Struggling Mightily with Masks

[dob1980]

I have searched and read this forum for a couple of hours, but haven't really found a solution to all the issues I'm encountering. Any help or advice is appreciated.

Prescribed Resmed VPAP S series 8, 20/12 IPAP/EPAP. The mask the DME supplier set me up with was a Phillips Comforblue Gel Full. It of course leaked numerous times throughout the first night. I eventually had to tighten it so much I could feel it pushing on my teeth, and it left a sore on my nose that does not go away during the day (and can't heal, since I still have to highly tighten, which I'll get to). The pressure never bothered me too much, and I felt immediate improvement in how I felt when I woke up. I know this therapy is going to make a positive change in my life . . . eventually

As I mentioned I had to tighten the mask to the point where I could almost feel the bottom strap against my spine. Not to mention the pain on the bridge of my nose. I'm not dumb (well, not always). I read everything about fitting. Watched videos on Phillip's website. Lifting it up and resetting. Pushing the plastic seal. "Be sure not to over-tighten", pfft. None of that stops the leaks. The only thing that stops the leaks is pressing down hard on the mask, and the only way to accomplish that is to tighten and tighten.

Told DME supplier of troubles with the mask, and they brought out a Mirage Quatro. At least during fitting it felt much better. But once I got to sleeping a new problem started. The Comfortblue had been tight on my teeth, effectively holding my mouth from falling wide open. But the new mask fit lower on my face, allowing my mouth to fall wide open at night. This of course cause all sorts of leakage, and the only remedy, again, is to tighten and tighten.

The other thing is that with the Comforblue, I felt the air blowing my mouth open and right down my throat. Opening my mouth, I felt like one of those guys in a wind tunnel. Air just completely filling my mouth. With the Quattro, it seems like the air is just going straight from the hose to the to the vents. Placing a hand near the vents, it's incredible how much air is going out. A lot more than I noticed with the Comfortblue. It seems like not nearly as much air is going to my mouth/nose.

In fact with the Quattro I'm having some night "events". I'll wake up with a violent arm or leg jerk. Those are what had set me off to the need for treatment, so I'm sure I'm not getting effective pressure at night.

1. Is it possible that not enough air is getting into my nose/mouth and going right out the vents? I can feel air rushing along my cheeks and jaw. It's not leaking, but it seems the thermodynamics are off. Is this a function of the larger dead space of the Quattro?

2. I'd turn up the pressure by I can't take any more tightening. I have a bright red mark on the bridge of my nose that has not gone away, not for one minute, since I started therapy.

3. It seems the only reason I need a full face mask is because my mouth falls open. I do mouth breathe, but that's only after I fall asleep. Going to sleep, I breathe just fine through my nose.

4. So this is a general question I suppose. As I mentioned, it feels like not enough pressure is going in my nose/mouth with the Quattro. As I understand it, two types of things happen with sleep apnea. One is that your throat is obstructed and you struggle to breathe, thus you wake up so you can breathe deeply and get air. The other is that you simply stop breathing, and wake up to breathe. VPAPs help by forcing your airway open, even if it's obstructed. Do they also help if you "forget" to breathe while sleeping?

5. My pressure setting is 20/12 for the IPAP/EPAP. Is there some other function of how much air is delivered? Could my DME have changed some advanced setting when she changed the mask?

I see they make a mask that fits over the whole face. I'm seriously considering that. I'm also thinking of a nasal mask and something that keeps my mouth closed. Any advice on these two options? Something has got to change. I can only sleep for 4 hours a night b/c of the pain on my nose and back of my neck. I swear it's so tight I feel like I'm being choked. Thanks again for any help, and sorry for the long read.

[TalonNYC]

one thing you might want to try is to loosen the mask. I know, that sounds backwards, but it worked for me.

The idea is that - unlike the gel masks - the seal on the Mirage fits better when it inflates. The goal is to create tension on the straps that's just enough to keep the leaks at bay. Too little and you get leaks, but too MUCH and you get leaks too.

Put the mask on with the straps loose, and start the air flow(and turn your Ramp off if you use it). Lay down in bed, because you'll get different leak patterns if you're sitting up. Then, slowly tighten the four straps so that you're tightening each one by a roughly equal amount each time. Do that only until you stop the leaks.

Then move into other sleeping positions and see how the mask reacts. re-adjust when necessary.

the end result should be that - at full pressure - you shouldn't feel the mask pressing on you at all. You will feel it there, but much like a balloon, you just feel it kind of resting on your face.

This does two things for you
1 - it'll help that nose bridge heal (you may want to put those antibiotic band-aids on it at night, not because of the antibiotic, but because they are essentially lubricated by the gel).
2 - if you open your mouth (like I do), the mask edge can now move WITH your jaw, instead of trying to hold it in place.

Good luck! And remember, unlike with a gel mask, you WANT this one to inflate a little.

PS, you can get silicone gel pads to go on the bridge of your nose to help with irritation. They are, however, not cheap. Our hosts at CPAP.com have a couple of options.

EDIT: Please fill out your profile (User Control Panel under the search box up top) and select the equipment you have. That will help a lot when you have questions. Using the Text Only option for the equipment is also a great idea.

[dob1980]

Thanks for the reply. Believe me when I say I have tried all your suggestions regarding the adjustment of straps. A nice, relaxed fit works as long as my mouth stays shut. But it seems like as my jaw and mouth open up, the contours of my face b/c quite odd, and difficult for the mask to fit. Tightening seems all that works.

http://www.resmed.com/us/products/vpap_ ... c=patients

This is my machine, which doesn't seem to be in the equipment list.

[zeeser]

I have a similar profile (VPAP S, Mirage Quattro, 20/16) and share your frustrations. The following thoughts came to mind as I read your post:

1. Your 20/12 Bipap settings seem too far apart; I get by with 20/16.
2. There is nothing wrong with mouth breathing, you can still get positive results.
3. Try mole skin on the bridge of you nose.
4. Try keeping your lips apart but teeth together to eliminate that air blast down the throat feeling.
5. That air going out the vents is normal and it prevents carbon monoxide build up inside your mask.
6. Do you check you results in the morning? If you press and hold the left and right buttons you get a menu of selections: go to RESULTS/EFFICACY DATA. This will give you readings on Leaks, AHI, AI etc. which may give you some insight to you "events".

Hang in there as the results are worth it! Tom

[TalonNYC]

The looks like a VPAP version of their S8 line of xPAP devices. I would stick the S8 VPAP ST in your profile, then type in the full model name of yours in the "Additional Comments" line.

Sorry that info didn't help, but your problem is something folks here have seen. I forget who, but just the other day someone was talking about what they were doing to help with an overly large jaw drop.

There are chin straps that can keep your jaw lifted. They won't stop mouth leaks because they can't seal your lips, but they can help with mitigating the jaw drop so that the Mirage can handle it. Others have taken to taping their mouths shut. I haven't done that, so I can't advise you there.

One thing I noticed, yes the Quattro dumps a TON of air out of it's vents. That appears to be normal operations for that mask.

[sister]

Hi,
I have tried for years and have finally realized that I simply cannot take anything on the bridge of my nose.I can use the mask that covers the whole face(fitlife), but it is heavy and hard to keep the leaks under control.
So, finally I tried the swift fx and found a whole new world! nothing on the nose,no heavy mask,

[Mary Z]

An IPAP of 20 is a high pressure and might (obviously) be hard to find a mask that can contain that kind of pressure without having to over tighten. I also had a problem with breakdown on the bridge of my nose to the point where I still have the scar.

I discovered the FitLife Total Face Mask by Respironics (not the one size fits all). It worked for me at high pressures though it took a bit of fiddling with the straps. I love this mask, most nights have 0 leaks and do not have to over tighten. My pressure is not as high as yours, but I have used this mask successfully in the past with high pressures.

I can't speak to the rest of your questions about venting and such- just don't know the answers.
Good luck. I know first hand the problems with finding a mask that works at high pressures. Oh, be careful of that red spot on your nose- it can turn ugly, be sure to cover it with a bandaid or put moleskin on the mask at that area.

[dob1980]

Thanks all for the responses.

I'll definitely get something to fit on my nose, but even then, it doesn't help the tight straps on my neck. I will definitely see if the Respironics FitLife is something my doctor will go with. After that, I don't know . . . Maybe discuss with him a nasal mask and something to keep my mouth closed, and getting my EPAP raised.

As far as checking my settings, I just checked them and noticed my AHI is slightly over 5. I don't know if that is an average or just from last night.

[TalonNYC]

There are also hybrid masks (one called the Hybrid, the other the Mirage Liberty). They have a mouthpiece and nasal pillows. Search the forum for info on either, and especially for the Lab Rat testing folks did to figure the best way to keep them from leaking.

[nanwilson]

Its okay to breath thru your mouth when using a ffm- that's what they are for. The air you are feeling around your mouth, is not air escaping, its air blowing at you from the hose. If It bugs me, I just swivel my hose in a different direction. When using a ffm you breath both nose and mouth but if your jaw is dropping way too far, a chinstrap is the answer. Many of the guys here use a papcap, it has a built in strap. Go to Pursleep.com and take a look at them. I would definately use a tiny bandaid over that "owy" that you have. When I used the quattro I ended up in the same boat, so I would use a dab of polysporin and small piece (I cut a big one) of bandaid over it. There is now a quattro fx out there that doesn't hit the bridge of the nose, do a read up on it, there is a thread going as folks are trying it out. I now use the respcare/innomed hybrid mask - love it.
I hope you fix all of your problems and begin to get optimum therapy thus feeling better.
Good luck
Nan

[dob1980]

So many options. But good to know for sure. The hybrid looks really cool. If I could just keep my mouth somewhat closed I think things would be a lot better. Right my jaw just falls wide open and throws everything out of whack. Do people really tape up their mouths? Wouldn't the adhesive irritate the skin?

[OutaSync]

Yes, some of us tape our mouthe shut AND wear a chinstrap to keep our jaws from dropping down. The only kind of tape that I have used that does not irritate my skin is shown in my signature line below. Lots of other people here use plain ole blue masking tape.

[dob1980]

I'll have to check that out. I'm reluctant to use the tape as I'm very sensitive to the adhesive used in them. Even a band-aid will mark up my skin for a week after use.

Is the Resperonics Premium chin strap the kind that thrusts your jaw backwards towards the neck, or up towards the nose?

[LarryPer1]

I had almost all of your problems , went through 3 masks and got a Mirage Liberty and all gone

[OutaSync]

I'll have to check that out. I'm reluctant to use the tape as I'm very sensitive to the adhesive used in them. Even a band-aid will mark up my skin for a week after use.

Is the Resperonics Premium chin strap the kind that thrusts your jaw backwards towards the neck, or up towards the nose?

The Respironics Premium chinstrap is designed to hold the chin up and not pull back.

I'm very sensitive to adhesive, also. The adhesive they use for EKG leads leaves welts on my skin that take a couple of weeks to heal.