has anyone found a mask that doesn't leak?

[feklar42]

Has anyone found a mask that works on someone with a small nose, but a normal/big face/head? The sizing charts say I should take a small mask, but the small-size quattro's straps barely fit around my head.

I've tried 4 masks in 4 weeks and each leaks like a sieve when it gets to full pressure. The quattro leaks even at mid pressures but did stop the dry mouth. Also, why do the DME's keep giving me Resmeds to try? I wouldn't even let them send me the first one they wanted--it fit so badly, it hurt; the next one they gave me was an Activa. I used it for a week and I hated it. The best fit I've had was an F&P flexifit, but I had mouth breathing issues and had to get a ffm. And they gave me another Resmed--the quattro. After thr first night I reallized it has the same fit over the bridge of my nose that made me reject the first one. Why do they keep going back to them? Is Resmed cheaper or something? The F&P was a petite and the straps were perfectly comfortable, while the quattro's straps barely (and painfully) fit, which also says cheap to me--why be stingy with the headgear?

I'm so tired and in so much pain right now I just want to cry. I spend my first hour in bed everynight fiddling with the straps--loosening, tightening, buckling, shifting up and down, and tucking in the plastic around my nose, trying to find some magic combination that will make the damn things work. I turn over and end up waking up with leaks all over, so I go through the whole readjustment thing again. The only thing that works with the quattro is making it so tight it leaves marks on my nose and my neck hurts for the straps. It still leaks around my chin if I shift an inch.

The air pressure is still killing my ears. My Dr. lowered it from 16 to 14 and it still leaves them permanently blown out. And no, I don't have an ear infection. My neck is stiff from the mask and not being able to move when it's on--or else it will leak. I'm in pain, I'm frustrated and annoyed and I just want to give the damn things to the dog as a chew toy.

[mdintx]

I just received a ResMed Activa LT. I've gone through a few masks. I couldn't get the Quattro to seal effectively. It felt like having a hovercraft on my face. The Swift LT has stopped working for me. The Mirage Micro roughed up my nose though it sealed pretty well.

I ordered the Activa LT based on the reputation of the Activa as being a mask that seals very well and works well for side sleepers. I haven't spent a night with it (just arrived today) but in my test fittings, I can literally grab the mask by the nose piece and move it side to side and it will not release from my face. This is with the straps loose. It also sealed well when using 3M Transpore tape on the sensitive areas of my nose.

What didn't you like about the Activa? Was it the size? If so, the Activa LT has a smaller frame. The Mirage Micro also has a similar frame size. People who struggle with the Quattro sometimes do better with the Ultra Mirage Full Frame. If the F&P product worked best for you, perhaps you should look into their full face masks at cpap.com.

Mouth breathing issues can be dealt with by utilizing a chinstrap or taping the mouth shut. Have you tried any of these?

If you have rounded nares (openings to your nose), a nasal pillow system might work. There are some that also feature the mouth section such the Hybrid or Liberty.

Basically, this process is often about trial and error. Being patient sucks while you feel like hell. We've all been there! My story includes starting off well and for some reason, going into relapse.

[carbonman]

The sizing charts say I should take a small mask, but the small-size quattro's straps barely fit around my head.

I spend my first hour in bed everynight fiddling with the straps--loosening, tightening, buckling, shifting up and down, and tucking in the plastic around my nose, trying to find some magic combination that will make the damn things work.

Here is a different perspective on sizing masks.
viewtopic.php?f=1&t=34880&p=299174&hilit=p298811
Hope it helps.

Another suggestion is to work w/your mask/machine when you are NOT going to bed.
Make some time when you can test/experiment/adjust when you are not tired and needing to sleep.

It's a journey.

[jdm2857]

...and do that testing with the machine on and in your usual sleep position(s).

[MurphysLaw]

Have you tried the Mirage Liberty? I used to use the OptiLife with petite nasal pillows until I had problems with my mouth opening. A chin strap didn't help much at all. My head is on the large size. I really like the Liberty's small sized nasal pillows, although I wish the head gear were a little larger.

I tried the FF Quattro for one night and I fiddled with the straps all night long, loose, tight, nothing worked well. The only time I didn't get leaks, I was in so much pain. I knew it wasn't for me. One night on the Liberty and I was sold.

Good luck to you.
Lynne

[feklar42]

What didn't you like about the Activa? Was it the size? If so, the Activa LT has a smaller frame.

I was using an LT Med--it's still pretty big compared to the F&P. It has basically the same plastic skin as the quattro, but with a much more protuberant inner cushion. The edges of the inner cushion start to feel really sharp after a few hours and I felt like the base of my nose was rubbed raw--almost like razer burn. Also the thin outer skin does not seal as well as advertised--at least for me. I got a lot of leakage around the bridge of my nose into my eyes. The quattro has the same thin outer skin seal and it works even worse on the quattro--I now get leaks into my eyes and over my chin. With the Activa I could tie a bandanna over my eyes to protect them, but the Quatro rides so high I can't do that.

I did try tying a bandanna under my chin to keep my mouth closed with the F&P. It didn't work.

I didn't like the few tests they did with nasal pillows. But again they kept bringing out Resmed ones (LT Swift for Her and the regular Swift)--I'm beginning to wonder if Resmed bribes my providers! I should have remembered this when I was testing ffm and asked for another brand. They just aren't made out of materials I like or for faces like mine or something.

[Yoda]

I have a very small nose, too. I use the comfort gel petite size. The leak rate is in the normal range. It took several tries to get one I could use successfully.

Good luck!

Cecile

[GumbyCT]

yea, w/o reading all the rant, I'll just say a mask that fits your face and adjusted properly will seal and not leave sores. Many choose to use their mask troubles for what they think is an excuse not to use cpap.

If you want learn, do some searching and reading. The nasal mask seals easier bc there is less surface area to seal than a FFM. Nasal pillows have even less surface area.

Good Luck

[rogelah]

ResMes has 3 sizes of headgear for the Quattro...small, standard and large. Maybe a change in headgear size would help.

[spitintheocean]

I use a Mirage Quattro size small at average pressures between 16 and 18 and have absolutely no trouble with the size of the headgear. Perhaps as pointed out by the previous poster your headgear needs to be upsized, not necessarily the mask.

Mind you, I do have the sort of classic face that most plastic surgeons like to advertise in their "before & after" catalogues and as a child, rarely caught my head between fence posts or in buckets so perhaps I'm not the best example out there.

I inevitably start out on my side with no leaks and only incur minor leaking (<.20L/sec) when I later roll on my back during rem sleep.

I never use the fasteners to attach the headgear but do have a routine that I have developed that does work quite well for me at these high pressures.

1. Start off with loosened straps and the adjustment knob on the front of the mask completely backed off (I always remove the mask by loosening the velcro fasteners and spinning the adjustment knob counter-clockwise)

2. Place the headgear on your head and the mask should fit loosely. Make sure the headgear is pulled all the way down at the back of the head.

3. Ensure that the bottom of the mask bellows rides in that hollow between your bottom lip and chin and the mask feels centered on your face.

4. Lightly tighten the bottom fittings by pulling equally on both sides of the lower straps. Make sure the lower straps are running below the jaw line.

5. Tighten the upper straps (simultaneous force isn't as important at this step but the upper mask should feel snug at this point).

6. Return to the lower straps and pull both sides equally to cause a snug fit.

7. Turn on the cpap unit (I skip settling/ramp and go to full blast immediately, primarily so I will know if my mask can handle the higher pressure .... before I fall asleep)

8. Turn the mask adjustment knob clockwise until the hissing stops. ( I usually just crank mine all the way) This sequence allows the bellows time to inflate and properly seal against your skin.

9. If any leakage is occurring, tighten the corresponding bottom strap as required. At this point, do not tamper with the upper strap fitting or all is lost.

10. If you are still incurring air leakage around the mask edges, first back off the adjustment knob, then recenter the mask and tighten the lower straps, followed by fiddling with the adjustment knob.

I make a point of washing my face each night at bed-time and seem to have settled into washing the mask every three weeks or so.

The last thing I do before putting on the mask is blow my nose and check the humidifier settings.

This may seem like a complicated, arduous routine but rarely takes more than fifteen or twenty seconds.

[apnez]

My experience. ResMed Activa LT : 0 a BIG ZERO leaks day after day. If you are over 7 you should learn how to adjust it within a... week. Never tighten too much, just what is necessary to avoid leaks. Nearly no marks, nothing that you can't handle. Perfect for side sleeping. And I learned to keep my mouth closed as far as apnea is concerned otherwise, it is another story!

[mthomtech]

I definitely found the F&P FlexiFit masks the most comfortable, with the ability to move around without creating leaks. I used to use the HC407, but switched to the "Zest" model last year, and love it. It's very small, which helped stop the leaks. The 407 did give me a few problems with leaks, causing me to tighten it more than I wanted to ... but the Zest holds steady with much less tightness.

One thing I found for myself was that I prefer the top of the mask more loose than the bottom (which seems opposite of the instructions), but the forehead pads bothered me if I kept the top tight at all. I also noticed that the mask touch points (top of nose and forehead pads) only caused an issue the first week or so ... then I guess my skin got used to it or the headgear relaxed a little, because it was fine later.

After moving to the Zest mask, it's much easier to find a completely leak free seal, and I can move from one side to the other with any problems.

[apnez]

By the way , feklar42, which one is your machine?

You are asking why do they provide me with only ResMed masks? If you have a ResMed machine ResMed machines take into account the normal leak figures of ResMed masks when giving leakage results. They are made to work together.... even if other brands can work anyway. This could be the reason. ResMed masks are not cheap masks. As a matter of fact they are considered as being probably made with the best materials compared to some other brands. No doubt that both ResMed and Philips Respironics are the top leaders.

Why did you hated the Activa as you said? The reason why they gave you an Activa is probably because the Activa medium is one of the best fit for a small nose but normal to large face which seems to be your case. Was it a medium ? The medium is their smallest model and is really small for a medium.

Be careful when you try a mask. Always read the exact procedure for that specific mask and apply the specific procedure. Procedures varies from one mask to another. Masks are different and procedures also. Proper adjustments are extremely important and adjustments should NEVER be painful. The big and frequent error is overtightening. This is what mainly causes marks, pain and nose soreness. My Activa "floats" on my face. If I tighten it more I get worst results, pain and more leaks The pressure does mainly the job. As spitintheocean says, allow "the bellows time to inflate and properly seal against your skin". It is the bellows that makes the seal. Not the pressure of overtightened straps.

What you are experiencing is NORMAL. Some need to try 5-6 different masks and sometimes start over again the process finding that one of the mask they rejected at the early stages becomes the winner as they, since the beginning, better learned how to cope with masks!

Good luck and be optimistic. You are nearer a solution than 4 weeks ago!

P.S Many people here have very good figures. They all found a mask with "no" leaks as a no leak mask is a necessity if someone wants good figures and an efficient treatment. No leaks is a must.

[Silver Pelt]

No Leaks is a must

No leaks are nice, but certainly not an absolute necessity when using a full face mask. I get good sleep and an AHI 0.5 - 1.5 with my leak at 55; 30-odd from the mask and the rest through my beard. Those numbers are from a full night with no large leaks. If the machine detects a "large leak" (more than 75 LPM on the Respironics Auto M) it stops adjusting pressure and scoring apnea flags and hypopnea flags, but I still get therapy. I can't see the results but I can feel them, and what matters more, getting good sleep or getting a low score on a high-tech machine? The point is to maintain positive pressure and keep the airway open, and that can happen even with leaks. The machine makes more noise with leaks, but as long as it doesn't wake me or my wife, who cares?

No leaks are much more important, basically essential, with a nasal mask, as leaks through the mouth relieve the pressure and prevent effective therapy. But with a full face mask some leaks are tolerable, particularly if they allow a comfortable fit and better quality sleep.

[feklar42]

Thanks for your input. As frustrated as I am, I do feel a bit better about the "masking process."

By the way , feklar42, which one is your machine?

M Series with C-Flex, smart card and humidifier. It seems like a pretty nice machine, though I don't seem to have any way of reviewing data without taking the card into the doctor. I asked the DME thereapist and he said he didn't think you could find that info out from the machine w/o a card reader. Maybe they just bring out the resmeds b/c they are the most popular, without taking into account that general popularity doesn't mean it will fit me. I think the resmeds are just not well-designed for my head--aside from the sealing problems, the lower straps cross my ears, not my jaw/neckline as shown in the photos, I wake up every few hours to pull it down and the cartilaginous areas of my ears still feel bruised by morning.

The big and frequent error is overtightening. This is what mainly causes marks, pain and nose soreness. My Activa "floats" on my face. If I tighten it more I get worst results, pain and more leaks

I keep reading this but it doesn't seem to be true for me. I go through the whole regimen spitintheocean listed several times a night (including turning the machine off and starting all over again). The bellows thing only only seems to work at lower pressures, by the time it hits 14 they are leaking and I end up tightening it down. One of the worst pain points isn't the bridge of my nose--it's the cheekbone where it connects with the bridge--the quattro and the first resmed (can't remember type) both pressed very hard against that. The hard plastic part of the activa sits further away from that part of the face, so that wasn't an issue with the activa. But, with the Activa LT Med, I found the interior cushion was unpleasantly stiff and scraped the bottom of my nose raw--I ended up pulling it lower and lower until it was almost over my lip. This is where I liked the F&P better--the foam insert was much more comfortable. It was also smaller, yet seemed to give less pressure on my sinuses/bridge and under my nostrils.

So far, about mask testing, I have learned
1) don't let the DME 'test' masks at lower pressure
2) test lying down and moving
3) test the actual size they are going to send me home with
4) Insist on trying more masks than they want to let me try. Despite my ranting on this board, I'm actually pretty shy IRL, so when they bring one mask out and say, "Hey that works," I feel bad about making them get more out. It actually took all my nerve to refuse the first one. The sleep tech tech actually looked annoyed at me for refusing it (I had a visible bruise on my cheek/nose bridge and severe red eye from it) pointing out it was the one I'd slept all night with. She had only given me 3 to try in the first place--the first was a larger activa that leaked so badly she took it off before I could even try it out, the second was a gel that practically covered my nostrils, so I couldn't breathe, and then the last one that I rejected in the morning.