Need Advice re Mask Issues

[RhoXS]

I have been using a CPAP for almost four years now. I dread using it because I have not been able to find a mask that is comfortable and seals consistently well without undue and annoying strap tension. I also wake up with a very dry mouth even though I use a humidifier. I force using it because it is very obvious from the lack of good sleep and sensation in my chest when I do not use it that it is certainly needed.

I have purchased three masks. The first was a Swift LT. It suffices but to make it seal reasonably it is too tight to be comfortable. The second mask I purchased was a Quatro FX full face mask. Even though the size gauge indicates it is sized perfectly it clearly feels too small and even the slightest movement breaks the seal. That accounted for almost $200 flushed away because I never have been able to use it. Last year I purchased a Swift FX, it is somewhat more comfortable than the Swift LT but I have a problem keeping it sealed. With both the LT and FX I wake up during the night with this incredibly dry mouth even though I use a humidifier.

So, all that being said, my specific questions.

Is there an ointment or something similar that can be applied to the nasal pillows to help assure a more constant and lasting seal? I read about Lansinoh ointment but that appears to address skin irritation that I do not have a problem with. My thoughts are to trade strap tension for some sort of sealing compound.

What is the cause of the completely dry mouth I experience? My lips appear to remain sealed so there is no obvious air flow to dry my mouth out. In addition, there is nothing wrong with my salivary glands so why do they appear to shut down when I use the CPAP? I doubt I am the first person to experience this problem so what do other do?

Is there any particular mask that, to most people, is considered superior with respect to comfort and effectiveness?

Thank you in advance for your thoughts.

[Sheriff Buford]

You asked the $64 question. As I was reading your thread, you stated you been at it for 4 years... then you stated three masks. I must admit 3 masks?? I know there are folks here that have "adapted" to the first mask they were given. I would also bet that there's a better mask (either comfort-wise or leak rate-wise) for half of those folks, but they don't know it because they've never tried anything else. Know that you can try a mask out for up to 30 days and return it for a different one. I would recommend you do this until you get one that is comfortable and doesn't leak. Your question can be the most asked question here besides "how to you clean your equipment". That's ok with me, that's why I live here. I went thru 6 masks until I found mine. My advise is to make one purchase and do the mask-swapping until you find "yours" When you find one that's close, someone here can help you tweak the mask for maximum therapy. I do it all the time for my mask.

Best of luck to ya'

Sheriff

[khauser]

Let's take care of the easy question. Your mouth gets dry when using nasal-only interfaces because you are opening your mouth and air is escaping through it. Air leakage through the mouth is one reason people try full face masks, so if you didn't throw the $200 mask away you might want to see if there's any good ideas on making that work for you. I don't use a FFM so I can't help in that regard.

You could also try different options for keeping your mouth closed. A chin strap might do the trick if the problem is simply that your mouth wants to open. But if it is pressure causing the issue then you'll end up with a mouth that's closed a lips letting air out. No real difference. Before you spend money on a chin strap you might want to try something homemade. Something stretchy that you can tie around your head and under your chin...

If you are working with a local DME, they SHOULD be letting you try some of these things without being forced to buy them all. That's about the only advantage a local DME has, vs. buying on the internet, and some local DME's don't even do that. Mine would let you try it in the office, but if you left, it was yours. (They are not my DME any more ... that's just ONE reason).

Ointment for the nose: Lanolin in medical grade is suggested. It's a little sticky (I am told) so helps the seal. Pugsy will probably chime in with a specific brand name. I haven't been able to find any locally, but that doesn't mean you won't. This ointment's TYPICAL purpose is for sore nipples from breast feeding, which should help you locate it in the store...

HTH

[SnoozeyQ]

I use Burt's Bee's lipbalm... in my nose and it helps with getting a great seal with my Optilife as well as protecting my nose somewhat. I have one area that still gets irritated, but overall I'm having good success using Burt's Bees and I even like the peppermint smell of the stuff.

[RhoXS]

Thank you for the very rapid responses. That is appreciated.

Using a local DME to try various masks is not a viable option. I do not use a DME because every time I tried to work with one it turned into a disaster. When I received my initial perscription the physicians office sent me to Apria. The Apria technician simply brought out one CPAP device and a single mask. When I asked if I had any options with respect to what devices were available he simply said "None." That did not seem right but I was not yet CPAP smart so I was unable to respond. He then started to throw away some of the papers that came out of the box with the new CPAP. I told him I wanted all the literature provided by the manufacturer in the box and he stated I was not allowed have it. Wrong answer! With that, to his surprise, I lost trust and just left as I will never tolerate anyone withholding information from me. I understand now the literature he refused to give me was the clinician's setup instructions but withholding that is still totally unacceptable if requested by the patient buying the hardware. Contrary to Apria's tech, there are no laws that I have been able to find that require withholding this type of information from a patient. I then discovered the physicians office sent me to Apria because they were the only local DME in network with respect to my insurance. I then decided to get educated, make my own decisions, and pay slightly more for an out of network DME. I then found the many local out of network DMEs were giving me prices that were insulting with respect to the same equipment offered by cpap.com etc. I now buy everything from cpap.com as they have proved reliable and helpful (except for filing insurance claims). So, as you can see, using a DME to try different masks did not work as Apria clearly told me I had no options.

I tried three masks over time as I felt it was well worth the money if I found something comfortable that I did not mind using. I might take your advice and buy one more with return insurance. The only problem is deciding which one to start with because there are so many to choose from and no real basis for a decision except others recommendations.

I now have no problem at all cleaning the equipment. In fact, it is very easy. I tried many approaches to this and although most were effective, the soaps, detergents, etc. left too strong an odor. To clean the nasal pillow I now first simply thoroughly wipe it down with wipes intended for this purpose. I then soak it all day in hydrogen peroxide in a small sealed container, not much bigger than the pillow. The weak H2O2 solution is readily available at all pharmacies. I believe it provides both some chemical cleaning action and sterilization. It leaves no odor. It does not degrade the silicon pillow becasue I just compared my original four year old pillow to a new one delivered a few days ago and could perceive no difference in flexibility, color, etc. I clean the hose less frequently but simply soak it for a few hours in a small plastic tub with warm (not hot) water and a few squirts of neutrogenia liquid soap. Every so often while soaking I vigourously shake the container. It seems to work well.

[Sheriff Buford]

Also know that cpap.com will display its masks by the "most popular". I often see the Quattro as the most popular, but I have come across a whole bunch of folks who have trouble with it. I guess that since they sell more Quattro's more folks are going to have trouble with it. I know people will respond to this thread by saying they love this or that and don't have trouble with it, but there are still those that have literally thrown theirs out the window on the freeway knowing the mask will receive miserable destruction. But that's the problem with folks recommending masks. Its like asking for a shoe recommendation. I love cowboy boots, but how many people people on the forum do you think I could convince to wear them? Best of luck to ya'

Sheriff

[Pugsy]

The Lansinoh lanolin ointment (not the cream) is a bit tacky and will help maintain a seal but it is not like glue. Don't use too much thinking if a little is good..more is better. If you use too much the body heat tends to melt the ointment and you have a slippery mess.

Normally it can be found in the baby aisle section of most stores where the nipples, pacifiers and such are found.
Some stores have a store brand but many don't. Lansinoh name brand a little pricey for the size of the tube but only a little bit is needed and it lasts a long time.

http://www.cpaplibrary.com/masks.html Check out this link for some videos with hints for fitting various masks. Maybe there is something in there that will help you. I have used the Swift FX for nearly 3 years now. My pressures go to 18 and more sometimes and I don't have a problem with the seal. Sometimes people tend to think it needs to be tight to get a better seal when actually loose allows better inflation and thus better seal.
More hints for fitting the Swift FX can be found in Janknitz blog here http://maskarrayed.wordpress.com/swift- ... ing-guide/
if you look at her other pages there is also a page on Taming the Quattro.

Dry mouth is indeed a pretty good sign of mouth breathing. It may or may not be negatively impacting therapy very much.
One needs to evaluate the leak line from software data to know for sure.
What machine are you using? Make and model? Do you know if it collects any useful data or has software available so you can see for sure how bad the mouth breathing is. Until we know for sure we have to assume the worst case scenario.

[nwyant]

I just started with the Wisp and I love it. Its comfortable and the seal doesn't break no matter how much I move.

[RhoXS]

Again, I have to start out expressing my appreciation for the quick responses good advice.

I have two machines as I live in two locations, my temp home where I work and my real home 1400 miles away. At home I have a Resmed S9 with humidifier I purchased last summer and at my temp home (where I spend the overwhelming majority of my time) I have a Resemed S8 with humidifier. I have everything I need, including the USB reader for the S8, but do not have the software.

I have a recording pulseoximeter (about the size of a large wrist watch) I can wear on my wrist through the night. In the morning I can download in the data and can view O2 saturation and pulse data graphically, plotted against actual time, on my computer. In my opinion this provides direct indication of the effectiveness of the CPAP system. The difference between the using and not using the cpap is very dramatic, and even scary. I have it with me and have been intending to use it for one of my periodic mini do it yourself sleep studies but have been procrastinating for no good reason. Based on how I have been feeling recently on some mornings when I wake up, I think the time has come to collect some data to assure the system is being effective. If there is an issue, I then have to determine if the issue is due to an inadequate pressure setting or leakage but this should be easy to do. In my opinion this recording pulse oximeter provides sufficient data to avoid dealing with a physician and a megabuck sleep study.

I have the LT with me now but my wife just shipped me the FX and I expect it in a few days. If the FX proves to be a better choice for me I simply am going to retire the four year old LT and order a second FX for home. I am also going to check out the Philips Respironics Wisp nwyant recommended. It appears to be a brand new product as cpap.com does not have it in stock yet and does not list a price. From the picture it appears to seal against the skin circumferentially around the nose instead of soft pillows directly against the nostrils. I would definetly buy this with return insurance as I see no way to predict how successful this mask will be. the Phillips Respironics ComfortGel Blue Nasal Mask also got my attention and I am going to explore that one also.

Thanks again.

[herefishy]

I see you know about cpap.com's return insurance, so you can get the mask that fits with just a bit of out of pocket $ for sending them back. Also, someone posted this yesterday and it sounds very interesting - http://www.cpapseal.com. Another thing you can try is silicone ear plugs - no, silly, not in your ears! Take one in your fingers and roll it around till it gets soft and you can make a kind of rope out of it, then use that to plug the leaks.

[Pugsy]

You can use ResScan software with your S8 machine and your S9 machine if it is one of the models that gathers full efficacy data to actually evaluate the leak line itself to give yourself a real time look at the actual leak pattern to get an idea if the mouth breathing is negatively impacting therapy.
If either of your machines has "Escape" in the model name...no leak data...in fact no data beyond hours of use is gathered.

If you do have a full data machine you can find ResScan here
Look in Uncle Bob's signature line
memberlist.php?mode=viewprofile&u=38643

There's a video tutorial here
http://montfordhouse.com/cpap/resscan_tutorial/

If you have full data...ResMed's large leak territory is 24 L/min on the S9 and on the S8 it is 0.4 L/sec.
Short excursions above the red large leak line....not the end of the world but if you spend a lot of time (say 1/3 to 1/4 of the night) then depending on how big of a leak..it may be impacting therapy. Depends partly on how big the leak is and how long.
25 L/min isn't nearly as bad as 35 L/min.