First Week Ups and Downs

[Big Storm]

Hello CPAP Community-

I was recently diagnosed with mild to moderate OSA via a home test administered by my clinic. After going through the range of emotions described in this forum, I began my treatment one week ago today. I'm using the PR REMstar Auto A-Flex 560 w/ heated humidifier and Quattro Air full face mask (size large). I'm a big man, 6'5'' tall, 295 lbs, 18.5 inch neck. I'm still getting acclimated to the jargon so I hope I'm reflecting everything accurately.

First, the good news. I was initially worried about feeling claustrophobic and / or feeling like I'm suffocating, but that did not materialize. I was also concerned about the comfort factor of wearing the equipment, but again, this proved to be manageable after a couple nights. Best of all, I'm experiencing some early positive results in the way I feel. I'm refreshed in the morning, my overall energy level has increased, and public safety on the roads is higher during my drive home from work . All very encouraging.

On the challenging side, I am fighting leaks in a major way. It's fine when I begin falling asleep at a pressure of 6, but I wake up an hour later once it's ramped up to 12, with air leaking into my eyes and out the sides of the mask. My initial remedy was to pull the straps tighter. While effective, it left deep strap marks on my face, pressure sores on my forehead and bridge of my nose. Not a sustainable, long-term solution. Next, I purchased the Pad-a-Cheek forehead pad, strap pads and a CPAP pillow. The pads helped my face, but the back of my neck and head still took grooves from the straps. Clearly, a tight mask, even with padding, is not the answer. I like the CPAP pillow, even though it did not help with the leaking.

Earlier this morning, I ordered Pad a Cheek and RemZzzz mask liners. I'm going to take a break for a couple days, let my face heal, and give it another go with the mask liners. If they do not work to address the leaks, I'll have to explore different masks (unfortunately nasal masks are not an option, as I must breathe through my mouth). I have a follow-up appointment with my doctor scheduled for mid-June. It should be noted I called the doctor's office for advice on the leaks, and the staff was completely useless. They did not offer me any advice other than "stick with it". All of the steps I'm taking are the result of reading through this forum.

THANK YOU to everybody who contributes to the discussion. It has been extremely helpful to me, and I look forward to the day when I can pay it forward. Until that day arrives, if you have advice for me or recommend alternative strategies for the leaking, I'm all ears. I see the benefits of CPAP and am committed to making this work. Cheers!

[Julie]

Hi - I hope you've loosened the straps a bit since starting - it can actually create micro-leaks if too tight, but it's understandable why you tightened them. You need to find a mask that suits you better (there are a lot out there now). Will your DME allow you to try some while lying down and after the ramp's gone to your scripted pressure? And do you feel the tech there has done a good job of fitting you rather than just handing it over with no adjustment tips?

[library lady]

Welcome to the Forum, Big Storm! You have come to the right place for help. I'm a relative newbie, been on cpap for a little over 3 months now. My mask is Quattro Air, and I had quite a time with the leaks as well. Learning the proper adjustment techniques took some time, but mask liners were the game changer for me. Like you, I bought padacheeks and remzzzzs. Once I started using the remzzzs, I was able to get through the night without taking the mask off, but continued to experience large leaks quite often. After quite a bit of trial and error, I've finally figured out the strap adjustment. There is an excellent blog piece "Taming the Mirage Quattro" that will help you with that. I don't know the URL for that, but someone here should be able to point you to that.

[tortoisegirl]

Welcome! Does your machine have a mask fit feature to use so you can fit at the max instead of starting pressure? Especially if its been less than 30 days, I'd go for another mask fitting at the DME, as you should be able to swap it out with no added cost (unless the new mask was more expensive). My doctor told me not to put up with mask problems for long at all, and to use that 30 day policy to my advantage.

See if you can get a different person at the DME if the one before wasn't helpful. If you let them know you are having a lot of problems, they may set you up with a Respiratory Tech instead of a salesperson. Have the fitter give you specific information on how to put on that specific mask (such as starting from the top and maneuvering it down, tips on fitting (such as if the lower or upper straps should be tighter), etc. I agree to at least try the mask with pressure at the DME, and better yet, lying down (my DME wouldn't let me lay down but at least they fit masks at therapy pressure, and I knew I could go back and swap it out). If it leaks when fitted by a professional when you are sitting up, its unlikely to do better at home, only worse.

If you swap it out during the first 30 days, its also likely they will let you keep the original mask, so you could go back to it if a new one is no better (mine said they would just trash my original mask if I didn't take it back home with me). I've found adding a tiny piece of tape on the sides of the bridge my nose where I tend to get some red marks helps. Even better was Lansinoh ointment under the tape (plus then the tape wasn't as sticky, as my skin is extra sensitive there right under my eyes). Some use other methods like bandaids and such, so you might want to read up here. However, there is a big difference between some red marks that subside during the day and bad sores.

Loose straps is definitely the way to go. For example, I can literally put two or three fingers on each side with each strap. It allows the cushion to easily inflate, which reduces leaks (vs. the cushion not being able to inflate). Since it seems like you are ok with forehead supports, that gives you a lot more FFM options than me, so thats good (I have a chronic headache and can't stand even a loose strap around my head). Hopefully your DME has some good options for you. Thankfully the Quattro FX is working well for me so far besides the minor marks. Best wishes.

[Big Storm]

Thank you all so much for your comments, tips, and suggestions. I look forward to a better week, and if not, new mask. I really appreciate your responses!

[Sheriff Buford]

I agree with finding the "Taming the Quattro" thread. You need to start the machine first (to allow the cushions to inflate) before putting on the mask. This is just the opposite of other masks. Here's what I do:

- I loosen the forehead adjustment.
- I connect the hose to the mask.
- I place the mask headgear on... but do not connect the lower straps.
- I lift the mask, then turn the machine on. This allows the mask cushions to inflate.
- I place the mask in the right spot, then connect the bottom straps.
- The bottoms straps were the same tension as the night before, so they normally do not need to be adjusted. I usually get leaks around the upper nose and into my eyes. I crank down on the forehead piece until the leak stops.
- The forehead piece should be very loose, as well as the mask. The mask should "float" on my face. I use the maximum EPR setting (upon exhale, the pressure will drop 3 cm/h2o). This will cause the mask to "lift" up and down very slightly. If it doesn't, I have the mask too tight.
- I'm still getting a leak rate of 2.4 l/m in the morning (Pugs.... turn your head).... but I attribute this to me still getting acquainted with the mask and a 2.4 l/m leak rate is acceptable (dang it!!).... the machine will compensate up to 24 l/m.


Sheriff

[DEXSUZ]

Mr. Storm: Should you continue to have problems with the Air, ask your DME if you can try a Quattro FX. The Air gave me major fits and the soreness that it created on the side bones of my nose left people asking me if I'd been beaten up. Gee!

The Quattro FX has been a godsend and has caused zero strap marks or sore spots. The only shortcoming of it is that it'll rise or dip on your face as you move around in the night. I quashed this problem by purchasing a Velcro strap (can be found at any medical equipment store) that links the lower straps underneath my chin.

I've now slept 500+ nights with the FX and all but 20 or so have been terrific. I rarely yawn during the day or feel a morbid desire to nap. Compared to the first 62 years of tortured sleep in my life, CPAP and the FX have given me a Lutheran version of Nirvana.

God bless and best of fortunes!

[Big Storm]

Quick update on my second week.....

Thanks to the great advice on this string, I feel like I'm turning the corner on leaks. Just as Library Lady commented, the mask liners were a game changer for me as well. I found the article in regards to "Taming the Quattro", and while full of great information, in the absence of mask liners it did not help my personal situation. The RemZZZ's arrived early in the week and quite frankly were a disappointment. In fact, for me, they seemed to exacerbate the leaks. Two days ago I received the Pad-a-Cheek mask liner from Karen, as well as the neck strap. Both worked great. Making sure the mask is not too tight, I removed the forehead straps, and this is a configuration that has proven successful for two nights in a row. Yes, small sample size, but it's SO encouraging. I was getting down about those darn leaks, not to mention my beat-up face....

Again, many, many thanks to this forum; not only to those who responded to me, but those who regularly post. Your encouragement and 'pictures of success' have kept me going. Cheers!