What is over-tightening?

In my initial post, I reported that I have been over-tightening the straps of my ResMed Mirage Quattro mask. I now think, perhaps not. As I adjusted the mask last night, I started from zero (that is, slack straps) and tightened only until I could hear no leaks and my ResMed S9 Elite reported an acceptably low level of leakage. Now, at that point, the straps were somewhat tighter than I could prefer. But, on the other hand, they were not nearly so tight as I could have made them. And, even then, the S9 reported that mask leaks were excessive overnight. So I wonder, were the straps over-tightened or not? How would I know?

BTW, I now realize that the root of all my problems is the failure of my local DME provider to observe me adjust the mask, just once, before sending me on my less than merry way. I suppose that's a routine omission. But what an obviously poor process it was!

NeedZZZ wrote:In my initial post, I reported that I have been over-tightening the straps of my ResMed Mirage Quattro mask. I now think, perhaps not. As I adjusted the mask last night, I started from zero (that is, slack straps) and tightened only until I could hear no leaks and my ResMed S9 Elite reported an acceptably low level of leakage. Now, at that point, the straps were somewhat tighter than I could prefer. But, on the other hand, they were not nearly so tight as I could have made them. And, even then, the S9 reported that mask leaks were excessive overnight. So I wonder, were the straps over-tightened or not? How would I know?

BTW, I now realize that the root of all my problems is the failure of my local DME provider to observe me adjust the mask, just once, before sending me on my less than merry way. I suppose that's a routine omission. But what an obviously poor process it was!

As counter-intuitive as it seems, I received advise about my straps that the looser, the better. I had my Swift FX mask just tight enough to keep it on my head. Now, I've been using the new Tap Pap which uses a mouthguard and no straps.

It sounds weird, but your mask can leak more when too tight. The mask has a seal that needs to inflate, so it needs to be loose before you turn it on, and then let it inflate to make the good seal. If it is too tight, the seal will not work.

If you put your mask on loosely, and then wait as the pressure goes up, you can feel the seal inflate.

How's this as a criterion, based on my experience last night: If the straps give you a headache, they're too tight.

My particular model mask, when tightened loosely, gives loud musical leaks whenever I move, preventing sleep. So I understand the "looser is better" criterion but it won't work in my case. As posted elsewhere, I now believe I have the wrong size mask.

just when you thought they couldn't make it any more confusing, some mask design require more or less tightening than others.in my experience if they leave marks on your face they are too tight. But not always.

LinkC wrote:in my experience if they leave marks on your face they are too tight. But not always.

Another good criterion, it seems to me. But do you mean, as I suspect, indented skin or do you mean raw, red, sores?

I think you are on the path of discovering that the mask you are using doesn't work for you. I don't like to tell folks that, and I prefer to hear it from them. You'll know the mask is not for you when you actually go outside and drop-kick the mask toward the garbage can. A full face mask should be loose enough to seal, and "lift off" the face when you first turn on the machine. If you have to keep cranking down on the mask to stop leaks and your neck or head hurts from the straps, then the mask is not for you. I you like the full face fit, there are many on the market, and I'm sure you can find one that will fit the contours of your face.

Sheriff

Just when you thought they couldn't make it any more confusing, some mask design require more or less tightening than others. In my experience if they leave marks on your face they are too tight. But not always.

NeedZZZZ.

The mirage quattro can be a beast to tame. I cussed mine at first until I was able to conquer it. What helped me the most was:

1) Do mask fitting at my maximum pressure rather than the lower initial pressure. Leaks are more likely to occur at higher pressures.
2) Fiddle with the forehead dial and know what it does. Rotating one way eliminates leaks by your nose and rotating the other way eliminates leaks by lower mouth.
3) I start with the forehead dial fully out, adjust straps so slightly snug, lay down and turn machine on...
4) where's the leaks? Can I fix it with adjusting the dial? Try it! If not, can I fix it with slightly tightening the bottom or top strap?
5) I end up going through a few iterations but it gets closer and closer each time... I have no strap marks in the morning and only once in 90 days had a red spot on the bridge of my nose.

My median leak is 0, 95% leak is 0, and max leak is 4.8 cm. These match very well with the best obtained by users of nasal masks.

A large Mirage Quattro fits me well and I love it! I'd put a bumper sticker on my car that says "proud wearer of a mirage quattro" if I could find one! For me, its a winner! YMMV.

BTW, I also use the Padacheek anti-leak strap. In night to night comparison, the anti-leak strap helps most with eliminating the occasional leak upon rolling on my side, a big plus since I spend about half the night side sleeping.

based upon my 6 months of use with the Quattro with bi pap pressures just shy of 20 ---

Small chirps on the side of your face tell me that your pillow may be pushing on the side of your mask and breaking the seal on the opposite side of your face.

Can you try a different pillow or sleep position?

I get minor strap marks on my cheeks, but they come from my face pressing onto the pillow all night... it's not from having the straps too tight. The strap marks are gone after showering and shaving in the morning

Dave

Denial Dave wrote:Small chirps on the side of your face tell me that your pillow may be pushing on the side of your mask and breaking the seal on the opposite side of your face.

Can you try a different pillow or sleep position?

I get minor strap marks on my cheeks, but they come from my face pressing onto the pillow all night... it's not from having the straps too tight. The strap marks are gone after showering and shaving in the morning

I sleep on my back specifically to eliminate any contact of the mask with my pillow. So, in my case, that's not the issue.

But, I'm not really complaining about what I'd call small chirps. These are loud toots of the sort I'm sure would awaken me.

Good additional information concerning strap marks, thanks!

MyIdaho wrote:1) Do mask fitting at my maximum pressure rather than the lower initial pressure. Leaks are more likely to occur at higher pressures.
2) Fiddle with the forehead dial and know what it does. Rotating one way eliminates leaks by your nose and rotating the other way eliminates leaks by lower mouth.
3) I start with the forehead dial fully out, adjust straps so slightly snug, lay down and turn machine on...
4) where's the leaks? Can I fix it with adjusting the dial? Try it! If not, can I fix it with slightly tightening the bottom or top strap?
5) I end up going through a few iterations but it gets closer and closer each time... I have no strap marks in the morning and only once in 90 days had a red spot on the bridge of my nose.

{snip]

BTW, I also use the Padacheek anti-leak strap. In night to night comparison, the anti-leak strap helps most with eliminating the occasional leak upon rolling on my side, a big plus since I spend about half the night side sleeping.

These are good suggestions. I think I've discovered all of them myself. Item #1 seems most helpful to me. My ResMed S9 Elite has a special test mode that applies high pressure and evaluates, in more or less real time, the leak rate. I use the test mode for mask adjustment. I guess that I could add that I start with straps just tight enough to hold the mask in position. Then I tighten them down only to the degree necessary to stop leaks, while fiddling with the mask position and the forehead dial. I got it all right pretty quickly last night but the head strap was so tight that the forehead piece caused pain that awakened me after only a couple of hours. Obviously, the straps were too tight. But nothing less seemed to get the leaks under control.

P.S. I forgot to address Padacheek. I haven't tried it yet but will keep it in mind, thanks. Tonight I'll try the Gecko thingy. I am definitely a gearhead.

Sheriff Buford wrote:I think you are on the path of discovering that the mask you are using doesn't work for you. I don't like to tell folks that, and I prefer to hear it from them. You'll know the mask is not for you when you actually go outside and drop-kick the mask toward the garbage can. A full face mask should be loose enough to seal, and "lift off" the face when you first turn on the machine. If you have to keep cranking down on the mask to stop leaks and your neck or head hurts from the straps, then the mask is not for you. I you like the full face fit, there are many on the market, and I'm sure you can find one that will fit the contours of your face.

Yes, my conclusion is that the mask is too large. I'm told that almost no one has a face so small as to require a size small Quattro Mirage. So maybe I'm wrong. But I've spent a month working on the problem and I'm generally pretty handy at making things work.

I don't know whether I like a full-face mask. I learned this morning that my prescription from the sleep center specified a full-face mask even though the preliminary report suggested a nasal mask. It seems to me that the medical advice is inconsistent and therefore not reliable as to mask type, mask size, and pressure (another whole discussion that I don't propose to initiate at this time, since my indicated AHI is okay).

NeedZZZ wrote:

LinkC wrote:in my experience if they leave marks on your face they are too tight. But not always.

Another good criterion, it seems to me. But do you mean, as I suspect, indented skin or do you mean raw, red, sores?

A well fit mask should not be leaving any marks of any kind. I only get marks on the side that is down into the pillow. But I get marks on my face from that even without a mask. I just smoosh my face into the pillow too hard.

If you are getting marks without pressing into the pillow, then it is probably too tight. If you are getting sores, it is WAY too tight.

It does sound like you have a mask that is too large. I wear a small quattro FX, and I wish they made a extra small. I have to get my mask just right, or it will leak at the eyes or the lower cheek. It took me about 6 weeks to master my mask, with a lot of swearing during that time.