IPAP/EPAP pressure changes & mask comfort

Hi all,

I got my bi-level machine about a week ago and I'm having trouble with the changing pressure on my face. I can't deal with how the mask expands & pushes against my face and then lets up with the different IPAP/EPAP pressures (set at 10/2). It's the pushing and stopping, pushing and stopping that I can't stand. I'm currently using a resmed f30 but I also have a BMC f5.

-I can tolerate it sitting up & otherwise mentally engaged
-I can sleep with the straps and mask on my face but disconnected from the machine
-f30 is fitted well (I think), the silicone gets a friction seal on my skin fine & I can't hear or feel any leaks, or crinkled spots from over tightening. the bits touching me don't move with the pressure changes
-f30 squishes my nostrils up and down, BMC f5 presses my jaw back and forth.
-I could deal with the higher pressure if it was a constant, but my muscles are too weak to breathe out against it, so
-I really don't think this is something I can adjust to with enough desensitisation, I have some moderate-severe sensory issues already & I've never won those battles before

My questions:
-Do the nasal masks that go under the nose also expand with changing pressure? Any other mask types that'll just jet it up there?
-Are there other solutions for this? Can I add another layer of seperation with those mask liner things? Will that help?

Sorry for the wall, thanks for your help

MattyToo wrote: ↑

Fri Dec 03, 2021 8:23 am

My questions:
-Do the nasal masks that go under the nose also expand with changing pressure? Any other mask types that'll just jet it up there?
-Are there other solutions for this? Can I add another layer of seperation with those mask liner things? Will that help?

You do pose some rather unique challenges considering your pressure needs and you own health issues.

I think that pretty much all the masks out there are going to fluctuate somewhat given your rather dramatic changes in pressure..

Your question about the under the nose cushion kinds of masks...I assume you mean the ones that don't cover the mouth like your F30 does. They might not be so noticeably annoying with the inflation/deflation thing since they are smaller overall.
The only way to know is to try though. It's the way with all masks no matter what our challenges are with any mask.
The main problem of course with the under the nose cushions...and mouth uncovered...is the problem of the mouth opening and letting air pressure exit out the mouth. Do you need to have the mouth as part of the sealed circuit because you can't keep your mouth closed???

I do think you probably should be talking with your medical care team about your rather unique situation and issues.
Where are you located?

As for a mask liner....I don't know if it would help or not but it is worth a try. Everything is worth trying IMHO.
You can buy liners or even make your own out of an old Tshirt.
Padacheek.com makes some great mask liners for lots of masks.

I don't know if the barrier is enough to get you past the sensory problems you are having with the inflation or deflation thing.

Pugsy wrote: ↑

Fri Dec 03, 2021 8:41 am

Your question about the under the nose cushion kinds of masks...I assume you mean the ones that don't cover the mouth like your F30 does. They might not be so noticeably annoying with the inflation/deflation thing since they are smaller overall.
The only way to know is to try though. It's the way with all masks no matter what our challenges are with any mask.

Sorry, yes I meant the nasal cushion type masks that just press up against the underside of the nostrils. I've been looking up different models and they all seem like they would press and relax, press and relax, against my nostrils, like the f30 is currently doing. I noticed you've mentioned in previous posts that you trialed the Nasal Aire prong mask - do you remember how rigid the prongs were? Are they soft silicone that expands with the air pressure to form the seal?
(I'm a little wary of being a princess-and-the-pea-type newbie who is being overly fussy in dismissing every popular standard mask.. but)

Pugsy wrote: ↑

Fri Dec 03, 2021 8:41 am

The main problem of course with the under the nose cushions...and mouth uncovered...is the problem of the mouth opening and letting air pressure exit out the mouth. Do you need to have the mouth as part of the sealed circuit because you can't keep your mouth closed???

I just tend to mouth breath sometimes as one or the other nostril is almost always blocked, and sometimes both. Maybe 1 night out of 5 I'll have trouble with totally blocked nose for part of the night. But I figure a mask I can wear most of the time is better than one I can't stand at all.

Pugsy wrote: ↑

Fri Dec 03, 2021 8:41 am

I do think you probably should be talking with your medical care team about your rather unique situation and issues.
Where are you located?

they aren't being much help, of course! I didn't realise but the mask selection in Australia seems pretty limited unless I buy it from America - doable, but postage times are probably 6 weeks at this time of year. If it's my only option I'll suck it up though. The local place won't do mask trials because of COVID.

I'll go give a home made mask liner a try. And ask around the myasthenia groups for their opinions, as most of them also have the high pressure support numbers. Thanks for your help!

Yes, the nasal aire prongs were tried several years ago.
The prongs are fairly rigid...not soft like normal mask silicone cushion material but I suspect that not so rigid you wouldn't notice the inflation/deflation thing. They have to inflate to seal. Initial sealing is from the baseline pressure though.
The fit has to be extremely perfect or there is zero chance of it working. I ran into this problem myself with the sizing.
I ended up being an in between size. I forget exact sizes but it was a situation where one size was just a little too small and the next size was too big and hurt like hell.

In all honesty I don't think the prongs are something you would find comfortable at your pressures especially the range between inhale and exhale. They aren't horribly rigid but they are thicker and more firm than one might think but there is some give to them when under pressure. That's how the initial seal is obtained. Imagine that inflation/deflation thing going on inside your nose. With every breath...

Actually the mask I would like for you to be able to try is the Bleep...my current preferred mask but it isn't available in Australia either. There are retailers that would ship though. Obviously keeping the mouth shut is critical and I don't know if you can do that. I also don't know if your condition impacts finger dexterity at all because they can be a bitch to attach.
Now there are plans to have a Bleep that has a bit different attachment system...but that's still in development and who knows when/if it will ever be available publicly.

Can you get hold of a ResMed N30 to try?
https://www.resmed.com/en-us/sleep-apne ... irfit-n30/

It is the cradle cushion version of my number two mask the P10 nasal pillow mask and while I personally haven't had a chance to try it....it does look interesting and I have thought that it might be worth just checking it out to learn about it.

Are you using the machine just to aid with breathing and not so much for sleep apnea issues?
If just for a general aid in moving air and not so much for obstructive apnea issues then maybe if you did do a little mouth breathing and lose some pressure it might not be that much of a negative for your situation.

Nose being partially blocked sometimes...I wonder if that is mainly a normal nasal cycle thing.
Is the side blocked usually the side that is down? If so...google "nasal cycle" and read up on it. It's actually normal...annoying for sure but normal.
Sometimes the added humidity from cpap will help with some nasal congestion.
Do you find that a hot steamy shower relieves your sometimes nasal congestion?...or make it worse???

back again for another 4am desperately exhausted update

I had an early success with a 2nd hand Eson 2 nasal mask a week ago, I napped for a few hours with it! Slept great! but have been unable to replicate since & am becoming more sensitised to all three of my masks and struggling more with them during the day too. I've tried mask liners with all 3, and tried attaching the hose to the top of the head gear/bed frame to stop it weighing the mask down. no joy.

I just want something that doesn't move with the changing pressure. I don't know what to do next, and I can't really afford to keep trying stabs in the dark. I'm wondering if I try to diy a fabric mask (using existing hardware so it has an exhalation port) and if that proves I can use it, to get a proper one. or do the same with an oral style mask. or maybe get something like the AirFit P10 but squish a ring of foam around the protruding bits to stop them accordioning up and down. I don't know, I just desperately want to find a way to make this work for me.

Pugsy:
I've been looking into the bleep, it looks like it could maybe work.. I do have dexterity issues but maybe I could manage it. Is it closer to a nasal pillow?

Unfortunately the N30 looks like the worst part of the F30 I already have - the big blob inflating against the underside of my nose

Yeah it is mainly for breathing support as a NIV, I do have a bit of obstructive apnea but that's mostly mitigated by positioning. It's really to help support my diaphragm by reducing its workload.

I didn't realise nasal cycling was the name for that! That's exactly what happens, but sometimes it seems to pause midway and block both

MattyToo wrote: ↑

Sat Dec 11, 2021 11:21 am

Unfortunately the N30 looks like the worst part of the F30 I already have - the big blob inflating against the underside of my nose

Potentially yes...but a much smaller "blob" inflating than the F30 much larger "blob".

And yes...the Bleep is somewhat more similar to a nasal pillow mask than it is similar to one of those cradle cushion kinds of masks that go under the nose.

I was just trying to think of a nasal mask with less overall bulk so that you would maybe get less of an inflation/deflation sensation.

Since you are mainly using the mask and machine to help overall ventilation and not so much OSA maybe any mouth opening issues you might have will be minimal and not really impact things all that much.
Gotta get you sleeping first and if the inflation/deflation thing is so annoying you can't sleep....that's a big problem.

About the only other factor, that potentially could be altered, that affects the inflation/deflation thing is going to be your actual settings.
10/2....that's a difference of 8 cm and that's a really big difference to be having with every breath. It's not a common setting at all likely would be problematic for a lot of people. If you could maybe reduce that difference to 5 or 6 cm....the inflation/deflation thing might not be so annoying but I hesitate to make that suggestion because of your rather unique situation. Maybe something to talk to your doctor about....maybe at least give it a try while awake and not planning on sleep just to see if it would even work or not and then talk to your doctor about the chances of a lower pressure support (that difference between inhale and exhale) being enough to satisfy your needed ventilation requirements while asleep.

Talk to your pulmonologist about using a ventilator that can use an active circuit. They use a separate exhalation valve and if you don't have OSA, you can turn the EPAP entirely off.