Looking for FFM Recommendations

[hskriver]

I am in the hunt for a new FFM that will stop some of the leaks I'm currently experiencing and wanted to see if anyone has some recommendations on what I could based on what I've used and the problems I've ran into.

A little background - I was diagnosed with sleep apnea a year ago and I've been struggling with residual sleepiness and still wake up multiple times at night. I feel better than pre-CPAP, but still tired enough to have a major impact on my quality of life. I'm fully compliant, sleep about 8 hours a night, and practice good sleep hygiene, so it's been stressful not getting the results I hoped for out of CPAP. I've had multiple sleep studies and pressure changes in the last year - I even did a MSLT to rule out narcolepsy.

Masks - I initially tried the Opus nasal pillows until I realized that I mouth breathe at night. I found a chin strap to be really uncomfortable and annoying, so I switched to the Amara View. I haven't had major complaints with that mask, but I didn't have a lot to compare it to and now I realize that it's not a fit. A few months ago, I realized that the small cushion for the Amara View was causing major leaks that were somehow not getting picked up by my machine - I only knew because my husband complained about the noise. So I bought a medium cushion and noticed a very minor improvement in my sleep quality. I mentioned this to my sleep doctor in my follow up visit last week and he started noticing a subtle leak pattern in my data that appears to correlate with REM sleep. He suggested trying a FFM that has a lip that goes under the chin or to try a chin strap with my Amara View. I got a new chin strap, but still just can't get it to work and be comfortable with the Amara View.

I also got the Fisher & Paykel FelxiFit 432. When I first put it on, I liked it better than the Amara View. I like how secure it feels compared to the Amara View (it can slip easily with changes in sleeping position). My first night using it was amazing - I slept straight for 7.5 hours for the first time on CPAP and I felt a lot better the following day too. However, the mask left red marks all along the bridge of my nose and my nose was a bit swollen/bruised on one side. I've loosened the straps as much as I can without having leaks and still can't get it to be comfortable. I now can't fall asleep in this mask unless I take a sleeping pill and deal with the soreness the next day. But sleeping pills leave me a bit groggy if I take them too many days in a row. I thought that the size might be off because the mask feels tight on my cheeks, like it's squeezing them a bit and it feels tight on my nose bridge. My DME sent me a medium size, but that's too big. I can't get it to not leak under the eyes and it sits on the lower part of my eyes instead of my nose. I did like the feeling of the medium on my cheeks though.

To sum up, the Amara View is mostly comfortable, but doesn't quite feel secure on my face and is causing leaks. The FlexiFit 432 is best for sleep quality and doesn't leak, but digs into the bridge of my nose and squeezes my cheeks a bit too tightly.

I'm pretty sure finding the right mask is the missing link in making my CPAP therapy as effective as I hoped it would be. I'm going to try to go to my DME's office soon and try some masks on to find the right one (my DME has been gone for a conference this week, so haven't heard back about when I can go in). But I was just curious if anyone has had similar experiences with masks and might be able to provide some ideas as to what might work with my face.

[Pugsy]

Have you considered trying a mask liner with either mask?
http://www.padacheek.com/PAC_Maskliners.html
The mask liner will help with the marks left from the F & P mask.
You can make your own mask liners to see if you think they will help or not...old T shirt works great.

Sorry I can help with specific FFM recommendations. I don't particularly like them and don't use them and the only one I ever could even remotely use all night was the Amara View. I kept it just in case I ever just had to use a FFM.

[hskriver]

Thanks for your thoughts, Pugsy. I have a mask liner for the Amara View because it was causing acne like breakouts - my DME called it "pressure necrosis". I've only had the F&P for a week and haven't tried ordering a liner for it. I'm not sure I want to spend money on a liner if I might return the mask. I did order a gel pad that sits on the nose, but it interferes with the seal and causes leaks.

Also for the F&P, I feel like it's digging into the nose because it's squeezing too tight and not just skin irritation. Do liners still help with that sort of discomfort?

[bonjour]

2 thoughts, Hybrid masks

or other solutions for the mouthbreathing

I use a P10 and tape to solve my mouth breathing, and I had it bad if Pugsy remembers.

[Pugsy]

Also for the F&P, I feel like it's digging into the nose because it's squeezing too tight and not just skin irritation. Do liners still help with that sort of discomfort?

I honestly don't know because I have never used a mask liner. I recommend them because so many people here have good success with them and I have used Padacheeks other comfort products and love them.
I don't blame you for not wanting the spend the money on a liner for a mask you may not keep.
Maybe try going the DIY homemade liner route??? I think OkieBiPap has a link for a pattern for cutting out your own DIY mask liner in several of his recent posts.

If the mask is actually digging into the nose it's possible that the size isn't ideal and it's also possible that the mask simply doesn't suit your facial structure all that well for whatever reason even if it is correctly sized.

That's the problem with us trying to tell you what works well for us...our facial structure may not be all that similar to yours so even if correctly sized and fitted...the problem could be facial structure related and the best mask in the world for a person might be a horrible mask for the next person for any number of reasons.

[Pugsy]

This Hybrid might be worth looking at.
It comes with all the various sizes of everything you need.
https://www.cpap.com/productpage/RespCa ... -Mask.html
It's a bit more finicky in terms of initial fitting and adjustments but once there it doesn't usually need much daily adjustment.
Prior to the Amara View this one would have been my choice if I just had to use a FFM.
I can't/won't do any mask that sits anywhere on my nasal bridge area.

Oh.."bit more finicky" is code for "it's a bitch" but it can be done. Just not as easily as fitting the Amara View is.

[hskriver]

@bonjour - I may need to look into nasal pillows with a chin strap again. I didn't like it the first time, but maybe I just need to try out more styles of chin straps. For some reason I have an emotional resistance to them though. I'm totally fine with using a mask, but for some reason the chin strap idea is just too much for me.

@Pugsy - I definitely understand the different facial structure thing, so I know it's going to be tough to get a lot of recommendations. Just threw the question out there in case someone might have an idea about a mask that is a bit wider than the F&P on the cheeks and a tiny bit bigger in the nose. The hybrid mask does look really tempting. I actually saw it or something similar in my DMEs office last week and thought it looked nice, but she didn't really give me an option to try on masks. She just grabbed the F&P mask, touched it to my face for about half a second, explained the headgear and sent me on my way.

I'm starting to lose confidence in my DME and would like to avoid trying out a dozen masks before finding the right one.

[Pugsy]

or some reason the chin strap idea is just too much for me.

Have you consider trying one of those soft cervical collars in an effort to bypass the chin strap and still keep the mouth closed. They help a lot of people. I personally would find it annoying myself but then one of my main preferences is "as little on my face and head as possible" so that pretty much excludes my using something bulk around my neck.

With the nasal pillow resistance...is it the pillows themselves or the fact you need the chin strap if you use the pillows?

[hskriver]

I haven't tried a cervical collar, but could check that out. It wouldn't interfere with the mask positioning, so I'd just need to be able to get into a comfortable sleeping position with it.

For the nasal pillows, it's only a resistance to the chin strap. I actually liked the first nasal pillows I tried for the most part. They did irritate my skin, but Lanisoh cream fixed that. I just feel like I've really struggled getting a chin strap in place and strapped correctly on my head while also wearing the headgear. If I put the chin strap on first, then it moves once I put the headgear on but if I do it the other way around I struggle getting the chin strap to stay in place on top of the headgear and the headgear shifts. Once I finally get it on and in place, then it pulls my jaw back making it uncomfortable and waking me up in the night or preventing me from sleeping in the first place. The most recent one I've tried also digs into my throat. I just end up feeling frustrated every time I try to use one and I don't like having that happen right before trying to sleep. My husband says I'm being irrational about not wanting a chin strap and I should just try more out - he's probably right. It's just that I already spend a lot of time each night putting on my mask, putting in ear plugs, and getting an eye mask in position and I don't want to add more steps.

[Okie bipap]

If you want to try making your own mask liners, her is a link to where I found the pattern for the liners I used to use. It is the same size and shape as the ones you can 30 in a package. I won't name the brand name right now. I made mine out of an old, well-used tee shirt. My wife crocheted a small bag we put the dirty masks in and just throw them in with the whites when doing laundry and then iron them dry. Ironing will return them to the original size. http://montfordhouse.com/cpap/diy-cotton-mask-liner.pdf
These liners will work for a small or medium mask. It can be enlarged for a large mask. You can make the hole in the center larger if necessary.

[Pugsy]

So how long has it been since you tried using the nasal pillow mask?
Do you still have the Optilife? Do you have any other nasal pillow mask in your possession?
Just how bad was the mouth breathing? Wake you up often? Half the night is huge large leak?

I mouth breath occasionally...I know it but it isn't for very long and I normally don't go deep into large leak territory and it doesn't wake me up...so I don't care. I let it happen and shrug my shoulders because for me trying to get a nice perfect leak line would cause more sleep problems than it would fix.

Do you mouth breathe out of habit or do you have to mouth breathe because of nasal congestion forcing you to mouth breathe to get enough air?

I did do the chin strap and taping thing early in my therapy...I was mouth breathing more out of habit (my nose is clear as a bell 99.9999% of the time). I eventually got into the habit of keeping the mouth closed (for the most part) so I quit doing the taping and chin strap thing. We can learn the habit of keeping the mouth closed (for the most part ). It's not impossible..it's not easy or fast either but not impossible.

[hskriver]

I returned the nasal pillows once I got the Amara View, so right now my only mask options are the Amara View or the F&P.

It was sometime last spring when I switched to the Amara View, maybe late March or early April. I actually don't think I've looked at what the leak data looked like from then. Initially, Sleepyhead didn't work with my machine so I couldn't look at the data when I was using them. I'll have to check when I get home. I was waking up pretty often due to it leaking though. If it didn't wake me, then I would wake up with a sandpaper feeling in my mask. I think I mouth breathe probably out of habit. I don't really know since I'm sleeping when it happens . I would guess that the mouth breathing is actually getting better because even with the Amara View, I would wake up with the sandpaper feeling a lot initially. That hasn't happened in a while. I actually find that my lips sort of seal themselves shut lately - I'm guessing somehow the humidity from my machine is causing that to happen. However, my doctor thinks that the Amara View isn't working because my mouth opens in REM and shifts the masks position, so maybe I'm wrong about it getting better.

@Okie bipap thanks for the liner pattern. I will try that out while I'm waiting to hear back from my DME on different mask options.

Really appreciate everyone's thoughts and help. This week has been frustrating since I feel so close to finally feeling better, but so far at the same time. Nice to have a place to get some ideas

[Okie bipap]

That liner will work with a regular FFM. If you want a pattern for a liner to use with the Amara View, PM me.

[diane@bydesignmedia.ca]

The Face Cozy is the best solution I've found to eliminate strap marks. It comes with two in the package and they're washable so they last for about three months. They're not pretty but it's more important for me to be pretty in the morning than while I'm sleeping with my CPAP on! facecozy dot com