Therapy thread Scoobydad updated

[ScoobyDad]

EDIT: Therapy posted towards bottom but reading the stuff leading up will give you an idea of what is going on.

First I was sent the philips dream wear pillow mask. The medium was small and as had to tighten it pushed on my teeth hard
Tried the large later pushed on my gums/teeth.

Then went to the F&P vitera. Full face. Worked for 2 weeks ok.
With a little riding up. After that it rides up a bit more and mask seal breaks. Or sleeping on side gets pushed off. It's to the point the two points are now pushing into my teeth through the skin for being tight. I shaved before bed and lots more seal breaks and movement.
So I have to pull it down
Sometimes turn my machine off and on due to high pressure like one cheek sticking out. Doesn't happen consistently. Mask seal break?
Gets moved sleeping on side.
Also it blows air on wife's face when we face each other.

Now I am on the resmed airfit f20
Tight on top of the nose. Don't know if I will get used too but overall better fit.
BUT. My cheaks puff out like a puffer fish if I relax them. The seal feels cheaper. I didn't sleep with it it's too uncomfortable

Is this a pressure thing? Or I have a odd head? My dad has the vitera too but my face is similar but not the same. He had a hard time due to his long gave which I don't seem to have.

[LSAT]

I love the Vitera...I am a restless sleeper. I sleep in all positions. I never have a problem with the Vitera.

[Miss Emerita]

Sounds like you're getting "chipmunk cheeks" using a full-face mask -- do I have the right picture? If so, that suggests you are mostly breathing through your nose with the FFM. Do you breathe through your nose during the day? If yes, then I'd suggest you try a nasal pillow mask, which won't press on your gums or teeth. The ResMed P10 is a minimalist mask that you might take a look at. If you try it, be sure to get the fit pack with all three sizes of pillows. When you fit it, keep in mind that the pillows are supposed to rest on the outside of your nares, not in them.

[ScoobyDad]

I breath through my mouth most of the time. I do sometimes through my nose a little because of it. But again mostly through my mouth. It is the chipmunk effect and it's as soon as I turned it on. I didn't even try to sleep in it. The others are wider to prevent it.
The other one they have the F30 but I am afraid after the philips pillow one which pushed hard on my teeth or gums.

I don't understand why it's so hard.
Thanks

Sounds like you're getting "chipmunk cheeks" using a full-face mask -- do I have the right picture? If so, that suggests you are mostly breathing through your nose with the FFM. Do you breathe through your nose during the day? If yes, then I'd suggest you try a nasal pillow mask, which won't press on your gums or teeth. The ResMed P10 is a minimalist mask that you might take a look at. If you try it, be sure to get the fit pack with all three sizes of pillows. When you fit it, keep in mind that the pillows are supposed to rest on the outside of your nares, not in them.

[Jlfinkels]

[snip]
I don't understand why it's so hard.

Part of the problem for all of us is we are in a rush for things to work. It takes time to get used to a mask and settings. For example, I started on P10 nasal pillows but kept opening my mouth while asleep, so i went to an F20 full-face mask. Once I learned to wear it correctly the F20 worked fine for a few months, but over time as the silicon wore out I had to keep tightening the mask until I finally replaced the cushion, which meant I had to refit it for the new cushion. Not a major problem, but it required diligence and focus, two skills I am sorely lacking.

After much reading and helpful advice from Zonker I started using a cervical collar with the F20 and realized I could keep my mouth closed during sleep as a result. So I decided to try the nasal pillows again and voila! No more mouth leaks. I went back to the nasal pillows and have gotten used to them and the collar. As a result of adjusting to everything I’ve even been able to reduce the pressure needed to keep the airway open, which not only lowered my AHI but also increased my comfort. Everyone is different, but for me it works well.

It’s a process, so patience is needed. Hang in there.

[ScoobyDad]

[snip]
I don't understand why it's so hard.

Part of the problem for all of us is we are in a rush for things to work. It takes time to get used to a mask and settings. For example, I started on P10 nasal pillows but kept opening my mouth while asleep, so i went to an F20 full-face mask. Once I learned to wear it correctly the F20 worked fine for a few months, but over time as the silicon wore out I had to keep tightening the mask until I finally replaced the cushion, which meant I had to refit it for the new cushion. Not a major problem, but it required diligence and focus, two skills I am sorely lacking.

After much reading and helpful advice from Zonker I started using a cervical collar with the F20 and realized I could keep my mouth closed during sleep as a result. So I decided to try the nasal pillows again and voila! No more mouth leaks. I went back to the nasal pillows and have gotten used to them and the collar. As a result of adjusting to everything I’ve even been able to reduce the pressure needed to keep the airway open, which not only lowered my AHI but also increased my comfort. Everyone is different, but for me it works well.

It’s a process, so patience is needed. Hang in there.

Thanks. First one over a month then got another. Then when that month was up got the ver one and 30 days was almost up so on to this one. But I can't sleep with my cheeks out. Not even going to try it.

I think I will call the doctor tomorrow before I phone in a replacement under 30 day trial.
Which I may try the last one. Or wait for them to order one from a supplier or go to another place with less strict covid policies and try a bunch on.

[chunkyfrog]

I get the impression that you are wearing your masks too tight.
Watch some of the headgear adjustment videos.
The silicone cushions are designed to work like an air chamber;
and will wrinkle and leak if squashed.

[Jlfinkels]

Thanks. First one over a month then got another. Then when that month was up got the ver one and 30 days was almost up so on to this one. But I can't sleep with my cheeks out. Not even going to try it.

I think I will call the doctor tomorrow before I phone in a replacement under 30 day trial.
Which I may try the last one. Or wait for them to order one from a supplier or go to another place with less strict covid policies and try a bunch on.

I found with the F20 it is a fine line between just tight enough and too tight. You want the mask to rest against the skin enough to seal, but not so tight that it leaves marks. That is the common problem with FFM as we think they have to be really tight to seal, but what happens is we place them just tight enough then when we add the pressure they inflate and seal properly. If done correctly they will hold the seal even when stomach, side-sleeping, or moving around. It is also very important to wipe the mask down daily with either a CPAP mask wipe or baby wipe.

If you have not done so consider watching some videos from TheLankyLefty27 on YouTube. He does a great job explaining how to properly fit different masks.

https://youtu.be/8s9vCgR06ZE

[zonker]

After much reading and helpful advice from Zonker I started using a cervical collar with the F20 and realized I could keep my mouth closed during sleep as a result.

[Miss Emerita]

When your cheeks blow up, can you just open your mouth to let the air out?

[ScoobyDad]

Thanks. First one over a month then got another. Then when that month was up got the ver one and 30 days was almost up so on to this one. But I can't sleep with my cheeks out. Not even going to try it.

I think I will call the doctor tomorrow before I phone in a replacement under 30 day trial.
Which I may try the last one. Or wait for them to order one from a supplier or go to another place with less strict covid policies and try a bunch on.

I found with the F20 it is a fine line between just tight enough and too tight. You want the mask to rest against the skin enough to seal, but not so tight that it leaves marks. That is the common problem with FFM as we think they have to be really tight to seal, but what happens is we place them just tight enough then when we add the pressure they inflate and seal properly. If done correctly they will hold the seal even when stomach, side-sleeping, or moving around. It is also very important to wipe the mask down daily with either a CPAP mask wipe or baby wipe.

If you have not done so consider watching some videos from TheLankyLefty27 on YouTube. He does a great job explaining how to properly fit different masks.

https://youtu.be/8s9vCgR06ZE

The f20 mask I read the instructions did not put on too tight. Then I tightened till the leaks stopped. I think this mask has the strongest seal. It's just causes my cheeks to pop out when I turn it on. So I won't sleep with it. The others kept it from happening except the V one once in a while one cheek. Don't know if it was over a seal break or not. But I would turn off machine and on and it was fine. It would happen 0 to 4 times at night.

[ScoobyDad]

I get the impression that you are wearing your masks too tight.
Watch some of the headgear adjustment videos.
The silicone cushions are designed to work like an air chamber;
and will wrinkle and leak if squashed.

The Phillips two sizes were because they said so.
The V one kind of but I did have to tighten it more because it will travel up and could get bumped to create a leak. Heck my lower lip even tight can fall out of the bottom.

This f20 I put it on loose and tightened till leaks stopped but got the chipmunk effect so no go. Otherwise it pinches nose more but it smaller and it seems to be a harder seal to break. I think it could be a little bigger for my big mouth.

[ScoobyDad]

When your cheeks blow up, can you just open your mouth to let the air out?

I breath through my mouth. I push the air out by pulling cheeks back in and it happens again unless I want to use cheek muscles to prevent it. I am sure they will loosen up while sleeping

[clownbell]

OP - Have you tried a pillow mask? They are easier to seal because the seal area for a pillow mask is smaller than the seal area for a FFM. Someone has mentioned the P10 which is popular. I use the Brevida. Different mask shapes fit various facial shapes.

Regarding mouth breathing, I don't mouth breathe when awake but my jaw gets slack when I sleep. I struggled with that for a year before trying mouth taping which has solved the problem. The MedVance 2" silicone tape works well for me. Your mileage may vary. Experiment and be patient.

[Jlfinkels]

I breath through my mouth. I push the air out by pulling cheeks back in and it happens again unless I want to use cheek muscles to prevent it. I am sure they will loosen up while sleeping

Back to some basic questions.

1. How long have you been on CPAP?
2. What are your pressure and EPR settings?
3. Can you download OSCAR and post some reports?
4. If no OSCAR what is the 95% pressure inhale and exhale from the “Sleep Report” screen on the machine? (Shows as “Pressure” and “Exp. Pressure”)

Many of us using a F20/FFM chipmunk had the chipmunk cheek issue for a bit, but it resolves over time with proper pressure, mask fit, and getting used to the device/mask.

Without more data (ala OSCAR) it is hard for those that understand those things to offer data-driven advice. We can keep throwing out ideas, but it is much more effective with data to base suggestions.