Aloha mask issues

NateS wrote: "Hi Papit! If your nose hurts, you have the top head band too tight. I started tightening mine up and that's what happened. When I readjusted it so that the top head band is completely loose, doing nothing but laying loosely on the top of my head, then I don't feel the nasal pillows on at all and I get my lowest AHIs. . . ."

I snugged up the top head band, yes. I did that to raise the pillows reservoir off my upper lip. It also improved the seal a bit and I achieved a great AHI. But it wasn't very comfortable. Others here tell me that the bottom of the pillows reservoir should not be touching my lip and certainly not pressing on it. That was one of the favorable design review advantages about the Aloha that I read here and attracted me to try the mask. Now I find that with the velcro strips effective in holding the rear band in place, I can loosen them some, but the pillows reservoir still sits on my upper lip, albeit without pressing on it as much as before.

Now I understand (I think) that the 4-ridge positions for angular adjustment options are supposed to be the primary means by which to raise the pillows reservoir off my lip, as well as reorient the pillows. BUT ! When I pull the prongs (head gear) outward from the left and right reservoir slots to achieve the needed clearance from my upper lip, only 3/16" of the ends of the prongs remain inserted in the channels -- with nothing for their ends to hook onto to hold a reliable connection. Those four angle-position indicator ridges are well outside the channel (between 3/8" and 5/8" from the end of the channel). And that's the situation with the top head band positioned in the front left and right slots. Looks to me if I used the rear left and right top slots, the prongs would be pulled completely out of the reservoir slots when trying to make the needed reservoir adjustment to keep it off my lip. Am I disoriented or missing something here? Or are additional headband sizes needed for longer prongs to accommodate the intended angular adjustment feature?

Check out the pictures below. (Yes, you're looking at the "L" on the outer side of the left prong engaged in the non-size-marked side of the pillows reservoir slot; leaving the "R" on the outer side of the other prong to be inserted and engaged in the side of the reservoir slot embossed with the pillow size.) Do I have anything twisted or upside down?

Might it make a difference if I removed the side strap covers and bent the plastic straps (Is this even feasible?) to "re-form" or reshape them with a slightly different curve to help facilitate the needed upward angular pillows reservoir adjustment? (That's a trick that worked for me when I was experimenting with the Opus 360 and its somewhat more rigid plastic side pieces that could be reshaped, by bending them, for ones face to provide the intended comfort.) Ideas? Thanks.

ps. Are you guys finding that smaller size pillows are giving you a better seal than the size pillow used with other pillows masks like the Swift FX for example?

I do not necessarily care about what the instructions, or people on this forum say about touching the lip - that is so dependent on your facial structure, how do they know? Sorry if I offended anyone, that was not my intention! If I only insert the tips of the prongs into the pillows I find that I am likely to wake up with a major leak during the night - if I can even get to sleep without the prongs popping out. I assumed that since there is an indent in the channel that the prongs go into, the prongs should be inserted as far as needed to get into the indent. Then the slots do work for adjustments.

When I adjusted the position of the top of the head strap to another slot, I found the mask to be less comfortable - I don't recall whether that affected the position of the pillows in relation to my top lip. However, it makes sense that it would have an effect, so maybe it would work for you? This mask is great because it does have so many things to adjust, but that makes it a pain to get it perfect for us! Our head and facial structure is a little harder to adjust (LOL!), so good luck with getting it right for you!

My first night on the Hybrid was I was all over the place. I actually called the Innomed/Respcare line customer service and the lady actually put me on the phone with one of the engineers who walked me through it. I've worn that mask for years since. The customer service over there goes over and above for the consumers. Let someone walk you through your situation. They may help you nail it and they may not but at least they're one of the few companies that will take the time to help us. My pillows don't touch my lip but It does slightly touch the area above my lips. Just slightly, however and I wear the headgear a little lose.

From the photos, it looks like you might have put your headgear on backwards. The first time I tried the swift fx, I wore it upside down. Just call the manufacturer and let them help you. I think you 'll be surprised how nice and helpful they are , unlike some of the giant companies who stopped caring a long time ago.

Good suggestions from you both. Thank you Issac and Sleepytoo2 for taking the time and thinking about this for me. I'll follow up on both thoughts and let you know how I made out after a few days of tracking. Am making progress already with the velcro and going in with the prongs at least as far as the indents.

Btw, do you guys have a link or phone number for me to chat with their engineers or customer support staff?

My enthusiasm for the Aloha continues, but I have gotten to the point of attempting to achieve perfection in reducing and even eliminating all leakage and, in so doing I myself have arrived at a point of frustration.

I want to keep the straps loose, but the problem is that the angle of entry between the two nasal pillows does not perfectly match up with the angle of entry of my nostrils. It seems as if I would like the entry points of the two nasal pillows to be a little closer together, but the trick of tying their necks together does not seem to work. When I tie them together ever so slightly, the tips touch, leaving no space for the bridge of my nose and thus defeating my purpose.

It seems as if what I wish I could do is to somehow start the tipping further down on the base, but the base seems too thick to allow that.

I am going to try the o-rings next, but I am not optimistic about that helping because, unlike the Swift FX, there is a lot more empty space to fill up between the bottom of the bell-shaped part of each pillow and the flat part below it.

I can almost completely drive out all leaks by tightening the back strap, forcing the base into the shape I need until the flat dime-shaped portion of each nasal pillow is flat against and covers the opening of each nostril, but then I look like piggy-nose, I feel the base against my face above my upper lip like Papit does, and it just doesn't seem to be the intended way to wear the Aloha.

Maybe I should get and try the medium pillows. I have been using the large.

The Aloha has spoiled me - I want no leaks, or at least no spikes above the ResScan red line, and I still get those, although my leak lines are better than they were with the Swift FX headgear or Bella loops.

Regards, Nate

It didn't work:

Loose top and back Aloha straps to avoid pressure on nose and upper lip area, Ruby on top instead of underneath to help hold front straps and pillows in place, audible leak signals annoying me all night:



Good events count, but how do I know if it's valid with all those leaks above the red line?

Looks like it's back to piggy nose!

At least until my new Aloha nasal pillows arrive.

Regards, Nate

NateS wrote: 'My enthusiasm for the Aloha continues, but I have gotten to the point of attempting to achieve perfection in reducing and even eliminating all leakage and, in so doing I myself have arrived at a point of frustration. . . . "

Cpap post 5-24-12
Welcome to the club, Nate. Like you, my leaks with the Aloha are very high and all over the place. For me they are far, far greater than with the FX. Also like you, however, my other numbers are looking great for my first nine nights now on the Aloha. From May 14 to May 22, my averages (see below) are OAI 0.6 and AHI 3.5, but most important for me, average came in at a nice CAI 2.6. Again like you, I’m not sure how much credence I can place on these “results” because my leaks have been so high and erratic: average night’s Leak data over the nine days was 95%ile 24.0 L/min and max 43.2. Here’s ResScan’s summary screen for the past nine days with the Aloha followed by the summary of just the last night’s data on 5/22.



With the FX, on the other hand, my Leak over the previous three months (2/20 - 5/13) was 95%ile 8.4 L/min, max 16.8, a huge difference from the much higher Aloha leaks; average CAI 6.4 (much worse than with Aloha for some mysterious reason), OAI 0.6, HYI 0.6, AHI 8.4. Centrals were always a significant concern to my doc and me. The 7.9 reported pressure in the summary is an artifact; the detailed graphs shows pressure mostly at 10 during the night, sometimes dipping to lows of 8.

I hope you have better luck than I did, Nate, in trying to downsize to Medium size pillows. My Aloha from cpap.com came with all three sizes and I also tried the smaller sizes, but they didn't help in my case so I’m staying with the Large, the same size I used so successfully with the FX.
Now that you see what I mean by Aloha's reservoir base pressing on my upper lip, you may want to try the following as it worked for me: For comfort, pull (snug up) the short hose up over your head just barely enough (to avoid or at least minimize too much upward pug nose pulling) to reduce the contact pressure of the reservoir on your upper lip. The challenge, btw, once you find the point along the short hose that you want to fasten to the Velcro loop atop the upper head band, is to fasten it so the tube won't loosen and slip at night. You can use some well-sticking adhesive tape at least temporarily to try this out.
By snugging up the short tube, happily, I am also getting the additional critical benefit of the pillows now sealing better against my nostrils. Nevertheless, my Leak at various times during sleep, last night (5/22) included, has too often been well above ResMed’s 24 L/min benchmark red line.
Even though I got especially good results by adjusting the short tube as discussed above (CAI = 1.8, OHI = 0.4, HYI= 0.1, AHI-2.3) during my 9-hour sleep on 5/22 with the straps only mildly snug, I heard pillow leaks as I awoke and so I’m not sure how valid these nice numbers are.
My leak figures, you see (which are similar to yours or worse) for that last night were 95%ile 15.6 L/min. and max 76.8 L/min. Pugsy might not think such leaks are the end of the world and I understand and agree with her reasoning, but those leaks need to be improved upon and they can be. I found that if I applied very slight upward pressure with my finger on the bottom rim of the bell-shaped pillows, that that sealed the leak and stopped the leak hissing sound. It worked that way for both pillows. Consistent with that finding, I am developing a fix with some good preliminary results for your and other members use. Hopefully any further refinements you and other members come up with will be shared back here as well so we can all move ahead together.
Here’s the design of my "customized pillow-orienting method “ in it's prototype design, one that might be useful for you and other Aloha users as well and I invite you all to try it (at your own discretion and risk, of course, because I am not a doctor). Instead of using O-rings around the collar of each pillow as you and Squid have tried, cut a sloped ring from a piece of soft plastic tubing that has the same inner diameter as the O-ring you would ordinarily use. The irregular height of the ring so cut, and properly positioned by turning its high point where needed under the pillow, would place its upward pressure mainly beneath the spot on each pillow exactly where it is needed to perfect the seal on each nostril. Once the sloped ring is turned to that position, a drop of non-hardening adhesive glue (or tape temporarily) should hold it in place. The height of the sloped-cut ring, as well as turning the ring to find the precise point beneath the pillows where the ring’s high point will apply it’s needed upward pressure to the pillow, will require some trial and error experimenting and patience. Use by fellow cpaptalk members, friends and family members for personal use is invited. Enjoy the results in good health. (All rights are reserved, but could be shared with interested commercial entities and other entities.)
Btw, be certain that the rear head band is not riding up behind your head at night. If it is, as it does with my hair/head shape, then it may not maintain uniform snugness through the night and that may complicate the leakage problems. I applied Velcro to that head band and it works beautifully.

Hi Papit, I admire your conviction to make the Aloha work! I agree with everything these posters are saying. I was thrilled when the Swift Lt came out both the regular and women's but I tried in vain to make those pillows seal for me. I just think they were seated a teeny weeny bit too close for my nares, which caused the right one to collapse regardless of the o rings or attempts to widen the gap. I find with the Aloha that if the space between the tip of your nose to your face is very small it remains off the top lip. Of course the placement and shape of your nostrils comes in to play to. My friend tried my Aloha, and although she has a small face, nose, head, like me, she found that those little black things that hold the pillows is just too angled for her, and not long enough to seat the pillows off of her top lip, the space from her top lip to her nose is bigger than mine as well. Perhaps, there is some way to mold those little black holders at a better angle. Could they be the issue? Or, could they be heated up and made plyable where you could stretch them out a bit? Just trying to brainstorm some ideas. If anyone could make this work for you I think it would be Dreamstalker, he helped me years ago with my Breeze Pillow Mask. Maybe you could PM him. Best of Luck my friend

Papit said

I am developing a fix with some good preliminary results for your and other members use. Hopefully any further refinements you and other members come up with will be shared back here as well so we can all move ahead together.
Here’s the design of my "customized pillow-orienting method “ in it's prototype design, one that might be useful for you and other Aloha users as well and I invite you all to try it (at your own discretion and risk, of course, because I am not a doctor). Instead of using O-rings around the collar of each pillow as you and Squid have tried, cut a sloped ring from a piece of soft plastic tubing that has the same inner diameter as the O-ring you would ordinarily use. The irregular height of the ring so cut, and properly positioned by turning its high point where needed under the pillow, would place its upward pressure mainly beneath the spot on each pillow exactly where it is needed to perfect the seal on each nostril. Once the sloped ring is turned to that position, a drop of non-hardening adhesive glue (or tape temporarily) should hold it in place. The height of the sloped-cut ring, as well as turning the ring to find the precise point beneath the pillows where the ring’s high point will apply it’s needed upward pressure to the pillow, will require some trial and error experimenting and patience. Use by fellow cpaptalk members, friends and family members for personal use is invited.

Wow, can we have a photo or two? Hard to picture in my mind.

Regards, Nate

Papit wrote: Pugsy might not think such leaks are the end of the world and I understand and agree with her reasoning, but those leaks need to be improved upon and they can be.

I say look at the leak line and evaluate how much actual time is spent with that leak being higher than you want.
Does it wake you up?

Up to you how much work you want to put into getting the leak numbers lower. I don't even bother looking at the 95% number that much. It is too easily altered by a short live spike into no man's land.

Everyone is certainly entitled to work on whatever they want to work on.

Here's an example below..please right click on image and choose "view image" to see the entire report if you aren't seeing the entire 8 1/2 hours....95% number looks awful at 22.4 L/min (sorry about the little box that got in the way) but the overall night really didn't have much leak to speak of. 45 minutes for the first increased leak right before the cluster of events (I was awake and extremely nauseated for about an hour) and maybe 15 minutes for the second leak spike. So out of 8 1/2 hours I had about an hour with less than "perfect" leak and even the first one barely hit 20 L/min briefly.

Look at this report...tell me what you would have me do differently to improve on that approximate hour with less than ideal leak line.????? Looking at the 95% number without looking at the graph leads one to believe the entire night was less than ideal when it was really quite excellent. Is it really worth stressing out over?? I see this stuff fairly often...short lived larger leak excursions but I sleep right through them and 95% number looks awful but the bulk of the night the leaks were minimal to none..
If this was your report how would you feel about it?
Follow the 95% numbers if you wish but evaluate each night individually based on what you see for the whole night. That 95% number is real easy to get weighted high and doesn't always tell the whole story.

Pugsy,

How then would you interpret and react to my leak line above in my post of Wed May 23, 2012 9:54 pm?

Thanks, Nate

PS - Here's the same night in SleepyHead:



when my leak numbers were Min: 0.00 Med: 14.40 95%: 37.20 Max: 68.40

NateS wrote: How then would you interpret and react to my leak line above in my post of Wed May 23, 2012 9:54 pm?

Just from the line itself...pretty darn ugly. Looks quite a bit like my ugly leak thread. You have seen it having you?
viewtopic.php?f=1&t=76445&p=698087&hili ... ne#p698087

In your situation you obviously spent a lot of time near at or above the magic 24 L/min red line. If this was a rare occurrence for you, then shrug your shoulders and move on but if this is an every night occurrence then yes, I would think it needs some serious work.

I don't need to see the 95% number for that one. My comment about talking about numbers (95%) to be exact is that just because they look bad on the surface doesn't mean that the whole night was total crap. I am betting your overall leak median average was also elevated on the night above where as in my example above the median average was just 6.0.

I am not saying ignore the numbers...just evaluate the whole picture along with the numbers and in your instance above..that picture is pretty ugly.

Those people that have known me for years know that I don't put all my eggs in the 95/90% basket for anything..be it pressure needs or leaks because that particular number is just a number and it very easily gets skewed. Sometimes it happens to be spot on and sometimes it is so far out in left field that it is useless.

Here is ResScan's version of my above night. I barely nudged the magic red line.

NateS wrote: PS - Here's the same night in SleepyHead:

I didn't see it before...I added my same night in ResScan report.

Your 95% numbers might be spot on given how ugly that leak line is.. Again, I am not telling people to ignore the numbers but instead look at the entire night whole picture before getting into panic mode about a leak.

Obviously there is a huge difference when comparing your leak to mine. If you are seeing that every night then for sure some serious work needs to be done.

I am only saying that judging by my numbers alone it might seem like a lot of work is needed when in reality there isn't any huge amount of work that needs to be done.

Heck, I might be mouth breathing for all I know during that time span...or the nasal pillows might have slipped out with movement. Does it mean I need to go buy a full face mask or tape or anything? I don't think it is bad enough to worry about. Now yours.....I would be worrying if I saw that often that looks like it would wake me up a lot.

Pugsy wrote:
Your 95% numbers might be spot on given how ugly that leak line is.. Again, I am not telling people to ignore the numbers but instead look at the entire night whole picture before getting into panic mode about a leak.

Obviously there is a huge difference when comparing your leak to mine. If you are seeing that every night then for sure some serious work needs to be done.

Well, here's the numbers for the last 60 days:



Nate

PS - and a graph:



Great AHI but is it reliable with those leaks?

NateS wrote: Great AHI but is it reliable with those leaks?

Probably more reliable than you think.

Number one...assume for the time that you don't go above 24 L/min that ResMed says they can handle things up to that point and the AHI is accurate. The entire night isn't totally large leak...assume half the night maybe..just for playing with numbers. So half the night not in large leak the AHI is likely very correct.

Number two...How accurate is the time when leak is say borderline just barely above 24 L/min? We don't know but I don't think that at 25 L/min the machine totally gives up and can't do anything. That ugly leak line thread of mine....what happened was I had some events slip past the defenses and the machine didn't know what to call them. I think that there is some functionality at numbers slightly above the red line. May not be ideal but I doubt that you had a huge number of events slip past the defenses and not get scored. You don't have any huge number of events with borderline (but lower than red line) leaks. I can't prove it one way or the other though so won't even go there as to making any statements about certainty.

Looking long term...compare yours with mine below. My median average (dark green) barely shows up on a handful of nights...yours it shows elevated a lot.
Obviously you are having significant leak from something, either nasal pillows or mouth breathing. For your situation you are obviously fighting a pretty serious battle and it is ugly enough that even if I was sleeping through those leaks I would not be happy with what you are seeing if that were my report.

So....what do you do? Goes back to the question of what are you chasing and how are you sleeping and how do you feel.
In your case the leaks are significant enough and happening so regularly that I would want to fix it if it were me. Just in case..... One hour in large leak doesn't make the whole night a flop. Half the night in large leak doesn't make the whole night a flop but I wouldn't be satisfied either if I saw your reports this consistently.

In all honesty...your reports look an awful like mine did when I first started therapy and I was mouth breathing like no tomorrow.

The nights with the much larger leaks at the beginning of this image below..those were first time using the Bella Loops night I think.