Need help with Dreamware Nasal fitting

[cisbrane]

I decided to dry the Dreamware nasal mask after looking at it's design, and I'm running into some issues. I'm looking for some suggestions on what I should try to hopefully fix the issues. Previously I had ResMed N20 which didn't fit right and a pillow mask from another company but was irritating.

I have a large head and one size fits all never fits me. Based on the measurements I saw online, I ordered a Large frame instead of the standard medium. Unfortunately ordering a Large frame meant I couldn't get a cushion fit pack, so I used the nose size template and looked like medium would be a good fit.

First, the frame looks to be in the correct position based on the pictures, but I find it a little loose on the top of my head. Should it be a tight or loose fit?

Next the main issue is the cushion. I can easily get it to where I can breathe in the air, but I have problems exhailing air. It feels trapped and that it does not escape fast enough through the vent. After much wiggling, I usually stretch out the cushion and put it back on I can get it aligned so the event is optimally placed. This is fine until I roll around to my side. Again feel like I can't exhale and I need to make adjustments which wakes me up. My nose did not indicate the wide cushion based on the template.

Lastly the headgear keeps slipping on my hair and the fit loosens up. I have to keep pulling the strap body down.

So is my frame too big? Wrong cushion size? Wrong cushion placement? I really like it once the adjustments are there...

[Gideon]

It could be any of the above. Fit should always be somewhat on the loose side, a VERY common fault is too tight. None of the masks are designed to fit tight.

Look at the manufacturer's video on fitting your mask. Look at the Mask Primer. I like to fit a mask by hand then fit the straps to match how my hand fit the mask.

Fred

[Fats Drywaller]

One possibility, if you don't want to buy a size L cushion to try (it's a gamble: no guarantee that it'll fix the problem), is to use an x-acto knife or tiny scissors to enlarge the vent in the M cushion.  I vaguely remember a recent thread here by someone who did that with some mask or other, enlarging the air feed or the vent or both, and posted photos, but now I can't find that with a search (can't remember what terms to use).

For use in your own searches, to maximize useful hits, the product name is "Dreamwear".  

OBTW, those fitting guides are notoriously inaccurate. I think the rule of thumb, oops I mean rule of nose, determined by various people's trial & error by this point, is to begin with the largest size, see whether that works OK, switch to the next smaller if not, and repeat.

[Gideon]

That rule of thumb is mostly for the P10 Pillow masks which should fit on, not in the nares of the nose.

[Fats Drywaller]

It seems to be more widely applicable than that. I've successfully used the size L cushion and pillows with Dreamwear and Brevida, even though an RT had told me (guesstimating) that size S would probably be the right one for me, judging by size of nostrils and/or the fitting guide.

From what I've seen, the fitting guides go by width of nose, which is not the whole story. Or the hole story either.

[Gideon]

No question but fitting guides are are just that guides.  Masks are undeniably the hardest part of therapy to get right and they are VERY individual.

[OpalRose]

A note on frame size. It should be a bit loose, but not so that it would drop forward if moving your head. It should not fit too tight either. Finding that happy medium is often a challenge.

On nasal cushion: Most folk seem to end of using a size larger in nasal cushion or pillow from what they measure for.

[Dana D]

I had the same experience.  Started with a small cushion, moved up to a medium, now I use a large one and it works the best.

[holden4th]

The frame might be the issue but it might also be how you've adjusted the frame and the straps. I use a Medium frame yet I have a reasonably larger head size. It works. The fit of the frame is all about juggling the position of the top part of the frame along with the tightness of the straps. If you pull the top part of the frame too far up on your head you tend to push the nasal cushion up into your nose and restrict the airflow which is what you appear to be experiencing. The same applies if you pull the straps too tight.

When I first got the the DW I would play around with the frame and mask to try and ensure a 'relaxed' fit every time I went to bed after a few days I got it worked out and could put the mask on, take a couple of breaths and know that it wasn't too tight and wasn't too loose.

Once I got this sorted it just worked from then on. When I changed to the nasal pillows I had to readjust.

The most important adjustment is the tightness of the straps. You definitely do not want to over tighten them. Get them comfortable and push the top of the frame either forward or back on your head until everything feels right.

Finally, see if you can get hold of a medium frame and see if that makes a difference.

[Fats Drywaller]

Next the main issue is the cushion. I can easily get it to where I can breathe in the air, but I have problems exhailing air. It feels trapped and that it does not escape fast enough through the vent.

A few things that eventually occurred to me:

• I just compared the M and L cushions from my Dreamwear package and found that although the L's air intake is larger and the cushion itself has a different size and shape (as you would expect), the size of the vent is the same between the two.
  
• Is the mask type set to Pillows in your A10's settings? (Yes, the actual type is cushion, but that's close to Pillows and it's definitely not Nasal or Full-face.)
  
• Have you experimented with EPR? It's always worth doing some experiments with EPR at least briefly, while awake, to see whether it makes a difference to your comfort.
  
• If the pressure is set to 4-20 as in your profile, that's probably too wide for any practical purpose. What does your prescription say? If it says 4-20, why was no titration done in your sleep study or studies? Should you be posting your Sleepyhead charts and asking for advice from the chart-experts?
  
• Also switch off the Ramp feature, if it isn't already off. This will have more of an effect when you have increased the low-pressure setting, but it could even have an effect right away with 4-20 if the APAP algorithm wants to go higher than 4.