Mask Input Requested Please

I know I'm broaching a big and personal topic, and I've read some or the info on masks here. Nonetheless, I'm requesting anyone with an opinion (that's probably everyone), to offer any suggestions for a next mask to try. I prefer side sleeping, but I can fall asleep on my back now, having worked with xPAP for almost 3 months. I'm a fairly active and light sleeper and tend to try to get onto my side.

I was titrated with a Mirage Swift II pillow and used one for a few days thereafter. I found the direct flow into the nostrils irritating. In addition, the retainer bar on the Swift II dug into my cartlidge bewteen the nostrils and my upper lip.

I next went to a mask trying a comfort gel Large, which was reasonably comfortable, but went to a small which reduced eye leaks. But am still getting leaks, especially when I turn to my side. I'm trying to learn to make mask adjustment as I turn.

I've tried the Comfort Lite 2. Initial comfort is good, but without fail the headgear feels like a vice grip when I ultimately wake up around 1-2 am. I believe it is not overly tightened. Also, I found the tube over the head problematic when I would turn. I don't have a head board to route the tubing up above me.

With a new DME a month into my therapy, and a change of machine from Resmed Escape II with EPR to Respironics BiPap Auto with BiFlex, and already having the comfort gel, the RT suggested the Activa, Large. I prefer it over the comfort gel because all in all, I don't have to tighten the headgear so much, and the headgear is just a little lighter overall though very similar. So when I wake up, I feel less chafing and irritation than from the comfort gel, which while not vice-like as the Comfort Lite 2, does "burn." However, I've found I still get significant eye leaks unless I pull the mask down to just above my upper lip. This brings the top of the mask lower on my bridge and away from between the eyes and does reduce eye leaks. But it's not a good fit, so I have asked the DME to provide me the proper fit which I believe would be the Shallow, since the top of that mask would naturally fit lower on my bridge.

The DME says I have to wait till my 3 month mask interval for Blue Shield before they can get me that mask. I've disagreed with them saying the Large is not a good fit and they should provide a good fit, and my RT is trying to work it out. In spite of the current fit, the Activa is my preferred mask right now.

So, to cut to the chase, while I'm waiting for an answer, and presuming/hoping I will get that Shallow soon, I'm thinking about a different mask, or pillow style to try at my upcoming mask replacement interval in January. I'm considering that since I have some "comfort" with xPAP and the machine now, and have the Comfort Gel and Activa, I might try the nasal pillow again. Considering anything I've said about my sleep patterns/preferences, especially light sleeper, side sleeping, etc. I'd be interested in anyone's input as to a good nasal pillow, or otherwise, to try - especially with the idea of minimizing eye leak and allowing for leak free side sleeping. I suppose the headgear comfort would be secondary if I wouldn't wake up and feel it. But in three months I haven't gotten there yet.

For reference, I'm a 48 y/o male, no beard/mustache, somewhat oval shaped head of average to smaller size (not bigger), I think about 7 1/8 or so hat size, not a mouth breather as far as I know- if any of this matters.

Here's the one's (mask or pillow) I'm thinking of, please add your 2 cents:

Swift LT - seems to be a different shape than the Swift II, more pliable and smaller too.
Comfort Curve - don't know about those cheek pads, but it seems unobtrusive and minimal.
Mirage Vista - no forehead pad. Maybe less stuff to get moved around on my side? I wear glasses at night and could read for a while before sleeping.
Micro Mirage - generally smaller-same as above. The forehead knob adjustment seems convenient and the vent location seems ideal.
Aura- I've read some about what Rested Gal did to customize this mask, but I think the tube goes over the head?
Any other suggestions???

Thanks in advance for any opinions or other advise toward any of the issues I've presented. I promise I won't hold anyone responsible for my ill fit or ask for a refund or replacement from any of you all.

Joe

Joe, I'm another Headrest (Aura) user. Was unable to use the Swift - headgear not suitable for me, pillows didn't seal well, barrel of pillows hurt under my nose. In general, if you've had a pillows style mask and felt the air enough to be irritating, I have to wonder if your pillows were the right size or firmly in place. (Unless you mean irritated the tissues.) Maybe I'm just lucky, but I can't even feel the air as long as the mask is in place before turning the machine on. I have used the Breeze and CL2 with a degree of success, both at some point dismantled and using my own straps. Even keeping the headgear on, every pillows mask I've used has needed an extra strap to stabilize it so as not to pop loose when turning over. (Caution - don't place it where it can inadvertently slide over the vent.)

Unfortunately it's mostly trial and error. What I have found in my nearly 3 years of cpap use is I think I could go back now and use some masks (if they were the right size) that I felt I couldn't early on. When using the stuff at all was maddening, there was no pleasing me.

Best wishes on your search for your "dream" mask.

In general, the more surface area that a mask has to seal, the harder it is to make and maintain that seal .... that is one reason I prefer the nasal pillow type masks (but then again breathing air through my nose is usually the way I breathe while asleep and awake) over nasal cushion type masks. Same thing goes for FF masks, which is why only bothered to make the Hybrid and Liberty masks work for me (I ended up keeping the Liberty as a backup in case of sinus congestion).

The other reason I don't use nasal cushion type masks or FF masks that fit over the nose is because those types of masks place pressure on the sides of my nose which seems to restrict blood flow for my sinuses which then causes congestion and airflow restrictions while breathing through my nose (I know, I'm weird that way) ... defeats the purpose of treating my apnea.

Like you already know, everyone will have their own opinions and experience with each different mask and each person's mask preference will be different. Unfortunately, you just need to at least try each one and start eliminating which types you absolutely cannot tolerate and try to narrow your choices that way.

Good luck and not give up!

I'm a big fan of the Nasal Aire II. It's counter-intuitive - you don't think sticking prongs up your nose will be comfortable, but the fans of this mask will tell you it's MORE comfortable for them than any other mask they've tried. And it's more stable.

I'm a full time side sleeper, and I toss and turn alot. This mask stays with me and seals better than anything else I've tried.

You can test drive it for free before you buy on my Great Nasal Aire II Test Drive. Information about that Test Drive, and others, is available on this thread:

viewtopic/t35991/Mask-Test-Drives--Try- ... uy-it.html

Trying a mask before you buy it is a great thing. All it costs you is the price of postage to pass it on to the next person.

Good luck!
Barbara

You don't have to have a headboard for the bed (mine doesn't) to rig a way to hang the air hose up. Here's a link to get some ideas:

LINKS to Hose hangers and methods of managing the air hose
viewtopic.php?t=10640

I am a side sleeper and I like my Swift LT. I am using an APAP with CFlex set at 3 so I get exhalation relief so it's not like air is being pushed at me all the time. In fact, I can barely tell I have anything on after a few minutes. It is very quiet and the headgear doesn't poke.

I'm very new (not yet 4 weeks) so I have limited experience, but I thought I'd share it anyway.

I'm using an Opus 360 nasal pillows mask. Although at first I hated it, along with everything else associated with CPAP, I'm pretty much happy with it now. Occasionally I get a slight irritation in my nostrils, but otherwise its quiet, leaks only a little, and most mornings I'm waking up thinking the machine is off.

I designed a very elaborate and sophisticated hose suspension device which helps enormously also. I stuck a hook in the wall (25 cents), tied a bit of string to it (0.0001) cents, and found a plastic ring for the hose (from the junk bin, no capital expenditure) which reduces the bend radius of the hose. Strung it up over the bed, threaded the hose through the ring . . . no leaks or strangulation.

I know I toss and turn, and this morning woke up on my stomach, mask still on, no noise or leaks

Just my humble thought to add to the mix

K

Thanks to all who have responded to my inquiry. A very wise xPAP user (RG) once advised me its the mask, mask, mask. With more success on the machine part lately, also thanks largely to same wise person, I feel it's time to attack the mask issue more directly.

In answer to Kteague about the irritation: for me it's not the flow so much as a sort of burning or irritation of the nasal tissues or passageways. I was titrated w/o humidification and with it seems better. I'm thinking of trying my CL2 some more with the pillows vs the nasal cusion for some time at least till the point of waking to that vice grip headgear, to see if I have any better feel with the humidification.

Babette's NAII appeal is tempting. I may go for that trial program on it. The clam like headgear of it and the Headreast/aura do put me off a bit. Seems like the CL2 to me.

Thanks RG for the hangar link. I'll check into that.

Thanks again to all for the ideas and input on your own experiences with your masks. I really don't know what I'd be doing (besides floundering in the "system") without this place and everyone who takes their own time for no personal benefit to help all the rest.

Gratefully,

Joe

I don't know if Resmed offers any sort of "fit" guarantee, which would be through the DME. Respironics offers it on some of their masks, again, through the DME. If it's been less than 30 days, call Resmed's customer service and see if they have a guarantee on the mask you have. If so, force the DME to make good on it.

Here's what I've found out about masks in the last couple of months, through personal experience.

1. Resmeds masks in "shallow" seem to fit where the normal Respironics mask does. If the Respironics is too low on the nose, a Resmed is probably the ticket (not your issue, I understand). Yes, the shallow fits lower than the large, and I've found it's much more comfortable for me. I've also learned that LARGE is HUGE. I've got a melon on my shoulders and large masks go way too high on my head.

2. Respironics full-face masks expect your mouth to be slightly open (1/2" to 1") and I couldn't get a seal without having my mouth open. I spoke to one of their engineers who said that all of their FF masks indeed expect you to be a mouth breather. I'm not a mouth breather, I just leak out the mouth because of pressure. I have a Resmed Quattro that doesn't seal as well as I'd like, but I've put Mack's Silicon Putty earplugs to use to resolve that.

3. IMHO, the comfortgel nasal mask doesn't have enough cushion beneath the nose. I can't imagine going from a L to a S. I'm a M, fwiw.

4. I tried the hybrid universal and I just cannot make it work, no matter what. I tried making it "mouth only" by removing the nasal pillows and blocking the holes, but the wind gust was absolutely impossible. Oddly, with a FFM, forcing myself to mouth-breathe, I don't have that issue.

I am an active side sleeper who switches from left to right about 6 to 8 times a night. The swift LT works for me without any seal/leak problems. Best part of all is that it seems to work best with the head gear very loose. So long as I am using the right sized pillow, the head gear need only keep the mask in place with the slightest of pressure and I get a perfectly flat leak line night after night.

I had more eye leaks with the micro-mirage over the comfort-gel. Also that knob you can turn to adjust better still can't find a good spot for those eye leaks. Just my experiences with these masks.

Good luck,

Thanks for more input. This is helpful, I think.

Ractar28, actually I miss spoke. I went from a Medium to Small Comfort Gel. I'll check on the fit guarantee for ResMed. It seems the DME should be telling me this stuff up front, specifically how much time I have to adjust the fit, what the parameters are etc. Frustrating. Anyway, It seems that the cut out for the nose bridge is too deep on all these masks. I don't have a "small" nose (Sicilian Male), but it's long with a narrowish bridge. So it seems a mask with a shallower cut-out for the bridge would seal better, hence the Shallow that will fit lower on my bridge, away from the eyes and more easily contact my bridge. It also seems the secondary seals could be made longer over and along side the bridge so with side to side movement, more of it would be inclined to stay in contact with the nose. jmho as a novice CPAPer though. I think I know what field I should go into for my second career.

Sleepyangler, thanks for the LT opinion and experience. This is the one I've been leaning toward... IF... it won't irritate my upper lip and area between my nostrils so much as the Swift II did. It's also helpful coming from a male, reference possible fit on me, and that you personally don't have to cinch down the headgear too much is promising too, as I do have trouble with waking to a head-in-a vice, burning feeling at times.

Bap40, thanks for the info on the micro mirage knoby thingy. It looks great and makes sense. Sometimes that doesn't translate into functionality. My sense is it would be very similar in response as the Comfort Gel for me, which you seem to confirm to a degree. Any comparison you may have to the activa or thought on the micro's exhaust placement would be helpful. For me, if it's similar in performance to the Comfort Gel, and the exhaust is better routed (which it seems it is) it may be worth a try. But I need to stay focused I think, overall, on reducing the eye leaks and overall comfort on the head.

Here's another question at large, about mouth leaks, that perhaps should be another post:

I don't think I mouth-breath. But I do notice the occasional build up of air in my mouth (when awake of course) and find I simply have to open my mouth and exhale it, then just press on breathing through my nose (also, that I have to open my mouth to exhale it seems to be evidence that I'm not a mouth breather too). Any thoughts about this? Does it suggest more that I should be concerned about? I suppose it happens when for some reason I'm not exhaling fully through my nose, for whatever reason. I'm now trying to train myself to do something I read here somewhere: to park the back of my tongue against the back of my throat to keep the air from filling my mouth. It's generally not a problem to exhale through my mouth occasionally, but thought I'd ask.

Thanks again for all the feedback

Joe

What helped me to decide was reading the individual mask reviews on https://www.cpap.com.

After reading those reviews, I ended up requesting the OptiLife mask because of its appeal to side sleepers. It comes with four sizes of nasal pillows, unlike most of the others that only offer three sizes. It comes with a clip that you can attach the hose to your night clothes to stabilize everything when you toss and turn.

Good luck to you.

Lynne