New Member Needs Mask Advice ASAP!

thr61 · Post by **thr61** » Mon Jul 02, 2007 8:57 am

I was pointed to this site by my neurologist who suggested it might be helpful in working out some of the issues I am having with finding the right mask. from reading through, it seems like this is somewhat the Holy Grail of sleep apnea.

I have been using CPAP for about two months and have been 100% compliant. However, I am having problems with the two masks that I have use.

I began with a resmed Activa. It worked OK, but I almost immediately developed sores on the bridge of my nose and between my nose and upper lip. I was given a different size and that helped with the irritation on the bridge, but not under my nose.

I then switched to the resemed Mirage Swift II nasal pillows. I like how light the system is and the irritation was eliminated. However, I am challenged to keep a perfect seal with the pillows without keeping the headgear quite tight.

In addition, with both of these systems, my wife notes that I mouth breath. Apparently this is an ongoing issue and I manage to do it even using a chin strap. If I really crank the chin strap down, I seem to do better, but it has given me a headache.

At this point, I wonder what the value is of using nasal pillows (which are light) with a chin strap (that add bulk and complexity.) I am also concerned that my mouth breathing is compromising the treatment and that is not acceptable to me.

Can I get some opinions on what direction I should take with a new mask? I know I can go with a full face, but wonder about the return of the facial irritation. I know that there are hybrids and wonder if that might work. I tend to sleep on my back (just to make the system work), but would be happy to have a mix of back and side sleeping.

Any advice from people who have been in this same situation would be appreciated. Suggestions as to specific masks that have worked would be great.

Thanks in advance.

Snoredog · Post by **Snoredog** » Mon Jul 02, 2007 9:03 am

If the Activa is too small it will ride down lower on the bridge of the nose and cause irritation, it will also cut into the underside of your nares.

You can:

Trim the inner lip on the cushion with a small scissors under the nose area and it will stop that irritation.

The Activa was too big, bulky and noisy for me, I use a Soyala Nasal, it is silent by comparison, is much smaller and lighter, seals just as good if not better requires about the same strap pressure. Elbow system is much better and it doesn't have that leader hose. Sizing is critical, if you are currently using a Medium Activa or other interface, I would suggest a large as their sizes tend to run on the small side.

yes, finding a mask you can use is the hardest part of this therapy. If you can control and maintain mouth breathing, I think you get the best therapy from a nasal interface.

Babette · Post by **Babette** » Mon Jul 02, 2007 9:08 am

Try the Nasal Aire II - I have little to no leakage, it's totally comfortable, and I can side sleep. No irritation sore anywhere.

https://www.cpap.com/productpage/innome ... re-ii.html

You can totally customize how you wear the tubes. View the videos on the above link. I eliminated the headgear and wear the tubes velcroed to my chinstrap at the temples, then over my head and "bolo" them together. I don't bring them around to the front.

Good luck!!!!
Barbara

thr61 · Post by **thr61** » Mon Jul 02, 2007 9:08 am

I would love to be able to manage the mouth breathing. Any good resources on this?

Guest · Post by **Guest** » Mon Jul 02, 2007 9:12 am

I started with the ultramirage Full face. A good mask but at my pressure (18) it leaked and made lots of noise. The DME basically told me to tighten it until it stopped and I developed the nose bridge sores, strap marks, and could not roll onto side without starting the adjustments all over again.

After that I tried the nasal pillows both the Swift and the Breeze - not much luck with these and I was going to send it back until I tried a smaller size pillow on the breeze, it then worked wonderfully. The chin strap with head gear is kind of a pain with this mask it is better to put the chin strap on the outside of the head gear to hold in place. The Swift I was using was the original and was too noisey for me.

I also tried a comfortgel nasal mask and have very good luck with it. Until this weekend I alternated between the breeze and the comfortgel. Both good and work well for me. But I really needed a full face because of mouth breathing. Even with the chinstrap I would wake up and feeel me mouth breathing.

Finally I have just discovered the F&P 432 full face. After two nights I believe it will become my favorite. ALthough I have to strap it down tight, it is not as uncomfortable as the Ultra Mirage and I can shift positions during the night without having to reset the mask. It feels a lot more substantial than the Ultramirage and does not seem to leak as much.

Good luck and I hope you find your mask soon.

Wulfman... · Post by **Wulfman...** » Mon Jul 02, 2007 9:14 am

Other than 3 nights on a Comfortfull 2, I've never used anything but the the ResMed Ultra Mirage Full Face mask. However, from what I've read, (if it's properly sized) the Activa needs to be worn "loose". Sounds like you were wearing yours too tight.
If you don't like the thought of taping your mouth shut (to prevent mouth leakage), the two full face masks I would recommend are the (new) ResMed Quattro and the ResMed Ultra Mirage FF.
CPAP.COM has a good mask sizing link. For a full face mask, use #5.

Den

Wulfman... · Post by **Wulfman...** » Mon Jul 02, 2007 9:19 am

P.S... Been using the UMFF for over 2 years. "I'd rather fight than switch."

Den

Babette · Post by **Babette** » Mon Jul 02, 2007 9:21 am

thr61 wrote:I would love to be able to manage the mouth breathing. Any good resources on this?

I use the Tiara brand Topaz chinstrap. Works beautifully for me. I also am religiously using Claritin & Flonase to keep my nose as clear as possible. I've tried the NeilMed brand saline nasal wash, but so far, it's not been helpful for me. It might, I just have to try using it more regularly, I guess. Others report they have gotten off meds alltogether by using this.

I've also experimented with taping my mouth shut, with great success.

I'm not a huge fan of the FF mask. I have one in case I get a cold and just HAVE to have one, but I prefer the nasal mask for every night sleeping.

Cheers,
B.

Snoredog · Post by **Snoredog** » Mon Jul 02, 2007 9:30 am

thr61 wrote:I would love to be able to manage the mouth breathing. Any good resources on this?

Well, you can try tape, I use the Johnson & Johnson brand 1" wide paper medical tape, you cut a piece about 2" long, fold back over about 1/4" of it so it doesn't stick and makes for a quick removal flap. I apply it horizontally over the mouth and it keeps me from leaking.

I've used the one shown in top-left:
http://www.bandaid.com/tapes.shtml

You can try a ace bandage as a chin strap but most of those don't work because they have to go around the chin and crown of the head to stay in place, this can pull your mandible backwards actually narrowing the airway, complete opposite of what you want.

You can also try a Full Face mask, but therapy is not as good (in my opinion) and they are prone to leaks, but taping can get old and I've found a Full Face mask works better than any other method.

Tape is inexpensive and easy to try.

ozij · Post by **ozij** » Mon Jul 02, 2007 9:36 am

thr61 wrote:I was pointed to this site by my neurologist who suggested it might be helpful in working out some of the issues I am having with finding the right mask. from reading through, it seems like this is somewhat the Holy Grail of sleep apnea.

thr61,
A word of caution: since you have been pointed to this site by your neurologist you may have neurological problems that we are not aware of.

Many of us - myself included - tape our mouths shut during the night. That lets us use light nasal pillows masks, and yet avoid mouthbreathing. We fold the tape in at both sides to create a pull off flap.

Mouthbreathig is detrimental to therapy -- http://www.chestjournal.org/cgi/content ... 126/4/1248

and mouthtaping has helped many.

HOWEVER:

Don't use tape if your have neurological problems that may
1. make you aspirate easily,
2. throw up when you're half a sleep
3. or not quick or dextrous enough to pull off the tape immediately if the need arises.

Take a look at this thread if you want to know more about the how to, and the pros and cons of mouth taping.

posting.php?mode=reply&t=21659

Take care,
And welcome
O.

thr61 · Post by **thr61** » Mon Jul 02, 2007 9:43 am

Nope. No neurological problems. Just sent to a neurologists for evaluation for the apnea (she treats for this as a sub-speciality).

I can try the tape, but how does this works with facial hair?! Ouch...

DreamStalker · Post by **DreamStalker** » Mon Jul 02, 2007 9:46 am

First of all … Welcome to the Gang!!

Finding the right mask interface is indeed the toughest part of the treatment. Everyone has different and unique combination of size and structure of the face and head … so what works well for some usually does not apply to everyone else. If you go into this treatment knowing this you will soon realize that the best method for finding an appropriate mask interface for YOU is trial and error. Of course some knowledge of the different interfaces and how they may interact with your specific treatment helps in the elimination to reduce the number of trials … and that is what this forum is good for.

If you are leaking air from your mouth during sleep, that is the first issue to take care of and your options are the following: 1) trial the full face masks (including Hybrid and Liberty), 2) learn to tape or glue mouth shut -- very few are successful with chinstraps, or 3) “train” yourself not to leak air (again not for everyone and you need software to make sure you do not leak).

Generally, FF masks are more difficult to fit (relative to nasal type interfaces) since there is more mask to have to fit to your unique facial features. In addition, if your skin tends to be on the oily side, these masks become even more problematic. The good thing about FF masks is that mouth leaks are taken care of (provided you find one that maintains the seal).

The nasal cushion interfaces have less real estate to have to fit to your face but may still pose similar problems with oily skin and facial features. I find that my sinuses are sensitive to the pressure of the seal around the nasal area of my face (like the congestion resulting from putting your face in the headrest of a massage table for a while). You have to keep mouth leaks under control somehow when using a nasal interface.

The nasal pillow interfaces have the least amount of contact with your face, mitigating a lot of the issues mentioned above. However, like the nasal cushion interfaces, you have to have software to monitor your leak rate and make certain you can maintain the pressure to keep the back of the throat open for respiration. Also, some folks really dislike having foreign objects stuffed up their nose. Nasal pillow interfaces do work very well for those who toss and turn a lot during their sleep (IMHO).

As you can see, each type of interface has its pluses and minuses and your job is to figure out which is the optimum type for you and start trialing those. Anyway, best wishes finding the right interface.

momadams · Post by **momadams** » Mon Jul 02, 2007 9:58 am

"However, I am challenged to keep a perfect seal with the pillows without keeping the headgear quite tight. "

Headgear and chinstraps shouldn't be tight. That just creates jaw and neck problems.

For the Swift, try loosening the straps (this IS counterintuitive...), using a larger pillow piece, and rotating the barrel slightly.

For mouth opening, people have found assorted solutions. Myself, I use a silicone "wax" shield between lips and teeth, a gentle chinstrap, and Poligrip Strips to hold my lips together. None of these are impenetrable restraints, but eventually teach your face.

For some of us, the full face mask isn't a viable option. Skin reactions to silicone, silicone reaction to face oils, pressure sores, festering pimples, etc. And so we learn to make something else work for us.

Shari

Babette · Post by **Babette** » Mon Jul 02, 2007 10:54 am

BTW, ozij, my "sleep doc" is also a neurologist. I'm not sure if this is a subspecialty of neurology or what. She is the medical director of my sleep lab, too.

Cheers,
B.

Sergey45 · Post by **Sergey45** » Mon Jul 02, 2007 10:59 am

thr61 wrote:I was pointed to this site by my neurologist who suggested it might be helpful in working out some of the issues I am having with finding the right mask. from reading through, it seems like this is somewhat the Holy Grail of sleep apnea.

I have been using CPAP for about two months and have been 100% compliant. However, I am having problems with the two masks that I have use.

Welcome on board.
You can take a look at my mask’s diary.
http://www.sleepapneasymptom.medgrip.com/cpap_mask.html
Good Luck.
Sergey

New Member Needs Mask Advice ASAP!

New Member Needs Mask Advice ASAP!

Masks

Re: New Member Needs Mask Advice ASAP!

Humidifier

Additional Comments: Pressure 16 cm H2O at altitude 6550ft