CPAPtalk.com

At diagnosis, I had an AHI of over 86 with 161 incidents in the first 100 minutes of sleep study which I'm told is pretty severe.

I got my CPAP and a full face mask and it seemed pretty comfortable when at the sleep center, most comfortable of the three I tried.
My machine is a Phillips Respironics Dreamstation auto cpap . pressures are set at auto 10 - 15 cm h2o.
My mask is a Simplus Full Face CPAP Mask with Headgear (Manufactured by Fisher & Paykel - sz Small)

Prior to CPAP I usually slept mostly on my stomach-side or my side. With the mask on I have found that if I don't sleep on my back, the mask leaks. Basically if any part of my cheeks or mask is touching my pillow, the mask starts to leak (most commonly near the bridge of my nose and my eyes). Tightening/Loosening the velcro straps doesn't really seem to help. I try to re-position the mask on my face and it helps for like a minute and then starts to leak again. I try to just stay on my back but then I get stiff and achy and need to turn over.

Is this normal? Should I get a different mask? I'm told that with pressures as high as mine the nasal pillows aren't as comfortable and apparently I open my mouth when I sleep so I need a full face.

I really need some advice as I can exchange my mask in the first couple weeks.

Papillow.com - take a look.

You might need to change your bed pillow or see if you can figure out some way for your bed pillow to not put so much pressure on your mask when it touches it.
They make cpap pillows with special cut outs but you can also make your own by going to some place like Walmart and getting one of the cheap memory foam pillows and cutting out your own little place for the mask to rest.
See these pillows for ideas.
https://www.cpap.com/cpap-comfort-clean ... pillow.php
Plus you can google "cpap bed pillows" and get some more ideas.

That "your pressure is too high for nasal pillows" statement is an old wives tale. We have people successfully using nasal pillows with pressures in the 20s.
But if you are indeed a serious mouth breather then you will need a full face mask if you simply can't breathe through your nose well enough to be comfortable with your mouth staying shut.
Is the mouth breathing because of serious nasal congestion that can't seem to be fixed or is it more out of habit? I thought I was a mouth breather too but ended up being habit from gasping for air all night.

Full face masks simply have more surface area to seal and keep sealed. It's just the way they are...the more area that touches the skin the more area for potential leak issues.
You should be able to sleep in any position you want with any mask you want. Sometimes it takes a bit of work to figure out how to get it done though. We have people sleeping on their stomachs with full face masks.

Do make use of any mask swapping time you might have with the DME to try other masks. You can always go back to a prior choice if it ends up being the best of the bunch. You won't know till you try.

If you mainly breathe through your nose during the day and don't have chronic nasal congestion forcing you to breathe through your mouth....there's no reason that you can't at least try nasal pillows if that is what you want to try. They are easy to seal and keep sealed in any sleeping position and worth trying if you can breathe through your nose well enough. If you are mouth breathing out of habit there are ways to maybe break that habit. I know I thought I was a mouth breather but it was mainly out of habit. I pretty much broke the habit and any mouth breathing I might do now is rare and brief.

Is the mouth breathing because of serious nasal congestion that can't seem to be fixed or is it more out of habit?

Honestly, I have no idea why I open my mouth... I don't while I'm awake but I must when I sleep. During my sleep study I started out with a nasal mask and at some point the tech brought in a chin strap, which was very uncomfortable, so then she moved me to a full face mask. I just assumed it was because my mouth was open. i have no congestion or allergies or have any trouble breathing through my nose. I can't even say it's a habit because i never doing it while I'm awake.

Any mask will work just fine with your pressures, and you can train yourself to not open your mouth and/or seal your mouth off with your tongue. I can open my mouth and talk with my nasal mask on, without any air leakage at all. I do occasionally have leaks out of my mouth, but it never lasts long.

I would highly recommend the new Respironics DreamWear, it is great for side or stomach sleepers. Another full face option is the Respironics Amara View, it is my alternate mask for when I'm sick with a cold and is comfortable when sleeping on my side.

I may be giving bad advice as I am new to this as well, so take what I say with a grain of salt. Are you sure the mask is leaking? What do your leaks say on your machine in the morning? I ask because towards the bridge of the nose there are vent holes for the air to escape which is not a leak. At first, when ramping at a lower pressure, I didn't notice it, but as the pressure gains you can notice the air escaping, but I am pretty sure it is supposed to. I have not reported any leaks in the first 6 nights of use.

I hope I am not incorrect in saying this.

there are vent holes for the air to escape which is not a leak.

flyergirl - that's what my husband thought it was too, but this is actually not those holes, it's coming out by the bridge of my nose and when I adjust the mask slightly it stops leaking, until I move again. Maybe I just have a goofy-shaped face.

I would highly recommend the new Respironics DreamWear

i'm not sure I have that many options, there were like three full face masks that my sleep center had as options. Not sure my insurance will cover if I get the mask outside of there. I think I may need to try a different full face mask - they had one that was a bit heavier and hand a nasal/forehead piece that you could adjust closer or further away from that area of the face.

Something to consider and you sure don't have to do it right away...use the DME and any mask swapping they allow first...is if your pocketbook will permit get a mask from cpap.com that comes with free return insurance so if you hate it and it doesn't work out then you can return it and get your money back.
Your insurance probably won't reimburse the cost unless they will let cpap.com be an out of network provider (call your insurance and ask) and pay that way.

It terms of the Simplus...are you sure they gave you the correct size? Did they actually measure your face or did they slap one on and say "that looks good"?

There is a printable sizing guide for the Simplus
https://5faacd0c97cf0d23c6dc-064f3cd61b ... d-2014.pdf

Sounds like your mouth breathing may be out of habit or the jaw is dropping down.
Up to you if you want to continue with trying full face masks or maybe try something else.
We will try to help no matter what you decide.

The DreamStation Auto CPAP will show leak data on the LCD screen...and mouth breathing will show up as a leak if it's bad enough. Right now there is no software available to see beyond what is on the LCD screen but later on software will be available so that more/better details about leak and therapy will be available.
The data available on the LCD screen is rather limited but is good enough to get you close.

I had similar problems and switched to a buckwheat pillow, one with some foam in it so it is softer. I just hollow out space for my mask it works much better for me.
Best luck!

Pugsy wrote:Right now there is no software available to see beyond what is on the LCD screen but later on software will be available so that more/better details about leak and therapy will be available.

Really looking forward to this!

Up to you if you want to continue with trying full face masks or maybe try something else.

If I try just a nasal mask (which was the most comfortable in my sleep study) and my mouth opens while I sleep, what does that mean to my level of therapy?

I think the small is the right size because they started with the medium and that leaked when I was lying down if I even so much as moved my head.

ShannanMN wrote:If I try just a nasal mask (which was the most comfortable in my sleep study) and my mouth opens while I sleep, what does that mean to my level of therapy?

It all depends on how much mouth breathing you might be doing as to how much it might impact your therapy....would it be a lot of mouth breathing with massive loss of therapy pressure for prolong periods of time or would it be maybe just a little bit for short periods of time.
These machines can compensate for some leaking but with massive leaking (mouth breathing or whatever causes the leak) obviously they can't go compensating for huge leaks.

So it all depends on how much and for how long.

Sometimes we have to decide which evil is the worst evil...not sleeping well at all because of fiddling with leaks on a full face mask or sleeping well and having a little bit of maybe not so great leak control.
I mouth breathe sometimes...I know I do but it never is for very long and most of the time it is within a range that the machine can handle/compensate for and I sleep through it all. 15 minutes of mouth breathing out of 8 hours of good solid sleep beats crappy 8 hours of sleep from screwing with mask leaks all night long any day of the week.

Besides...if you mouth breath enough to impact therapy it only impacts the therapy when the mouth breathing is happening...it doesn't negate the other therapy time when leaks are within acceptable limits.
30 minutes of big leak only hurts the 30 minutes when the big leak is happening...it doesn't mean the entire night's therapy is in the toilet...just that 30 minutes.

There are ways to help keep the mouth shut...chin straps help some people...some people elect to tape their lips shut...some people use a soft cervical collar to help keep the lower jaw up if it is a droopy jaw that is the primary culprit.

I am not anti full face mask...but I hate to see someone struggle with one and have crappy sleep because of the struggle when maybe they don't have to if they don't want a full face mask.
My job isn't to make a mask decision for you...my job is to help you make a success of whatever mask you WANT to use. If you end up with such massive mouth breathing leak that it simply cannot remotely be considered anywhere near decent therapy I will be the first to tell you to make peace with with a full face mask.

My suggestion would be to try a mask that you WANT to try and think you have a better chance of getting good sleep with and then we evaluate the leaks to see if you really need a full face mask or not and go from there.

My suggestion would be to try a mask that you WANT to try and think you have a better chance of getting good sleep with and then we evaluate the leaks to see if you really need a full face mask or not and go from there.

I really appreciate the help! I think what I'm going to do is go back to the sleep center and try different masks while lying ON MY SIDE, WITH MY PILLOW and AT FULL PRESSURE to see how different masks affect me. When I did the first fitting, the pressure was at 4 and I was just on my back - not very realistic testing.

ShannanMN wrote:When I did the first fitting, the pressure was at 4 and I was just on my back - not very realistic testing.

No not very realistic at all but still better than what most people end up doing in their "fitting".
Mine was in a chair, upright and no machine anywhere.
But then I already knew what I thought I wanted to try first and would only consider the others if what I WANTED didn't work out. I was pretty sure I knew my body well enough that even if I had some initial problems that I could sort through them and I was right.

It's your therapy and you won't know how anything might or might not work until you try.
Is it always easy...heck no, but I can guarantee you that you won't have a single problem that someone else hasn't also had and was able to solve eventually in some way or another.