[Equipment] MASKS - the point of failure of xPAP Therapy

[jbuch002]

Maucat ..... join the club of frustrated xPAP devotees. I'm almost one month into therapy  - ResMed Autosense 10, Amara View full face mask, prescribed initial pressures of 6cm to 18cm, EPR 2. Without this forum I would have boxed the thing up and sent it back after the first miserable 2w. 3-4X per night awakenings, leaks then no leaks, CAs, then OAs then the opposite with huge leaks.

I'm an active sleeper. That means I roll around. I hate sleeping on my back where a full face mask works best. I'm a side sleeper. I'm also a mouth breather. Thanks to help I got here, I've realized the mask I was prescribed is probably not the right one for me. My facial bones just don't permit a great seal to begin with and when you move your head around, it puts pressure on the full face mask producing leaks. No amount of fiddling fixed this for me ..... different size mask, different strap positions, different levels of tightness, different ways of putting my head on hard and soft pillows. I've tried everything. We also did a lot of jiggering with settings in my ResMed AutoSens 10 and believe we reached the correct settings based on reviews by Board Members of my SleepyHead data - when the mask didn't leak, I slept like a rock and AHI's down below 2 from highs of 7-10 . It was pretty clear my prescribed mask was the problem.

I studied Bonjour's Mask Primer and along with advice from Advisory Board members and comments from others, I've just ordered the  Airfit P10 Nasal Pillows and a chin strap from Supplier #1 (see the list of suppliers available through the forum). I'm remaining open minded. If this doesn't work, I'll try something else. Important to note that some Durable Medical Equipment providers will allow you to try a mask and send it back if it doesn't work so you can try another one.

I'm a Physician Assistant now retired. I can tell you with no uncertainty that you elevate your risks for cardiac arrhythmias like Atrial Fibrillation. Chronic A-Fib increases your likelihood of experiencing a stroke by 5X without a history of Rheumatic Heart Disease. With it, it's 17X times higher.  https://www.ncbi.nlm.nih.gov/pubmed/570666. You increase your risk of Hypertension and by extension all types of Cardiovascular Disease with untreated OSA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387304/

So, yeah, I cannot emphasize the importance of staying with it. Get SleepyHead on your PC or lap-top from the links here. It's easy to install and easy to use. The graphs it presents will just look like a lot of spaghetti to you at first but if you take a screen shot with your display set up according to the instructions found at this forum, then post them for evaluation, you'll get great input from Board members and in a day or two you'll  be able to read and interpret them in meaningful ways. Hang in there my friend. Your life depends on it.

[CB91710]

I guess when you're as sleep deprived as I am, sometimes it's just good to ask "am I the only one?" ...

Absolutely not.
I GENERALLY use the P10, however, the large works best, but is just a touch too large and prone to becoming displaced.  The medium works OK, but the draw is difficult until the pressure comes up, and leakage is higher.   The issue with both... more with the medium... is I will get irritation in a nostril and will have to switch to a Nasal Mask for a week while my nose heals.

The Nasal Mask doesn't leak, but it applies a small amount of pressure to the top of my nose which makes it slightly difficult to breathe, but mainly, it increases congestion.

Full face masks tend to leak around my chin.

Seriously, I'm not sure if I own more CPAP masks or Concealed Carry holsters...  both are highly personal and a trial and error process to find one that works for you.

[paulag1955]

Rich...I'm dying. If I didn't know better, I'd think you were related to my husband, who has more holsters than I can keep track of.

[sonicboom]

I guess when you're as sleep deprived as I am, sometimes it's just good to ask "am I the only one?" ...

Absolutely not.
I GENERALLY use the P10, however, the large works best, but is just a touch too large and prone to becoming displaced.  The medium works OK, but the draw is difficult until the pressure comes up, and leakage is higher.   The issue with both... more with the medium... is I will get irritation in a nostril and will have to switch to a Nasal Mask for a week while my nose heals.

CB and maucat - you might trial the Brevida - it shouldn't irritate your nostrils as the pillows are softer and it is less prone than the P10s to dislodge as it has a velcro strap system for tension.  You also won't feel starved for air using a one up size.  With the strap tension system using a bigger size adjusted right the pillows shouldn't dislodge.  I used to use the P10s.  This is now my favorite.

[CZOscar]

You are not alone.  Reading all the responses also emphases the obstacles, trials and errors needed to get comfortable with CPAP therapy.

My story: I failed first time on CPAP and had to return the equipment (U.S.A. Medicare) due to ignorance and terrible masks fit

Was still exhausted and was getting worse so did another sleep study and decided to learn all I could and make it work come hell or high water.  This forum helped tremendously - Thank you all.

I too am an active sleeper and move around a LOT and am still looking for the perfect mask hahaha.

I currently own the F-20 and P-10 by ResMed and Amara View, Pico Nasal and Dreamwear by Respironics.  Just this morning I placed an order for the Brevida by F&P.  So my quest for good mask continues but here is where I am in regards to masks.

F-20 very well made mask, great fit, but ends up with bad leaks even wearing cervical collar  and/or Chin Strap.  Mask is large and is easily dislodged when I move around I’m guessing.

Amara View tends to be the best mask right now but far from ideal again due to leaks.  I do like the smaller profile and I can wear glasses and read with CPAP on.

P-10 works ok but I get mouth leaks and it is uncomfortable with the prongs in my nose.  I can tolerate it one night then need a break.

Dreamwear cushion is by far the most comfortable and causes least wake ups.  I absolutely  love the comfort AND having the hose on top is great since getting tangles in hose is one of the factors that causes wake ups.  Do get mouth leaks but with less wake ups does tend to mostly work best for me.  I’m working on controlling mouth leaks and if/when I do this or another pillow type will be my go to mask.

I ordered the Brevida since my research indicated it might be worth a try.

I know what my perfect mask looks like but it does not exit.  A small well fitting full face or hybrid (like Amara View) with Tube on TOP.

Having said this - what I do know is CPAP therapy is not easy, damn frustrating, but until there is a magic replacement, CPAP therapy even with all of the mask frustrations is better than without.

Good luck

[SarcasticDave94]

Ditto on the above. I have had a few issues with mask leaks until I knew how to address them. I use the F20 AirFit FFM. I've stuck with it by changing seal size to a small. It occasionally leaks a little, but I'll cinch it up and go with it. I'm a mouth breather and side sleeper. Being stubborn, I made mine work well.

And I know I'm guilty of what I'm going to say: I think we likely tend to put focus on the machine and pressure settings, forgetting about the mask brand, style, size, etc. Probably we should have focused on mask first. Without the right mask, the machine and settings really don't mean much because the mask failure will completely overshadow the others IMO.

[CB91710]

CB and maucat - you might trial the Brevida - it shouldn't irritate your nostrils as the pillows are softer and it is less prone than the P10s to dislodge as it has a velcro strap system for tension.  You also won't feel starved for air using a one up size.  With the strap tension system using a bigger size adjusted right the pillows shouldn't dislodge.  I used to use the P10s.  This is now my favorite.

I tried the Brevida for a week or so.
I have a heck of a time getting a good seal with Nasal Pillows.  I LOVE the way they feel and work, when they work for me.
The medium P10 works pretty well, but I get high leakage when I roll onto my left side (no issues on the right side).
The Brevida was really good for 2 days, then I started getting leakage blowing right into my eyes.

I've been using the Dreamwear for the last week or so and so far I've been very happy with it.

[sonicboom]

On the Brevida, if you turn the swivel where the diffuser is to the opposite side of your downside eye it generally shouldn’t be a problem since the Brevida seals at the top of the nose as well, unlike the P10s. That was my issue with the P10s - downside eye becoming dry. I liked the Dreamwear but for me it was noisy and also caused dry eyes.