ZZZ Mask

[Kato]

Hello- I've been struggling to adjust to life with Cpap for about six months now. After my sleep studies, I was sent home with a Resmed S8 Elite II with heated humidifier and the Mirage Quattro full face mask. I can't remember what my pressure setting was, though I was told I had mild to moderate Apnea. The Quattro was a nightmare for me- it leaked constantly, forcing me to strap it on so tightly, the bridge of my nose was developing a callous, and those forehead dents would last most of the morning. The clinician suggested I try the Mirage Activa nasal mask, coupled with a chinstrap. The results were just as awful- I could not get a seal no matter how many adjustments I made. I wanted to get away from the forehead support, so I had high hopes for the Mirage Liberty. The mouth mask seemed to work OK, but I could never seem to get the nasal pillows seated properly. (and I tried all three sizes) Which brings me to my latest mask, the Probasics Zzz-Mask. The entire body of the mask is made of silicone, supported by a plastic framework, and no forehead support. I liked the simplicity of it, and it got good reviews. The first few nights were pretty good- it was comfortable, and I got a seal. However, the last few nights I've been waking up around one or two in the morning with a very dry mouth, forcing me to take off the mask, shut down the machine, and reach for some water. I know the humidifier is fine, I can feel the humid air during ramp up, and I am replenishing the reservoir nightly. It almost feels as though the incoming air pressure is being forced into my nose and then directly out my mouth, drying it out. With this problem, and all the previous mask issues, could it be that my pressure is set too high? It almost feels as though I'm strugging to exhale against the pressure, and subsequently, my breaths are short. Any help ar advice would be GREATLY appreciated!

[ozij]

Hi Kato,
It's very possible that air is being pushed out of your mouth.
Here are some things you can do with your machine:

1. If you can control your EPR -- that's exhale pressure relief -- set it at 1 number higher than it is now. If it's off start it at 1.
2. Check your "Efficacy Data". That's your AHI, the number of breathing disturbances you have each hour. The best way of doing that is by holding down the right and left button for a few seconds, and then, going through the Review menu by pressing the left button. Once you're in the Efficacy menu, press the down key. Your AHI will tell you how the therapy is affecting your breathing. And how the changed EPR is affecting it.

. Todays results disappear at noon to clear the screen for the next 24 hr. period so checke results when you get up.

Depending on your AHI and how you feel, you will be able to decide whether to make more changes in EPR, or to start changing your pressure.

You can change the pressure in .2 increments or decrements on the Elite -- and those little changes may make a difference.

You may need to access the clinician's menu in order to give yourself permission to see the EPR menu. If that is the case, you'll find instructions here:
viewtopic/t38985/Searching-for-Clinicia ... te-II.html

Make sure to write down each and every setting before you start making any changes.

[Slinky]

Keep in mind tho that air escaping from your mouth w/a full face mask is NOT therapy lost, it is still there in the mask and being breathed in. It has no where else to go.

I use the Zzz-Mask Small full face mask and like it really well. I did have trouble at first w/the headgear being WAY too large for me. But a few nights of adjustments and folds in the straps held in place w/velcro strips until I found just the right adjustments and then a pair of scissors to cut out the folds and velcro strips to put the cut ends back together and I've been good to go every night since. Every night I get a Median 0 Leak rate and considerably less than 10 95th percentil Leak rate and almost never go over 24 L/M maximum Leak rate. I can sleep on my sides or my back ... haven't tried tummy sleeping altho that was my favorite sleep position most of my life. A whiplash ended tummy sleeping. My neck just can't handle tummy sleeping anymore. I never was one to bury my face in my pillow, I always had my head turned one way or the other.

[ozij]

Slinky,
I remember you said the headgear was of terrible quality, falling apart after a few days - has something changed?

[Slinky]

No, it wasn't falling apart, Ozij. It was just "stretchier" than the Resmed or Respironics headgear and so a "fix" for one night didn't hold and had to be tightened a bit, the fold made a bit large, for several nights. I guess you might say it was a looser stretch that didn't quite go back to original size for about the first week, maybe two, before it settled down and didn't stretch any looser.

[Kato]

This is some terrific info- thanks!

[ozij]

No, it wasn't falling apart, Ozij. It was just "stretchier" than the Resmed or Respironics headgear and so a "fix" for one night didn't hold and had to be tightened a bit, the fold made a bit large, for several nights. I guess you might say it was a looser stretch that didn't quite go back to original size for about the first week, maybe two, before it settled down and didn't stretch any looser.

That's very good news, Slinky. I may be trying out this mask soon (next week I hope...).

[Slinky]

I hope you have good luck with it, Ozij.

I'm waiting to hear the results of a bi-level re-titration using my Zzz-Mask. According to the tech I had a 0 Leak rate during the titration, just like at home.

I was originall titrated on a bi-level w/my Simplicity simple nasal cushion and 2L of 02 at IPAP 13, EPAP 8, and PS of 4 in Auto mode. It was an improvement over my S8 Elite which had been an improvement over just 2L of 02.

At first the VPAP Auto at the titrated settings were an improvement. But then after 3-4 months they wanted me to switch to straight bi-level (Spontaneous) mode. That didn't work out well at all. The transition between IPAP and EPAP were just too abrupt for me. The EasyBreathe technology is not "engaged" in Spontaenous mode in the VPAP Auto OR the VPAP Auto 25.

So I went back to Auto mode where I was happy and comfortable. But then I went thru another titration to try to adjust the "comfort options" in Spontaneous mode. I used my Simplicity most of the night but towards morning they switched me to the OptiLife nasal cradle cushion and a chin strap. They came up w/IPAP 10, EPAP 5, PS 5.

But that didn't work for beans for the pressure transition in Spontaneous mode. So after 2-3 weeks I went back to Auto mode at those pressure settings.

In January last year I had a COPD episode (not enough for hospitalization) and it seemed that after that my VPAP therapy started going downhill. My leak rate was high w/the Simplicity but AHI pretty good. My leak rate was lowered some w/the addition of the chin strap. AHI remained good as well.

I was given the opportunity to try the Swift LT for Her. It went all right and I rather liked it but prefer a nasal cushion to nasal pillows. I never noticed any difference in Leak rate or AHI to speak of.

Then I was given the opportunity to try the OptiLife nasal cradle cushion at home. The very first thing I noticed was a very decided feeling of an increase in pressure tho there was none. And my Leak rate really went outta sight. So back to my Simplicity and chin strap.

By last fall I was having some throat problems. Constant feeling of pressure and/or phlegm in the center of my throat at the collar bone area. Soft tissue CT scan of the neck and US of the thyroid revealed multiple nodules on the right lobe and one on the left. Of the two largest one was 1 cm and another 2.6 cms. Neither palpable to touch. FNA biopsy indicated they are benign.

Meanwhile my AHI was climbing tho the usual somewhat high Leak rate remained the same. So that is when I tried the Zzz-Mask. And w/the Zzz-Mask I experienced the same thing w/it that I did w/the OptiLife nasal cradle cushion. The sense of DEFINTELY higher pressure. BUT also a considerably higher AHI and the virtually non-existent Leak rate. And, of course, my sleep had been going to h*ll in a hand basket. Thus the recent titration.

Temporarily they've come up w/IPAP 10, EPAP 5, PS 5 and they used no 02 during the titration. The tech said I never met the criteria for the addition of 02. The doctor was supposed to go over the PSG yesterday and the dictation should be available tomorrow or Friday. I was told there might be another interim pressure adjustsment between his going over the PSG and our appointment 23 Feb. But no call or visit from my DME provider today so I assume that is NOT going to happen.

The problem w/this recent titration is that I only slept about 3 hours out of 6 hours bedtime. About an hour and a half when I did go thru a good full sleep cycle and one good REM stage. The rest of the time that doggone sense of no sleep, just dozing in and out. That good sleep cycle was at the beginning of sleep early in the night. So I haven't much faith in the results whatever they may be.

And IPAP 10, EPAP 5, PS 5 at home w/no 02 sucks so far. I'm adding the 2L of 02 back tonight. I spent over an hour last night under 90% 02.

What mask will you be switching from to the Zzz-Mask, Ozij? It will be interesting if you do or don't notice any difference in your sense of pressure.

I hadn't noticed any difference in pressure from the Simplicity to the Quattro. Which kind of thwarts my theory that the difference is caused by the short narrow hose off the Simplicity and the Swift as compared to the direct CPAP hose to the mask of the other masks.

[Kiralynx]

Kato,

I keep water in a sports bottle by the bed. I can reach for it, slide it under the mask and grab a fast sip and get my mask back down without causing too much in the way of a leak.

I always get dry when I'm using a full-face mask, but that could be because I'm usually taking decongestants because the only time I use a full-face is when I'm down with a respiratory infection!

The Zzz-mask is a pretty comfortable one. Of course, I got rid of the head gear that came with it and replaced it with a CL2 strap. Which is what I seem to do with every mask....

[OwlCreekObserver]

I've used the ZZZ full face mask for a very long time and wouldn't use anything else at this point. I like the fact that I can order just the replacement parts I need instead of having to buy an entire mask. The only exception is the L-shaped valve thingy which apparently only comes with new masks.

I don't buy the ZZZ-Mask headgear however. Instead I buy the Premium Headgear with EZ Peel Tabs for Comfort Series Masks (stock #1033678). I believe it's sturdier and does a better job overall than the stock harness.

The mask does take a little getting used to because it has no forehead support. Once I figured out its "personality" it worked just fine. I'm a side and back sleeper and rarely have any problems with it.

But the biggest draw for me is that the mask does not irritate the bridge of my nose -- not now, not ever. I have a perfectly good Ultra Mirage FF mask in the drawer as an emergency backup and I like the way it fits, but it really hurt my schnoz, no matter how I adjusted it.

Here's another plus: Shortly before I went on CPAP a few years ago, I shaved off my beard. I recently decided to try wearing it again, at least until it interfered with my CPAP readings. I'm now wearing a full beard and I'm showing no more leaks than without it. I do tend to wear masks slightly tighter than some folks, but I still think that's quite remarkable.

[Added]: Sorry, I neglected to address your dry mouth issue. I've experienced the same thing but it's an infrequent occurrence and I've just come to accept it as one of those great, unexplainable mysteries of the universe. Oddly enough, a couple of mornings ago I had the opposite problem -- water running down my face when I took off the mask. But that's the only time it happened. Yet another mystery, but not a big deal.

[pb5927317]

I have been on for a week now, and with full face mask I was getting very dry in my mouth. I have a heated humidifier....last night I turned it off, and it seemed my leaks and my dryness were better....worth a shot I think.

[ozij]

Well, I finally got a ZZZ mask today -- that's 2 months after I thought I would.... Have just tried if for fit -- and can't seem to get a stable seal -- so I would appreciate tips of any kind.

Small was too small, I'm using a medium.

• What is the preferred routing for those who like the mask?
• Do you find you have to keep it tight?
  Any tips about how high (or low) on the nose?

Slinky, I've been using an Ultra Mirage FF for about a month and a half now -- I may feel a bit more pressure with the ZZZ, but not a dramatic change.

O.

[Ruffinit]

I use the Drive (Zzz) FFM and have for months. I run at a pressure of 18.5 to 25 on my VPAP Auto SV. I had the same issue with the Quattro; leakage and the bloody nose bridge. I worked with the DME and tried a good 2 dozen masks before she brought out the Drive. It's worked great from the beginning. I use the ResMed Liberty Mirage headgear with mine.
I had the dry mouth for a while after switching to the Drive with a good seal. I ended up turning the humidifier up as far as it would go and I think subconsciously I learned the keep my mouth shut while sleeping even though in some cases it would blow open. The nice thing about the mask is that if you get it set right on your face the bottom of the mask "cups" the edge of your chin and helps to keep your jaw closed. As it's gotten warmer out, I have gradually decreased the humidifier as some mornings it feels as though there is water/sweat inside the seal as mentioned above.
As for the positioning; I've gotten to where I can feel the mask being on right.. That said, it just cups the lower edge of my chin and is just below the bridge of my nose. The straps (with my pressure) have to be tight. Tight enough they'll leave marks, but because of the way the mask is designed it is still comfortable. The design of the elbow that is attached to the front of the mask is such that you can change positions in the night without it leveraging the mask to lose your seal.

Hope that helps.

[ozij]

Thank you, Ruffinit. That sounds much lower than I tried -- I'll see if I can use it that way.

[ozij]

I've been doing some searching...
The masks is produced by APEX -- and here's an intstruction manual: http://www.apexbrand.com/pictures/modul ... 777475.pdf

Fascinating language... but it is indeed meant for under the chin use.

O.