Can't Find a Mask That Doesn't Leak

[jimD]

I am 66 years old and, after a sleep test on October 24, 2009, was diagnosed with severe sleep apnea (AHI=58!). IMHO, my first titration trial was a total failure -- as a result, my previous sleep doc prescribed the ResMed S8 Autoset II. He also prescribed a ResMed Mirage Quattro FFM.

I used this setup in auto mode for a few weeks and then switched to a Respironics FitLife FFM -- the Quattro was really hard on the bridge of my nose. From Nov 20, 2009 - January 11, 2010, the CPAP 95th percentile pressure was 12.1 cmH2o. Overall, my results – though far from perfect - were very satisfying: AI=4.7 / AHI=15.5 / Leak=22.2.

I had a septoplasty Dec 16, 2009.

I switched sleep docs and had a second titration trial on Jan 11 -- the sleep technician and doc recommended a ResMed Swift LT mask and chin strap, even though I am definitely a mouth breather. Her titration test showed zero apneas at 14 cmH2O. I went along with it since the nasal pillows are *much* more comfortable than *any* FFM! They also recommended switching to CPAP mode at 14 cmH2o.

The sleep tech also detected 164 periodic limb movements with arousals -- I started on .125mg of Mirapex on Jan 19, working my way to .5mg over a two week period.

I've been in CPAP mode (no ramping/No EPR) at 14 cmH2o since Jan 19. Though I tried 3 different chin straps, the Swift LT leaked too much (I even tried taping my mouth shut!). I switched to a ResMed Mirage Liberty, which seemed to offer a nasal pillow option for us mouth breathers. Unfortunately, the 14 cmH20 kept blowing the pillows out of my nostrils. Unlike the Swift, the Liberty doesn't allow for adjustment of the angle at which the pillows enter the nostrils (I tried medium and large pillows). Even my Mirage Quattro and FitLife masks leak much more at 14 cmH2o than they did at 12.1 cmH2o.

My overall results with any of these masks are not disastrous -- my AI is still staying below 5. However, it's difficult to interpret my results with leakages that are all over the map ... Jan 19 - Jan 28: Median=9.6 / 95th percentile=30 / Maximum=48.6 L/min.

Is it even possible to achieve zero leakage at a steady 14 cmH2o? If the answer is yes, I would *really* appreciate your suggestions. Also, is there a "hybrid" mask like the ResMed Mirage Liberty that allows you to adjust the pillow entry angle?

[harry33]

you seem to need a full face mask and a humidifier, has anyone tried to figure out why you mouthbreathe when asleep, do you mouthbreathe when awake?, if not then liptaping usually teaches you to eventually keep lips shut

try to find an experienced mask fitter who has a range of different brands to try

[Muse-Inc]

The RespCare Hybrid is the original hybrid-style mask incorporating pillows with an oral cushion that covers the mouth. The 2 masks fit quite differently. The Hybrid's pillows can be set at two heights and are larger overall with a single-wall construction, softer too it seems to me. The top of the head strap helps keep the pillows in place. Rooster has an entire thread on fitting as some-many of us need an additional strap/fix to keep them securely in position. Quite a few of us wear the Hybrid. LinkC wears it, I think he requires a higher pressure than you.
viewtopic.php?t=14422&highlight=

[SnoresLikeWalrus]

I have successfully switched from the quattro full face mask to the liberty "hybrid" (nasal pillows and covers mouth)

it is like the liberty was made for me....the pillows (small) fit just right even though the mask is size large.

you never know until you try is what I found out.

[Gerald]

I'm using a Headrest mask with 2" Blue #2080 3-M painter's tape. AHI is consistently below 1.0.

Gerald

[scrapper]

the Swift LT leaked too much (I even tried taping my mouth shut!).

Does the Swift LT leak, or do you leak from mouth breathing?

If it's the Swift LT, there are a couple other option out there. Ensure you are using the right sized pillow. As my pressure went up, I went to a smaller pillow in order to keep it seated and sealed at the nares. You can also use a little lansinoh (bought in the baby aisle--originally for nursing mothers) to help with the seal.

Another member (gl) inserted "O" rings around the pillows to add stability:

Here you go. The o-rings I use with a medium cushion are 9/16" I.D. (13/16" O.D.) x 1/8" Wall. I've included a picture of the packaging from the ones I bought at my local Lowes, the brand is BrassCraft. I went to try to get some from a Lowes in Texas recently though and they didn't have the same brand so I don't know if these are just a regional thing or if they've changed suppliers. Regardless, the brand shouldn't matter. Obviously, if you want to do this with one of the other size cushions you'll need to get a correspondingly larger or smaller size.

For the picture, see:
viewtopic.php?f=1&t=45777&st=0&sk=t&sd= ... 15#p411149

[mars]

. Overall, my results – though far from perfect - were very satisfying: AI=4.7 / AHI=15.5 / Leak=22.2

My overall results with any of these masks are not disastrous -- my AI is still staying below 5.

Hi JimD

My understanding was that acceptable therapy was an AHi of 5, not an Ai of 5.

You quote an AHi of 15.5, which is 10 over the acceptable 5.

Did I understand you correctly?

cheers

Mars

[torontoCPAPguy]

Here's my take as a relative newbie....

I started with the Swift LT nose pillows and it was horrific. I am a side/stomache sleeper and everytime my nose smooshed up against the pillow the Swift LT also smooshed and my air supply varied (all one need do is look at the design to see what I mean).

I then tried the mask that came with the CPAP machine - what a torture device THAT was! I actually awoke some mornings with blisters on my nose, especially the bridge.

So off I went to the supplier (who was a thief of the highest order $300+ for the Swift?) and made my point in no uncertain terms. Here, try this one he says, handing me a Mirage Activa LT in Large. I went home, put it on to lay down and try it out properly with my own bed and pillows and prompty fell sound asleep for almost two hours. Dead to the world.

I have yet to return the sample to him, but will, along with the Swift LT nose pillow for a full refund you can be sure. And I am absolutely hooked on the Mirage Activa LT. It is like wearing... well, like wearing nothing. And the supply of air is constant and no leaks for the most part.

I would suggest you give it a try and perhaps try a couple of others. The Mirage Activa seems to blow up like a balloon when the machine is turned on and improves the seal. I may have to wiggle it about a bit and adjust the straps to get a solid seal (takes a minute) but once done... it's like I am not wearing a mask at all and no leaks, even if my nose smooshes up against the pillow.


Mind you I have only been using it for about a week now.... am about to pick up an S8 Autoset with software and card reader to see what's going on in real life... highly recommend anyone using CPAP know what is going on night to night. I am so excited I can hardly wait! I have been sleeping better and feeling better day by day. Good luck to you. I empathize totally.

[Sergey45]

In my signiture you can take a look at all masks I've used. It might help.
Good Luck!

[jimD]

Thank you all *very* much for taking the time to help me out with this new CPAP thing.

I've learned more from your comments/suggestions/other links in a few hours than I've learned from all the "professionals" I've met since the day I was diagnosed!

[SleepingUgly]

Jim,

Maybe Whitebeard's fix for the Liberty would work for you:

viewtopic.php?p=280295#280295

Bleeping Beauty has modified his fix to use scrunchies, and she doesn't use the side portion of Whitebeard's fix. She describes how to loop the scrunchies together in the following link:

viewtopic.php?p=441576#p441576

But she may have pictures of the entire fix that she can post.

When I saw the Whitebeard fix, I thought it looks like an instrument of torture. I'm using The Hybrid now with BB's fix with the scrunchies, and it seems to be working and is comfortable. The pillows were coming out during the night and now they aren't.

BB, we need you...

[SleepingUgly]

I should mention that in combination with BB's scrunchie fix, I started using Lansinoh inside my nostrils and on the rims of my nostrils. The stuff is so thick and sticky that it really helps with the seal. In case you're not familiar with it, it's nipple cream for nursing mothers and you can usually find it in the section of the drugstore where they keep baby supplies like formula and diapers. It is pricey, but the tube will last a long time, and I wasn't sure if the consistency of the generic version would be the same, so I stuck with brand.

[BleepingBeauty]

Jim,

Maybe Whitebeard's fix for the Liberty would work for you:

viewtopic.php?p=280295#280295

Bleeping Beauty has modified his fix to use scrunchies, and she doesn't use the side portion of Whitebeard's fix. She describes how to loop the scrunchies together in the following link:

viewtopic.php?p=441576#p441576

But she may have pictures of the entire fix that she can post.

When I saw the Whitebeard fix, I thought it looks like an instrument of torture. I'm using The Hybrid now with BB's fix with the scrunchies, and it seems to be working and is comfortable. The pillows were coming out during the night and now they aren't.

BB, we need you...

Thanks for the shout-out, SU.

I'll post a new thread with step-by-step pics (so it doesn't get lost in the shuffle here and will be more readily available to other members). I'll come back here and post a link to the new thread.

[BleepingBeauty]

The pics and directions for the Liberty/Hybrid fix I use are here: viewtopic/t48808/viewtopic.php?p=446053#p446053

[DoriC]

Thank you all *very* much for taking the time to help me out with this new CPAP thing.

I've learned more from your comments/suggestions/other links in a few hours than I've learned from all the "professionals" I've met since the day I was diagnosed!

No surprise! You've come to the right place and you're getting lots of knowledgeable people to help you. Good luck.