Lip gets stuck- full face mask (F10/F20)

[regbeach]

Does anyone know how to prevent your lip from getting stuck in bottom of full face mask (F10, F20) during the night? My mom has been using the AirFit F10 for Her somewhat successfully for awhile.  She added the Remzzz liner after I read about it here. It was a turning point in use since it eliminated the trumpet-sounding leaks.  Her leak rate varies from 0-8% still and AHI is avg. 8.  Sometimes I check the stats during the night and the AHI is much higher early on.  

During the night, I (or her aide) has to reposition the mask because the seal surface moved to her bottom lip. Sometimes this causes a loud leak.  Sometimes the seal is still in place.  Some nights the lip gets stuck once.  Other nights it can happen every couple hours.  My mom is a stroke survivor with deficits that include aphasia- difficulty communicating- so she cannot describe to me how it feels during the night or if it feels different to start on the nights that have more lip issues.  She also cannot adjust the mask herself since she can only use one hand so the issue isn't corrected until I wake up and hear a different sound from the BiPAP machine.
Any ideas or input on what to look for when I first put the mask on would be greatly appreciated.

A tech that came to house a long time ago sized her as a small.  The sleep lab changed it to a Medium since she opens her mouth during the night.  She uses Medium. I think the large would not seal on her face when her mouth is closed.  

I wash the mask every 2-3 nights (not every night since she uses the liner).  Washing seems to help with leaks but not lip issue.

I try making the bottom straps tighter without making it uncomfortable. They are tight enough that the mask can't be lifted off her face.

She sleeps on her back with head straight or to the right. She can't turn to left due to dystonia.  Because of the way her head turns the right straps on top and bottom are tighter than the left side.  I tried making them even but get lots of leaks.

I noticed some nights when I put the mask on her that it is pulling up before I put the bottom straps on.  Is that typical?

Last night, she used the F20. The seal is much better.  I didn't have to use the liner and had no loud leaks.  Her lip still got stuck several times. The provider did not send the "For Her" version.  The hard frame and head gear is bigger but the cushion is the same as the For Her.  I was hoping the improved seal would solve the issue.

Thank you.

[PaytonA]

I use the F20 and if I opened my mouth too far I would end up with the seal in my mouth. I do not have that problem but I can see where some people might. I also use the Mirage Quattro and have found that with this mask I have to work hard to get my mouth open far enough to end up with the seal in my mouth. I think it would help your mother's problem to get fitted with a Mirage Quattro as it allows a lot of mouth movement without getting leaks or misplaced seals.

Best Regards,

PaytonA

[Melman]

I had the same problem with the F20. A soft cervical collar or $10 chin strap from amazon will probably fix the problem. both work for me. The chin strap doesn't need to be very tight to prevent my mouth from dropping open.I've used an Avalon Aire Super Deluxe chin strap ($10.30) for a couple of months and hardly know it's there.

The OTC cervical collar ($10.52) is a good choice because it comes in 3 different heights and neck sizes. I've used that as well and it's quite comfortable.

[regbeach]

I got the ResMed chinstrap for my mom but she couldn't wear it. My mom is partially paralyzed and has aphasia (which is difficulty communicating). I think it made her feel more helpless or afraid she couldn't get out of all the stuff on her face if she wanted/needed to (for lack of better words).

She did try the Quattro and Quattro Air once but it didn't work out, as well as the Amara View. The Amara seemed to be OK but her AHI increased and the sleep dr. said she wasn't a fan of it.

Last night, she used the Large AirFit F20 (usual size is Medium). It gives more room around her mouth. It is too soon to tell if it will work out. It did get close to her lip once last night. It is really close to her eyes which may be a problem long term.

Any other ideas for masks to try that would reduce the lip stuck issue?

[ajack]

would she be able to tolerate the cervical collar that has been mentioned? It can be loose, it's there to stop the mouth opening too much.

[Russatrice]

I didn't see this post at first, it answers some questions I added in your other post.
I have an idea, not sure it'll work, but that's what I would try: Can you fashion a strap that attaches to the lower mask straps and runs under your mom's chin? Doesn't have to be super tight, just something that prevents it from riding up. I always modify everything, so this seems like a doable solution to me.
Also, I read that you said the mask can't be lifted off her face and that the seal compresses completely on her nose. I wonder if the straps are not too tight? The silicone seal is supposed to inflate to form the seal, so the mask should not be too tight. Keep in mind though I have a different brand of mask, so these are just some thoughts to consider.

[PaytonA]

For the F20 it seems to me that all of the flexibility is in the seal. The headgear does not seem to be very flexible at all. I may have missed it but if the seal is compressing completely on her nose, I would venture to guess that the top straps are too tight.

Best Regards,

PaytonA

[regbeach]

Update on my mom and her lip getting stuck in mask & Sleepyhead data.   We tried:

Simplus Forma FFM- couldn't get it to seal adequately on her face. 
Quattro FFM- wore with a mask liner for a few hrs but it made leak noise, Phillips unit showed 31% large leak.  I could experiment with forehead dial/straps.
Chin strap- wouldn't wear
Cervical collar- didn't try due to dystonia (neck spasms)

F10 FFM Large with liner (usually wears Medium)- lip didn't get stuck but hard to get a good seal. F10 sits lower than F20 FFM so F10 very close to the side, saggy part of chin.  About 2 of every 3 nights had high leaks and she felt tired next day.

F20 FFM, Large with liner- it sits very close to corner of her eyes, but is not as low on her chin as F10 Large so I devoted the most time to this.  Results inconsistent,  0-3% Large leak about 50% of nights as reported on Phillips unit; some nights leaks higher-up to 23%. No adjustments for lip needed so I (or her aide slept great) but the next day if leak % was high, mom was miserable.

Recently my mom spent 2 weeks sleeping in different bed/house.  After high leak nights with Large masks, I used F10 Med with liner.  9/10 nights had large leak of 0-3%.   I had to adjust mask at least once each night since close to or on lip, but seemed better than the Large in terms of large leak %, AHI and sleep quality.    When we went back to her house, she got a haircut and now the F10 Med is giving us more trouble during the night- 3-4 adjustments needed and her aide is getting leaks in the teen% the last couple days.  Same pillow, different mattress.

Even with 0% leak, the AHI with F20 seems to average higher (generally in teens).  0% leak night with F10 Med has AHI mostly less than 8, with some nights in low teens.
 

I have attached 4 Sleepyhead graphs. Liner used with all masks.  I noticed Sleepyhead always reports large leak % as 0.  I track it from the Phillips unit.
8/27- F10 Med., 1 adjustment during night, 0% large leak
8/13- F20 Large, 10% Large leak
9/2- F10 Med. 8% large leak, lots of adjustments during night

8/14- F20 Large, 0% large leak

https://i.imgur.com/4QFuywl.png

https://i.imgur.com/jEQZ5nw.png

https://i.imgur.com/eMGssWg.png

https://i.imgur.com/8HRfbil.png


1. Do you see anything in this data that would lean you towards one mask or the other? 

I looked at the 95% leak rate and 95% total Leak. I understand the leak rate is excessive leak above what the mask is designed to leak. These attachments may not show it but based on several random days, there doesn't seem to be a significant difference.   I looked at an old screenshot from 2015 with F10Med when I started using the liner. The 95% leak rate was .8 and 95% total leak was 67.   For an unexplainable reason, the F10 Med. with liner no longer gives us a 95% leak rate that is that low. 

2. Any ideas why the F20 Large seems to have higher AHIs than the F10 Medium? I know AHI can vary night to night.  Maybe the higher volume somehow affects AHI?    When there is a lot of leaking, her AHI in past was unusually low and she was tired so I dismissed those AHIs as inaccurate.  I read something in the SH info that supports that.   That's why the high AHIs with the F20, with and without large leaks, seem either inaccurate or if accurate, almost "caused" by the mask.

I recall with the Amara View that, in general, the AHI was higher than with the F10 Med.  When I asked the dr. about it back then, all she said was that she wasn't a fan of the Amara View.

Thank you.

[PaulaO2]

Then there is the Fit Life total full face mask. As long as she isn't too claustrophobic with it, it may work for her.

Also, checking the AHI at night while in use is only accurate up to that point. It will change by morning because of time.

My mother has aphasia too. I would see how the chin strap would frustrate her. The Fit Life may not be as confining, however.

And I don't think a cervical collar is good for your mother. Not with her muscle issues.

[Walla Walla]

Putting leaks and API aside for a moment. Is there a mask that you've used that your Mom prefers? You might want to use the mask she has the most comfort wearing and stick with that mask.