Newbie seeks mask suggestions

So it’s been one week of CPAP therapy for me, and after reading quite extensively on this forum, I thought I’d ask for some advice. But first, I’d like to thank the entire community here for this invaluable resource. You’ve not only helped me with the technical aspects but also the psychological considerations. Because of the information I found here, I was so much more informed and well-adjusted going into this process.
 
I’ve known I have OSA for quite some time and finally requested a sleep study. My pre-treatment AHI was 102 (gulp), and I was prescribed a pressure of 15 cm and sent home with an S9 programmed to function in straight CPAP mode. I knew from reading here that it would be an adjustment, but I’ve made up my mind to commit to this, even if I don’t feel any better physically, so I’ve made friends with my machine (if not my mask, yet) and am dedicated to making this work. I’ve been 100% compliant and monitoring my results with Sleepyhead every day, and I’ve got a good idea of what to look for now. I’m fortunate in that I’ve had an easier time than many: I got started with a good machine, and I can sleep through the night with the mask on my face without too much discomfort or claustrophobia.
 
Looking at my data, it’s clear the treatment is working well for the most part. I’ve had three nights with an AHI under 5, and it’s been between 10-20 the other nights. On those nights when it’s higher, it’s been because of 20-60 min periods where the mask apparently becomes dislodged, and while the pressure only goes down a few cm, my AHI skyrockets (>90) until I wake up and reseat the mask. The strange thing is that the numbers show I have a good deal of leakage all night long, but most of it does not seem to be a problem. In fact, it seems like when the leakage is sustained at a certain level—even a high level—there’s little adverse effect, but when the leakage is erratic and goes up and down a lot in a short period of time, that’s when the problems start.
 
I thought the mask fit well when I tried it on at the clinic, but y’all know how that goes. I’m a side/stomach sleeper and when my face sinks into the pillow, the mask rides up and springs a leak around the top of my nose. I reseat it and go back to sleep, but I’m not always waking up when it happens. I’ve read that over-tightening can cause leaks, and I’ve read that it’s supposed to “float on your face,” which, well, LOL. That might work if I were on my back when I sleep (and also dead), but on my side, I have to make it as tight as possible or the leaks are much worse. I tried the smaller size mask and the fit wasn’t good. The other FF masks I tried (Mirage and a comfort gel one) were leaky even lying on my back. I also got the padacheek liner, but it did not improve the situation (it feels good but still leaks). And now, one week in, I’m waking up with real pain in my lower teeth.
 
I’m a mouth-breather by default but tolerated the nasal mask pretty well during my sleep study. The problem was that my upper lip was sore for days afterward, and between the mask and the chinstrap, it didn’t feel like less stuff on my face. I tried the nasal pillows at the clinic, and they would be ideal except exhalation was extremely difficult, even with the largest pillows and EPR set to the max. I have a big head/face and facial hair (although the hair does not seem to be the issue with leakage) and my face really seems to sink into the pillow at night. I usually sleep on the edge of the pillow with my arm under my head.
 
So: what masks should I try next? I understand this is a highly-individual process but I’m hoping for some educated guesses, given my pressure level and sleeping habits. I don’t mind lines on my face but the pain in my teeth after only a week is really troubling to me. My main goal would be to find a mask that is as stable as possible (without doing damage to my face/jaw). I’m looking at the Forma FF mask since it goes under the chin and the leaks seem to be connected to the mask riding up my face. But of course reviews seem mixed. I’m willing to try a nasal mask, too. The Sleepweaver looks comfortable but it sounds like it doesn’t work well for higher pressures. I’m also willing to give the nasal pillows a shot, but the exhalation difficulty concerns me. Does one just get used to it eventually? I know they all take some getting used to, but how long do you give a mask before moving on?
 
Thanks in advance for all your help. It’s really great to read about others’ experiences.

Welcome to the forum.

I have given a mask one night and moved on. To be fair it was a known experiment and I already had success with the nasal pillow mask to fall back on. I had no patience to go through any more torture. Other people just love that mask too. It was the only full face mask that I could remotely tolerate and a dismal failure so all I could offer you would be my thoughts on the various nasal pillow masks I have tried.

With facial hair the nasal pillow mask is going to be one of the easiest to maintain a good seal. Properly fitted with correct size and there really shouldn't be all that much difficulty exhaling with one. There are people here on the forum using nasal pillow masks with pressures in the 20s. If you want to experiment with nasal pillow mask perhaps using it while awake and watching TV might help the adjustment (yes, we really do get adjusted so that exhaling is no big deal) or perhaps use the ramp feature and work up to the pressure you need. Just a thought to consider.

Mask preference is so individual it really is a crap shoot. What one person just loves another person just hates. You learn best by trying different ones yourself. Unfortunately really expensive experiments. Sometimes forum members will sell their "failed experiments" at a reduced price to make mask experiments affordable. If your DME has a generous mask swapping policy then by all means utilize it. Most mask manufacturers have a 30 days return policy but often the DMEs set their own in house policy.
Check with your DME to see what theirs is and make use of it while you can.

Try a mask liner with the Quattro Fx
Mask choice is a personal but Activa LT nasal mask and chinstrap works quite well for me. Its light and I can keep it loose and doesn't have to be tight to maintain a seal.
https://www.cpap.com/productpage/resmed ... dgear.html

Make sure you check the 30 days return insurance policy
https://www.cpap.com/returns.php

pacificpap wrote:I’m a side/stomach sleeper and when my face sinks into the pillow, the mask rides up and springs a leak around the top of my nose.

Hi,

I wonder if there is some pillow technology that can help here. I know that companies make CPAP-specific pillows. Generally, they are sturdy foam with some cut-outs strategically places so there is no pressure on your mask. You might be able to fabricate something on your own that fits the bill. I use a number of layers of pillows, and slide one do it supports my head starting around the ear, and thus, nothing presses upwards on my mask.

If you are not position sensitive (ie, your OSA doesn't get worse on your back), try sleeping on your back for one night to see if you can get better results with leaks. That will help nail down whether it is your sleeping position, or if something else is going on.

-john-

I am wondering what percentage of hose-heads have to use a FF mask? Perhaps I'll set up a poll to query the members here.
Years ago, I would have put the number at 10% or less. But now I think -- based on all the posts I read here -- that it must be up around 50%. I thank my lucky stars that I have never been a mouth breather and had to be stuck with a FF. IMO, there are ten times the number of choices with nasal masks or pillows.

Thanks everybody. I have an appointment with my DME to try some other masks on Friday. The specialist on the phone also said 15cm is too high for nasal pillows, but I said I wanted to try them again anyway. Since I'll have to return the Quattro FX, I'll be looking for something I know will work and will just try to shop elsewhere for masks I'm less confident about.

It was hot here last night and the FF mask gave me fits due to sweating. I'm going to give the pap pillow a shot and hopefully I'll have a little better luck with the next mask.

pacificpap wrote:The specialist on the phone also said 15cm is too high for nasal pillows, but I said I wanted to try them again anyway.

Hi,

Don't let a non-CPAP'er tell you what works and what doesn't work. I run at an inhale pressure of 20, and I get along very well with nasal pillows. I find that the smaller size pillows give me a better seal. Round "nares" (the holes in your nose) work best for nasal pillows. Slotted nares don't work so well. Mine are in between, and I still do OK. My bigger challenge is keeping my mouth from leaking. I find I have to do both a chin strap and tape, either one by itself isn't enough.

pacificpap wrote:It was hot here last night and the FF mask gave me fits due to sweating.

I tend to keep the A/C a little cooler since I run with the humidifier turned up. I also keep a fan running in my bedroom to get some circulation. Different things work for different people. The bottom line here is that your comfort is really important. Don't be afraid to spoil yourself a bit since the more comfortable you are, the better chance you have of getting good sleep. For example, I invested in some memory foam, and while it was a little costly, it made a huge difference (less hip pain means far less tossing and turning).

Good luck with the new mask!

-john-

pacificpap wrote:The specialist on the phone also said 15cm is too high for nasal pillows, but I said I wanted to try them again anyway.

I agree with John. I use a nasal pillows mask (OPUS 360), and it works just fine with the pressure set at 13cm in CPAP mode. I'm also a side sleeper and a mouth breather with facial hair (gosh, that sounds Neanderthal), yet the only leak issues I had happened when my chinstrap slipped off of my chin one night and I started breathing a bit through my mouth.

I am very intrigued with the concept and design of the SleepWeaver ADVANCE Soft Cloth Nasal CPAP Mask, so that will probably be the next mask I'm going to try. That being said, I am very happy with the mask I currently use. Hope all goes well for you on Friday. Good luck.

pacificpap wrote:The specialist on the phone also said 15cm is too high for nasal pillows...

This makes me so angry. Where do they even GET this stuff? For me, nasal pillows work BETTER at high pressures than a FF mask, because they leak far less. Good for you for insisting on trying them anyway.

I'll be honest: as someone who has tried over 13 masks now, I think FF masks should only be suggested to people who've tried nasal masks/pillows WITH CHIN STRAPS first, unless they're specifically requested. I think they're just so much harder to get used to for the vast majority of people. They leak, there are more parts to fit, and they're just more stuff on your face.

So, you asked for suggestions. Here are a few.

I think all new people should give the Aloha a go. It won't work for everyone, but I think it does work for most people. It is nasal pillows, and this mask is VERY comfortable and resistant to leaks. The Aloha is reasonably priced online, but your DME might not carry it. If that's the case, I think you should try the ResMed Swift FX and Bella Loops. Also decent, fits most people, popular, and far more comfortable than a FF mask.

I also suggest getting a chin strap from your DME, just in case you need one. Some people don't, some people need them all the time, and some people need them at first and then get used to sleeping with their mouth shut. Good to have, regardless.

I sleep with (and LOVE) the Pilairo nasal pillows, a mask that was just released in the US a few weeks ago. If your DME carries it, might be worth trying on. It won't be as great for everyone as the Aloha, but those that love it, (like me), really love it. And it seems to do BETTER the higher your pressure is! But I would start with something more universally comfortable (like the Aloha) if you can't try this one on in person.

Good luck, and let us know how it goes!

what is considered a good "AHI" and what does this stand for?? I have an S9 Cpap machine and see this alot with readings. I am new to this and confused...

Thanks all for the input. My DME has the Swift FX and the Opus 360 but not the Aloha. The Opus sounds a bit better for my needs (fellow Neanderthal here) but I'll have to try both and see. I know the pillows will feel better then the nasal mask, I'm just concerned about the exhalation difficulty I felt the first time I tried them (just tried for fit, haven't used them). Somehow exhaling with the other two mask types was much easier. I was wondering if I should get a nasal mask from the DME and just go out of pocket for the nasal pillows so I'll have something I know will mostly work while I'm looking for something more ideal, but I'm more encouraged to give the pillows a shot now.

What's strikes me looking at the data each morning is that I'm a pretty lousy judge of how well I'm sleeping. Nights that feel ok can show up a very problematic, whereas nights that feel tortured can show up in Sleepyhead as pretty damn good. Seeing those periods where the mask leaks and I go right back to a three-digit AHI reminds me just how important this whole endeavor is.

In terms of exhalation with the nasal pillows, I think that for some people the size of the pillow can make a big difference. With the first ones I tried I had trouble exhaling and the sound was like a train. They were evidently too small, and air was leaking around the edges and sending the pressure up. So you could need to do some experimentation to get the right size. The Swift FX I have came with 3 pillows: M, S, and XS. They also come in L.

Good luck!

pacificpap wrote:Thanks all for the input. My DME has the Swift FX and the Opus 360 but not the Aloha. The Opus sounds a bit better for my needs (fellow Neanderthal here) but I'll have to try both and see. I know the pillows will feel better then the nasal mask, I'm just concerned about the exhalation difficulty I felt the first time I tried them (just tried for fit, haven't used them). Somehow exhaling with the other two mask types was much easier. I was wondering if I should get a nasal mask from the DME and just go out of pocket for the nasal pillows so I'll have something I know will mostly work while I'm looking for something more ideal, but I'm more encouraged to give the pillows a shot now.

The last I looked, our forum sponsor, CPAP.com, has the OPUS 360 on sale for $82.50. I went through my DME provider for my OPUS 360 since I wanted it immediately and wanted the option to exchange it if I didn't like it. The price was higher through them, but since I have a 15% co-pay, it wasn't really a big deal.

The more I use my OPUS 360, the more I like it. As for exhalation, I don't have a problem at all. At first I set my s9 to ramp for 15 minutes, and I felt a bit of exhalation resistance with that setting. Later I reduced the ramp to 5 minutes, and I like it there. I guess it's a matter of personal choice and what is most comfortable to you. Since you have a beard like I do and have been struggling with the other genre of masks, I think you'll like the nasal pillows. However, if your nares are long and narrow, the nasal pillows may be more of a challenge to fit. Anyway, glad to see that you have narrowed your decisions. Good luck the rest of the way.

If your DME doesn't want to let you try something - Go somewhere else. Try on everything if you must. It's your face and your money.

Mine didn't want to sell me or even let me try a SleepWeaver Advance. One store I called told me my setting of 8 was too high for the mask. The store I ended up at does not deal with my machine but the Assistant/Tech/Sales Person was so willing to help me that I've sent someone else to her for the same mask today when they read my review on my facebook. She was more than willing to help me, wanted to see how my machine worked and gave me the 30 day guarantee with her. Last night was my first night with it and today I felt wonderful. I even went for a bike ride (I haven't done that in more than 5 years.)

Take your pillow (the one you like to sleep on) with you. If they don't have a spot to lie down put it on the table and put your head on it. Sitting in a chair with it on your face is not going to give you the same feel as lying down with it.

Good Luck!

I just spent an hour trying masks at the clinic, even brought my pillow with me for extended smush tests. They didn't have the Aloha or the Opus, but they had just gotten the Pilairo, and in the end, that's what I went home with.

The Swift FX was the other nasal pillow I tried, and it was much better this time. The large pillows made all the difference compared to the medium. It was close between the two, but I went with the Pilairo because it felt so good and seemed to have a better seal. Disadvantages were that it was significantly noisier, and I'm concerned the headgear isn't adjustable (then again, I won't have to worry if it's too tight or loose anymore).

I also tried a nasal mask that was small but problematic, and I tried the Mirage Liberty. I was really excited about that one, since I will need a backup FF for when I'm congested, and it's expensive, but I couldn't get a seal at all with two sizes, it leaked everywhere. Goes to show you that you can't go by looks at all in this game.

Got the Resmed chinstrap because the others were so bulky and I could imagine them being soaked with sweat by the morning. Maybe I'm one of the lucky ones who can learn to nose-breathe on my own.

So, Pilairo. I'm excited to try it, feels like I jumped about 25 years in mask technology coming from the Quattro FX. It was the first one they'd gotten. And it's good to know the Swift is an option if this doesn't work out. Cheers!