Post
by Janknitz » Sun May 07, 2023 6:48 pm
I think the place to start working on this is with your mask. You are not getting a good seal. Looking at your chart, the leaks start almost immediately and are persistent throughout the night. It's not the pressure that's the problem, it's the seal on your mask. If I had to guess, I'd put it down to the memory foam cushion (looking up the F20 online it seems to be a memory foam cushion mask--forgive me if that's not correct, even if it is an air cushion, you STILL have a mask problem).
Ever put your hand down on a memory foam mattress pad or pillow and then remove your hand? The impression from your hand remains for a few minutes and then slowly fills in again. What that tells me is that the memory foam is not very dynamic, but your face has so many muscles and types of movement, it is very dynamic. As you fall asleep your face relaxes. Gravity and your position change the dynamics of your facial muscles, taking a breath with your mouth, wiggling your nose, blinking, etc, all change your face--but it takes some time for the memory foam to catch up to those movements.
Looking at reviews for the Airtouch F20, it works for a lot of people, but clearly it's not working for you. I tried a memory foam cushion in my early days on CPAP, I found that it really needed to be crammed down on my face to not leak, to the point where I couldn't really move my face. Perhaps a mask liner and anti-leak strap will help you--it's a cheaper solution than a different mask, but it's unclear if it will work for YOU (just because it worked for others doesn't mean it will work for you). Also, memory foam deteriorates quickly--have you changed the cushion every 30 days as recommended? Silicone is much more resilient.
Most of us use air cushion masks, and there is a reason. Air cushion masks are dynamic and move WITH your face, filling in the gaps as you move IF properly adjusted. That's a big "if", in that it's very hard to properly adjust a full face mask whether you are using an air cushion or not, because there's a LOT of surface area to cover, and positions and pressures do change throughout the night on APAP. There's also a nuance using air cushion masks, in that the air cushion must be fully inflated with air to work. The instinct is to mash it down if there are leaks, but you need to do the opposite, release the pressure until the cushion fills up and molds to your face. It takes some work to get it adjusted properly in the first place and find that "sweet spot" that will allow it to respond to increases in pressure, changes in position, etc. But most of us can learn to master it.
There are other FF masks that have air cushions you could try to see if you have better leak control. I also wonder if you really need a FF mask? Nasal masks and nasal pillow or cradle masks are SO VERY MUCH easier to seal, simply because the surface area and amount of movement they have to manage is much smaller. Some people start off CPAP thinking they need a FF mask because they have been mouth breathing for years, but the mouth breathing can be because of air hunger caused by the apnea. I, for one, was surprised to find out that I didn't need a FF mask once my apnea was under good control.
Unless and until you get those leaks under control, everything else is moot. The leaks are too big for effective treatment, and your AHI and graphs illustrate that pretty clearly. Give a mask liner and leak strap a try, but if they don't work, you need to be looking for a different mask.