Help Choosing a Mask

[ty845]

First, my thanks to all the forum regulars. I've been lurking since I made my first visit with the sleep doctor and the conversations that I've read here have been extremely helpful through my first six weeks of CPAP.

I'm seeking advice on masks. I'm a mouth-breather and back-and-side sleeper who has tried three so far with little satisfaction and a whole lot of irritation.

The story so far…
Quattro FX (Small): my first 3 weeks of CPAP. I found that the only way to eliminate leaks into my eyes was to really cinch it down on my face. On the occasions that I was able to keep it on for several hours I awoke with sore teeth, cheeks and nose. Additionally I wasn't able to sleep on my side without more leaks, even with the mask clamped onto my face. I never had more than 2 hours sleep in a row on this mask.

Mirage Quattro (Small): my next 3 weeks of CPAP. This mask worked much better for me, in that I could sleep on my side and that I could usually eliminate leaks into my eyes and minimize chin leaks. The problems that I've had include pretty severe acne/irritation on the bridge of my nose and minor pain upon waking up from the pressure on my cheeks/upper teeth. I can't seem to relieve the cheek pressure without guaranteeing chin leaks whenever my mouth moves. I was able to sleep 4 hours in a row a few times with this mask.
If I go back to the Quattro, I may try a padacheek or other liner which, I expect, would help with the nose bridge but no the check pressure/pain.

Swift FX (Small): Because of my difficulty with the full face masks, my doctor lent me these nasal pillows for a week. I'm three days in and, while it is certainly the most comfortably fitting mask of the three, I leak a lot through the mouth, which is sore and dry when I wake. I also find that they're not as comfortable for side sleeping (because the headgear routes between my cheek and the pillow) and that they squeak with each exhale.
Tonight I will try a make-shift chin strap (I will tie an old tie around my head) to see if that helps with the mouth leaks.

Questions
Anyone else had problems with sore cheeks/upper teeth with the Mirage Quattro. Have you had any success relieving that pressure and, if so, how?

Is it typical for the Swift FX to squeak on exhale? Any advise on reducing/eliminating the squeak?

I'll try my make-shift chin strap tonight, but is there any other good advice for a mouth-breather trying to make nasal pillows work?

Is there another mask worth trying? Has anyone in a similar situation had any luck with a Total Face Mask or Hybrid Mask? (My DME provider recommended against each of them when I met with them to exchange the Quattro FX.)

All thoughts are welcome!

[jaybeem]

Are the squeaks from leaks? If you put a finger up to the edge of the pillows can you feel air coming out? I use this mask and have never heard a squeak. I used to have flutters/vibrations, I think because I am really between a small and a medium pillow size. I used Lansinoh around the edges of the pillows to help with the leaks, but have gotten obsessive about keeping the pillows squeaky clean and have switched to Mustache Sealer for Diving Masks (which I think it is the Super Glue of mask sealers).

I am curious to see what responses you get about the squeaks!

[tired teacher]

I get squeaks but not consistently. Sleep on back and side. Side a real pain as the gear shifts off of the nose a bit.

[mgaggie]

Is it typical for the Swift FX to squeak on exhale? Any advise on reducing/eliminating the squeak?

I'll try my make-shift chin strap tonight, but is there any other good advice for a mouth-breather trying to make nasal pillows work?

My FX whistles a bit when I exhale, usually when I exhale strongly (a bit like blowing a nose). I stopped it by not exhaling as deeply and slowing my breathing down.

A few posters on here tape thier mouths shut with painters tape or surgical paper tape. I will be trying painters tape myself tonight as I am having trouble getting the FFM I was given not leak.

[zoocrewphoto]

You might try the hybrid.

I will tell you though, that it it often takes practice to make a mask fit right. Do NOT over tighten it. That just makes it worse. The best thing to do is to post where and how it is leaking and people can tell you what to do with it.

For example, I started with the Quattro FX. I used it in the sleep study with ZERO leaks. But get home with one, and I had trouble with it leaking, mostly at my eyes. I didn't realize it until people here told me, but I needed to move it slightly down on my nose. If it leaks at my eye, it is too high on my face. If it leaks down at my cheek, I need to readjust the cushion a little downward, but not the whole mask. I also found that my headgear was too big for my head, so it was hard to get the velcro adjusted well without the velcro being in my hair. I got the smaller size headgear, and it fits much better.

I can now go a couple months without adjusting the velcro, but I do still have to readjust the mask a couple times before I go to bed to make sure it is in teh right position without any leaks by my eyes. Once I have it right, it is good for several hours. This mask has been great for me, but it took me 6 WEEKS to master.

[zorki1c]

I'm relatively new here but I have discovered that my result with the Swift FX improved greatly when I started scrubbing the pillow every day (not just rinsing it in soapy water but rubbing it with soap ). Virtually no mask leaks when I do that. I';m a nose breather so mouth leakage is minimal.

[ty845]

Thanks All,

Re: Swift FX Squeaks
I can't tell if they're from leaks or something else. Since it sounds like that's not typical, I'll assume that it's this particular loaner mask and not an innate characteristic of the model. Last night I found that it squeaked on exhale as I was falling asleep and it squeaked on exhale in the morning--but when I got up in the middle of the night it was not squeaking. It looks like my pressure was higher at that point, so the squeak my vary with pressure. When I was playing around with the mask I couldn't find any definite leak. I tried pressure on different parts of the mask to see if pushing it in one place or another would stop the squeak, but I had no luck.

Re: Last night with a chin strap
My chin strap reigned in the amount of air I leaked through my mouth last night a bit, but I still had moderate mouth leaks for half of the night. mgaggie, I'll take your suggestion and try taping my mouth shut tonight to see if things improve.

Re: full face mask leaks
Thanks zoocrewphoto, it absolutely wouldn't surprise me if I'm setting up the Mirage Quattro just a bit askew and that is causing almost all of my problems. Ultimately it is the mask that I'd most like to get to work because it's fairly comfortable for side-sleeping and allows me to not worry about my mouth at all.
My problem with the Mirage Quattro is that, when I keep it loose enough to relieve the pain on my cheeks/upper teeth that I either leak out by the slope of my nose or I leak whenever my mouth moves. This varies based on the selector. When the top is closer to my face, the nose slope leaks but the chin is secure. When the top is farther away from my face, the chin is secure but the nose leaks. I haven't been able to find a happy medium.

[MagsterMile]

I totally agree with keeping the mask squeaky clean. Since I've stopped using 'wipes' for cleaning, my leak totals have gone way down. Last week or so, I've been disassembling the cushions-pillows from the mask frame and thoroughly washing - everyday - in warm soapy water. After rinsing the cushions, I put them into a cold water and vinegar bath for a short while to remove any remaining residue. Suggest using Ivory liquid handsoap, clear. I think that is the secret to less leaks. Someone here on the board recommended the Ivory Handsoap Liquid. I do use the Mirage Liberty or Inomed Hybrid and alternate them every few days. Not sure why DME's don't recommend Hybrids. The Mirage Quattro Sz Small (which I suffered through for six months) always hurt my nose bridge and leaked incessantly into my left eye. Perhaps my eyes are set too close together. Using the small Liberty and Hybrid now. I do sleep mostly on my side so recommend a cpap pillow to help with the mask also.

[ty845]

So last night was my best night ever since starting CPAP with an AHI of 2.1 on nearly 5 hours of sleep. I still had, what I can only assume are, mouth leaks but my mouth wasn't exceedingly dry or sore in the morning.

Question: The wiki says wiki/index.php/Mask_Leaks

Warning against mouth leakage
Whether you use a nasal mask or nasal pillows (or any other kind of mask except a full face), if air leaks out through your mouth, the PAP therapy will not work.

Is this true? I'm almost certain that I'm leaking air through my mouth in the middle of the night (my wife said that I was), but my graphs in SleepyHead show that my pressure is being maintained by the CPAP and apneas are still being recorded. I'm also not finding my mouth and throat very irritated upon waking up. Is there any reason that I should stay away from nasal pillows?

[memapenguin]

Is there another mask worth trying? Has anyone in a similar situation had any luck with a Total Face Mask or Hybrid Mask? (My DME provider recommended against each of them when I met with them to exchange the Quattro FX.)

I love my Mirage Liberty Hybrid, as a mostly side sleeper I manage to wear it rather loosely but if I need to sleep on my back (due to occasional leg/back pain) I find I need to tighten it up more as I have an overbite and my lower jaw drops when I sleep on my back. I had tried the Quattro Fx sm and the Amara FF xs and was unsuccessful in getting either to seal well and both made my nose sore and leaked into my eyes. Good luck in your quest for "your" mask.

[Pugsy]

So last night was my best night ever since starting CPAP with an AHI of 2.1 on nearly 5 hours of sleep. I still had, what I can only assume are, mouth leaks but my mouth wasn't exceedingly dry or sore in the morning.

Question: The wiki says wiki/index.php/Mask_Leaks

Warning against mouth leakage
Whether you use a nasal mask or nasal pillows (or any other kind of mask except a full face), if air leaks out through your mouth, the PAP therapy will not work.


Is this true? I'm almost certain that I'm leaking air through my mouth in the middle of the night (my wife said that I was), but my graphs in SleepyHead show that my pressure is being maintained by the CPAP and apneas are still being recorded. I'm also not finding my mouth and throat very irritated upon waking up. Is there any reason that I should stay away from nasal pillows?

Mouth breathing/leaking doesn't always mean that the therapy is negatively impacted to the point that "PAP therapy will not work".
It all depends on how much and how long the mouth leaking/breathing is occurring.
I know that I open my mouth sometimes during the night (have woke up breathing with lips parted) but when I go look at the leak line graphs sometimes I can't even spot the time that I woke up with lips apart.

I rarely see leaks above the large leak territory line and when I do they are usually very brief....like 5 or 10 minutes. Certainly not the end of the world in terms of cpap therapy effectiveness because of 5 or 10 minutes out of 7 or 8 hours of sleep.
I am not going to go down the full face mask road (don't want to) or even bother worrying about such a small time frame of maybe mouth breathing. My over all sleep quality for the entire night would be much more negatively impacted by trying to use a FFM or even taping or wearing a chin strap trying to fix maybe a short term problem.

Now if leaks or mouth breathing are waking a person up then they are unwanted because they are disrupting the sleep cycles we need so we would want to try to limit that aspect.

I sleep right through most of the times I probably have a little mouth opening issues and I sleep quite well. Much better than I would if I were to try to use a full face mask and while taping (I have done that in the past) isn't a horrible experience, it can be annoying and disrupt my sleep.

So look at the overall leak line graphs and evaluate the time spent in large leak territory if you go there and then determine just how much of an impact that any leaks may be making. Then you can decide which is worse...a little mouth breathing or trying to eliminate any negative occurrences from that mouth breathing. Some people are only happy with a perfect straight flat leak line and that's fine if that is just fine if they want to go down that road. Some people are like me...happy with less than perfect leak lines or numbers as long as leaks aren't huge for prolonged periods of time and they are sleeping just fine.

[lobo405]

Have you ever heard of Opus masks?
I have this type of mask after trying some others and love it.
It's just important that I adjust the whole thing correctly so that it's not to tight and not to lose but then I almost don't feel the mask and leaks are rare.
Also the hose directly attached to the mask is not to long so that the coupled extension hose doesn't get stuck to my bed and so.
One can easily guide the hose above the head or downwards to my chin.
Only one thing I don't like, but I think many masks have this, are the vent holes.
The air comming out irrittates both me and my partner, so since about two years I mount something on the holes that diffuses the air and that's great.
Juts replace it at regular intervals as it gets black somehow.