This newbie is a problem child

Re the beard and a suitable mask;

If there were a "full face mask" style mask that was essentially a nasal mask with a mouth piece that I put into my mouth and closed my mouth and lips around it, so I could still mouth breath, I'd love to try that.

Oh my....nice looking beard but it will play hell with getting the mask to stay sealed. Not impossible but it will be a challenge.
Mask liners will likely make it worse.

Mask fit feature...a special selection on your machine (not related to the mask type choice) where you can fit your mask at higher pressures when you first put it on and hopefully help manage leaks better.
Explained in the manual
https://www.respshop.com/manuals/ResMed ... %20her.pdf
I think it blows at 3 to 5 minutes at the higher settings.

Right now when you are fitting the mask and start the machine it is starting out in ramp lower pressures so what seals good at lower pressures doesn't work so great when your ramp ends and the pressures needed are so much higher.

So either turn ramp off or use the mask fit feature.

Your mask choices in full face coverage with a beard like yours....extremely limited.
Do you ever need to breathe through your nose?
There is this mask but the nose can't be used at all.
https://www.cpap.com/productpage/fisher ... -cpap-mask

I did use the "mask fit" feature with mixed results. According to the mask fit, the F20 would not seal up no matter what I did or how hard I smashed it on my face. It was about ten minutes of torture fighting to exhale while the machine is trying to blow my head apart. But I could not find or feel where it was leaking from other than around the connection from the elbow basically. I tried and tried. My wife tried to feel it too. We were unable to find it. Yet the first night it did work well. Just not the last two.

I have never tried to think about marrying the Oracle with a nasal mask. Always though of the Oracle as something to be used if the nose was useless and out of the picture. Do let me know if you figure out something.

The_Boaphile wrote: ↑

Fri Oct 16, 2020 3:06 pm

I think I may have found a possible solution for this "problem child" with an old beard...

hc452-oracle-oral-cpap-mask-fisher-paykel.jpg

oracle-oral-cpap-mask-cushion.jpg

I could use a "nasal mask" AND this mask together to get there from here. I'm a handy guy so I can figure out how to connect the two of them to the machine to make it work.

That's an innovative idea, but I think it will be difficult. A nasal mask tends to take up the room under the nose, including the mouth area, though not directly on the mouth. The Oracle is likely to interfere with that fit, unfortunately.

Nice beard! I'm a bit envious, but not of the problems you have.

I believe you already tried nasal only but without a doubt if you could find a way to keep your mouth shut during the night that would be the way to go. But I'm useless about suggesting what might work with a beard towards keeping the mouth closed ... I see no good answers.

khauser wrote: ↑

Fri Oct 16, 2020 3:25 pm

The_Boaphile wrote: ↑

Fri Oct 16, 2020 3:06 pm

I think I may have found a possible solution for this "problem child" with an old beard...

hc452-oracle-oral-cpap-mask-fisher-paykel.jpg

oracle-oral-cpap-mask-cushion.jpg

I could use a "nasal mask" AND this mask together to get there from here. I'm a handy guy so I can figure out how to connect the two of them to the machine to make it work.

That's an innovative idea, but I think it will be difficult. A nasal mask tends to take up the room under the nose, including the mouth area, though not directly on the mouth. The Oracle is likely to interfere with that fit, unfortunately.

Nice beard! I'm a bit envious, but not of the problems you have.

I believe you already tried nasal only but without a doubt if you could find a way to keep your mouth shut during the night that would be the way to go. But I'm useless about suggesting what might work with a beard towards keeping the mouth closed ... I see no good answers.

Thank you both.

This nasal mask, which sealed up nicely except for me opening my mouth, should work fine with the Oracle mask. Now to get it ordered and get the two of them married together. I'm NOT shaving off the whiskers. LOL

Worth a try! One problem you'll encounter is how to join the two tubes. I did a quick search and it doesn't look like anyone sells it.

Be careful, you'll see hits but unless they are for 22mm connectors they won't work, but the picture LOOKS correct. Just can't see the size...

Have you tried the Resmed F30i? https://www.cpap.com/productpage/resmed ... -face-mask
I have a beard similar to yours (shorter - about four inches currently) and have used it successfully. Some leakage through the beard is inevitable, but as long as you keep it down below large leak territory you still get good therapy. But then I have used the F20 successfully also. So what works for me may not work for you.

I am using the P10 with a gag combination and a cervical collar at this juncture, (I ain't shaving my beard either. obviously ) because I can and it is more comfortable for me. (seriously) I can breath through my nose with no problem though.

Anyway, I just wanted to wish you good luck in finding your ultimate combination and confirming that it can be done.

JPB

Just reread your thread and see you have indeed tried the F30i.
Will work on reading comprehension.
Good luck.

jimbud wrote: ↑

Fri Oct 16, 2020 5:33 pm

Have you tried the Resmed F30i? https://www.cpap.com/productpage/resmed ... -face-mask
I have a beard similar to yours (shorter - about four inches currently) and have used it successfully. Some leakage through the beard is inevitable, but as long as you keep it down below large leak territory you still get good therapy. But then I have used the F20 successfully also. So what works for me may not work for you.

I am using the P10 with a gag combination and a cervical collar at this juncture, (I ain't shaving my beard either. obviously ) because I can and it is more comfortable for me. (seriously) I can breath through my nose with no problem though.

Anyway, I just wanted to wish you good luck in finding your ultimate combination and confirming that it can be done.

JPB

Just reread your thread and see you have indeed tried the F30i.
Will work on reading comprehension.
Good luck.

I have used the F30i with leaky results. I did try the cervical collar. My neck really disliked it. ;-(

Thank you for the suggestions. I am still working at it. Takes time with experiments being limited to once per day and wait time on getting new products.

Something to consider and the good folks here can sanity-check my thoughts... You want to control leaks as much as you are able, but don't get obsessed with them if you are otherwise doing well with controlling apnea events and sleeping good.

You are showing mid-teen AHI numbers, but you need to verify if that is your true AHI and determine if there are false positives skewing your AHI. This is where Oscar helps to zoom in on each event, analyze it, tally false & true events and then do the math. And even if everything is configured optimally for your situation, you can still have bad nights, so I try to look for patterns over successive nights and not be too concerned with a bad night that pops up every so often.

For example -- I struggle with back & shoulder pain that causes me to re-position a lot throughout the night and I am awake enough when that happens to be aware of it. Each time I do that, I register events and those should be discounted as they are not true apneas, but are sleep/wake junk. When I am actually asleep and my APAP is doing it's thing, my sleep-apnea is typically well under control -- at least to a very tolerable level.

As for masks, my facial hair is just a 'stache & goatee and I'm settled on a nasal mask. But every face is different and a normal expectation should be trying out an assortment of masks until you find one that works for you, or at least "good enough" to stick with for awhile until you spot another mask to try. I've thought I had found "the perfect mask for me" two or three times now. I think I went through 6 masks my first year. Finding the best mask for me may be a never ending journey -- I try to keep an eye peeled for new mask designs hitting the market that *might* work better for me. How do I know if a new mask will work better? I don't for sure until I try it out. But based on past experience with other masks types, I have a growing base of experience to draw on that helps. It's probably more of knowing what I do NOT want from prior mask trials that did not work for me than anything else. So use a vendor like CPAP.com or similar who allows you to try masks out and return them for credit/refund if they don't work for you.

The mask I currently use (Circadience Elan) is cloth-like and I get a good seal with it against my facial hair, but I can still manage to "wipe" it loose on the pillow when side sleeping. Now you might try that mask and it works great... or it may be a horrible failure with you... Like everything with PAP therapy, everything varies person to person. But as far as leaks go, I pretty much ignore them unless they are bad enough to wake me up enough to adjust the mask and/or if my AHI stays elevated above what I normally expect for several successive nights (enough to make me fire up Oscar to see what's going on).

So long diatribe short -- we want to minimize large leaks where possible to help whittle your *actual* apnea events down to a tolerable level (which can vary person to person, but generally under 5/hr). Don't ignore leaks, but if your true AHI is tolerable, the leaks aren't causing other issues (waking you to fix them or otherwise messing with your sleep) and you are feeling good/well rested, perhaps don't be overly concerned with them.

All that being said, it sounds like you likely have some work ahead of you to get your large leaks under control. So use Oscar, or let the good folks here help you use Oscar, to try and determine your true AHI to target/tune your therapy. It sounds complicated and the graphs can seem a mess, but once you get the hang of it and know what to look for in the context of true/false positives, it's actually fairly simple.

Good luck with it!
-JD

People with full beards can get full face masks to seal but it is a challenge. I saw a leak report from a guy with a big bushy Santa Claus beard and his leak line was prettier than mine. And we see ugly leak lines from people with zero extra facial hair.

I think success or failure when facial hair is involved might be related to the hair's texture and how well it can be compressed to form a seal. Softer hair might be easier to compress than more coarse hair. Obviously being female I have no personal experience but it's logical and my husband does have facial hair and it is very coarse. We have often joked about the chances of getting a FFM to seal with his hair if he ever needed cpap.

I think the idea to marry a nasal mask and the Oracle might work IF one could find a way to attach 2 different masks to the one long hose.
Now I know it can be done because in the hospital for Covid and needed breathing assistance they were using one machine for multiple people but what they used to attach to the one main hose I have no idea. The coupling product is probably out there somewhere but I just don't know where.

Necessity is the mother of invention they say. It's always worth at least trying.

Well it's been a while since my last progress report as I was waiting for this oracle mask to arrive. I needed the Oracle mask to finally have a victory over mask leakage most due to having high pressure and a beard. I received it two days ago. So after making a hose fitting so I can run two masks on one line, I have used it in conjunction with a Dreamwear Nasal mask two nights. The first night was not a success. Even though I used the strap with the Oracle mask, my face was unconsciously trying to hold the thing on with either my bite pressure and or my lips having on for dear life. I was basically having cramps in my jaw and around my mouth. The pressure INSIDE my mouth was so great, it was trying to blow the thing out of my mouth. Regardless, that it was impossible with the strap, my body thought I needed to help.

I am a mechanical kind of guy. I make things work and figure out mechanically how to get from point A to point B. It's a gift. So I determined that I needed less pressure in my mouth while maintaining the desired pressure in my airway overall. I don't breath continuously through my mouth, but I need that option available when I want it in order for this to work. So I figured out how to reduce the pressure into my mouth when I am not breathing through my mouth. I made several modifications to the oracle mask to make this work. This allowed my face and jaw to relax.

I dropped my pressure down PS 6.0 over 16-25 to PS 6.0 over 10-19 because of the rib pain and cramps I have been having at the higher pressures. I'll work the pressures up as my diaphragm gets used to it. So last night I had the best numbers so far. For the very first time, after nearly 3 months, I feel like there is light at the end of the tunnel.

If I am reading this right, it looks like maybe I should change my PS from 6.0 to 5.0. What do you think? Thanks again for the help.

The OAs you zoomed in on look more like arousal breathing to me.

I have long though you might need to reduce the PS and maybe not just to 5.
Plus if you reduce PS a bit then you might be able to use a little more minimum EPAP should it work out that you still have very many OAs AND your were for sure asleep when they happened.

Awake/arousal flagged stuff...we have to ignore except for the fact it points to not being asleep and that of course has to be addressed in other ways.

Well I had the best result so far two nights ago. The first graph shows the results. At these pressures, ( PS of 5.0 and 12.0/20.0) I continued to have a fair amount of discomfort from exhausted exhale muscles that are not accustomed to this yet. I am sore all day in my lower ribs and especially my right side and shoulder, which I am certain is related to this extra work to exhale. It's like blowing up balloons all night long. The shoulder pain at night is really uncomfortable and so far unavoidable.

So last night I tried it again at that higher pressure setting. After the first hour I just could not stay asleep with this shoulder pain. So in the mind fog of just waking up and wanting to get to sleep, I slashed the pressures to PS 5.4 and 10.0/15.4. The shoulder pain subsided very quickly. Unlike the previous week or so, I didn't even have any shoulder pain the rest of the night. So I need to build up these exhale muscles over more time to reach more preferable results eventually.

So two questions for now;

1. Is there sort of a way to estimate time wise how long I might expect it to take to get used to blowing up balloons all night long? I'm determined to get there. Even if it takes a year. I'm going to get there but without this pain. I'm just wondering in broad terms what I might expect.

2. Are Central apneas harmful?

Thank you very much for the feedback. Pugsy seems to have taken me under his wing. I appreciate that. Any other feedback, especially if anyone else has experience with the pain from higher pressure exhaling would be appreciated as well. Thank you!