what defines "overtightening" the mask?

[johnthomasmacdonald]

I've used the swift fx nasal pillow, resmed quattro ff and now the fisher forma ff and the instructions all state: "don't overtighten the mask". However i find that the only way that i can keep the mask from leaking like a sieve right from the get go is to tighten it as much as possible. I've ordered all the pad a cheek stuff but it is yet to arrive, will that make a big difference?

[BlackSpinner]

The quatro especially works like a hovercraft. The more you tighten it the less space it has to inflate. If you have to tighten it down hard it means it doesn't fit your face.

[johnthomasmacdonald]

hello blackspinner,

That makes sense since the provider claimed i was "medium" and that seemed to agree with the face measuring scale they had but i couldn't believe it since i haven't been a "medium" sized anything since i was born and named "snowshoes" by the nursing staff based on the size of my dainty feet

[BlackSpinner]

It is not only the size but the shape of the face. Your nose, cheek bones and chin and their relationship to each other. It depends on what the shape of the face that the manufacturer used as a model. The Quatro seems to have used Ken/Barbie as their default setting.

[robysue]

Ditto what Black Spinner said as applied to the Swift FX nasal pillows:

The nasal pillows need to fully inflate against the edges of the outside of your nostrils. If the straps are too tight, they pull the tips of the cones way too far into the inside of the nostril or smoosh the nasal pillow up against your nostrils which triggers piggy nose and prevents the cones from fully inflating.

With the FX headgear, the top strap should be loose enough to get a finger or two under the strap without any work at all. The back strap needs to be tight enough to stay above the ears and around the top half of the back of your skull instead of slipping down onto your ears and neck.

The angle of the pillows is also important. The tippy-top part of the cone needs to be aimed just right or you are likely to get a small-to-medium leak right around the cone and (usually for me) directly onto my lip. Look at the pictures in the fitting guide to see what the angle needs to look like---it's hard to describe.

Finally: If the straps are nice and loose and the pillows are still leaking, pull them gently away from your nostrils---there will be lots of wind blowing in your face. Once the pillows are completely off of your nostrils, gentling allow them to settle back down and rest against the outside of your nostrils. That usually is all you need to get a good seal.

[Suddenly Worn Out]

I have read all the Resmed stuff about overtightening the FFMs and warning not to do it. Ive played and played with it over the years. I have some high pressures. An RT told me if you have high pressures, you will get leaks.

I dont have leaks on the quattro, but it is because I tighten that thing down hard and replace my cushions every two months, not three months. After three months they leak no matter what I do.

My definition of overtightening a mask means you get pressure sores or imprints in your face or forehead or neck area.

I have found the Quattro fit me much better when I lost a lot of weight. Evidently, losing those chipmonk cheeks and thick neck is good for a nice Quattro fit. I found when losing weight, I did not have to tighten it down nearly as much to get a good fit without leaks.

i find when very overweight, the loosening the mask up so it inflates just does not work well. I get too many leaks that way and wake up tired, with high leak rates recorded on the machine.

Solution? Lose weight if possible to make that mask fit your cheekbones and chin better.

Eric

[johnthomasmacdonald]

dear robysue,

Thanks for the advice, you've given me far far more information about how to use the FX pillows than my provider and sleep doctor combined - mostly i've relied on the youtube video

dear suddenly worn out - I'm not really overweight although i'm trying to drop about 30 pounds because of severe osteoarthritis - joints can't carry even muscle anymore it seems - and to see if it improves my apnea to be really lean so maybe that will make a difference when i reach it

[archangle]

This is yet another reason people should not be given Full Face Masks (FFM) unless they have a specific problem like uncontrollable mouth breathing or clogged nose.

FFMs are usually harder to make fit.

[Goofproof]

This is yet another reason people should not be given Full Face Masks (FFM) unless they have a specific problem like uncontrollable mouth breathing or clogged nose.

FFMs are usually harder to make fit.

And you won't know if you have a problem unless you have a machine that collects full data, the software to read it, and knowing what to look for. A Full Face mask bypasses mouthbreathing failure by doing a end run around the problem. Catch 22, treatment, the good thing as we use a type of mask out face starts to conform to the mask shape, helping the leak factor. Jim

I use both type of masks without major leak problems, both have leak rates conforming to the makers specs @ my pressure of 15 cm

[johnthomasmacdonald]

dear archangle, I do in fact have uncontrollable mouth breathing - they started me with FX swift nasal pillows and to use them i need to duct tape my mouth shut and wrap my head in sticky ace bandages - none of the chinstraps help at all - and even then they only control my apnea about 1/3 of the time, the other 2/3 my ahi number is as high as when i don't use anything - see my sleep doctor on Oct 1 - not that they've been of much use

[chunkyfrog]

If the mask requires a tight fit to seal, it does NOT fit you.
I was unable to get any full face mask to work until I found the Philips/Respironics Comfortgel.
This comparatively heavy mask has a deep gel cushion with a lot more size/shape flexibility than any other full face I've tried.
You may need to try more styles/brands to find a good fit.Fit is everything. Don't give up.
And unless you NEVER get the sniffles or have total control over your mouth while asleep (who does?),
a full face mask is, at the very least, preferable to sleeping without CPAP.
Note: duct tape is too sticky for your skin--please use something easier to remove in case of a cough, sneeze, or vomit.

[Tino2You]

Ditto what Black Spinner said as applied to the Swift FX nasal pillows:

The nasal pillows need to fully inflate against the edges of the outside of your nostrils. If the straps are too tight, they pull the tips of the cones way too far into the inside of the nostril or smoosh the nasal pillow up against your nostrils which triggers piggy nose and prevents the cones from fully inflating.

With the FX headgear, the top strap should be loose enough to get a finger or two under the strap without any work at all. The back strap needs to be tight enough to stay above the ears and around the top half of the back of your skull instead of slipping down onto your ears and neck.

The angle of the pillows is also important. The tippy-top part of the cone needs to be aimed just right or you are likely to get a small-to-medium leak right around the cone and (usually for me) directly onto my lip. Look at the pictures in the fitting guide to see what the angle needs to look like---it's hard to describe.

Finally: If the straps are nice and loose and the pillows are still leaking, pull them gently away from your nostrils---there will be lots of wind blowing in your face. Once the pillows are completely off of your nostrils, gentling allow them to settle back down and rest against the outside of your nostrils. That usually is all you need to get a good seal.

[Gin]

My experience, limited as it is, is that when I get leaks, I loosen the straps. It's counter-intuitive, but for me it works.

[greatunclebill]

the answer is that loose, tight and over-tight are subjective terms that you need to determine for your face and mask. my experience is that you have to have the mask on straight by having the straps even, right and left. that is don't tighten one side more than the other. set the mask on your face fairly loose and tighten the straps evenly til it is snug. then apply the air pressure. if it leaks, tighten both sides a little at a time evenly until it stops leaking. if it never stops leaking, change masks. when it does stop leaking, lay down and move side to side. if it starts leaking, continue tightening a little at a time til it stops. if it leaks at night, repeat the process.

for best results when buying a mask, go to cpap.com and find the mask. then fish thru the links on the page and find the sizing guide for your mask so you know if you have the correct size. if you have the wrong size it is not going to work. if you have the user guide that came with your mask, it may contain the fitting and sizing instructions.