[CPAP] Mask choices

[SueDonym]

I got my first APAP machine (Dreamstation Go Auto) just a few days ago, along with a full face mask (Comfort gel).  The first two nights my AHI was 12-13, then for the next three nights it was around 4.  The trouble is that I found the mask quite uncomfortable, so I got a Dreamwear nasal pillow, which is really comfy.

But here's the problem.  For some reason I've not been able to go to sleep with it, and my AHI is 12-13 again.  I've only used it for 2 nights so far, so maybe I just need to get used to it.  Any suggestions?  Maybe an increase in pressure?

[SueDonym]

Just to add:

With the full face mask, the auto pressure was 7.5, with the pillow I feel like I'm not getting enough air (feel like I have to work to breathe and I'm kinda on-edge).  I've just watched some TV (40 minutes) with the pressure at 8.3.  Apparently I had:

Clear airway obstructions: 1
Obstructive apneas: 1
Hypopneas: 5

Can this really be right?

[Fats Drywaller]

Don't sweat it; give it time. Quite possibly you'll get used to it in a few days. I don't know of any magic method for adapting oneself to any mask or all masks, and if anyone else does, I'd love to hear about it.

For possible future use: The Dreamwear can be converted easily between nasal-pillow and nasal-cushion just by replacing the nosepiece, which costs about $20 but you have to know what size you need; if you don't know in advance, then you might need to buy another after trying the wrong size at first. You can find lots of discussions here and/or in the "Mask Reviews" forum (I can't remember where everything is) about the Dreamwear and which is preferable, pillows or cushion. I found the cushion to be too leaky when not sleeping on back, but some other folks have not had that problem.

Also, and I've griped about this in one of my Dreamwear posts in one of those threads, there are three sizes of frame for the Dreamwear (S, M, L), but the retail package of the entire mask only has the M size (it's such a trivial kind of mass-produced made-in-China silicone part that you'd think they would include all three sizes in a "fit pack" or something, but nooooooo). Refer to the card that should have been included in the package with your mask; it has illustrations of the proper and improper fitting of the M size. If your head is average, well & good; if it's not, you might need the S or L size instead. Someone has posted a scan of that instruction card in a Dreamwear thread here, but again I have no link and would need to search.

[Fats Drywaller]

With the full face mask, the auto pressure was 7.5, with the pillow I feel like I'm not getting enough air (feel like I have to work to breathe and I'm kinda on-edge). 

It sounds like you probably need a larger pillow size, and that too can be snapped out and replaced easily without needing to get an entire new mask. Did you get a "fit pack" with all sizes of nosepiece, or just one size? Is this from a DME, or an item that you bought yourself?

Edited to add: Again, frame size can be important; a wrong size can bend the mask out of position and make it difficult to breathe. See the card scans at: http://www.apneaboard.com/forums/Thread-...#pid196219

Also, if it's difficult to exhale, try enabling EPR (exhalation pressure relief; expiratory pressure relief) or whatever Philips Respironics calls it on their machines. Typically you can set it to a delta of 1, 2, or 3 cm H2O. It's probably a good idea to increase the set pressure or range by that amount at the same time, but that part might not be essential, depending.

[SarcasticDave94]

Welcome to Apnea Board.

If the numbers you mentioned were while awake, you can disregard because you were awake. Not trying to be captain obvious, but the CPAP is relatively accurate on events only while sleeping.

The mask is the most important, and the hardest part to get right. You have various form factors, full face, pillow, nasal, to choose from. Several manufacturers to consider as well. Then you have the specific model and then cushion sizes to account for. Lots of CPAP users struggle on the mask choice and fit for months unfortunately. The good news is once this is accomplished, almost all the rest is comparatively quite easy.

[SueDonym]

I've got the large pillow already. Yes, I got the fit pack, but the supplier fitted it and then kept the remaining parts.

[stanleydean]

Hi SueDonym and welcome to the forum, where unlimited good help is available. My recommendation is that you download SleepyHead and get some data posted here on the forum. This will allow us to see something about what's going on and to follow up with some suggestions for better comfort and treatment. If you had a sleep study obtain a copy for your file and also post a copy. Also you need to have a copy of the Rx written by your doctor to keep in your file. You should be able to do these things by following links posted below with my signature and by others.

Also, you may want to give the full face mask a few more nights trial and see if you can get more comfortable with it. Dig around in the forum, the Wiki etc. as time permits and you will have a better understanding of the whole situation. Good luck.

Stan

[Fats Drywaller]

I've got the large pillow already.  Yes, I got the fit pack, but the supplier fitted it and then kept the remaining parts.

(double-take) Doesn't the Dreamstation, even the Go, have a configuration setting for mask type? If so, that should be changed when switching among full-face, nasal, and nasal-pillow.

In any case, I would call the supplier and ask to be given the leftover parts. The size that will be most comfortable and/or the size that will give you the best air flow (not necessarily the same thing) might be unpredictable, and there's nothing wrong with trying all of 'em to find out. You're entitled to everything that was included in the package.

I added this to an earlier reply, but in case that fell through the cracks (I don't know whether the board marks that post as unread after an edit), the scans of the sizing card are at: http://www.apneaboard.com/forums/Thread-...#pid196219 thanks to c0mbe.

[ardenum]

I rotate between nasal and ffm every few days, cant sleep with one all the time.

[Fats Drywaller]

An update after doing a quick search-and-read here about the Dreamstation mask settings, X1 through Xwhatever (and "Off" for non-Philips masks, which is cute): Never mind, because the consensus is that it probably doesn't matter much, the usefulness of that option is questionable, and if APAP is on, it will swamp any tiny difference caused by the X setting, assuming a wide enough pressure range. FWIW, the mask type for the Dreamwear, from its package, is X1, so might as well set that just for luck.