Aloha mask issues

Pugsy,

I really really appreciate your time and insight, and I thank you very much.

So you think my great AHI numbers are credible? Yes, I do feel great almost every day and I seldom if ever fall asleep anymore during the daytime, unless I have had a very short night of less than 7 hours. I prefer 8 to feel my very best.

I very much liked the Swift FX with headgear and the Bella Loops even more, but the big improvement for me with the Aloha is this: When the Swift FX slipped and a leak came on, I had three variables to deal with. It might have slipped right or it might have slipped left or it might have slipped down only, or down and left, or down and right, so I had to play with the nasal pillows a lot until the hiss or the audible signal stopped. And then there was the trick during realignment of being careful not to jam the flat round foot of the pillow into one of my nostrils.

With the Aloha, if there is a hiss or an audible signal, it is pretty much limited to slipping down. I lift it up. I do still have to be careful not to jam the flat round foot of the pillow into one of my nostrils. I can almost eliminate the leaks by tightening up the back strap and squeezing the pillows against my face, but then I get the piggy problem and the slight soreness and the general impression that I am working against the Aloha's design instead of with it.

So for me the leak problem is more soluble more quickly when I get a hiss or a signal with the Aloha. But I also want to substantially reduce the number and significance of the leaks which still occur. And that problem remains to be solved, even though I am wearing a Ruby chinstrap which to me appears to keep my mouth shut.

I generally wake up due to the audible signal. It disturbs my sleep, but I do usually fall back to sleep very quickly. I could turn it off and probably sleep through the night, but then I would be ignoring the need to solve the leak problem, which I am determined to solve with nasal pillows, not a FFM.

That's it in a nutshell.

Thanks so much again, Pugsy and please do feel free to comment further if and when you have any other suggestions or observations!

Regards, Nate

PS - Pipit - looking forward to your excellent photography!

NateS wrote: So you think my great AHI numbers are credible? Yes, I do feel great almost every day and I seldom if ever fall asleep anymore during the daytime, unless I have had a very short night of less than 7 hours. I prefer 8 to feel my very best.

I do think that for the most part they are credible and the other part likely credible. I don't think you are missing an AHI of 10 or something like that for sure.

I don't expect perfection (which is a good thing because I sure won't get it) and sometimes we just have to sit back and try to figure out the lesser of the known evils. Leaks are something that we always will have with is unless we duct tape these things to our faces and even then I am not so sure. I think we all want to have the best possible outcome to this therapy.
Let's face it...it's a PITA to do this mask thing every night so we figure if we are going to have to do it then we sure as heck want to get it done right so as to not waste our time. I am the same way. The difference is I have 3 years now to realize that a little imperfection here and there isn't the end of the world and I don't stress out nearly as much over things when they are less than ideal. I do try to do my best...I always try but if I have little slip ups I just don't go way overboard trying to fix something that only breaks on a rare occasion.

Obviously your leak issues are much greater than mine and they for sure warrant continued effort to reduce them if for no other reason than the hissing wakes you up. The fact that it also is really ugly just adds a bit more impetus to things. Is it ideal? Of course not but even a leaky night is better than a no machine night.

I hope you find your balance that you need to resolve your leak issues. I know in the back of your mind you are "what iffing" and that is just human nature. Keep at it and things will eventually get resolved and you can find yourself in the situation where a leaky night is no longer the norm.
Evaluate each night individually and try not to worry about that overall summary thing and remember that when we look at those numbers (especially the 95%) that sometimes they can be miss leading to us. They might point to something really ugly for a good bit of the night but they might just be pointing to something ugly for one hour out of 8 hours.
Funny that if the 95% numbers are really good we can pretty much know that for the bulk of the night the leaks probably weren't an issue but conversely we can't assume that a borderline number means that the bulk of the night was horribly bad. It might be but then again it might not. That is the whole reason I tell people to look at both the numbers and the graphs.

I know for a fact that I am not very good at interpreting data, so I can take a bit of a blast on that, but Pugsey am I missing something here? If I feel comfortable when I mask up, fall asleep in a reasonable amount of time, wake up feeling like I slept pretty good, have a good day, check my data in the evening, have low AHI's with a minium of centrals, should I care what my leak line looks like? Years ago I was compulsive about the screen read out, read it everyday before work, above 1 AHI, had a terrible day, lower than 1 great day, so I stopped reading the happy face screen before I began the day, it was making me crazy! If I need to look at the leak line when my #s are good and I feel ok, than please let me know, because after 7+ years of chasing the mask that would make me feel better, regardless of leaks, which for me are higher now, I have never felt better, my numbers have never been this consistently low, and although I've never had high blood pressure, my pressure has never been this good. I try to take the approach, "if it ain't broke...why fix it". As far as the data, I do the best I can with it, and when in doubt....yes, I call on those who have more ability to decipher it. That said, am I remiss in not paying attention to the leaks line?

portiemom wrote: am I remiss in not paying attention to the leaks line?

I doubt it. You have been around long enough to know at a glance if your numbers are whacko and know to look at the leak line. I would wager a good bit of money that if we looked at your leak lines over several nights that they would be quite acceptable for the bulk of the nights...."you sleep well, don't wake up with leaks, feel great, no complaints"... Heck, there is no reason to even look at the data unless you are curious or you had a weird night and you wonder what happened.

All I am saying is that if you look at your numbers and they seem to be out of line...then go look at the leak line if need be.
Don't get into panic mode before even looking at the leak line.
Now of course if all the numbers are well within acceptable limits...no pressing need to do anything other than pat yourself on the back and move on.

I really don't advise people putting the leak line under a microscope all the time. It simply is not needed unless there is a problem. If there are possible problems then the whole report needs to be evaluated anyway.

I guess what I am having a hard time explaining is that I don't see the need to go into panic mode until the numbers AND the graphs point to a problem then if it is broke then for sure fix it.
When someone relies solely on a "number" instead of evaluating the whole picture it just makes a lot of work when it really may not be needed. Granted sometimes work is needed but usually one doesn't report sleeping well, not remembering leaks, low AHI, feeling good when there is maybe a problem.

I actually really dislike the whole concept of 90/95 % numbers. People too easily forget the OR BELOW part of that definition. Then they go into panic mode and make a bunch of changes to something and end up making things worse. Plain old fashioned common sense just flies right out the window in panic mode.

Nate needs to work on his leak....mainly because they wake him up though. While things look pretty ugly there it's not like the whole night is shot and might as well not be on the machine...that just isn't the case.

Now that I thoroughly have freaked out those people who just have to have perfect straight leak lines and 0.2 L/min is the worst they ever do... I am not saying that managing leaks is not important. I am just suggesting that if something doesn't seem to be as good as a person wants it to be that they need to look at the entire picture before letting panic mode creep in and evaluate the whole picture and then decide how important it happens to be to them...not to me.
I don't count.

I have gone for as much as 6 months without even pulling the card out of the machine. I simply don't need to see my data every single day. I do check it when I do an experiment though. Gotta have a baseline to compare experiment results to.

Numbers are just numbers until one applies them to the context of things but we do seem to zone in on them pretty quickly because they are there and our little human brains have to have some sort of pigeon hole for various numbers.

Now if you told me that you felt awful, your AHI was fine but you slept horrible, woke often fiddling with the mask or whatever...then we would be looking more deeply at things but you are so right....if it ain't broke don't fix it and a few minutes here and there of a larger than wanted leak doesn't break anything unless someone has the need for "perfection" and those people sure wouldn't want to be looking to me for suggestions. They will think I am a nut job and needing a serum acorn level check really badly.

Pugsy, I have to complain!
With all your posts, detailed comments and advices, I am now spending too much time reading this forum. My work starts being affected and it is obviously your fault.

More seriously...

Pugsy, what would we do without you?
Your posts (and PMs) are great, you are so helpful and most of the time your extensive and practical knowledge associated with your wisdom makes all of us look at our data with a different perspective. I do agree with you that looking at the whole picture is the most important and that with too much information available we sometimes get confused. When it comes to looking at numbers, you are the voice of reason on this forum. Many thanks.

Papit: For your leaks use the "lansinoh"...you won't have any more leaks!! The others gave you the rest of the info...not getting this mask too tight is key.

Hope this helps!

Janice

Thanks Pugsey, now I can concentrate on things like the state of the economy....our servicemen and women.....all my friends and their problems....WHAT TATOO I'M GONNA GET....you know the REALLY critical stuff and yes, userinsingapore is right, you are definitely the voice of reason, PM of reason, and the REASON I scream PUGSEY when I am in need of HELP! Lovya woman!

Ahhhhh! LOL! : ) I just knew I'd get a rise out of you! Yeah, I get your point and it's rational thinking. I'm just a weird engineer perfectionist. This is more like a fun challenge for me than tedious work. So I actually enjoy the challenge and the prospect that when/if I am successful in coming up with a winner solution to a common problem, people will like and appreciate it. That's where I'm coming from. I think quite a few folks with aloha's may be finding that the pillows aren't as good a fit as others they've used. Wait till you see my fix.

I also am inspired to work on this because the rest of the mask is rather well designed. I find the pillow the only real weak link in the mask. Will be back to you later.

Pugsy wrote:

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.

Papit wrote:Ahhhhh! LOL! : ) I just knew I'd get a rise out of you!

You devil, you goaded me on purpose and now I have band aids on my fingers from all that typing..

Now I remember the perfect engineer...I see why all this bugs you. It doesn't fit in a neat orderly precise cubby hole.
No problem. Have fun fiddling with things till you get them just perfect for your needs. That's what it is all about anyway.
As long as you are happy and satisfied doing what you do then that is just the way things should be.
I used to do a lot more reports under the microscope thing...lots more..but that was long ago and I have mellowed some and my reports border on boring most of the time anymore.

While I really do enjoy the challenge of 'fixing' things and making improvements for all kinds of devices, understand that my leak graphs, "big picture-wise," Pugsy, have been very much as atrocious as Nate's, sometimes perhaps worse -- and this is a new phenomena for me as my leaks with the Swift FX have for MONTHS been minimal, well under control and a total non-issue. The leaks with my new Aloha were a nasty surprise given all the positive reviews I read with nary a mention of leak problems. So that, in addition to my yen for fixing stuff, is additionally driving my attempt to see if a minor modification can alleviate the rather serious leak problem that at least some of us are really having. So much for background. And btw, the so-called big-picture approach to things, also known as maintaining a reasonable top-level perspective, always makes sense and I don't think anyone argues with that.

Now for some pictures that Nate asked for. These are first attempt prototypes. I used standard off-the-shelf (hardware store, electrical section) insulated plastic grommets that I reshaped by cutting them in a special slanted way to slightly reorient the posture of the pillows. Grommets are little plastic linings that are inserted in electrical junction box holes through which electrical wires pass. Their usual purpose is to protect the insulation of the wires from being cut by the sharp edges of the holes in the metal junction boxes to prevent short circuits and fires. They're cheap, costing perhaps $1.50 for a dozen.

The first photo shows a pair of unmodified red plastic grommets next to a pair that I intentionally cut in a sloped manner.


The second photo shows how I wrapped or mounted the cut slanted grommets around the stem of each pillow.


The third and fourth, as well as the second, photos demonstrate how the sloped cut shape of the grommets beneath the pillows exerts an uneven upward pressure on the bottom of the pillows, thereby orienting them a bit in one direction or another. The direction of such orientation can be adjusted by simply rotating the uneven cut grommets around the stems of the pillows to change slightly the direction in which the pillows point and, therefore, change the way the pillows seal against the inner layer of skin in ones nostrils. That's the principal.





Materials other than split grommets may be used. For example, my next experiment will be with tubing, cut on a slant like I did the grommets, and having a diameter that will allow the pillows to be scrunched just enough to be pulled up through the short piece of tube and then allowed to expand and take its normal shape. Also, the amount of slant cut into each grommet need not be as pronounced as shown if only very small degrees of pillow reorientation are needed. Adjustment of the pillow orientation will be accomplished the same way; i.e., simply by rotating the sloped cut tube's high point around the base of the pillow until the best sealing orientation of the pillow is found. This is not really that complicated and many forum members who are handy with tools should have no trouble with this. Please do let us all know here if you come up with variations that may be superior to what we've been trying so we can all benefit.
Tonight I'll give my modified Alohas pillows a try and see how it goes. It was a nice challenge to figure out how to tackle a really bad leak deficiency given my the pillows provided and my facial geometry. Hope it works because I like everything else about the mask. By the way, I find it more comfortable and a lot sleeker to wear the head gear without the covers. The fabric underneath is really quite nice.
Comments and suggestions are welcome.

Hey Papit, that is soooooooooo way cool...........now we have exactly the opposite problems with this, so please help me widen the pillows on the Swift Lt..... It seems to me you are trying to narrow the gap between the 2 pillows on the Aloha, and I need to widen the 2 pillows on the Swift Lt. this just proves to me that not every mask nasal pillow mask will work for everyone. Unless of course with your amazing technical abilities you come up with pillows that work independently of each other that we can slide the into the entrance of each nostril and lock em down....YOU CAN DO THIS!!!! I have great faith in your abilities to come up with the ULTIMATE PAPIT UNIVERSAL NASAL PILLOW MASK!!!! Yea ha, you already have the greatest mask Name!!!! Kudos Papit you are worthy of many LAB RAT awards!!

portiemom wrote:Hey Papit, that is soooooooooo way cool...........now we have exactly the opposite problems with this, so please help me widen the pillows on the Swift Lt..... It seems to me you are trying to narrow the gap between the 2 pillows on the Aloha, and I need to widen the 2 pillows on the Swift Lt. this just proves to me that not every mask nasal pillow mask will work for everyone. Unless of course with your amazing technical abilities you come up with pillows that work independently of each other that we can slide the into the entrance of each nostril and lock em down....YOU CAN DO THIS!!!! I have great faith in your abilities to come up with the ULTIMATE PAPIT UNIVERSAL NASAL PILLOW MASK!!!! Yea ha, you already have the greatest mask Name!!!! Kudos Papit you are worthy of many LAB RAT awards!!

Turn the grommets by 180 degrees?

Great photos with a great concept!

Ingenious! Looks very promising - please keep us informed.
In the meantime, I am hoping to get my new pillows today.

The ones I have now have been in use since April 5th.

Nate

That is so clever!! I really believe you should patent this idea because sure as shootin' someone like our dear mask manufacturers will pick it up and run with it. It's a cheap, quick fix to solve a persistent dilemma for a lot of folks and adds immeasurably to the adjustability factor that will allow the mfgrs. to up the cost of their product. How many other nasal pillow masks do you think this would work on by varying the height of the little tube?

Suz

Now that I've had a chance to look at the close-up photos, it appears that the silicone material used may be too thin to support the stresses and so the pillows collapse (fold) over and loses the seal.

I don't have an actual Aloha mask to study up close but I recall having this issue with the Opus mask when it first came out. Opus redesigned the pillows soon after and IMO made the problem worse. I gave up on trying to re-engineer added support for the Opus because the Swift LT came out soon after and addressed the issue with shorter neck between the reservoir and pillow seal seats and thicker silicone material for the reservoir portion that prevented collapse or fold-over.

What I really liked about the Opus was the "ball swivel" (which the Aloha also appears to feature) whereas the Swift LT only has a 360 degree "plane swivel". The plane swivel mitigates stress leverage from hose movements in a single plane whereas the ball swivel mitigates stress leverage from hose movements in orthogonal 3D.

IMO, my ideal nasal pillow mask would be the Swift LT with a "ball swivel" hose attachment. The Swift LT solution is to just attach the hose to the top headgear strap with enough slack to keep any hose movements from leveraging the pillow seal loose. I use the PapCap with the Swift LT headgear over top and the hose attached to PapCap crown loop. The remainder of the hose is routed overhead to Command hook on wall via a couple of retractable key chain devices. Have yet to find a better nasal pillow system for one who tosses and turns a lot while asleep like I do.

Best of luck with your lab ratting.