Pressure changed to 16 - does this limit me to nasal masks?

[highacidity]

I had a second sleep study recently, and afterwards the doc raised my pressure to 16 from a previous setting of 12.

This seems to exacerbate the issues I have with my Activa mask, and after discovering this forum, I thought to try other interfaces as money allows to find a better fit.

The RT at my DME said not to use nasal pillows/prongs with that setting, and I can kind of see the rationale, but I am really hoping to have more options with my search for an improved fit.

First time post/newbie member info: Have used CPAP for over two years, I maintain compliance for the most part, but sometimes find myself waking more than I think I should to adjust the mask, and turning over in bed feels like a major project. I am a side and prone sleeper, which does not help matters. I have tried to train myself to sleep differently, with no success.

Currently I have an older Remstar machine (insurance will not replace it for a while) and the Activa mask. I like the way the bellows-like cushion moves with me, but the whole hard plastic assembly seems to hit the pillow too often causing leaks. It feels like if that assembly was smaller and not as deep, maybe that would work better, it feels almost too big, and I have the smallest size. I am a very short person, with facial/head proportions to match (for example, the dentist must use child-size appliances on me). Also, the strap assembly rides up to the point where the top strap in the back is totally off my head, to fix that requires tightening the straps so much that the bellows cushion function is defeated.

I saw the Breeze with the Dreamseal mask option, that looks promising, but many of the reviews mention leak problems.

I realize every person is different, etc. but I am becoming very frustrated, and despair of fixing the problem without spending a lot of money. I hope this post makes sense and sorry if I am not following some site conventions properly as of yet, although I am an "experienced blogger" (how funny that sounds) every community is different too

[Wolfmarsh]

I am at a pressure of 17 and use a UMFF.

I love it.

I have to strap it down pretty tight to get rid of leaks, but it doesnt bother me at all.

[highacidity]

... and thanks for the reply. I guess I was hoping for something less bulky. I am not sure how a full face mask would work with my propensity to sleep on my side and tummy. How do you sleep using that mask?

[snoregirl]

I am on auto 10 - 15 and I use a swift pillow. I have definately been to 15 with no problem, but that is not for the whole night, so I can't say how you will do with a pillow, just that for whatever time I am there it doesn't seem to bother me.

[momadams]

I use a Swift at 16 cm h2o with no problem. But I live at altitude, so it would translate to a lower pressure at sea level.
Shari

[Shari]

I have used a Swift at 18 with NO leaks. I loved it.

After my latest study I was switched to BiPAP at 21/18. I am having some minor (but immensely annoying) leaks at the higher pressure.

DME said only a mask would work at my pressure and very reluctantly allowed me to try a pillow system. Try a different interface, it may work for you.

[JZ]

I can't speak to the pressure issue with nasal pillows as my usual pressure is 7 to 8 with occasional spikes up to 10. But like you, I have a small head and facial features. I am mostly a side sleeper.

I know a lot of people like the Swift or better still the Swift II. But the Swift did not work well for me as the nasal pillow cylinder stuck out too far on the sides. I could not sleep in my normal side position without dislodging the pillows and causing leaks.

I now use a ComfortLite 2 nasal pillow system, which works pretty well for me. It has available several sizes of nasal pillows, a "direct seal" nasal interface, and a "simple cushion" interface that is a very small nasal mask. I think these work well for side sleepers. Someone else will have to advise you about whether they would be appropriate for your 16 pressure.

Good luck. Hang in there until you find a mask that works for you.

Janna

[rested gal]

I had a second sleep study recently, and afterwards the doc raised my pressure to 16 from a previous setting of 12.

---

The RT at my DME said not to use nasal pillows/prongs with that setting ...

The RT is mistaken. Nasal pillows interfaces (Breeze with nasal pillows, ComfortLite 2, Twilight NP) certainly can be used at pressures all the way up to 20 and more.

At any pressure -- high, low, inbetween, you might find that an extra homemade strap or two placed over the nasal pillows and tied behind your head will help stabilize just about any mask better for toss and turn sleeping. Like so:



An additional strap doesn't usually have to be tight at all. You know how you can use your fingers to push lightly against the front of a mask and the leaks stop instantly? The homemade strap acts kind'a like that. Works much the same way as having your hand there, to give a little bit of "light push" from in front.

It also helps (with any mask, at any pressure) to hang the main air hose overhead:

LINKS to Hose hangers and methods of managing the air hose
viewtopic.php?t=10640

I didn't see a humidifier listed in the equipment in your profile. If they didn't give you a heated humidifier to use with your machine, I really think they should have. If they tell you they didn't because the doctor didn't prescribe one, I'd be getting the doctor to prescribe heated humidification immediately. Even if you think you might not need it, better to have it available just in case. You can always leave it turned off.

While my pressure doesn't usually get above 14 for brief periods on occasional nights, I did experimentally try three nasal pillows masks at a straight pressure of 20...just to see if they could handle it.

With my usual extra strap across the pillows, these masks sealed fine at 20. I could barely breathe out against that pressure, so I didn't leave it there long...less than ten minutes for each mask. Long enough to be sure they worked fine and maintained their seal during a lot of turning over from side to side.

Personally, I'd also be pushing for the doctor to prescribe one or the other of these two machines and would try to get the DME to swap your machine. They probably won't, but it doesn't hurt to try.

1. Respironics M series Auto with A-Flex
or
2. Respironics BiPAP Auto with Bi-Flex

Given that they are raising your pressure considerably, I'd want a machine that can vary the pressure as needed throughout the night -- night after night. And will give good relief from pressure each time I exhale. It's very possible that you don't need that pressure of 16 ALL night. You might need it only during worst case scenarios -- when in REM and sleeping on your back. I'd want a machine that will vary the pressure as needed.

Good luck! And welcome to the message board.

P.S. Here are links to a lot of different masks. In the topics for each mask, you'll find some cool tips and tricks to making the masks work better if they need a bit of tweaking.

LINKS to MASKS - nasal mask, nasal pillows, nasal prongs
viewtopic.php?p=35286

[highacidity]

If anyone sees this after so long... sorry for the delay with my reply, I had a bout of food poisoning which pretty much knocked me out for a few days.

Thanks everyone for the input.

Rested Gal, thank you for the details!

I didn't see a humidifier listed in the equipment in your profile. If they didn't give you a heated humidifier to use with your machine, I really think they should have. If they tell you they didn't because the doctor didn't prescribe one, I'd be getting the doctor to prescribe heated humidification immediately. Even if you think you might not need it, better to have it available just in case. You can always leave it turned off.

Actually, I was prescribed a humidifier with this last prescription change, but I am waiting to get it until I return from my extended vacation which starts in little over a week.

Personally, I'd also be pushing for the doctor to prescribe one or the other of these two machines and would try to get the DME to swap your machine. They probably won't, but it doesn't hurt to try.

1. Respironics M series Auto with A-Flex
or
2. Respironics BiPAP Auto with Bi-Flex

Given that they are raising your pressure considerably, I'd want a machine that can vary the pressure as needed throughout the night -- night after night. And will give good relief from pressure each time I exhale. It's very possible that you don't need that pressure of 16 ALL night. You might need it only during worst case scenarios -- when in REM and sleeping on your back. I'd want a machine that will vary the pressure as needed.

I wonder if I can get the doc to prescribe one of the units you suggest. I will try when I get back. I am going to be traveling with the GoodKnight for a few weeks first.

I have a lot to consider here