I'm an old hand at the small size problem. One difference is that I put the nasal pads in and had an instant panic attack and so have done a full-face mask from the beginning.
I started with an F20. The "small" headgear is ludicrously large on me
I actually cut the back strap so that I could lap it over and use a big safety pin to take out like 2 inches, and that got the straps off my ear. The first year-and-a-half I was on therapy I started with a size small cushion and then went to XS, but neither really fit right. I lost 130lbs and then it REALLY didn't fit right. I was having to crank it so tight that I got a bloody pressure sore on the bridge of my nose.
My insurance changed and my first DME went out of network, so I picked a new one and "test drove" the DME by going in and having the RT try to fit me for a mask. The RT was kind of an idiot, but we DID find that the Amara View worked pretty well for me. (You know, you would think that when you have something called
sleep apnea, the "professionals" would have at least figured out that you are, ya know,
asleep when you use the mask! So carefully putting the mask on you and lining it up exactly and then telling you to remain
perfectly still is not a practical plan.) But this was Lincare, which I quickly realized was simply about having a phone rep call you and send out supplies and bill insurance without any sort of human contact. The Amara doesn't touch the bridge of the nose at all so no more bloody sores, but I kind of flailed around on whether I was a medium or small with that, and it's not really the question that can be figured out over the phone!
The Amara View is NOT a good mask for anyone whose face is not an average size -- in this mask the size is strictly about how far your nose sticks out from your face, and all of the sizes are exactly the same height and width. I was part of a mask study which I later realized was comparing the Amara View with the not-yet-released Dreamwear. When the Dreamwear came out I asked for it, at which point came to the limits of the call-center-mail-order model of cpap supplies that is Lincare. So I made an appointment at a Lincare office (different city from the first Lincare I used, which was in a work town and I know longer worked there.) I arrived at my appointed time and it was clear that they had no idea that I was coming, but the RT did happen to have a Dreamwear mask and she fit me with it, and I took it with me. Apparently Lincare really is incapable of providing any sort of in-person cpap help and the only people that you interact with are minimum-wage call center employees. And they never submitted the mask to my insurance and never sent me a bill because they didn't seem to have any procedures for this in-person encounter! I still have a pile of unneeded Amara View mask supplies still sealed in their packages, and I figured I was done with Lincare. But bottom line is that small face is probably not going to work well with the Amara View.
Next stop on my journey was a small-chain (3 stores I think) DME in the town of a new job. (I'm a girl scout leader, and a leader in another troop works in the office there, and so I was willing to trust them.) I mentioned that I have lots of flow limitations and the machine will ramp the pressure up to whatever I set the max at, but 1) that doesn't stop the FLs, and 2) if I set the max down and don't let it go to where it wants to go, I don't have more events. The RT was
aghast that I
dared to touch the settings (I was 4 years into therapy at this point, and wasn't intimidated.) She said, "
Are you a respiratory therapist?!?" I replied that, no, I'm not a respiratory therapist, but I do understand tuning and forcing data, and I lost 130lbs and kept it off via close control of data, and what's
your superpower? Anyway, I was able to get my dreamwear masks from them.
Then in Fall 2019 I was part of another mask study, this one comparing the Dreamwear to the -- at the time still pretty new -- F30. This is ResMed's version of the minimal-contact mask like the Amara View & Dreamwear. It has a
much more forgiving fit for us small-face people that either of those two masks, but at the time I decided that I like the hose connection at the top of the headgear rather than hanging off the end of your nose like every mask other than the dreamwear.
I'm not sure about the details of your small size, but what is important for me (and after 6-1/2 years of cpap therapy I am only now understanding this) is that the size is not
only a mask-fit challenge. My sleep-disordered breathing is a result of my small size -- the airway just isn't big enough to allow me to breathe through my nose when I'm asleep. As long as I'm awake I can breathe just fine with mouth closed, but the instant I get drowsy my nose closes up and my mouth has to open or I can't breathe. There is no way I can sleep in a nasal mask.
The stuff that I've been working on very recently has made me realize that I need the F30 mask -- it's the only one that will stay sealed if I change position. One of the challenges of the big weight loss is that my face kind of "falls away" from the mask depending upon what position I'm in. And then it does the "mask trombone" thing! (Daughter is a trombone player, and everyone in my family are physicists. They can explain why a leaky mask is a trombone not a piccolo...) So I think that you should ask for an F30 mask. Oh, and that mask is also sized strictly on how far your nose sticks out from your face. The reason that it's more forgiving is that the cushion is a lot bigger, so narrow face or wide face it still works.
Ok, sorry, that was a whole novel! but, anyway, takeaway is don't get an f20 mask, get an f30! If you can't make the F30 work, then the dreamwear might be a good next step.
