Questions/problems with Puritan Bennett BREEZE mask

[roncron]

I am trying out the Breeze mask (w/ nasal pillows). I have a couple questions and would be grateful for any advice or suggestions.

First question (for anyone here):

I'd like to find out the "normal" or acceptable leak rate for this mask, so I can compare my actual leak rate (reported by Encore Pro).

Here's one page from the Breeze manual with "vent flow rates":

http://www.scsv.nevada.edu/~roncron/cpa ... -rates.pdf

With my auto CPAP machine, my pressure is normally in the 8-10cm range. Does this table mean that my "normal" leak rate should be in the range of 25-28 LPM (liters per minute)?

Or, does it mean that 25-28LPM is the total amount of air going through the mask, including the part that goes down my nose and the part that is lost thru leaks?

I'm not sure, but it doesn't seem like it could be the total amount of air going through the mask, because Encore Pro reports my leak rates ranging from 25-40LPM when I wear this mask. That would mean that no air is going down my nose.


Second question (especially for folks who use or have used the Breeze):

I'm having trouble making this mask comfortable. The first night, I had it on pretty tight, and achieved a very low AHI & leak rate, but woke up with my nose hurting pretty bad. The second night, I wore it more loosely, and my nose hurt less, but my leak rate and AHI were higher.

I think what causes my nose to hurt is the pressure of the shell (the piece that holds the nasal pillows up against the nostrils).

This is particularly uncomfortable if I sleep on my back. The "cradle" of the headgear sits on the lower curve of the back of the head. Laying on my back, the pressure on the cradle from the weight of my head forces the shell & pillows hard against my nostrils, which is what hurts.

Should I try a different pillow? Sleep only on my side? Return the mask (I bought it from cpap.com with return insurance)?

To those of you who use or have used the Breeze, do you have these issues? Do you know of a way to alleviate them? Do you have any other tips that will increase my success with this mask?

Thank you!

-Ron

[rested gal]

Ron, check out the fixes some lab rats came up with for the Breeze:

LINKS to Lab Rat Trophy awards
viewtopic.php?t=15104

I know that one of the big pluses with the Breeze is nothing at the sides of your face. But....if an extra, soft stretchy strap, or cannibalized different headgear altogether makes it work better for sleeping, especially on one's back...I say, do what will make it work!

I used the Breeze for over a year -- loved it. But I was a habitual side sleeper. One side or the other, turning over often during the night. Rarely, if ever, slept on my back. I guess not sleeping on my back was habit formed in a lifetime of no treatment. Probably I subconsciously stayed in positions (on my side) that lessened the chance of apneas.

After almost two years using cpap every single night, I found I was beginning to sleep on my back occasionally. Took that long, I suppose, for my body to find out that was ok with "cpap" going.

By then, I was using the Aeiomed Headrest mask instead of the Breeze, so sleeping in any position was easy. Had I still been using the Breeze, I'd have lab-ratted the back of the headgear off for sure.

At any rate, even after PB made the "halo" straps longer and added that little ladder like adjustment in front for those straps, I still used my own homemade strap instead. Yeah..."the leg." Kept it more stable for me than the straps that come with it.

I wear the homemade strap down even lower than in this retouched picture:



Note in the retouch, I routed the hose up. That's very important with the Breeze, imho, to hang the main air hose up where the weight of the air hose doesn't tug at the headgear if you turn over.

[JeffH]

I tried the breeze for a week and couldn't make it work for me. Went back to the Breeze's daddy...the Adams Circuit that is all soft adjustable straps that work great. BTW, I don't' use the angle piece on my Adams. When I bought my first one they didn't come with it, and when I tried it later, I didn't find it helped me.

Like I told DreamStalker, the front half of the Breeze is a great piece of design. The back half, a nightmare!

[ozij]

Setting up
the Breeze by WillSucceed.

I never used it too much for back sleeping either.

You really have to fiddle around with all those many change points - including the screw in front that tilts the shell in and out.

When I used the Breeze - I found it helpful to stick a folded tennis sock between my head and the outrigger - it kept the shell from being so heavy on my upper lip.

And yes, in the beginning my nose was sore.

O.

[Bookbear]

I use (year and a half) and like the Breeze. You are correct, the chart in the patient manual IS the "vent rate", i.e. the average amount of air that is "leaked out" from the lil blue jet exhaust port on the front of the plenum (the plastic bit that holds the nasal pillows). Note that it changes depending on your pressure. Unless you have a very old machine, your cpap should easily be able to deliver the stated pressure with the Breeze's vent rate (it's one of the lower rates around). Essentially, the mask has to have a way to expel the co2 you exhale. Since the Breeze has no valve assembly, that exit is always open. When you are breathing in, some of the air is being vented out that exit (the vent rate). Cpap's are built to compensate for vent rates as long as they are not too excessive. The leak rate your software is showing you is well within limits.

WillSucceed's page of tips on fitting the Breeze gives excellent advice... it should be every Breeze user's basic reading. Also, Rested Gal's repositioning of the halo straps is worth considering. Several people here use that mod very successfully. That cradle piece at the base of the skull can be adjusted (as can many other parts of the Breeze). Also, a soft pillow may help with that. I found an especially firm pillow (Temperpedic) did not work as well for me with the Breeze for that reason.

I would add that positioning your main hose from the cpap to the Breeze is essential to minimizing leaks. Be sure it is hung over your head (a hook on the wall or headboard, even a ceiling hook to hold up a wire or tether to fasten the hose to). It is easy to use a rubber band or similar to thread the hose through to provide some 'give'.

I have found that rinsing the pillows daily in a cup of hot water and mouthwash really helps keep the pillows pliable and soft. Don't skimp on this! Also, note there are four sizes of pillows. If you are having problems with leaks, try a different size - it makes a considerable difference.

Good luck with your therapy!

[wingshot37]

I have been successfully using the PB nasal pillow interface with my CPAP machine for 7 years. However, several months ago I started to develop a leak that blew air into my right eye. I bought and tried all available sizes of new pillows....no luck. I couldn't see anything wrong with the plastic end piece where the pillows are inserted, but I bought a new plastic end piece to see if it would help.......same problem, same air leak blowing into my right eye. Frustrated, I closely inspected each plastic end piece, the old and the new, with a magnifying glass under a strong light, and found the same problem with each. They are made out of two pieces of plastic welded together like a closed clam, but the weld seam on each had separated just slightly on the right side. No opening was visible, but I could see slight movement under magnification when I pushed the two pieces together. I fixed them myself with a thin bead of Gorilla Glue placed along both inside and outside the seam area, and then worked it into the separated seam by flexing the two pieces together several times. I kept the seam closed until the glue set with a small plastic spring clamp, but masking or packaging tape should work as well. Mystery and problem solved! This glue is waterproof, and so far (4 months) has not been affected by the detergent and vinegar used to clean it. Hope this may be of help to others.

[kteague]

I used the Breeze for several months, and actually got my first real sleep with this mask. Never could back sleep with it though because the pressure on the back pushed the nosepiece out of place.

If the nosepiece is pushed against your nose between the pillows, sounds like your pillow size could be too small and allowing the pillows to go into your nose too far. They should sit against the outer rim of the nose with just the tips inside. Using a larger pillow helped me with that.

I also had trouble with a leak along the seam of the nosepiece, and I glued it and added moleskin to smooth the edge. By the time I angled it to fit my nose and not leak, it was resting on my upper lip and rubbing it. Again, the moleskin took care of that.

I ended up following some others lead and deconstructing the headgear.

[DreamStalker]

I have tried almost all the nasal pillow type masks (except for Bravo) and the one that I continue to use 99% of the time is the Breeze ... I chopped it up and rebuilt it for my toss-and-turn sleeping style (no metal plate pressing against the back of my skull and no upward pressure tugging on my nose) ... front, back, side, no matter, it works any which way.

See RG's link for details.

I have modified it a little more since then. I added the hose cover to mitigate rainout and also added a chinstrap to keep it from riding up the back of my head. I wear a soft stretchy fleece headband underneath too. Actually, with the fleece headband, there is enough friction to keep it from riding up most of the time. Nevertheless, still very light weight and very quick and easy to put on and off. I can put it on in the dark and hook up to main hose with sense of touch only in about 20 seconds.

[rested gal]

See? See.....?

See why DreamStalker won a Lab Rat award?!!

Super picture, Roberto!

Good advice, wingshot, about checking the clamshell seam if odd leaks occur. Good fix with the glue.

What Kathy (kteague) said about the size of the nasal pillows is a strong possibility:
"sounds like your pillow size could be too small"

I think most people do better with nasal pillows for the Breeze that probably seem like they'd be "too big." I think most men should get the Large or Extra Large, and women should get the Large.

The Breeze's nasal pillows are so soft and smushy (except for the "mediums"...the clear silicone for some reason is a tad stiffer than the colored pillows) you can use a larger size than you'd think you'd need and they smush up against the outside of the nostrils quite comfortably. They seal better that way, I think, than using a size that goes much into the nostrils.

The color of the most common sizes of Breeze nasal pillows:

small - light blue
medium - clear
large - pale green
extra large - lavender

[rested gal]

For new readers who might want to dig into more topics about the Breeze, here ya go:

LINKS to Breeze nasal pillows / nasal mask topics
viewtopic.php?p=31202

[roncron]

What would I do without you all?

Thank you all so much for the great tips and links to information. Rested Gal, you should be a librarian (I work at a university and the most important person here is the librarian - they connect all researchers and students with the critical info they need - you do too!).

Dreamstalker, I love your headgear mod - especially the little alien face.

Ozij, thanks for the link to WillSucceed's tips for the Breeze.

And thanks to the rest of you.

I owe the people on this forum so much, you guys have really made a difference in my quality of life!