Newbie needs advice

[jldbeck1]

I have a question. Let me describe the situation first. Ok, from the beginning, I did a home sleep study and discovered my constant state of tiredness was due to severe sleep apnea (average AHI was 60). My therapist put me on an cpap and was able to reduce that down to 30. I was maxing out the machine so we went to a bipap. With the new machine my average AHI is under 5 and I am no longer falling asleep at work anymore or while driving. The machine shows that I am averaging about 5 hours of therapy a night but in all reality I think It is more like about 3 hrs. I’m no longer nodding off in the day but I still feel tired all the time. The problem seems to be, it takes me about 30 minutes to fall asleep, then after about 2 hours I wake up due to air leakage. After waking I hit the ramp (set at the max of 45 minutes) and the pressure is reduced down to 15 and again it takes me about 30 minutes to get back to sleep and then about 15 to 30 minutes later I start having leaks again. At this point I get frustrated and usually turn the thing off. Now, I’m usually up the rest of the night or I am sure if I do fall back to sleep my AHI is back up around 60.

I have tried 3 different masks and adjusted them every which way possible and have only ended up with sores on the bridge of my nose and blisters on the back of my head from the straps being so tight. So, my thought is to reduce the pressure max from 23 to 21 and sacrifice a little AHI for maybe less leaks and possibly more overall hours of sleep. Of course my therapist is against it as she is happy I’m above the 4 hr min for compliance and under the 5 AHI. So my question is, should I take it on my own and test this thought or keep fighting with the leakage issue. Any advice would be greatly appreciated.

Cheers,
jim

[PollCat]

Welcome to the forum, Jim. When you said you tried 3 different masks, did you mean three types of masks? What do you do right before you go to bed - or in other words how's your sleep hygiene? I cannot help you with a full face mask adjustments but someone on the board can and will shortly. I couldn't stand wearing anything other than pillows - my beard interfered with the seals !

[jdireton]

Jim,

Welcome!

It sounds like most everything with your therapy is going well. You've had to work at it, and BPAP is a serious adjustment, but you've done it. AHI below 5 is exactly where you want to be. Congratulations on your success!

Don' stop at three masks! There is a mask out there that will work for you without causing you pain. Let us know what masks you've tried and what your preferences are. With the headgear as tight as you indicate, you may actually be causing the leaks. Most masks don't work properly when over tightened. Your profile says you use a full face mask and they are notoriously the most difficult to get a good, leak free seal from.

Don't give up, with all the other work you've done there is a solution out there and you will see eight hours of sleep a night!

[jldbeck1]

Thanks so much for the quick responses. The only mask I have tried thus far are 2 diferent sizes of the full mask. The medium size seem to fit best but left a sore on the bridge of my nose even when using a optional rubber gurad piece. I fought with it for about 2 weeks trying various strap tightness. If I loosen it, it leaks, if I tighten it, I get the sores. Went to the the larger one and the sore finally heeled but I can't get the leakes to stop at high pressure plus now I get sores on the back of my head. I then tried a nasal only mask and had the same leakage problems, now into my eyes. I tried all possible strap adjustments. I gave up and went back to the large full face mask. I ask my therapist about the nose pillows and she said she only heard bad things from patients at higher pressures. So that's where I'm at.

[jdireton]

Jim,

Can you give us the manufacturer and model, as well as the size. I don't use a full face but there are people on this forum who do that can give you some recommendations.

I don't use nasal pillows, but I hear the same as your RT said, they may not be recommended at higher pressures.

Masks can be one of the most challenging aspects of getting therapy to work for you. I hope we can help.

[jldbeck1]

Yes, it's the ResMed Mirage Quattro™ Full Face Mask. It is very comfortable at first but once the pressure goes up it leaks from the sides and the straps around the back of my neck start digging in and make it almost unbearable. I thought maybe with time I would get use to it but it's been 3 months with this one.

[GreginColo]

Hi Jim, I am also a relative new user and must use a full face mask due to mouth breathing. I use the Mirage Quatro FX (the one without the forehead support). I had tried other masks but was having the bridge of nose soreness problems. What also helped me were the pointers offered by Jeffy. He wrote a very thorough and thoughtful set of pointers about how to get to best get adjusted to your mask. Also I try to to always wash my face and sometimes even shave, before bed as that helps the seal. But most impotantly, read the suggestions from Jeffy, they very helpful to me.

[trish6hundred]

Hi jldbeck1, WELCOME! to the forum.! There are quite a few masks out there so don't give up and as you have discovered, the mask is the most difficult thing with CPAP therapy. Keep checking back into the forum for more suggestions. Best of luck to you.

[PaulaO2]

Full face masks are notorious for leaks.

Have you tried the Quattro FX? It doesn't have the forehead support. Ask the therapist to show you all the full face masks they carry and try each one. Each mask, even if looking identical, is different. Some like the Quattro, some like the EasyFit.

Nasal pillows are not recommended for pressures higher than 15. They start pushing away from the nose.

If you are tightening it so much you are getting sores on the back of your head, it is way too tight. Not only are you probably creating more leaks, but you are hurting yourself. Most masks are designed now to float on the face. It is the pressure from the air itself that is holding it in place. This works great until you lay on your side or it otherwise gets skewed. Then that seal is broken.

You said the therapist mentioned compliance. Are you still needing to be compliant for insurance reasons?

There's two things to look at in terms of how well the CPAP therapy is or is not working. One is the AHI. You want that less than 5. The other is how you feel. It is the goal to have a low AHI and feel great but often that's not possible. You need to decide which you want. A low AHI means the sleep you are getting is good. But what good is that sleep if you aren't getting enough of it. Are you sleeping the same amount of time before therapy started? Do you feel better or worse since you started? Some would say that you aim for as low an AHI as possible and some say it is the quality of sleep that matters more. That's something you need to decide for yourself.

You've only been using the machine for 3 months now. I know that seems like a long time but it's not. Some folks take forever to finish adjusting.

Look into 'sleep dept' and 'sleep hygiene'.

[JJJ]

Yes, it's the ResMed Mirage Quattro™ Full Face Mask. It is very comfortable at first but once the pressure goes up it leaks from the sides and the straps around the back of my neck start digging in and make it almost unbearable. I thought maybe with time I would get use to it but it's been 3 months with this one.

Hi Jim,

I'm kind of late offering suggestions, but I wanted to add a couple things.

First, full face masks are generally only indicated for people who breathe through their mouth as well as their nose. If you don't breathe through your mouth when asleep, then a nasal or nasal pillow mask will give you fewer leaks. Plus, some find them lots more comfortable. Even if you are a mouth breather you may be able to get away with a nasal mask plus a chinstrap.

Others have noted that the nasal pillow masks are not recommended at higher pressures. While that is generally true, the Pilairo is rated up to 24 cm. The Pilairo is brand new on the market and most DMEs are not aware of it yet or they may not have it in stock. And since they have no experience with it they try to steer you away from it. If you don't mind spending a few bucks out of pocket, it can be had at Supplier #1 for under $100.

There is a review of the Pilairo here, plus a long thread about it that I started a month or so ago after I finally got mine. I am pleased to say that, although my pressure is not as high as yours, my leaks are negligible now. I was lucky that my DME was one of the first to get them in stock, plus it had been over three months since getting my last mask so insurance paid for it.

But I hasten to add that if it's not your cup of tea, I won't be offended! Masks are the hardest part of the CPAP journey because they are a very personal thing. It took me eight masks to find one that worked, so don't give up!