[Equipment] Leak/Fit problems - looking for mask suggestions for first-timer

[fs12]

Hi all,


I just got all my CPAP supplies and I'm on night three of sleeping with my CPAP at home. Obviously still getting used to everything, but I'm struggling with my mask.

I have a ResMed AirFit F20 (medium), which seemed like a good option for me. I've been a mouth breather all my life, and trying to breathe through my nose when falling asleep makes me feel like I'm not getting enough air.

First night I had major water build up in the mask a few times during the night (I think it was drool - ugh), and kept readjusting the mask throughout the night. Second night was okay on the drool front, but the mask puffed out my cheeks, which continued to hurt throughout the day and made my teeth super sensitive to cold. Night three I tightened the mask a little more which helped keep my cheeks taught, but now I have red marks and irritations on my nose and cheeks that have not gone away after being awake for five hours. Also woke up once to clean out drool from inside of mask.

It feels like I do spend a fair amount of time readjusting the mask during the night. I sleep on my side and spend about half of the night on the left and the other half on the right, or swap back and forth a bunch. It seems I have to readjust the mask every time I move. My upper shoulders and neck are also super sore these past three nights - I think I might be building up tension from not trying to move so much.


So, I'm thinking that perhaps a different mask would help? I do feel like I should have gotten a large size mask, but I'm also wondering if there's a different one that would be better for me? In the sleep study I used the F&P Simplus which seemed to work decently well.
Last night I breathed through my nose for most of the night, something which honestly surprised me, as I didn't think I could stand it. But the CPAP pressure helped so I could get enough air intake through my nose. So now I'm wondering if a nose mask with chin strap would be a viable option?

I'm not going through insurance or a DME, so I don't want to end up with a warehouse collection of masks...

I'm attaching my sleep graphs from the past three nights. You can see clearly where I woke up to readjust the mask... Although the AHI isn't great yet, I feel markedly well rested and not groggy when I wake up, which is a huge change. So - yay for that!

Thanks for any thoughts or suggestions you may have toward figuring out what mask to buy next.



Day 1:
   

Day 2:
   

Day 3:
   

[mesenteria]

It's good of you to come by for some help, and I'll offer some reassurance at this point.  You're bran' spankin' new at this, and you're learning every night.  You are adjusting.  So is your equipment as it also shapes itself based on your use of it...what you subject it to while you sleep.

My first two nights were horrible, but the first was by far the Great Grandaddy of all of them to date.  I didn't know about my slack jaw and lips, so I was awake constantly, and then slipping off into sleep only to be immediately awakened again by my mouth opening and the gale of pressurized air emerging from it (I elected to use the N20 nasal mask and still use it exclusively).  I taped my mouth the second night.  And that's my story, now with an average AHI of 0.72 four months in.  I had to learn it all, and so will you.

Are you being monitored remotely by a therapist who is looking at your results each day?   

All that to say that it looks swimmingly normal for you with only three nights under your belt....er mask.  I'll let the experts try to fine tune your system for you........

Good luck.

[Walla Walla]

With the F-20 Airfit I found if you loosen the top straps until they leak and than make tiny adjustments until it stops leaking you can wear them looser than you think. Than do the same with the lower straps. Also check out Mask primer on the link below. Finally make sure you have the correct size cushion.

[fs12]

Thanks for the thoughts and suggestions.

I tried to loosen the mask completely and then tighten as needed, per your suggestion, Walla. I think that helped at the top, but I still had to tighten down the straps on the bottom significantly. It seems that's what is making my shoulders and neck hurt so much - the tightness of the straps makes me pull my head down unnaturally while I sleep.

Last night I again had water/drool in the mask, and woke up several times to readjust. I also have to readjust the mask every time I switch sides, though that seems normal to me.

I wonder if a nasal mask with chin strap would help the neck muscle strain?

I don't have anyone monitoring me daily - I have an appointment with my sleep doctor in a few weeks to check in.


On the upside, it looks like my AHI was much better last night. So clearly something is working, aside from the mask comfort.  



     

[Ron AKA]

Aside from your mask problems, which I share with you, I think you need to put your machine in APAP mode and increase the max pressure to 20 cm. Won't help with the mask comfort, but it may reduce your AHI.

[fs12]

Ron - thanks for the tip. I've still been struggling with the mask, but my AHI for the past few nights have been 2 and under, so I'm very happy about that. My AHI during the initial sleep study was 89 - so I feel great!

I have a new mask arriving tomorrow, and look forward to trying it out. And since my appointment with my Dr. isn't for another few weeks, I'll probably start messing with the Auto CPAP settings over the weekend.

I decided to try the F&P Simplus FFM, since that's what I had in the sleep study and it seemed to work well. I also ordered a nasal pillow mask with a chin strap to see if I can use that. Either way my current AirFit F20 will be returned ASAP! (I think it's a well-thought out design, it just isn't for me...)

[gwc2795]

I decided to try the F&P Simplus FFM, since that's what I had in the sleep study and it seemed to work well. I also ordered a nasal pillow mask with a chin strap to see if I can use that. Either way my current AirFit F20 will be returned ASAP! (I think it's a well-thought out design, it just isn't for me...)

The mask is one of the major efforts you have to put into cpap usage. It is hard to find the right mask for you as an individual, what works for me might not work for you.

Keep it up you are progressing amazingly.

[Ron AKA]

I started out with a ResMed AirFit P10 nasal mask. It has worked reasonably well, but the straps that hold it on your head are mickey mouse and are not up to the job. It frequently falls off during the night. I have added a chin strap harness which helps to keep my mouth closed and when I put it on over top of the P10 straps it helps to hold them in place too. So far this has been by best mask and I have achieved AHI's as low as 1.0 with it. But I am plagued with leaks still. I have tried the Mirage Quattro and that was the worst for me so far. I could not keep it in place and keep it from leaking. I tried one of my wife's Mirage FX nasal masks, and it was better but still not as good as the P10, and has the same mouth opening issues. My current attempt for a solution is the AirFit F20 that you are using. First night was really bad with an AHI of 13 or so. I just couldn't sleep with it. Last night was better with an AHI of 7. I am going to stick with it for a while to see if I can get back down to my typical 2.5 - 3.0 range of AHI, and achieve some comfort. 

I think part of the mask issue is the pillow. I have had good success with an neck support memory foam pillow when using the P10, but it doesn't work well with the F20 mask or the Mirage Quattro. It is too hard and dislodges the mask when you side sleep. So my current pillow project is a softer down alternative. I had some very good results with that combined with the P10 mask. I am hoping it may work with the F20 as well. I guess some time an patience is required to find out...

[fs12]

Reporting back after getting new masks! And a question about setting up the Auto CPAP settings...


So, I received a few mask options in the mail on Friday. I slept with the Aloha Nasal Pillow mask the first night, which was good, but the pillows scrunched up my nose uncomfortably and made my skin break out. No good. Last night I tried the F&P Brevida Nasal Pilow Mask, and I think that might be a winner. Feels great around the nose and stayed on well.

The Halo Chin Strap is okay - but it feels like it's making my jaw tense up during the night. I had to take it off in the middle of the night because my jaw painfully hurt on one side. I'm wondering if taping my mouth instead would work to keep my jaw relaxed but prevent leaking?
I feel like I have to concentrate on keeping my mouth closed as I'm falling asleep...


So - different masks is helping a lot! Thanks for everyone's input and help.

Now to the question - would switching my machine to the Auto CPAP setting help reduce my AHI even more? It seems like I still get some events that start with erratic breathing. I'm attaching a close-up view to show that. What would I set the machine to? My prescribed pressure is 11 cmH2O. And I put the C-Flex+ setting at 3 with the nasal mask as exhaling put weird pressure on my ears without it.

Thanks for any thoughts!


Last night full view:
[attachment=5715]


Last night close-up:
[attachment=5714]

[Fats Drywaller]

The Halo Chin Strap is okay - but it feels like it's making my jaw tense up during the night. I had to take it off in the middle of the night because my jaw painfully hurt on one side. I'm wondering if taping my mouth instead would work to keep my jaw relaxed but prevent leaking?
I feel like I have to concentrate on keeping my mouth closed as I'm falling asleep...

This is subjective and more moral support than practical advice, but I'd say to try it for a while with no chin strap and see whether you can learn to subconsciously keep your mouth closed. Without CPAP I'm a mouth-breather, but I have never wanted to use a full-face mask, and fortunately I haven't needed to use the chin strap that I've held in abeyance (it was included in a Resmed Mirage FX package). My mind knows (theoretically) that it should/must keep mouth closed while the mask is on, and somehow that has filtered through to my reflexes well enough that now the only mask types I even consider are the lightweight nasal-cushion and nasal-pillow ones.

Sometimes we tend to think that we must get to the final good configuration of mask, habits, etc. right away, just by jumping there, but IRL it's an incremental process and it's OK to make all sorts of mistakes in the first few weeks as you find by trial and error what works for you.