Firefighter new to cpap, in need of some help.

I am a former firefighter. I hate full face masks. Notthing like a SCBA. I suggest the resmed Activa nasal mask. No blowing into your face. It stays on and is very comfortable. The higher your pressure the better the seal if worn correctly. Use tape to keep your mouth closed if thats a problem.
You might also lower the pressure a bit . Just for a while until you get used to it. Maybe lower the upper limit of an auto 1 or 2 for a few days. To build a tolerence to the pressure. Sneak up on it. LOL Good Luck

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Hi Naegling

Everybody is different, but what worked for me was to get a small pillow (12"x18"). I got the Buckwheat hull from CPAP.com, since it came with a pillow case, and it's supposed to be cooler in the summer. I found that if I used my regular pillow, when I slept on my side, I would push the mask into the pillow and lever the mask off my face. With the small pillow, most of your head is still on the pillow, but the mask itself is hanging off the edge instead of getting wedged off my face.

I also used the PAPCAP, and got rid of the neoprene headgear for my Quatro FFM. You use velcro for the upper two clips, and well padded adjustable velcro straps for the bottom. Those and finally the chinstrap (comes with the PAPCAP) stopped most of my leaks during the night.

Not trying to sound like a walking advertisement (or should that be a sleeping advertisement? ) but that's what worked for me.

-Bill

I am a firefighter/paramedic for the past 17 years and have been on CPAP since September 2006. My pressure started at 9 but I have settled into 11 for the past couple of years and found it to work really well for me (AHI usually 2 or 3 at highest). I was blessed in that I got accustomed to CPAP almost immediately - the feeling of a mask, the pressure, everything. Within the first 2 weeks I would wake and think my machine had turned off, then would feel in front of the vent holes and realize it was still on - I was just very accustomed to the pressure. I have a fat face and I think that kind of helps me with the fit/seal/leak aspect. I do agree completely that the slightly loose fit works best (I use a Quattro FFM and LOVE it).

As far as the things to aid in your seal, I have not used any (unneeded), but what others commented in this thread is congruent with what I have read previously. As far as the waking up in a panic about being asleep in a fire, do you have access to your data? I was just speculating that perhaps you might have a large leak or some bad mask positioning that allows a period with a lot of apneas, low sats, stresses your body, causes an arousal (wouldn't use that term around the fire station), and causes you to wake like that. I am a big-time side sleeper too, but I manage to position my face and mask into the pillow in a way that actually makes the mask more secure - only trial and error will get you there. I had thought about the full face thing before (where it covers your whole face), but I don't know if that many hours of increased pressure might have some long-term effect on the eyes (have 20/10 and don't want to deteriorate that).

I am also blessed to experience the opposite effect that you describe - my mask relaxes me so much (and I wear it so much as compared to my SCBA mask) that I actually experience a slight relaxation when I put on my SCBA mask at an incident or even training, which helps to temper/control the adrenaline rush you feel at a fire. While I DO have my frustrating nights of having to fidget and position my mask once in a while (thankfully very rarely), my mask is kind of like a "comfortable old x" (x for whatever your mind thinks of, T-shirt, pair of shoes, jeans, bed, recliner, sweater) to me. I think that is key to overcoming a lot of the initial frustrations of CPAP (and preparing for future frustrations) - thinking of things (especially the mask) as an old friend, a thing of comfort and help, and not a thing you "HAVE to do" and end up dreading. The mind, and the way we think, are the most important factors in much of life. Proverbs 23:7 (KJV) says "For as he thinketh in his heart, so is he...." We just got back from a cruise and the other guys in my cabin (chaperoning a Senior Trip) would probably all have 100% positive things to tell someone about CPAP if all they know is what they witnessed from me and my CPAP. I can hardly imagine life without it, but do have the occasional recliner nap I wake from and remember how miserable I used to be all the time. I hope you experience improved results very soon.

BTW - What type of SCBA mask was that pictured? We use Survivair packs/masks. Our packs have the integrated PASS and very-nice-weight composite bottles, but we got them before you had to have a heads-up display in the mask of remaining air or any of the other new requirements.

Another thought -

We work 24 on and 48 off. I also work a secondary job riding the ambulance, which entails one additional night a week away from home. Especially in my situation with two other places I spend the night, I have found that it was well worth the investment for me to acquire additional machines, masks, etc. to keep at those jobs. Lugging all my stuff and getting it together every morning (especially at home trying not to wake the wife) got to be such a hassle, and the additional machines have made it much more pleasurable (also being backups I can go get if the one I am using dies on me one night).

I've used the Quattro for a year and a half now and have a few suggestions. Some of these will duplicate what others have said, but I'm just going to lay them all out as things to try. I also think a different mask and a different style of mask should be on the list, but I've never used anything else and am limited to ways to try to make the Quattro work.

1. Get the right size mask. Many people have noticed that the right Quattro for them is smaller than they would have guessed. I have a big head and assumed I needed a large, but a medium fits me best. ResMed has a tool on its web site for estimating the right size. The mask nests in the indentations above the nose and above the chin. A mask that's even a little too big can never fit right.

2. Fine tune the forehead pad and memorize the setting. The dial gives lots of flexibility, but it easily gets turned. I start at the closest setting and then dial it out with the mask on until the pressure is just barely off the bridge of my nose. Too close causes pain and can raise a sore, but too far encourages leaks under the eyes. The closest setting that doesn't leave redness in the morning is best and should be left alone.

3. Clean the inner cushion. I hate making the effort every day, but I have oily skin, and that oiliness wrecks the seal. I use a little liquid soak and warm water, and I don't bother daily with the whole mask, just what touches my skin. I believe other people have good success with wipes. It makes a huge difference.

4. "Float" the mask. The theory of the Quattro, I believe, is that pressurized air should fill the gap between the inner and outer layers of the pad, kind of like a tire inner tube, creating a pneumatic cushion. This lets the pressure help push the seal against the face instead of just trying to blow the mask off your face. I have never had anyone at my DME show any sign of understanding this. Their only technique is pull the straps ever tighter until the mask seals by brute force. I simply think they are too busy to bother. Getting the "float" takes effort and experimentation. What has worked best for me is to pull the lower straps as tight as I feel comfortable with, then start with the upper straps loose and pull them tighter bit by bit, testing at pressure each time, until the seal is good.

5. Find the right pillow. There are two schools of thought for side sleepers like you and me. One is a pillow with a definite edge or indentation, which lets the head rest on the pillow but the mask hang over. There are special CPAP pillows made of fairly stiff foam designed for this. I think buckwheat pillows work this way too. The other is to get a big, fluffy, side-sleep pillow and nestle your face right into it. That's what I do, and I find that with my face turned slightly into the pillow it actually helps me keep the seal. Of course, you cannot bury your head so far in the pillow that it blocks the vent, but I have never found that to be a problem.

Good luck. I doubt that there ever was a new CPAP user who did not have a period of adjustment.

Try the FitLife by Resperonics. This fits the entire face just like the SCBA. I sometimes use this mask when my nose gets too sore from my Quatrro. Let me know if you try it and how it works. I am an EMT as well as a sleep tech, so love to see other Emergency Responders on here! Welcome!!!