Help with Tidal Volume and Mask Fit

[Bigmike52]

Good morning. I have been on Cpap therapy for 1-1/2 years and have been concerned about a proper mask fit the whole time. I have had 2 DME's in this time. The first would not even return any calls so I returned the equipment after 9 days and got another DME. After 3 failed mask fits, the new DME wanted to start charging me for any mask I tried. As I am retired and on Medicare, it just wasn't in the budget. I have been without a DME since April and even ended up buying my own machine since 3 more DME's have not responded to taking me as a patient, even with Medicare's help. I was prescribed a FFM (mouth breather) and tried three including the F20 Airfit & Airtouch, Quattro Mirage, and Dreamware with major leaking problems. I also tried nasal masks and presently 3 nasal pillows and taping my mouth. The worst has been P10 (see attached leaks for last night) Swift FX and Nuance. I have used your sponsor but quite frankly cannot afford the high cost and shipping charges to send them back.

Another problem has been my extremely low Tidal Volumes. Is there any way to get them up? I asked my Sleep Doctor and his response is "Don't worry about it and leave your pressures alone". (I swear that is one of the first things they learn in med school) I am concerned this low number can be some respiration problem. Since I really don't know what TV is, I am anxious to find out why mine is so far away from the 500 average. I would be so appreciative for any help in either matter...…..Mike

screenshot-20180911-050541.png

[Pugsy]

Any chance you have facial hair involved with mask fit?

Tidal volume has a wide range of normal. Nothing you can do about it if it is normal for you. If you are concerned there are lung function tests that could be done to determine if there is a problem for you to worry about or just reassure you that your just have a lower than normal as your norm.
https://en.wikipedia.org/wiki/Tidal_volume

I thought cpap.com sent a return prepaid label as part of the free return insurance. It has to be printed off and attached to the package.

[Bigmike52]

Thank you Pugsy. No, pretty much clean shaven daily. As far as returning masks to Cpap.com, it is more about the initial high cost. Much lower on other sources, but no returns. It's a shame when a person pays in to Medicare since 1962, but due to people NOT doing their jobs we can't even get what we're entitled to....Mike

[Pugsy]

Okay, I understand...it's about the initial cost of the mask and not so much the cost of the return.

Are you fitting/sealing your mask at the beginning of the night to the pressure that you ultimately will be using or at the ramp pressure you are starting the night with?
If you are starting the night fitting the mask at the ramp pressure you might try fitting at the pressure you ultimately will be using.
What seals good at the lower ramp pressure may not seal so great once you get up to the pressures that you use all night.

[Bigmike52]

The Dreamstation has a mask fit I run them through. Many times the next day it says I had no leaks when I know better. Looking at the graph I attached I have my doubts it could possibly be near correct on Tidal Volume or Mask fit based on the "large leaks" Sleepyhead is showing. I'm starting to believe I look like SpongeBob SquarePants, and need a square mask to work. Know of any?

Mike

[LSAT]

The Dreamstation has a mask fit I run them through. Many times the next day it says I had no leaks when I know better. Looking at the graph I attached I have my doubts it could possibly be near correct on Tidal Volume or Mask fit based on the "large leaks" Sleepyhead is showing. I'm starting to believe I look like SpongeBob SquarePants, and need a square mask to work. Know of any?

Mike

If the leaks are not affecting your sleep, and you have a low AHI, ignore the graph....

[Cpapian]

Per WikipediaTidal volume is calculated as 7 ml / kg of ideal body mass (in a healthy young adult adult).

Asleep my tidal volume is considerably less than when awake. And when I sleep on my stomach, it is considerably less.

If when you are awake you have problems breathing and getting enough air in your lungs, then that is something to be concerned about.

If after sleeping you awake with a headache that improves as soon as you wake up, then maybe you may want to dig into this. First thing I would try is an oximeter. They are fairly inexpensive (Contec 50 d or f I believe is around $70, using my memory) and see if your nightly oxygen is dropping.

[Bigmike52]

I have been considering an Oximeter as my lung capacity is not what it used to be and I am waking with headaches everyday but they do not go away. Thank you for your comment.

[raisedfist]

The only full face mask that really works for me is the Fisher & Paykel Simplus. It's well liked in sleep labs as well. One bonus is that it's cheaper than ResMed and Philip Respironic's offerings.

With the nasal pillow masks, did you try different pillow sizes? On the P10 pillows, only the large pillows worked for me in terms of comfort and controlling leaks, and not feeling starved for air.

I'd see what happens to your tidal volume once your leak issues are under control. Fixing the leaks would be my primary focus. If you have breathing problems during the day, you should see a doctor.

[Bigmike52]

Thanks for your help Raisedfist. I like the looks of the headgear on the F&P mask. I have had no success with a FFM but if I found one that didn't flutter and leak it probably would be what I should be using. The problem I have is I am blind in my right eye as I have Glaucoma. The thought of losing sight in my left eye due to mask leaks is terrifying, and leaks on FFM are always going directly in to my eyes. Again thank you.

Mike

[Cpapian]

I have been considering an Oximeter as my lung capacity is not what it used to be and I am waking with headaches everyday but they do not go away. Thank you for your comment.

I agree with raised fist and others, if you feel you lung capacity has diminished you should see your family doctor to tested.