Fitting a Full Face Mask

I will be going in this afternoon to be fitted for a full face mask, as I have developed an upper and lower respiratory infection. I have only been on APAP a little over two week, and until two nights ago, was completely compliant. I found the pressure comfortable (7-15, mostly running under 10) and wasn't having any particular problems with the mask (Swift II). Then I decided to try a Swift LT, just to see if it might work even better. That night I woke up suffocating, and I thought it was the mask, so I switched back to the II, but still couldn't get comfortable.

By morning, I realized that my sinuses were swollen. I also had some congestion in my lungs, not bad, but there. I tend to react to lots of chemicals and odors, so I thought maybe it was an exposure. I spent the day trying to get some improvement, using antihistamines and nasal wash, but no joy. By bedtime, it was clear I wasn't going to be getting any air through my nostrils, so I reluctantly slept without my APAP. Twelve unrefreshing hours later, I woke up even more congested, and gave my DME a call.

Since my doctor wrote a very open script for my mask (patient's preference with all necessary supplies), I am able to go in today to be fitted for a full face to get me through whatever this is.

I wear glasses, and would like something that works with them, if possible. I am very sensitive to pressure on my head and face, which can trigger headaches. So, I am looking for the least amount of contact, or maybe contact that is easy to spread evenly, so it isn't worse in one spot. I am a woman, with a medium face. I wear a small nasal pillow in the Swift II.

Any thoughts about what might work for me, or what I should pay attention to in the fitting? I have only tried two masks, the two Swift masks, so don't have much idea of what tip off there might be that a mask will give me problems.

Thanks for any ideas!
Susan

I got a FF mask last week. They had to fit me for it. Maybe ask to try on 2-3 to see which one feels right for you. I dont know about wearing glasses with it, or else I didn't understand your post. Take your time and make sure it feels right. Wish I could help more, but I'm kinda new to all this.

Look at both full and the Hybrid and Liberty.

You'll want something without a forehead support if you want to wear your glasses with the mask.

Some of the masks can be found in XS sizes.

Thanks, Sleepy Boy, for your well wishes. What kind of mask did you get, and how are you doing with it?

Cflame, they didn't have a Hybrid, but they did have a Liberty. Seems like more people here like the Hybrid, I wish they had one to try out. I am so completely blind without glasses, and I usually read for a little bit to slow down before sleeping, so it is an issue for me. That is part of why they originally gave me a Swift II.

I have to give my DME kudos. At first I thought they were going to give me a FF mask as an extra, because I needed it to get through this cold. Then the lady making the appointment told me they were going to switch it out for my Swift. No way was I going to give them the Swift, as I have been sleeping soundly, with no leaks, low numbers, and good comfort. Plus, that wasn't what I was first told. The lady was a bit stumped, because she told me my insurance would not cover a second mask, which I knew was true. But then, she said they could just give me a demo mask. Hurray!

As I said, they did not have a Hybrid, but did have a Liberty. It seemed to fit in the office, lying down, with my machine running. No leaks, fairly comfortable, just kind of weird, after the Swift. Even though it was a demo, they replaced the pillows, the shell, and a broken clip. They told me that unless I didn't like it, I could keep it. Sounded like a good deal to me.

I watched the DVD, and spent some time tweaking the fit. It wasn't nearly as comfortable as the Swift, but OK. I didn't start out with leaks, but as I relaxed more and more, I found I was feeling something in the hollow of one cheek. The more relaxed I got, the more it felt like the seal was letting go there, but I couldn't feel any air leaking.

I also noticed that the Liberty was giving me a LOT more humidity than the Swift. So much so, that I was able to breathe through my nose. I didn't expect that. But the impending leaks were bothering me more and more, and I couldn't relax enough to really sleep. Finally, about two hours in, I woke to a big flapping leak on my cheek, and decided to give up for the night. I turned the machine off, and checked my stats. My AHI was 94, with AI of 20!!! That is higher than it ever was without CPAP. Can leaks or problems like that cause the numbers to go up? I have been running 0.0 to 0.5 with my AI, so this was a shock.

I put my Swift back on, and did find that my nostrils were a little more blocked with it, but not enough to have to stop. I finished out the night with my best numbers ever, with even my HI very low, even though the pressure went down a bit.

So, questions:

1. Does a FF or hybrid type mask need more pressure to control apneas?
2. Could the leaks cause the machine to score higher AHI?
3. At my sleep study, most of my apneas were centrals, though I had many more hypopneas, and those were scored obstructive. Could the Liberty be triggering more centrals somehow?
4. How to stop leaks at the soft part of the cheeks?

Any new thoughts would be greatly appreciated. I know there will be times I have to wear a FF or hybrid type mask, so I want to get this figured out before the next time hits. I could switch out, if necessary, the DME has other demos they would let me try. However, if at all possible, I want to be able to wear my glasses, so I am willing to do some work here.

Thanks!!

Hi Riverdreamer: I have had the Quattro for a little over a week. The first 3-4 nights it about drove me nuts, I couldn't get it to seal. I found out I have to leave my teeth in at night. I have a full upper and a lower partial. With them in, I have no leaks that I can feel or hear. I really like it, I'm sleeping 7-9hrs. and feeling great during the day. I've been on cpap since July, and just now getting some good sleep. This is my third mask..Thanks, Larry..

I wish I had seen this earlier, but they should tell you this when they fit you.
Make sure all the straps are loose and any forehead adjustments are out. Put the mask on and tighten up the straps on the bottom but not real tight, tighten the forehead straps and on most masks these do not get very tight at all they kind of float. If you had any kind of forehead adjustment on your mask adjust it now but not too tight. Turn the machine on and hook the mask to the hose, you will probably need to tighten the lower chin straps.
For most full face masks the upper portion kind of floats and any straps there are to hold it in place as a guide not to ratchet it down. The bottom straps are where most of your adjustment is to be made, again do not ratchet down on it.

When you get a mask you should get documentation with it that tells you how to put the mask on and adjust it and those directions should be similar to what I just told you.

I have tried just about every mask on the market.

Good luck

Larry, so glad to hear you are doing well! You must be very determined to put up with it for so long, and only just now be getting some sleep. I will remember that if things get rough. I've been lucky that until now, I haven't really had trouble with the machine or mask, but I am still a ways from feeling great. I have multiple health conditions, some possibly related to sleep apnea, but many that are not. So I don't necessarily expect CPAP to fix everything, but boy! Is it ever nice to sleep. I have had problems with sleep for over 16 years, and this has been a revelation. I hope you continue to see improvement now that you have the mask working for you.

Gerry, thanks for the tips. They didn't really explain the reasons behind how to fit the mask, just kind of did it for me. I knew, from reading here, that it wouldn't necessarily help to over tighten things, but in the middle of the night, it is hard to think what to try next. I know you have all been there. I'm just trying to figure out what to do about the cheeks. It has been a long time since I thought I had hollow cheeks but it seems when I relax, everything just drops. I can't figure out how to fill that space without over tightening. I will spend some time playing with it, see what the various straps can do. I wonder if padding the straps so they pull from a different angle would make a difference?

We all know how to adjust a mask properly if we have been around for over a week or two. The problem is sometimes we don't always use what we know. You are absolutely right in the middle of the night everything flies out the window and we pull the mask tight or crank it down. We all do it, so we can't deny it. I have a friend who has been on cpap about six years and he still wakes up some mornings with marks from him cranking down.

Sometimes I catch myself in the middle of the night and I will actually sit up loosen everything up and readjust it and go back to sleep.

I like that avatar, riverdreamer

Thanks, nobody!

How did you ever come up with that screenname. Kinda weird replying to nobody.

riverdreamer wrote:They didn't really explain the reasons behind how to fit the mask, just kind of did it for me

I've been using a Quattro for about the last year; it's the only mask I could get to almost sorta not leak all the time ...

The cushion on the quattro (and similar masks; I've never tried Liberty or Swift so I can't speak to them) depend on the air pressure to properly form the seal. The cushion has two layers (flaps): an inner stiff one and an outer soft thin one. The inner layer provides shape and structural support, as well as reinforcing face contours that protrude too much. The outer layer is the one that actually makes the seal. The air pressure tries to blow the flap out, but it theoretically is too wide for the opening to stretch enough to allow the flap to flop. Therefore the air pressure will push the mask away from you face while the thin seal holds the sides in (same way a hovercraft works). The straps of course keep it from blowing across the room.

The reason for the specific procedure for fitting is to get the mask on straight (it doesn't work if it's tilted), and with the right amount of strap tension to allow the mask to move away from your face the necessary little bit. If the strap is too tight the thin flap gets pressed against the inner stiff one. Since the thin flap is much larger than the stiff one it distorts and inevitably allows one or more spots to pop open. Hence the cheek flapping.

So much for theory. Here is my reality:

I, like you, have a problem where the mask fits perfectly until I actually almost fall asleep, then my face relaxes and changes shape causing the seal to blow out. I believe in my case it's exacerbated by the fact that the lower strap crosses the back of my neck - so if I lift my chin the mask tightens (a lot) and if I drop my chin the mask loosens (a lot). I am often able to help that somewhat by using one of those contoured pillows (I have a PAPillow, there are others) to hold my chin in one place while I sleep. I also need to do a balancing act, lying on my side with my mask partially over the side of the pillow and my cheek supported "just so", so that when I start to fall asleep and my "chubby Polish cheeks" (as my wife calls them) relax the pillow keeps them from dropping enough to keep the seal. Unfortunately I also have arthritis and other assorted ailments which keep me from lying too still so it's not long before I shift and upset the balance.

So far I am getting more or less adequate results in terms of not being too sleepy during the day, but I definitely am not getting the most effective treatment possible. My data shows high mask leaks usually for about 20%-25% of the night. I'm trying to get a video hookup so I can record myself at night, to see if there's anything I can do better.

Anyway, good luck! It took me around 5 months to get "barely adequate" treatment due to mask leaks, almost a year before I was really starting to get consistently improved results. It was a long time - fortunately I had had a couple really good nights early on, memory of how good I felt kept me trying (and is still keeping me trying). BTW switching to an APAP helped a tremendous amount since the air pressure is kept more or less to a minimum.

I still consider the full-face mask one of technology's great unsolved problems though!

(Wow, did I really blither that long? )

kennethryan, blither away! You gave me exactly the kind of info I need to understand what to try to fit this mask. I have many of the same issues as you do, including chubby cheeks, arthritic pain that makes me fidget, and what happens when I tilt my head forward and back. It helps to explain how the seals are supposed to work (they have the same seal in the Liberty.) I have been using the Swift to try and stabilize a bit, then I want to work on the Liberty to see if it will work or not. I know there will be more times that I will need it, as I frequently have exposures that cause swelling in my respiratory system, so the Swift isn't always going to work. I hope you can get some relief now that your treatment is doing better!

I'm thinking about trying the cloth gasket I saw people talking about. Now that the change isn't so urgent, I have time to do some reading and see what I can do to make something work.

Severeena, I haven't tried, or even seen the Hans Rudolf. This was an emergency change due to a sinus issues, so I had to take what the DME had in house. I can't tell, but it looks like, from the picture, that it doesn't have a forehead strap. Could I wear glasses with it? If it works for that, it would go onto my short list as an option. Thanks!