Mask Change P10/ N30 to F20 Issue (Resmed)

[mcman56]

Due to skin irritation issues, I have been going back and forth between a P10 and an N30 nasal pillow type mask.  I have leak problems with both and this has gotten worse over time.  The leaks do not show up as an issue in the Resmed app and do not look bad to me in Oscar but make a whistling sound so repeatedly wake me up.  Chin straps don't seem to work very well either.  The root cause may be that I may squirm around a lot in my sleep because the straps move.  

To resolve both issues, I decided to try a full face F20 mask.  The Resmed site recommended this probably due to facial hair.  I tried it last night and as soon as I turned it on, there was an extremely large volume of air flow.  Shortly after, there seemed to be an excessive level of pressure in the mask.  The experiment ended quickly.  Would a full face mask be expected to feel that way after using the nasal pillow type masks?  I have no ramp time so would adding a ramp time help this issue?  Would changing the mask type on the Resmed machine make a difference?

From an equipment perspective, I can see why this could happen but am not sure how to correct.  The nasal pillow type masks have very little volume so the machine could pressurize fairly quickly.  The full face type mask must have 10 or 20 times the volume.  The machine would try to achieve pressure in a short time period and if that did not happen, the only thing it could do is increase flow to try and get there.  With very high flow, it could overshoot the desired pressure and end up with too much.  This is my theory but if true I would expect the control system to eventually stabilize and work as desired....maybe I did not wait long enough?      

   

[gainerfull]

Did you switch your machine to the full face mask setting prior to the f20 trial?

[mcman56]

I did not realize there was one.  I will go into the machine settings and take a look.

[DaveL]

I have leakage issues too.

I've used a ResMed N20 for years. I mouth breath. I have a Knightsbridge Dual Band cap to hold my mouth shut. It sort of works...

I sometimes tape my lips shut That works better. However, my tape hurts when I pull it off.

I also use a soft cervical collar to keep my jaw from dropping. When it does I have positional apnea.

I've tried the N30i and P30i. Neither has worked for me.

My goal is to simplify my treatment. Frankly i'm frustrated wearing all this gear. I've just started using an F&P Evora Full full face mask.

I hope this helps.

[mcman56]

Getting the right setting on the ResMed allowed me to give the mask a try but I had 2 issues.  
1. One was leaking so I kept playing with the strap.  Does the Oscar data below suggest I had less leaking as the night went on?
2. I got the highest AHI I have sever seen when using CPAP.  The previous high was probably around 8 and I average around 2.5.  Could leaking artificially push this number up?  It seems to me it would be more likely to artificially push the number down.

I tend to mouth breath and chin straps don't seem to work that well and that was one reason to try the full face mask.  Psychologically, I don't think I could tolerate tape.  In addition to a short beard (maybe 5/8"), I have a receding jaw.  Can that combination be a challenge for a full face mask?  Are there any recommendations other than pull straps tighter?

   

[AndyB]

I've tried many masks during my 8+ years of using a cpap machine -- everything from full face masks to nasal masks to pillow masks. Some worked okay, others not so much.

I've settled on the Bleep DreamPort Sleep Solution. I use it with a Releaf cervical collar and Cover-Roll soft tape. This combo is very comfortable and provides excellent therapy. It is extremely minimal and fuss-free -- no leaks, no headgear, no pressure sores or red marks on one's face.

It takes a week or so to get the hang of putting on the DreamPorts, but it soon becomes second nature and no big deal. The Bleep website has several helpful videos about proper application of the ports. The Cover-Roll tape is effective in preventing mouth leaks and is not painful to remove (just peel the tape off slowly from one side to the other using a dog-eared corner to give yourself a piece of the tape to grasp easily).

Bleep also sells the Eclipse mask, which is similar in concept to the DreamPort mask. Many people seem to like the Eclipse. I've tried both and prefer the DreamPort.

Good luck!

[SarcasticDave94]

The big issue with full face masks, and even though that's the type I've used the most, there's several drawbacks. The biggest thing is there's a lot more area to seal. It requires higher accuracy to get it right, and if not it goes more wrong than nasal pillows or cradle.

Right now yours isn't sealing very well. The median leak was 55.x, meaning most of your therapy was blowing around the mask. That's why AHI went up.

If the full face is going to work, it needs to be the right shape and size for you, and it'll need adjusted correctly, meaning not tightening with extra force. Any facial hair may make it unsuitable or less than ideal.

[Nightynite]

A lot of people including myself have always struggled with leaks, and have purchased all sorts of mask trying to find the perfect fit. One thing that is probably the culprit for a lot of people is the tossing and turning during sleep and their bumping and moving their mask and breaking the seal on their pillow. When I lay down at night and turn on my side to sleep I always try to sleep on one end of the head pillow and make my mask hang over the end so it’s not touching anything. But usually when I fall asleep and start moving around a little , I tend to bump or drag my mask on the pillow and there goes my seal.  So it may not be your mask all the time. It’s the movement we do that’s the real culprit.

[SarcasticDave94]

BTW something to think about, if you're moving a lot at night, maybe to take hose weight stress off the mask would be a hose holder.

[robbob2112]

You said you tried the F20 full face mask - I assume the standard airfit version (silicone) since it wasn't mentioned. I had similar issues with the masks you mention and my go-to now is the F20 airtouch version of the mask. The contact point is made of memoryfoam verse silicone so it conforms to the face better and also seals MUCH better over facial hair.