I have just come off my 45 trial period and start with my own new machine tonight in fact. Resmed 10

I tried 3 different masks and settled on the FP Vitara despite still getting leaks ( it was about improved comfort)...but getting reasonably good results(12 - 16 events down from 61)....

Then my clinicians did a max pressure adjustment and the leaks seriously reduced and the Events Results improved out of sight. eg AHI events less than 6

The early nights were a bit testing and It has been a matter of perserverance.... it took me about 3 weeks to come to grips with all this CPAP thing (because of mask and leaks mainly)

but I really believe I am there now...and I have to be...because its now part of my life and future.

I have been feeling great since day one. (THE MAIN THING) and...My sleeping partner is very happy as well and also gets better sleep.

My clinicians advise that I still will get improvements as time passes.

Good luck and pleasant dreams

[Steerpike58]

Your experience is similar to mine and I am also a newbie. In fact I have just come off my 45 trial period and start with my own new machine tonight in fact. Resmed 10

I tried 3 different masks and settled on the FP Vitara despite still getting leaks ( it was about improved comfort)...but getting reasonably good results(12 - 16 events down from 61)....

Were those three masks given to you by your clinic? Did you discuss the fact that the FP Vitara was still getting leaks, and did they not have any suggestions?

Then my clinicians did a max pressure adjustment and the leaks seriously reduced and the Events Results improved out of sight. eg AHI events less than 6

I presume they lowered it?

I have been feeling great since day one. (THE MAIN THING) and...My sleeping partner is very happy as well and also gets better sleep.

My clinicians advise that I still will get improvements as time passes.

Good luck and pleasant dreams

That's great news for you! In my case, I got little relief from the CPAP machine and they discovered I have mainly Central Apnea, so now I'm on the path of a more detailed sleep study and the possibility of an ASV machine, but early days on that. But I do have 5 masks

[Craig H]

They suggested.... we try lowering the pressure and that worked fine.

They were prepared to try different masks but I was happy once the pressure was lowered and the OSCAR stats showed exactly what happened when they did.

Thing about masks is learning how to control them or what causes issues. eg facial expressions, lip licking, body position, neck position, strap tensioning, mask positioning...

Key thing I did was get a new contoured memory foam pillow from the first day with the CPAP trial.

At the start I used it with the high curve under my neck. When I tried it the other way...low curve under my neck...big change for the better. Saw that on a youtube tip about neck and throat angle ( constrictions).

Little tip that might help others: I use a small sticking plaster on the bridge of my nose to stop skin wear or irritation ( because I also wear spectacles).

Another little tip: I use a splash of diluted MILTONS in a dash of mild unscented laundry detergent when I wash any of my gear. (Miltons is for baby feeding gear sanitisation...eg teats)

[Steerpike58]

...

getting the right mask is, imho, the most difficult thing to acquire in this whole apnea journey.

yes, cpap.com offers a return policy. but check that closely as i'm not all that certain that is for every mask. so check with them.

you'll need a prescription. and cpap.com doesn't accept insurance so it will be out of pocket.

also, while there, you read customer reviews of the masks. might be a little bit of help.

good luck!

Thanks for the info, Zonker! I spoke with CPAP.COM and they confirmed they needed an Rx, but the Rx for the mask can be 'patient preference' so you just need to be sure the doctor doesn't specify a specific mask (if you want to experiment with new ones). They also pointed me to their return policy; they have a specific policy on masks, and it's pretty limited (30 days total, including shipping both ways - so not a whole lot of time to try) and they reserve the right to cancel it - so I assume if you don't find happiness pretty quickly they'll cut you off.

I see Amazon sell masks/headgear/cushions without an Rx; I presume that means they are breaking the law (I already ordered one cushion from them, so I know it works). On closer inspection, it seems they are selling individual components of the mask (headgear, frame, cushion, adapters, etc) and not full mask kits, so that may be how they get away with it.

So - a question for those who have been on CPAP for a long time - do you typically have a good ongoing relationship with your sleep doctor / sleep clinic, and are they the source of advice, recommendations, and trials for new masks/cushions? I'm thinking that new mask designs come out from time to time, and/or your face changes (eg a beard), etc so do you just have a periodic 'check in' with your sleep folks and they may offer you something new to try?

[zonker]

So - a question for those who have been on CPAP for a long time - do you typically have a good ongoing relationship with your sleep doctor / sleep clinic, and are they the source of advice, recommendations, and trials for new masks/cushions? I'm thinking that new mask designs come out from time to time, and/or your face changes (eg a beard), etc so do you just have a periodic 'check in' with your sleep folks and they may offer you something new to try?

nope. i stuck with the 4th mask i found, the one in my sig.

some DO try new stuff. i know pugsy will get curious and try one out, just to see what it is. but i'm satisfied with mine and don't see the need to try something new.

also, i have NO ongoing relationship with sleep doc or any other professional. been on my own, save for the forum, for eight years.

[dataq1]

a question for those who have been on CPAP for a long time - do you typically have a good ongoing relationship with your sleep doctor / sleep clinic....

I see my pulmonologist at least annually and have had a good on-going relationship for the last 19 years that I have been "using". They review my OSCAR reports ( I provide a couple of current daily's and the summary page), they examine my nasal passages and septum (for changes), examine my throat and uvula (for changes) and perform a pulmonary function test at least once every two years.

BTW, I also see my ophthalmologist, cardiologist, and gastroenterologist annually ( at 78 can't really tell which 'wheels' are wearing out and are about to go "flat").

My pulmonologist usually says, keep up the good work (cpap-wise) and keep a watchful eye on leaks. They offer no suggestions about new masks, they rely on the three or four local DMEs to advise on those. (In, fact they seem to go out-of-they way to avoid any entanglements with DMEs - Unless a patient specifically asks for a certain DME, they rotate for new patients among the four locals to avoid the appearance of preference)

I am a long time mouth breather ( due to deviated septum and enlarged turbinates - the turbinates were "corrected" but left some scarring) so my preferential mask in a full face. I would not even consider a nasal. Tried several FFM (full-face masks) over the years and the style I like the most is a full face mask with a built-in chin support. I presently use a Fischer-Paykel 431 mask, and have been using that mask for at least 8 years. HOWEVER, I found that the hard plastic frame had a curve in it that would irritate my cheek bones. So I slowly modified the frame to accommodate my facial bones, and now I have a (as best possible) a comfortable mask that does not irritate when I side-sleep or almost prone. I've been using that mask (with a spare) for 4 years. I keep expecting Fischer-Paykel to discontinue that model (most of the DMEs don't keep it in stock and have to order it) but so far so good. When I eventually go to the nursing home and sit for hours in the hallways sleeping - well that is their problem. Afterall, I'm just there to die peacefully.

I got over the "strangeness" of mask wearing years ago, and I really don't care if I have strap marks on my cheeks.

But MOST of all, I really like waking up headache free!

One thing that helped me to reduce leaks is to go to bed clean shaven.

But, if the auto pressure of the CPAP gets above 15 or so, there is likely going to be some "burbling" at the cushion/seal. OH, I could fix that with some super glue, but for me it's just easier to turn off the CPAP and then restart it (resetting the flow limitation pressure driver). If that happens 3 times a week I'm happy !

[Janknitz]

I went through about 8 masks at first, and the one I finally settled on is not the one I use now. I was lucky at the time to have good CPAP coverage with Kaiser, and their clinic let me try and keep trial masks until I found the one I could work with. It was a FF mask, and eventually I "graduated" to nasal pillow masks and finally to the mask I use now. The HMO I had required a prescription for a specific mask and dealing with a lousy DME (Crapria) and once I had to go through them it was a nightmare.

I lost my good CPAP coverage when my husband lost his job, and I'm actually thrilled because I don't have to deal with Crapria any more. I buy masks from cpap.com or Amazon with NO hassle now.

[Steerpike58]

I went through about 8 masks at first, and the one I finally settled on is not the one I use now. I was lucky at the time to have good CPAP coverage with Kaiser, and their clinic let me try and keep trial masks until I found the one I could work with. It was a FF mask, and eventually I "graduated" to nasal pillow masks and finally to the mask I use now. The HMO I had required a prescription for a specific mask and dealing with a lousy DME (Crapria) and once I had to go through them it was a nightmare.

I lost my good CPAP coverage when my husband lost his job, and I'm actually thrilled because I don't have to deal with Crapria any more. I buy masks from cpap.com or Amazon with NO hassle now.

Thanks for the info! Your location indicates NorCal, and you mention Kaiser, so we may be referring to the same location - the Kaiser sleep center in Martinez. I'm curious - were you able to get masks from Kaiser AFTER they gave you a prescription for the machine, and you had your own machine at home? Was Crapria a factor with Kaiser, or do they have their own DME operation? I'm still in the 'investigation' mode, so I haven't been issued a machine yet.

[Okie bipap]

As previously mentioned, mask selection is a very personal thing. Zonker found his preferred mask after two tries. I have been using a machine for over 8 years, and still try out any new mask that comes on the market that looks interesting. I usually purchase them from CPAP.COM. I have returned some after thrying them, and have passed others along to other people to try. My current mask is over a year old, and I recently changed the cushion after a year of use. My insurance would furnish masks much sooner than that, but I am old school and use things as long as I can before replacing them. I will probably continue to try new masks as long as I continue to use a machine.

[bwexler]

I have found that choosing the right CPAP Mask can be as simple as choosing the right spouse. I got lucky with the spouse (57 years in).
After 13 years with CPAP I have only collected about 2 dozen different masks.
The F&P 431 is my go to full face mask when I get congested. That hasn't happened for the past year or 2.
The Sleapweaver 3D has become my daily driver for the past 5 or 6 years. When I need a change (every few months) I go to the Dream Wisp for a few days.

As far as seeing a Sleep Doc, I can't even guess who my sleep doc would be if I wanted to see one. The folks here have been far more helpful then all but one sleep doc I have seen and he cut me off when he discovered he was no longer in network with my insurance.

BTW, I also see my ophthalmologist, cardiologist, and gastroenterologist annually ( at 78 can't really tell which 'wheels' are wearing out and are about to go "flat"). Quote

dataq1 at 78 myself I find your list of regular Doc visits a bit short. I would add my Dentist, Dermatologist, Chiropractor and imaging center.

[Janknitz]

Thanks for the info! Your location indicates NorCal, and you mention Kaiser, so we may be referring to the same location - the Kaiser sleep center in Martinez. I'm curious - were you able to get masks from Kaiser AFTER they gave you a prescription for the machine, and you had your own machine at home? Was Crapria a factor with Kaiser, or do they have their own DME operation? I'm still in the 'investigation' mode, so I haven't been issued a machine yet.

Kaiser is a weird sort of bird. Kaiser is in reality your DME, and Crapria is the supplier. You have zero choice as far as suppliers. It's Crapria or nothing. 100% of the time the billing was wrong, and they often tried to substitute cheaper items for what was ordered, orders were wrong.
I once filed a greivance with Kaiser for a billing error, LOST the appeal, and 6 months later got a refund check because I was correct about the error.

The Kaiser sleep clinic in Santa Rosa was great. Right before I lost my coverage I went in for an appointment, and they HANDED me a brand new ResMed Autoset to take home with me--they apparently didn't wait for Crapria delivery anymore. I was NOT on Kaiser Advantage, had really good coverage, that paid for the machine outright. This was days before the last month on that insurance!

As for masks, they would always see me for mask fittings, let me keep the masks I tried on and give me extra pillows. But to get a mask from Crapria, Kaiser must specify the exact mask on your prescription, and they have a limited formulary. You can switch masks any time, but Kaiser must change your prescription every time.

It's been about 7 years since I lost coverage. I don't know if they are still operating the same way.

I don't intend to stay with Kaiser when I turn 65 in about a year. For one thing (there are many other reasons), they require "perpetual rental" of DME including CPAP machines on Kaiser Senior Advantage. No capped rental, you never own the machine. I'm not planning to play that game.

[dataq1]

dataq1 at 78 myself I find your list of regular Doc visits a bit short. I would add my Dentist, Dermatologist, Chiropractor and imaging center.

Yep, Derm twice annually, Dentist & hygienist minimum 3X/year, PCP min 3X/year, Ureo 1X/year, pedo 3X/year, AND imaging center whenever I need a new passport or drivers license !

[SueW1950]

I found that one of the masks I was given in my initial trial was perfect for me… and then Philips REspironics stopped making it. I looked for similar but it didnt seem to exist so I started poking about on ebay and found a number of different masks available in what they called a “fit pack”. By this method I acquired a Pico (Philips) and a BMC N4. The Pico was OK and I liked that it was so much lighter than the previous (name now forgotten) but in the end I chose to go with the BMC N4 because I found its fit much better.

I guess what I am recommending is: Look for fit packs, that way you get to trial various sizes and its not hugely expensive to do so.