Opinions, Will this mask work for me?

[Marnid2014]

I am bound and determined to wear the P10, I am claustrophobic and have tried so many and this one fits the bill and makes me feel comfortable. I am tracking my numbers to see if it's working and need your opinion.

I have worn it for 2 nights as follows:

AHI 0.10
1 EVENT OA
MEDIAN 4.50
95% 27.60
MAX 33.60 ( but that one was just a mask adjustment.

Last night was:
AHI 0.66
1 EVENT OA
MED 8.40
95% 26.40
MAX 28.80

I am using a chin strap but still think I am doing some mouth breathing as my mouth gets a bit dry. I slept pretty well. I think the mask gives me a little bit of air flow that I feel at one nostril. I have tried the larger size and it's worse, so went to xmall and it's still there but it's slight. Perhaps when I move around, it gets worse, I am not sure. I am also using Lanolin in my nose to kind of "stick" the pillows in better.

[robysue]

Marnid,

Those median leak rates are "ok."

The 95% leak rates are borderline----meaning, you need to look at the leak line itself and figure out a rough approximation of how long your leak rate is AT or ABOVE 24 L/min.

Is Mr. Green Smiley showing up in the morning??? That's just as important as the 95% leak rate when the 95% leak rate is > 24 L/min.

That said: Having looked at your other data, my guess is that Mr. Green Smiley is showing up and on the first night I bet the leak was below 24 L/min for most of the night. On the second night, that median leak rate is just high enough that combined with the 95% leak rate, to take a long look at the leak line data and estimate just how long the Large Leaks lasted.

[Marnid2014]

Mr. Smiley showed up both nights. It's a bit hard for me to make a good judgement, but it looks like most of the night I was almost at 0 leak and it peaks for say, 40 seconds and then goes back down to 10, 0, 15, and stays there and then peaks again for 60 seconds etc.

[herbm]

Those leaks are "Ok" and the AHI is great.

BUT, those leaks are way more than you SHOULD be experiencing.

For comparison: Last night my leaks with the Airfit P10 were WORSE than usual, in fact it woke me up halfway a couple of times until I roused enough to just FIX IT.

My leaks were 0-median 12-95% 19.2 Max

My median is almost always 0, and even my 95% is frequently AT or VERY near 0. My max almost never crosses the 24l limit (for Resmed).

This comparison is more useful with a Nasal Pillow mask since there is VERY LITTLE to adjust. It's not like a FFM where everyone's face is SO different, and there are so many things to adjust on complex headgear.

With the P10, there are only 3 things to get right:

1) Correct pillow size (and this may not be OBVIOUS)
2) Correct pillow placement -- a LITTLE more complicated than most people think
3) Headgear fit

Also, make TRIPLE sure you are putting the pillow on COMPLETELY (snap it down) and you are putting it on in the RIGHT DIRECTION -- the angles should be close away from you and far near you upper lip. Pretty obvious but people have made this mistake far more than one would expect.

Put the mask on in front of a mirror. Put the pillows in. Pull the headgear into place. If it is too tight, you need to stretch it. You might try strap padding (Pad-a-cheek or something) if it is SLIGHTLY too loose.

The fit of the headgear should likely be NOT QUITE SNUG -- I would have tightened my headgear significantly more if it were adjustable -- turns out that is was (accidentally) perfect for me.

I try to put the strap RIGHT ABOVE my ears, and into the depression at the back of my head above the base of my skull and below the curve of my cranium.

IF I feel that the strap is too loose, then I pull the top band up at an angle (away from the bottom band) to make an angle up to 90 degrees but usually somewhat smaller, maybe about 40-60 degrees up near the BACK OF THE CROWN or my head.

Pillows must be "in" but not so large as to "fold".

Press the mask body gently FLAT against your upper lift. It should feel fairly comfortable and not dislodge the pillows or cause them to shift around much.

That is the PRIMARY CHECK I make during the night -- almost any other fiddling with the mask will move the pillows, especially if you do it AFTER they are inflated under pressure.

NOW: Don't mess with it again. (As much as possible.)

Go to the machine, PLUG IN THE HOSE BEFORE you turn on the machine.

Turn on and bring the machine up to FULL therapeutic pressure. NO RAMP!

Check the leak.

Go to bed and avoid "bumping" or moving the mask around as much as feasible.

It is almost impossible to replace the correctly size pillows while under pressure IF you get them moved. Just get up and go back to the bathroom until you learn to avoid this.

Turn off the machine (ALWAYS) before removing the mask.


Last night, when I "fixed" the pillow position, I did an 'extra maneuver' which works but may not be pleasant.

Basically, I just made a loose fist and brought it up to my nose as if covering a cough and TAPPED the darn thing back in.

I seldom dislodge the mask but it happened last night and this "tap" basically just FORCED the pillows deep into my nose. This is not the most comfortable position but it works and since I was barely awake, it was no problem to just go to sleep and leave them that way.

Note: It's not terrible uncomfortable but it isn't the IDEAL position -- however it is VERY tight against leaks

No, I didn't really bop myself in the nose, but that was ALMOST what I did.

[PaulaO2]

Personally, I think the Nuance leaks less due to one thing: the mask's hose. The hose coming out of the Nuance has a swivel, the P10 does not. With such a lightweight mask, it doesn't take much of a tug to dislodge it. Same with the Nuance. That swivel let's the hose move and eliminates a pressure point.

[herbm]

Don't tug (or push) on the hose. Problem solved.

Seriously, it's not that hard to avoid.

My main way to mess up was to press my mask against my body pillow. I have learned to lower my body pillow down about 3-4 inches.

Also, the masks with a swivel have MORE projections that are hard and solid versus the almost immediately soft and flexible hose on the P10.

Route the silly thing down your body in a straight line, hook it to the machine hose and run it (over your body if necessary and) off the bed at belly button level.

[Marnid2014]

I tried all the things you said and I still had leaks. Funny part, I hear absolutely nothing coming out of the mask, it's totally silent, other than the exaust. I look at it in the mirror, even close up and if I move my head back and forth, there is no daylight showing, so why the heck am I getting these leaks.

Last night I tried the FX for her again and it was better, however I slept by force on a wedge pillow all night on my back. My AHI was ok, a bit up in fact, but the leaks were better but not great.

AHI 0.95
MED 6.0
95% 20.40
MAX 21.60

At least they were all below the red line, but it's just not natural for me to sleep on my back. I guess I could train myself if necessary.

Taking a look at my lower pressure back in February, I am going to take my chances and lower my pressure back to 6 on my own. I hope that Medicare doesn't have a freak moment when I do this, my doctor gave me permission to have the DME do it, but I am sick of them coming out and doing something I can do on my own. Back in February my numbers were very good, I was wearing the FX for her and the only reason I changed is that I actually remembered an Apnea and called them and asked them to change it. I have to experiment, I know that, maybe 7 will be better.

I will try the P10 at that level as well and see what I end up with, using your suggestions on how to put on the mask again.

My levels back then were
AHI 0.78 0.95 0.72
MED 1.20 1,20 2.40
95% 7.20 7.20 8.40
MAX 9.60 10.80 9.50

and so on. Problems seemed to start when I went up to 8. Wish me luck and I hope Medicare doesn't lose a lung. I have been on therapy and they do have the first card I mailed in, so I am not sure if they will want another????? I think 100% compliance should count for something.

[PaulaO2]

Herb: So...my CPAP sits at my head. But to wear this mask, you suggest a page full of how to make it fit right then you say to route the hose down to waste level them back up to my machine?

No thanks. I'm too lazy for that. I'll stick with my Nuance.

I'm glad it worked for you and I'm glad you are so gung ho about it. However, just like with every mask, it isn't going to work for everyone. Keep that in mind.

Marnid: All Medicare cares about is compliance. They don't care if it is actually working.

[robysue]

Marnid,

The Medicare bean counters are going to look at compliance hours and nothing else. The DME will notice and whip you soundly with a wet noodle when (if?) they recognize you changed the pressures on your own because that denies them the chance to charge somebody for the 10 seconds of work. The doc may need to be reminded that he gave you permission to change the pressure back down, but after that won't mind.

It sounds to me like you over reacted to the "apnea you remembered" and jumped the gun in deciding that you needed more pressure. And the higher (and unnecessary) additional pressure started causing far more problems (in terms of leaks) than it fixed (in terms of reducing an already very low AHI any further).

So my advice: Change the pressure back down. If you have a few events here and there, don't get too worried about them. If you wake up thinking you've just had an apnea, turn the machine OFF and ON to make the wake easy to find the next morning when you look at the data. If this kind of thing is OCCASIONAL, don't make a deal out of it. If you start waking up several times a NIGHT with this kind of feeling on multiple nights during the week, then you've got a bad trend and it's worth thinking about increasing the pressure.

For what it's worth: I do think you'll be able to make the P10 work for you. Remember that you don't have to have a near perfect leak line. You only need a good enough leak line AND sleep. If the leaks are below 24 L/min for the most part AND you're sleeping through them, don't worry about them too much.

In particular you write:

Mr. Smiley showed up both nights. It's a bit hard for me to make a good judgement, but it looks like most of the night I was almost at 0 leak and it peaks for say, 40 seconds and then goes back down to 10, 0, 15, and stays there and then peaks again for 60 seconds etc.

You can ignore leaks that are in the 10-15 L/min range as long as you are sleeping through them.

If the really large peaks (the ones above 24 L/min) are short lived (like less than 2 or 3 minutes) and you are sleeping through them, you can ignore them too---unless they're so numerous that it looks like you're spending significant time above 24 L/min. Use Mr. Green Smiley for getting a handle on this: If he shows up and you don't see any prolonged periods of Large Leaks and you are sleeping through them.

For now only worry about leaks if Mr Red Frowny starts showing up OR if they're constantly waking you up.

[robysue]

Herb: So...my CPAP sits at my head. But to wear this mask, you suggest a page full of how to make it fit right then you say to route the hose down to waste level them back up to my machine?

No thanks. I'm too lazy for that. I'll stick with my Nuance.

If I had to work as hard a Herb does to make the P10 work, I would have abandoned it right away.

Right now I'm switching back and forth between the Swift FX and the Airfit P10. They are both equally easy for me to use: Pull the mask on, turn the machine on, tug the pillows once or twice to get them seated comfortably, and start hugging the hose since that's how I prefer dealing with the hose.

That said: I think the lack of a swivel at the mask end of the hose on the P10 is a serious design flaw. It's not a (much) problem for me since I prefer to run the hose down along my body and hug it. It's a huge issue for someone who prefers to run the hose overhead.

I also think the one-size-fits-all headgear is a potential design flaw on the P10. I've got a small head and I find the P10's head gear triggers piggy-nose problems because the headgear is just a bit too tight on my head. If the straps are just right (about as apart as possible), there isn't too much of a piggy nose problem, but the the straps move around alot more than the Swift FX straps do.