Mask Fitting

[Johnnyb01]

Noob here, I have been on Cpap therapy for slightly over a week now (started Thursday before last) and have already swapped out masks once and may be swapping again this week. DME started me with a ResMed Mirage Quattro (Medium) and it made a sore spot on the bridge of my nose after 2 nights, also when I got the mask tight enough so it wouldnt leak into my eyes after a couple of hours wearing it, it felt like the forehead supports were boring into my head. Contacted the DME and set up a meeting with her (This past Thursday) and she suggested my current mask (ResMed Airfit F10-medium) and suggested I take a night off of therapy to let my nose heal up some. I have only worn it one night so far (went on night shift starting last night) but I don't think it is going to put the same pressure on my nose, however I have to tighten it even more than the previous one to keep it from leaking.

Some extra info, I used the ramp feature the first night, but that just led to constantly adjusting the mask as the pressure built to fix leaks that popped up. I would rather go ahead and get the full pressure on, fix any leaks and go to sleep. Humidity (temp) is set at 83deg but I am still waking up with a dry mouth (reminds me of my drinking days, waking up with "cotton mouth" after a long night drinking lol) is this normal?

One last question, what is an acceptable leak rate for this combo of pressure and equipment?

[Julie]

You may need a smaller size mask, if not a different one - there are so many available and most of us have to try various ones before finding the right one. Overtightening can start even more, if smaller leaks, and leaking creates dryness. Also, feel free to just turn off the ramp feature altogether, most of us do it early once we're on Cpap a while. What might help with leaks and soreness are called Pad-a-Cheek liners (.com), that act as buffers between the mask and you - the person who created them is a member here.

[Johnnyb01]

Thanks for the response Julie, the DME had me try on a small first (in the office with no pressure applied) and it barely covered my bottom lip, so we went to a medium (similar process during my sleep titration? test, used the Mirage Quattro during it) which sits slightly above my chin (feels like the mask is about to slip into my mouth if I open it more than a crack). When first using both masks, I started with them very loose and tightened each strap a little at a time until it quit "flapping" and then quit "squealing" then tightened it a little more to get the little "hisses" gone, if I loosen it up any (as I was concerned about overtightening) it starts leaking again.

I picked up a ResMed Gecko for the bridge of my nose (small) but it wants to leak around it unless I stretch it some to thin it out where it meets the mask.

Oh, and the ramp feature is off, it was more of an aggrivation than anything else!

[JimP]

Since new headgear tends to stretch for a few nights, what I do is run my machine without ramp just to be sure that I've not developed any new leaks and then put it on ramp to go to sleep.

I had a problem with the Airfit F10 mostly due to the contour of the cushion. To get it from leaking air, I had to position it and tighten it so that it was painful after a few hours. I never could get the nose part to not make my nose sore.

You might have a similar situation with the Quattro given that its also a ResMed product. I don't know if they changed the design between mask.

What I wound up with is a Respironic Amara. Seems to fit the contour of my face better which with less tightening (can't say that any of these mask are comfortable) isn't painful (especially on the bridge of my nose).

As others will tell you, try different mask and different sizes. They're definitely not all the same.

[Kiddle]

I am also a newbie and had very similar problems until recently.....
Before starting therapy, I would wake up about 15 times per night to drink water because my mounth was so dry. For my first mask, I was given the Resmed FX Mirage, a nasal mask. It made me naturally breath through my nose so no dry mouth. But it leaked constantly. The ramp was a real nightmare. I would fight with the mask to make it stop leaking then,as soon as I would fall asleep, the pressure would go up and the mask would leak. I would readjust the mask again and it would take me another 30 minutes to fall asleep again. I tried to adjust the mask without the ramp to get a good fit then put the ramp on again, but this didn't help me. The other problem is that I sleep on my back and both sides. Any change of position = a leak.

So after a week of this I was given an F&P Eson- also a nasal mask. No leaks ! But after three nights, it was putting to much pressure on a nerve in my cheek making my left canine tooth hurt. This in spite of the fact that I was being really careful not to over tighten.

I went back to sleeping with my "ex". NEVER a good idea In trying to stop the leaks, I must have been overtightening? because the bridge of my nose started to really hurt. I purchased some of those gel-ish bandaids for blisters. I cut out a small disk of the gel part and placed it on my nose. This solved the nose problem and didn't worsen the leaks. Note: only use the gel part of the bandaid. The adhesive is way too strong to be used on the face. Trust me, I tried. After another week with my "ex" I was getting deperate from lack of sleep. I was feeling worse than before therapy (and that was bad)

Friday, I started using the Resmed P10 ( a pillow). I slept 9 hours the first night and 8 hours last night with very few leaks or disturbances. It is extremely light so no real pressure points (at least for me). The tubing that connects to the mask is extremely flexible in ALL directions- no more fighting with the tube. And... it doesn't leak (very little) in all my sleeping positions. I think I am over the hump now.

I know everyone is different, but wow, do I recommend this mask. Good luck on finding your soul mate. It will happen.

[englandsf]

Two things - try adapting to pillows (p10 is my fave too) or - if that fails - try the largest size F10, it gives more lip room and is softer on the nose bridge. Like others said, adjust it lying down at normal pressure and use as little pressure as ou can

[Pugsy]

what is an acceptable leak rate for this combo of pressure and equipment?

Since you are using the S9 machine ResMed says 24 L/min leak is the beginning of large leak territory. Keep you leaks below that and the machine should be able to compensate for leaks.
If you do go above 24 L/min it doesn't always mean that the leaks were causing the entire night's therapy to be in the toilet. It depends on how far you go and how long you stay up there.

Mr Frowny face for leak reporting the prior night's leak result on the LCD screen doesn't show up unless we spend 30% or more of the time over 24 L/min.

If just going by the LCD leak number on the machine...that's a 95% number which means for 95% of the time the leaks were at OR BELOW that number. It doesn't mean that's where it was at all night. In general if the 95% leak is below 24 L/min we know that leaks were within acceptable limits for the bulk of the night and no real huge reason to look at the leak line graph. If it's borderline or higher then closer evaluation of the leak is needed to see just how much time might have been spent in large leak territory and how far it went into large leak territory.

Of course any leak (even if tiny) that disturbs sleep is unwanted but because it is disturbing sleep. Anything that wakes us up is unwanted.

[Johnnyb01]

Two things - try adapting to pillows (p10 is my fave too) or - if that fails - try the largest size F10, it gives more lip room and is softer on the nose bridge. Like others said, adjust it lying down at normal pressure and use as little pressure as ou can

I would like to pick up a set of pillows along with a chin strap to use on nights when I am not having sinus/allergy/congestion issues, however they would not work as a 100% solution for me as I have these types of issues off and on year round causing me to mouth breathe many nights.


There may be hope as I decided this morning to try the mask (currently thr AirFit F10 in medium) without the Gecko pad and see how it did, I was able to loosen up the straps considirably and still maintain a good seal, also does not seem to be irritating the bridge of my nose or forehead like the Mirage quattro was. I'll give it a few more days/nights of use and report back

[Johnnyb01]

what is an acceptable leak rate for this combo of pressure and equipment?

Since you are using the S9 machine ResMed says 24 L/min leak is the beginning of large leak territory. Keep you leaks below that and the machine should be able to compensate for leaks.
If you do go above 24 L/min it doesn't always mean that the leaks were causing the entire night's therapy to be in the toilet. It depends on how far you go and how long you stay up there.

Mr Frowny face for leak reporting the prior night's leak result on the LCD screen doesn't show up unless we spend 30% or more of the time over 24 L/min.

If just going by the LCD leak number on the machine...that's a 95% number which means for 95% of the time the leaks were at OR BELOW that number. It doesn't mean that's where it was at all night. In general if the 95% leak is below 24 L/min we know that leaks were within acceptable limits for the bulk of the night and no real huge reason to look at the leak line graph. If it's borderline or higher then closer evaluation of the leak is needed to see just how much time might have been spent in large leak territory and how far it went into large leak territory.

Of course any leak (even if tiny) that disturbs sleep is unwanted but because it is disturbing sleep. Anything that wakes us up is unwanted.

havent had any leak that woke me, I didnt look at the leakrate this afternoon after waking up but I havent had Mr frowney face show up yet, so I guess I am good on that

[englandsf]

Johnny

Once you get the pillows try to breathe through them even with congestion, I have disciplined myself to lay down breathing through my mouth then taking 10-12 deep nasal breaths through the mask which clears me out a lot and enough to manage the whole night.

Make sure you're not using too much humidity - as that can actually hinder. I use unheated passover humidification alone (zero heat, zero humidity). The dry cool air dries out my nose and helps.

Practice keeping your mouth shut and you're good to go!~)

Takes time to get it right - in my case a full 4-5 weeks until I got the right mask/humidity combo. Good luck

[jaycee2]

Johnny

Once you get the pillows try to breathe through them even with congestion, I have disciplined myself to lay down breathing through my mouth then taking 10-12 deep nasal breaths through the mask which clears me out a lot and enough to manage the whole night.

Make sure you're not using too much humidity - as that can actually hinder. I use unheated passover humidification alone (zero heat, zero humidity). The dry cool air dries out my nose and helps.

Practice keeping your mouth shut and you're good to go!~)

Takes time to get it right - in my case a full 4-5 weeks until I got the right mask/humidity combo. Good luck

I tried the AirFit P10 Nasal Pillows at the DME's office. As a test my APAP was set to a CPAP with no ramp and at the highest pressure that I've been using. The large pillows were used and I couldn't breathe. I could feel the air in the nose and inhaled and breathed normally but it as if the air didn't get into my trachea or lungs. After a minute I had to take it off. There was no sense of being stuffed up. There was no humidity since I had to empty the water chamber in order to take it to the office. At home it's set on 4. On 5 the warmth is lovely but causes the nose to stuff up. The LPN who works with me said that patients tell her that the nasal pillows are a problem if the air pressure is set greater than 10. Mine was set to 15.

Any ideas on why this happened? And as for practicing keeping the mouth shut, once I'm asleep there is no control over that and the jaw slackens and therapy air is lost. Thus the need for the chin strap.

[Pugsy]

A word about humidity needs and preferences...it's highly individual...and there is no right or wrong amount that works for 100% of the population. Some people need more...some people need less and we have no idea what your nose needs or wants and it is something that you will have to figure out for yourself.

People whose nasal mucosa don't need or want much humidity will tell you that too much humidity causes congestion...and it does...for them... but your nasal mucosa may not be like their nasal mucosa and too little humidity might also cause congestion. Too little humidity can be just as problematic as too much humidity....it all depends on what your nasal mucosa prefers. So "less humidity" is NOT the end all problems solution for congestion for all people despite what some people might say...yeah, it is for them but that doesn't mean it works for everyone.
Heck..you might be like me...and would snort water if I could...that's how much moisture my nasal mucosa needs to be happy.

[Pugsy]

The LPN who works with me said that patients tell her that the nasal pillows are a problem if the air pressure is set greater than 10. Mine was set to 15.

Hogwash, BS or old wives tale. There are people using pressures exceeding 20 cm all night long who successfully use nasal pillows. Yeah..maybe a bit of a challenge to seal but so would any other mask have challenges at those pressures.

There was no humidity since I had to empty the water chamber in order to take it to the office. At home it's set on 4. On 5 the warmth is lovely but causes the nose to stuff up

Not using water in the humidifier for a few minutes at the office wouldn't do much to dry out the nasal mucosa..it's the long term (over night) usage that may or may not be an issue.
Did you know that you can set the humidity and air temperature separately if you wish...there is a way to use the warmer temp but with a little less humidity? I think with the new AirSense machines those settings are independent of each other but you may have to go into the clinical setup menu to change the humidity selection. I am not familiar with the new ResMed machines as to what is available without being in the clinical setup menu but I know you can use the warmest air possible at the least humidity selection available if you want to. Two separate settings available.
Edit for clarification...to have the 2 settings available with the ResMed machines ...one for hose air temp and one for humidity preference... you have to be using the ClimateLine heated hose.

[cathyf]

...try the largest size F10, it gives more lip room and is softer on the nose bridge...

HAHA -- maybe I should change my handle to cathy-the-pinhead, because my size small F10 is actually a little too big. If I push it up too far it leaks out the top -- between my eyebrows. If I get the top in the right place then it's ok as long as my mouth is open but as soon as I close it then I'm leaking out one or both bottom corners. Sure makes it hard to stop mouth breathing!

But, anyway, our mileage all varies a LOT so experimenting for yourself is the only way to go.

[jaycee2]

The LPN who works with me said that patients tell her that the nasal pillows are a problem if the air pressure is set greater than 10. Mine was set to 15.

Hogwash, BS or old wives tale. There are people using pressures exceeding 20 cm all night long who successfully use nasal pillows. Yeah..maybe a bit of a challenge to seal but so would any other mask have challenges at those pressures.

There was no humidity since I had to empty the water chamber in order to take it to the office. At home it's set on 4. On 5 the warmth is lovely but causes the nose to stuff up

Not using water in the humidifier for a few minutes at the office wouldn't do much to dry out the nasal mucosa..it's the long term (over night) usage that may or may not be an issue.
Did you know that you can set the humidity and air temperature separately if you wish...there is a way to use the warmer temp but with a little less humidity? I think with the new AirSense machines those settings are independent of each other but you may have to go into the clinical setup menu to change the humidity selection. I am not familiar with the new ResMed machines as to what is available without being in the clinical setup menu but I know you can use the warmest air possible at the least humidity selection available if you want to. Two separate settings available.

Thanks Pugsy. I have the clinical manual so will have to try that. Do you know if that also applies to the Resmed Autoset S9?