Fit questions from new user

I'm very interested in trying the hybrid, though was not sure how to get on the list. This is my first time veiwing the forum and i haven't figured it out yet. I also had numerous other questions on fit and which mask to get which i'll try to post in a separate thread but will post here as well in case i don't figure it out.

I only started using CPAP a few weeks ago and am having a horrendous time getting dialed in. As a matter of fact the titration study was one of the worst sleep nights of my life as I would wake up at each and every change of pressure.

I now have an M series respironics REMstar auto with humidifier and i reset it from the prescribed to the lowest setting so i can get used to it. Now muy problem is finding the right mask. The script was for user choice but I have no clue what my choice is having never used this before.

I originally thought the nasal pillow might be a good choice but the apria rep (apparently some on this site are not fond of apria) suggested i try the mirage micro nasal mask by resmed. I got a cold within a few days of use and that made me think perhaps nasal masks and/or pillows are not for me as i have chronic sinusitis anyway (despite being a nose breather) and even at the lowest pressure, with my clogged nasal passages it just did not work. Would a pillow system work better? I have no clue.

So my second mask is the fisher and paykel flexifit 432 in medium. Am i really a medium? I don't know but the apria rep seemed to think so. Initially the seal on the chin was poor and i tried with and without the foam cushion insert. I finally realized the best fit came by cutting the foam insert so only the nose bridge piece remained. That allowed the more pliable gel piece to seal against by chin but there is still a little leak on my cheeks that prevents any sleep. I went to apri today and a different rep told me as i am thin with thin face that most masks won't fit as they are designed for wider faces. She recommened a resmed mirage quattro as first choice as she said it was the narrowest. The next choice by her was a respironics comfort gel full, then a hybrid or finding a specialty mask as a third choice.

At this point insurance will no longer pay as i've had two masks in 3 weeks, but i still need to try as i have had no sleep improvement. I'm at a loss as to how to figure this out. I may try buying the quattro and splurging for the insurance i see on this site but boy it's gonna get expensive really quick if that does not work. Hell it already has been expensive. Also i noticed some talk of problms with the straps leaving marks or digging in to peoples faces. I guess due to my narrow face that has not been an issue for me but what has is the lower strap sits at the juncture of the base of my skull and the top of my neck. I need to tighten it soooo much for a good seal that as i write this at 8pm, I can still feel the neck strain from last night's tight strap. I see a softcap headgear that does not use straps and seems like it would even out that pressure and i think i'll try that.

So all this boils down to several questions;
1) Anyone with a more narrow face have any thoughts on the best mask for a narrow face? I realize all faces are different but i'm trying to narrow my choices as much as possible to a few likely candidates.

2)Anyone with chronic sinusitis or allergic rhinitis have any thoughts on nasal pillow vs nasal mask vs full mask vs hybrid mask vs??

3)What are reasons why people don't like Apria? (i've had a few problems already) Any other thoughts on DME providers in the san francisco bay area?

4)Anyone have similar issues with headgear and stress on the neck? Any advice on solutions? Does the softcap seem like a viable approach?

5)I briefly saw something about using some sort of gel or lube to create a better seal but haven't heard of this before. Can anyone offer thoughts or ideas on this or anything for a better seal?

Any and all advice, thoughts or comments are appreciated. Also if and when i find a mask that works, I'd be wiling to set up the ones that don't work for me as test drives as well or do some other thing of similar use with them if folks have other ideas. I know i've been pretty frustrated with the process so far and the lack of help from the testing center and the DME in finding the right mask and appropriate pressure so i'd certainly like to limit the pain for others if i can. thanks agin for all advice.
cheers,
gregg )

if you register on this site... you'll be able to send and receive PM's... and that's how you get on the list.

Welcome to the forum!!
As for your questions;

1) The only way I've found to get a mask that works for me is to try as many as possible. I get mine used, from forum members who are selling masks that didn't work for them.
2) If you need to breathe through your mouth for any reason, get a Full Face mask or a hybrid type mask. Mouth breathing with any nasal mask will ruin your treatment. I think everyone should have 1 working FF mask for times of congestion.
3) Most of us have horror stories from Apria. There are some Apria locations that are good, but none near me. My office gets every order wrong.
4) If you mean the papcap, it seems to be working well from what I've read here. You could always PM a current user for more info on it.
5) There is Ayr Gel, and Lansinoh. Both work for sore nares and both help with the seal.

Brenda

So how does one find forum members selling their masks? The Resmed mirage quattro is the one i'm looking for next.

What is ayr gel and lansinoh and how do you use them?

I've heard lots of talk about use of panty hose to prevent leaks. Can someone tell me what your doing with the pantyhose?
Gregg )

I have a long, narrow face and have found that, so far, the 432 is the best fit. I, too, had to do some cutting on the foam cushion, but it doesn't sound as though I've done as much as you. My RT also thought I would need a medium, but I really need a large. You might try the larger size to see if it fits better. A seal and cushion set will cost you about $55 from online vendors.

I'm going to try the FP 431, which is like the 432 only without the gray foam cushion.

I have chronic sinus problems and mouth breathe part of the night, so full face is a necessity for me. Although I have been looking at the FP Oracle which is oral only. You might take a look at it, too. It comes with nasal plugs that you are "required" to use for the first two weeks and I'm not so sure about that part. I don't like pillows and the Nasal Aire because I don't like stuff up my nose. Maybe I can handle it for a couple of weeks if I can not use them afterward.

Babette runs a test drive, as do a few others. I believe there's a link to test drive info in the signature on her posts.

Keep looking for the right mask. I've tried about 7 or 8 and still haven't found the perfect one. Have found one I can put up with though. It takes most of us a few weeks before we can sleep all night with the thing on, so don't beat yourself up if you can't after only a week! Buena suerte! (Trying to practice that Spanish I'm learning at night class!)

Another tip - if you're having sinus or congestion problems, trying turning your humidifier down or even off and see if there's improvement after 1-2 nights. It's not mandatory to use it at all (it's just a comfort thing) and if there's enough humidity around to begin with, you may not need to use it, or use it only on a lower setting.

Ayr Gel comes in a little tube. It has aloe in it and helps with irritation as well as helping with the seal.
Lansinoh also comes in a tube. It is lanolin, and is made for breat feeding mothers. You can find it by the baby products.
It is kind of tacky so helps with getting a better seal.
Panty hose, or more accurately tights can be used to make an extra strap to hold the mask on the face. Just cut off a leg
of the tights and tie it where you need the extra strap to stabilize the mask.

Brenda

If you find you need to experiment with different masks, you can find some good buys at Cpapauction.com - most sell for less than half of the original price. I am still in the experimental stage too, and am trying to get a FFM for nights when my nose is just too congested. I use a Confortlite 2, and It took me a while to get used to the nasal pillows, but last night I finally got a good comfortable seal, and slept like a baby. Nose feels a litle funny this morning, but considering it had something stuffed up it all night long, I can understand. I switch back and forth between the pillows and direct seal just so my nostrils don't get too sore.

I have been putting a little vicks vapo rub in each nosril and it seems to work well for me in keeping my nose open.

I would hate to have to pay full price for several different masks, as my insurance sucks (I am not even going to go there) and I am paying out of pocket for all my needs.

Good luck from one newbie to another.

Skittles

I'm about 7 to 8 weeks since starting therapy, and I have an FP 431. It comes with small, medium and large seals. I started with medium, and after a few nights of leaks, I tried the large (which I was swimming in). So, I tried small, and the leaks were worse than the medium. So, I sit on medium. Leak rate runs about 0.4 L/s up to about 1 L/s.

I'm convinced that I have a narrow nose bridge and my eyes are closer together than the mask allows. Most of my leaks jet directly into one eye or the other.

I also have chronic sinusitis and allergic rhinitis (mold is one hit for me, so at some point I will try it without the humidifier). My only experience with a nasal mask is during my titration study. I spent an hour or two on it. It felt fine at first, but then the bridge of my nose started to hurt considerably. After switching to a FFM, everything was fine. That's why the DME-R/T dropped off the FFM.

The DME has already collected one round of data from me, and I've talked to an R/T again -- we decided to see if the somnodoc was displeased with the leak rate, and if so, look for another mask.

Everything else about the mask has been fine for me -- I've been sleeping well, and mask comfort has been good.

Julie wrote:Another tip - if you're having sinus or congestion problems, trying turning your humidifier down or even off and see if there's improvement after 1-2 nights. It's not mandatory to use it at all (it's just a comfort thing) and if there's enough humidity around to begin with, you may not need to use it, or use it only on a lower setting.

It's the opposite for me...if I don't have the humidifier turned on, I get more congested. Everyone's different, so you'll have to experiment to find what works best for you.