Searching for best mask

[sailon1]

Hi, I'm a relative newbie on PAP, started nearly 3 months ago.

During hospital sleep study, I used a Respironics Amara View Full Face (hybrid) Large mask. I can't seem to get a consistent seal with this mask.

When I received my home DME after the test, I was a bit confused and selected the ResMed F20 AirFit Full Face mask. It sealed ok, but the bridge of my nose was very sore after just one night.

My DME supplier has a mask satisfaction guarantee and provided me with a ResMed F30 AirFit Medium (hybrid) mask. The F30 works best for me in maintaining seal. It's not perfect, but pretty good. It does give me some significant pain in the morning between my nostrils/above my lip. They do not offer a large size in the F30, just Small and Medium. I sometimes get leaks around my mouth which is typically slightly open during sleep.

I've ordered a chin strap. (I really DON'T look forward to yet a couple more straps around my head a night)... but it may help with keeping a more consistent seal around my mouth.

I'm still thinking there may be a better solution. Wondering about the ResMed F20 AirTouch memory foam mask. Does anyone with experience with it have an opinion vs the AirFit model that want's to bruise my nose? Or what about the full face Respirionics gel masks??? Note that I do run a fairly high pressure at 16 cm of water column.

Would appreciate any suggestions from those with experience. Can't quite afford to just buy them all and give them a test drive unfortunately.

Thanks!

[clownbell]

I have had good success with the Brevida nasal pillows mask, though my pressure is not as high as yours. In my case, the seal is good and does not loosen when I turn over.

[StevesSp]

My advice would be to consult those who have used the mask you're trying to master. Each mask is different and requires it's own approach and 'management'.

Many will tell you which mask THEY use, but that doesn't necessarily mean it will work for you. Each mask has its own challenges. These are addressed through correct sizing, headgear tension and also figuring out how you can minimise leaks through posture, pillow choice and sleeping position. But even then, particularly with full-face masks, some mask will work better with your facial 'topography' than others.

My own experience has been that persevering with one mask for a while is the only way to determine if it works for you, paying attention to the above (sizing etc).

Some general rules apply though, of which determining the correct size is only one. The first of these is getting strap tension in the 'Goldilocks Zone', i.e. not too slack, but not too tight either. Many newbies assume that tighter means less leaks, but the fact is that deformable cushions can be compressed so much that they become almost solid, and so can't conform to facial features. I bit of 'give' is vital, especially when you move around (your face shape will change if you move from lying on your right side to your left, or onto your back).

I guess what I'm saying is that finding the best mask - and learning how to live with it - is a journey. Don't assume that, because it didn't work for you first try it's the wrong mask.

Caveat: I have only used full face masks. Some or all of the above may not apply to nasal masks.

[srlevine1]

Your DME is provided with a number of courtesy masks for teaching or trial fitting. They are the same as the commercial product but are sometimes labeled not for resale. See if you can get your DME to give you a few different masks based on your face geometry and habits (e.g. mouth breathing) to try.

I tried over 15 masks to get to the ResMed Mirage Activa LT which fits fine and has minimal leakage. However, I keep trying new masks against my gold standard mask to see if I can improve fit and functionality.

[OpalRose]

Can't quite afford to just buy them all and give them a test drive unfortunately.
Thanks!

Unfortunately, this is a common issue with many Cpap users.  The bottom line, having Sleep Apnea is expensive!

If you're unable to get much help from your DME, you can take advantage of some of the suppliers on the list above, like Supplier #1 who offers 30 day free mask trials.  
Yes, you will get stuck with shipping to return the mask, but not quite as expensive as buying and storing in a closet left unused.  

I was lucky enough to use a nasal pillow mask from the start and haven't deviated much from that.  But if you are unable to overcome mouth breathing, then a full face mask is best.

Be sure to read the Mask Primer.  There may be some guidance there to help.

http://www.apneaboard.com/wiki/index.php...ask_Primer

Also, check out some mask reviews, but remember... what works for one person may not work for you.

http://www.apneaboard.com/forums/Forum-C...sk-Reviews

[srlevine1]

MEDICARE USERS ARE ENTITLED TO BOTH MASKS AND CUSHIONS ON A 3-MONTH BASIS. NOTHING KEEPS YOU FROM REQUESTING A DIFFERENT MASK EVERY THREE MONTHS.

[Ratchick]

OK I have used the F20 (the silicone and the foam) and the F30i - my vote would always go to the F20 Airtouch (the foam one). I, too, am excessively prone to soreness on the bridge of my nose. I've (touch wood) managed to avoid it for the last few months between using the F20 Airtouch and a strip of hydrocolloid dressing over the at-risk area of my nose (something like Duoderm extra thin, for example). That combo has meant zero soreness and a great seal - for me (and my stepdad who is on high pressures of BiPAP for COPD and has a beard). I find that I can leave the top pair of straps reasonably loose, which helps reduce pressure on the nose, just barely tightened enough.

For the record, I also have my jaw drop open when I fall asleep. I honestly found a soft cervical collar way more comfortable and effective than a chin strap in the end, but it's entirely what you're comfortable with.

Make sure that when you're fitting your mask, you do so in your sleeping position, with you dropped down and back, if you can, to as close as possible simulate the shape of your face while sleeping. Turn on the mask fit, then hold the mask to your nose until it just stops leaking, with one or two fingers. That's around the pressure you need. Then, while still gently holding it in place, tighten up the straps to get the same pressure/fit without leaks. Another hint I find with the F20 Touch is that sometimes I can fix a leak by gently snugging up the opposite strap - so if it's leaking on my right cheek or eye, then a teensy tug on the bottom left and so on. It's counterintuitive but it seems to work.

If you're still finding your nose painful on the bridge, there are also products made to reduce pressure like Resmed's gecko pads. I got a bunch but I've stopped using them because they didn't really work for me personally. Some people also find liners help too, creating a better seal with less tightness on the straps.

The problem I had with the F30i was that it rubbed under my nose too, and I found it shifted a lot and would obstruct my nostrils, with both sizes. The small was better for a mouth seal but honestly, nothing has really suited me as well as the F20 Touch. You don't have to buy the whole mask though. Just get a single insert and use it with your F20 Air headgear, if you still have it.

Now, I use either the Resmed P30i or P10 if I have to give my nose a break, but thankfully since the last time, where it was really bad, 2nd degree pressure sore that took two weeks to heal up, I've managed to control things with the foam inserts and the duoderm.

[sailon1]

Thanks! Super helpful info. I still have the F20 AirFit and yesterday ordered the F20 AirTouch seal and some CPAP wipes to give it a good try. It seems my DME supplier had the 2nd mask as a part of their offering under Medicare, but they said that was the last I could do, until my 6th month "anniversary." So I'll give the F20 AirTouch a trial and have the F30 AirFit as my back-up in case of bruising... and see how I get along as I approach the 6th month... and make any adjustments there. I also have my first face-to-face appointment with the sleep Doctor coming up in a few weeks to certify compliance for insurance. Perhaps they can help me out too. Their staff has been fairly helpful on the phone, but I've found my DME supplier has limits on how far they'll go to help me get to the best solution. I've found that CPAP has greatly improved my AHI, although I still vary from occasional lows of <1 to highs in the mid-teens. Still averaging overall about 9. That's not below 5, but way better than the 42 I had w/o CPAP.

Thanks again. This board seems to be the best source of info for learning how to optimize the Apnea/CPAP experience and I'm grateful for it.

Happy New Year!

[sailon1]

Thanks. My DME supplier says my Medicare allows for a new cushion every 30 days, mask every 90 days and new headgear every 180 days. Overall this seems very good, but does limit a complete switch to a completely new system to 180 day cycles. I have high hopes that the F20 AirTouch, that fits one of my current headgear/mask sets will be a helpful advancement, possibly interchanged from time to time with my F30 AirFit. Will continue to monitor this board and talk to Dr and DME supplier for suggestions. I'm pretty sure I'll need either a full face, or hybrid. Not very likely that I'll be able to switch to becoming a non-mouth breather although I continue to work on trying that to reduce dry mouth. Will be trying the chin strap and may try a cervical collar soon to minimize mouth/jaw drop and accompanying leaks with the F30.

Thanks for your help!

[Ratchick]

The NHS doesn't fund the replacement Airtouch inserts, sadly, so that comes out of my pocket but it's so worth it. I can usually stretch out an insert for at least 5 weeks, sometimes 6 or so, before I start noticing that it's a little leakier, so once every 30 days for the insert is fine. I'm still using the same mask part, and I ended up swapping to a 3rd party headgear because although it's less than half the price, the velcro on it is STUNNING. And even if the velcro fails on it before the 6-month mark, a quick stitch with a needle and thread will tack it in place if nothing else works.

Good luck with your trials!