Wrong Mask for a New User?

[SwampYankee]

Right off the bat I do not have any data.  I know everyone will want to see it but I don't have it.  And here is why:

My mother just started CPAP therapy with a Resmed Aircurve 10 VAuto with full face mask.  She is in her 60's and has never had a CPAP.  I've been using my Resmed Airsense 10 APAP for a year with great success so I convinced her to get a sleep study.  Her report came back with 60 apnea's per hour.  So she has been using her machine for the last 5 days and is able to get 4-6 hours of sleep with it.  Inhalation pressure is set to 15, not sure on the exhalation.  They ultimately want to get her up to 20.  She seems to be able to tolerate the Bipap pretty well but cannot get a good seal on the mask.  She is using a Resmed F30 mask.  I don't know much about them but I use an F20 and know it is very different.  They gave her a "small" and she is leaking like crazy.  Last night she was at 69L/min based on MyAir results.  Her apneas are still in the 25-50/hour range.  I have told her to keep working on it until Monday then call the equipment dealer to get a new mask or a new fit.  She insists it is tight as she can reasonable make it.  Is the best mask for a brand new CPAP user?  Why didn't they give her a Quattro to start?

Any advice would be great.  I am 2 hours away and she does not have a card reader so that's why there is no data...

Surprisingly, she is feeling a good deal better despite the huge amount of apea's and hopes that if it works properly she'll finally stop feeling like a zombie and possibly be able to take fewer antidepressants!

[Sleeprider]

First, tight is not right for a mask. A properly fitting mask floats on the face and achieves a good seal. If it is necessary to crank down on the straps, the mask is wrong. The Mask Primer wiki is a great resource to read and understand to help your mom http://www.apneaboard.com/wiki/index.php..._Checklist

If your mom is still at the 25 to 50 AHI range, I will bet good money, her doctors are on the wrong path increasing pressure, although that huge leak rate makes any data suspect. What is the breakdown of the events? If she is experiencing a lot of centrals, she may need to go to a titration for bilevel ASV, not increase the pressure and make the problem worse. Don't assume the doctors know best, it's pretty rare that they do. Get a good mask fit so the leaks are tolerable, then get the data! If you have been reading the forum, you know that many members achieve amazing improvements in AHI and leak rate using a soft cervical collar. The collar should prevent chin tucking that puts pressure on the throat tissues causing flow limitation, hypopnea and obstructive apnea. The collar stabilizes the head position and helps to get a better mask fit. In this case, I'm sure you're frustrated with your mom's caretakers and must be questioning their competence....good for you. You're on the right track.

[SwampYankee]

My experience with full-face masks is a little suspect because of my beard.  It has to be tight or it leaks.  When I trim my beard the mask works better...  I've solved the problem and my AHI's are always under 0.5 per hour (last night was 0.1).  With that in mind, I can see your point on tight not being necessary in normal circumstances.  Since my APAP has been working so well, I'm not regularly reading the forum but I will check up on cervical collars and look at the mask checklist.  

Thanks!

[Sleeprider]

SwampY don't miss the new Optimizing Your Therapy Wiki http://www.apneaboard.com/wiki/index.php...ng_therapy Good stuff here in the positional apnea and cervical collar sections.

[DeepBreathing]

There is no one right mask for any particular person. People (and their faces) come in all shapes and sizes - which is why there are so many different types of mask on the market. What works perfectly for me might be a total failure for you. Have a read of the mask primer http://www.apneaboard.com/wiki/index.php...ask_Primer then get your Mum to go back to the DME and require them to try a variety of masks. These need to be tried on, under pressure, while lying down. Ensure there is some sort of free-return policy, as masks which feel OK in the office are sometimes not OK in bed.

[SwampYankee]

They did not do any mask trials.  They just picked the F30, put it on her under pressure and told her she was good.  Admittedly, they did the same to me with Quattro and it took me a year to decide I could find something better.

[DeepBreathing]

told her she was good.

And that's where the system falls down. It's up to the patient to decide if it's good, and not accept inferior treatment / equipment to suit the DME. I obviously don't know your mother but she needs to be a bit feisty and assertive to ensure she gets the right product to suit her own face and condition.

[SarcasticDave94]

GWhat I've found is 3 things are true about all mask fittings:

1. Tight ain't right

2. Your fit, placement, strap setting, and brand/model are personally unique to you

3. The DME are always an extremely poor judge on mask fitting and model selection

Best to ya on this & kudos for helping your mom & as mentioned above, check out the wiki

[Fats Drywaller]

I want to add to Dave's list of rules of thumb, or rules of nose, about masks:

4. Although the try-out at the DME is obviously essential, that's not necessarily the end of the story, because the patient might find that some further adjustments and some experiments with different sizes (depending on the mask type) are necessary at home. This goes beyond just saying that the people at the DME can't judge that stuff properly. The real testing has to be done at the patient's leisure, in the actual sleeping environment, with the actual machine & settings, over some number of hours or nights.

5. Having to go through a few mask makes & models before finding one that's right for the individual is normal and expected. If insurance will cover everything, great; if not, that's just a personal cost of doing business with CPAP or ASV.

[mesenteria]

When you think about it, the masks have an engineered, and lengthy trials confirming, their shape.  I mean the shape they hold as you gently hold them in your cupped hand.  When you attach them to a harness and don the apparatus, there will necessarily be some minor-to-major deformation of the mask, the cushion I mean, as it conforms, or attempts to conform, to the unique contours of any one face.  This distorts the mask, and causes it to pucker and fold.  That's where the leaks are likely to take place, or if too loose, between the cushion's surfaces and the skin.

A mask that is not suitably sized, shaped, and/or fitted, will not perform optimally, meaning that the therapy will also suffer necessarily.  Keep in mind that the machine can overcome some leakage by design, but the wearer may not be able to adapt to, or tolerate, the feeling of air leaking around his/her eyes, as an example, and won't be able to fall asleep or to stay asleep.

It's a fact of the industry: there are good places and bad places.  I was lucky and was able to get good help and instruction, plus good supervision from afar via the internet.  It appears that some unfortunate users are merely handed stuff and advised, kindly, to go home and figure it out.   

I wish you both success.  It is going to take some patience and learning, but the eventual outcome will be worth it.