High Pressure Woes

[mikeinwny]

I have been using a Bipap AutoSV with heated humidity for about 9 months. My settings are very high - EPAP 17, IPAP 17/22. My prescribed backup rate is 14 but I've found using the AUTO setting to be more comfortable. Leaks are a frequent problem. I am using a ComfortGel Nasal mask with a chin strap because I've been a mouth-breather. I' tried a FullLife full face mask but it feels like my mouth is being blown open by jet engine, leaked like mad and was generally very uncomfortable.

I frequently take my mask off without realizing it. I have been struggling to hit the 4 hour minimum usage per night, although there have been a few rare nights that I've managed to keep the mask on for 6 to 7 hours. My sinuses are aggravated quite a bit and I have been taking clarinex and using nasal sprays, Nasonex and Patanese. Just when I start to put a string of good nights together, my sinuses flare up and I am set back to square one. Sometimes I become so congested that I can't wear the mask at all.

Currently my AHI is averaging about 22. It was 42 before switching my backup rate from 14 to AUTO.

I guess I am looking for any tips from people with high pressure settings. What type of masks have you had success with?

[echo]

Welcome to the forum!

A couple of suggestions I can offer, though I'm not anywhere near your pressure (10.5cm) :

- The Mirage Activa is great mask that seals really well, even at higher pressures, and even (especially) for people who toss and turn a lot. However it's still a nasal mask so you will still need to watch out for mouth breathing / mouth leaking. You can see it on cpap.com if you click on the mask in my profile.

- A daily sinus rinse can go a long ways towards helping congestion problems. Try a neti pot with a teaspoon of salt (or the special salt packets they come with). I find it works best in the morning for me, others rinse in the evening.

- Too high a setting on the heated humidifier can also worsen the congestion - you might try setting the heating a bit lower and see if that helps. For me, it's a bit seasonal - i need more humidification during teh winter months when it's dryer in the bedroom.. in the spring/summer I often need less humidification, and too much results in congestion.

- One last note, have you noticed whether you're _still_ mouth breathing/leaking? Sometimes that can contribute to sinus problems too. A chinstrap may not help against that, as the high pressure may just force its way out of your mouth regardless of how tight your jaw is clamped shut.

I truly sympathize with you, as will many on this forum. Congestion can be difficult to beat, especially when those high pressures just really irritate your nasal passages. Good luck, and welcome again! You've come to the right place

p.s. hopefully you'll get some feedback on the nose sprays - some, like Afrin, are known to cause a rebound effect, making the congestion worse when you stop using it. It's not something I know much about, sorry.

[Jersey Girl]

Dear Mikeinwny,

I too am a sinus sufferer. I find that I use the humidifier at 2.5 in the winter and only 1.5 in the spring/summer months. I use a daily nasal rinse - AYR - it comes with 100 saline packets that you mix in the bottle with warm water - the bottle comes in the box too. I rinse daily in the morning and then use prescription nasal spray Astepro at night when congested. The daily saline rinses really help so that I don't always need the nasal spray at night. What is nice about Astepro is that it has some antihistimine in it but doesn't have the addiction/rebound affects of Afrin.

I use a Swift FX as my preferred mask, but when I had a nasty sinus infection I went to a nasal mask as the air coming directly through nasal pillows in the Swift FX was too uncomfortable during the sinus infection. And, I clean my mask every day with citrus magic cpap wipes and then with ivory dishwashing liquid and hot water every week. I clean the hose with hot water and ivory dishwashing liquid each week. I clean the humidifier with distilled white viniger and water to disinfect it every week.

I hope this info helps. I'm afraid that I don't have too much advice on full face masks, as I don't wear one, but I am sure that others hear can help you on that one.

Regards,

Jersey Girl

[DoriC]

Have you looked into any other FF masks? My husband uses the Resmed UltraMirageFF with success and the Quattro is another one.

[wacyone]

Mikeinwny....First off,do NOT give up.I also use a Auto SV with pressures higher than yours.My EPAP is set at 14.0 cm,my IPAP max is set at 30.0 cm.I do have my Backup rate set on 10 bpm.I have used the Resmed Softgel,the activa and the one I like best is the Activa LT.I also use a chin strap.My average leak runs from 38 up to about 44 which for my pressures I don't think is to bad.I think I find is to clean not only your face just before retiring for the night but also the mask.I find using Citrus wipes on both face and mask almost like leaves a slight sticky surface so the mask hooks up better.Hope this helps you out but NEVER GIVE UP.This battle is won Slow and STEADY.

WES

[doughsthoughts]

im using the Auto SV Ipap max 20 Ipap min 12 epap 7 BR 13

The Swift FX is awesome, it never leaks on me I can sleep on my stomach and toss and turn with it.. its just great..

I also barely make the min 4 hours a night.. but the DR said if thats what I can do, thats what I doo. that amount of sleep with the Mask is 100 times better than 20 hours with out .. and hes right.. I use Flonase for my nose, with saline spray occasionally to make sure its moist.. if I don't i ll get bacterial infections..

Keep up the goood work..

[rubymom]

For people who take off their mask without realizing it, you could try taping the mask to your face so that you'd feel it when you were taking it off in the night. The more conscious it is, the more likely you can control it.

Also, have you tried sitting and reading or watching TV with your mask on so you get used to it? Worth a try.

[OCSleeper]

Initially had a Quattro FFM. Started to leak around 15. Switched to UMFF. No leaks from 17+ with APAP, but felt like my face was in a wind tunnel--just like those old NASA movies of that guy on a rocket sled with no wind shield. Much lower pressure with Auto Bipap (90% 16/13).

[LinkC]

I use the RespCare Hybrid at 17 CPAP. It is the ONLY mask I've been able to attain a decent leak rate with. During the time I'm awake, I have virtually NO leaks, but the charts show I have some thru the night. I DO have to use Lansinoh or an elastic strap on the nasal pillows at that pressure. I also wake up with strap marks. But at least it isn't hissing and blowing air in my eyes all night!

[WindFlyer]

ResMed Ultra-Mirage Full Face mask. Works like a charm.

[allen476]

Hi,

I don't use BiPAP like you but my pressure varies from some nights at 20 to a low of 15. I used to use a Quattro FFM but found that I actually get a better seal and sleep better with a nasal pillow mask. It has been a slow process to get the mouth leaks to stop but I am getting close. I found a chinstrap,tape,and Polident strips work together nicely but I still am having a tiny bit of leakage.

Allen

[nghy]

Hi,

I have a BiPAP autoSV Advanced with the EPAP floating between 14 and 18, and the Pressure Suport floating betwee 4 and 8. The SV advanced can titrate each breath so that is why the settings are allowed to float. I was never able to tolerate the nasal pillows. I've found that the ResMed full face masks, the Mirage Quatro and the Mirage Ultra work for me although they don't solve the leak problem entirely. One observation with the full face mask is that the smaller the mask the less force needed to hold it to my face. I've tried all three sizes. With the large size my chin rests inside the mask. (This solves some of the mouth breathing problems) With the medium size the bottom of the mask rests on my chin. (Easier to keep the mask in place, but the mask tends to ride up on my face as the evening progresses.) With the small mask the bottom of the mask sits in the indentation just below my lower lip. (The mask stays in place and there are far less leaks, however, unless I purse my lips a little the mask seals rest right on the corners of my mouth.) My face suits the medium size best, but I can adjust to the small masks. The proof is that I have the least leaks with the smallest masks. I also use the PAPcap which has a soft cloth chin strap to help keep my cheeks from puffing. I do not have as severe sinus problems as others. Nonetheless, I did install both the pollen filter and the white ultrafine filter on my machine. When I added the ultrafine filter I noticed a subtle increase in my ability to breathe comfortably. I need lots of moisture from the humidifier. During the winter heating and the summer air conditioning seasons, the heater is set at 4. During spring and fall, I drop the setting to 2-3. I also found that REMZzzs mask liners help minimize leaks with full face masks and provide additional comfort from contact with the mask seals. One other point, I use Biotene non-alcohoic mouthwash each night before I go to sleep. This helps control mouth dryness. That's all my tricks....

[mikeinwny]

Thanks everyone for the tips. I am going to experiment with some of them and see what happens. Just as an FYI regarding my sinus problems, I have tried using NeilMed Sinus Rinse and it just makes things worse for me.