Replies to This Discussion

Permalink Reply by Renee on October 22, 2009 at 10:48am

Hello Again Neal,

OK, I think I’m all set. I am going to ask the DME to send the Activa LT and Mirage Vista. And now some musings . . . I thought I’d look at a full face mask (not for use now – but because I may be switching over to Bi-Pap) so either the Mirage Liberty (less mask, more freedom, a full face mask that seals individually at the mouth and nose; less skin contact and an open field of vision, feels light on the face; ideal for patients seeking a comfortable alternative to conventional full face masks) – or the Mirage Quattro (dial offers a choice of 24 positions on the forehead support to suit individual facial structures; the mask’s Spring Air™ cushion technology accommodates movement during sleep and provides an effective solution for jaw drop; has fewer parts than other full face masks, making it easier to handle, assemble and disassemble for cleaning). I am thinking from your previous advice that I would probably be better off with the Quattro rather than using the nose pillows of the Liberty, but if I do have to switch to a full mask and am also breathing through my mouth, I am wondering if then the nose pillows are OK. Can’t seem to get away from trying to use a smaller mask . . . but, then again, with the Liberty, while I would have less touching the side of my face and forehead – I would have an intrusion in my nose. And with the Quattro, it looks like the part on the forehead would provide stability throughout the night. And they both appear small – so I think they could both be fine if I do need a full mask at some point.

And thanks for the mention about the 30 day mask guarantee – I will mark my calendar ahead of time to remind me to make up my mind in case I think I am going to want to request an exchange.

You really have been great in helping me with this, Neal. Thanks so very much !

My Best,
Renee

Neal Buckner, LRCP said:

The Activa mask only goes over the nose. So using a chin strap is a good idea to get started. You might find that after you have been on CPAP for a while the need to open your mouth will go away. The OSA sufferers brain programs itself to know what sleeping position and jaw position is the most successful at getting any kind of sleep. Once you start using CPAP the brain will start a "re-programing" process. First will be the adjustment to having something on your face. It's not natural to have something on our face when we sleep. At the same time our brain recognizes a certain level of airflow and depth of breathing as being a normal breath. Once you place air pressure to the upper airway the brain tends to make you think you aren't getting enough air where in actuality the gas exchange in the lower airways is actually better. Try sticking your head out the car window while driving 50 mph. Or ride on a motorcycle with an open face helmet and no faring. The sensation and result is the same. At first it feels weird like you can't catch your breath. But the longer you ride or have your head out the window the easier it gets because the brain registers the CO2 levels as staying normal and in some cases improved. Your "ventilation" is good. Once you get past that initial adjustment it becomes second nature and even gets to the point of your subconscious triggering anxiety if you don't wear your mask at bed time. Just like the way it was programmed to make you feel more comfortable to lay on your side to sleep and open your mouth to breath now.

I digress. Yes use a chin strap to start. Or a full face mask if that doesn't work. Then once you have become comfortable and compliant. Then see if you can graduate to a simple nasal mask. As far as the Vista mask goes. It's a good mask. But keep in mind that, although mask may look cool, it doesn't mean it will work for you. Everyone's face is different. Have the DME bring several options. Personally I have had more success with the Activa than the Vista on my patients. But again, everyone is different. So try a few. And don't let the DME provider fool you into thinking that you are stuck with a mask. ResMed and Respironics both have a 30 day mask guarantee. If for any reason the mask you initially get set up with doesn't work. Either due to seal or discomfort, to include pressure sores and skin irritation, they will replace that mask with the DME company at no cost. So you have the option to change your mask.

The goal is to make you,the consumer and patient, comfortable so you will use and benefit from the PAP therapy.

Neal

Renee said:

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Permalink Reply by Neal Buckner, LRCP on October 22, 2009 at 11:57am

Again I would stay away from nasal pillow systems. The Liberty mask is a good mask. However, it's a niche' mask. I would suggest the Quattro. And why are you already thinking you might go to BiLevel? The EPR (expiratory pressure relief) on the Autoset II has 3 levels. Call it a poor mans BiLevel if you will. It will allow up to 3 cmH2O of relief upon exhalation. And typical delta or Pressure support in BiLevel settings is 4 cmH2O. There comes a point of over thinking things. Keep it simple. Give what you start with a chance for a few weeks first. THen fine tune from there before you start thinking about thinking of changing theraputic modalities. BiLevel, although very effective, is a expensive up grade if not needed.

Good luck and take a deep breath! lol

Neal

Renee said:

Hello Again Neal,

OK, I think I’m all set. I am going to ask the DME to send the Activa LT and Mirage Vista. And now some musings . . . I thought I’d look at a full face mask (not for use now – but because I may be switching over to Bi-Pap) so either the Mirage Liberty (less mask, more freedom, a full face mask that seals individually at the mouth and nose; less skin contact and an open field of vision, feels light on the face; ideal for patients seeking a comfortable alternative to conventional full face masks) – or the Mirage Quattro (dial offers a choice of 24 positions on the forehead support to suit individual facial structures; the mask’s Spring Air™ cushion technology accommodates movement during sleep and provides an effective solution for jaw drop; has fewer parts than other full face masks, making it easier to handle, assemble and disassemble for cleaning). I am thinking from your previous advice that I would probably be better off with the Quattro rather than using the nose pillows of the Liberty, but if I do have to switch to a full mask and am also breathing through my mouth, I am wondering if then the nose pillows are OK. Can’t seem to get away from trying to use a smaller mask . . . but, then again, with the Liberty, while I would have less touching the side of my face and forehead – I would have an intrusion in my nose. And with the Quattro, it looks like the part on the forehead would provide stability throughout the night. And they both appear small – so I think they could both be fine if I do need a full mask at some point.

And thanks for the mention about the 30 day mask guarantee – I will mark my calendar ahead of time to remind me to make up my mind in case I think I am going to want to request an exchange.

You really have been great in helping me with this, Neal. Thanks so very much !

My Best,
Renee

Neal Buckner, LRCP said:

The Activa mask only goes over the nose. So using a chin strap is a good idea to get started. You might find that after you have been on CPAP for a while the need to open your mouth will go away. The OSA sufferers brain programs itself to know what sleeping position and jaw position is the most successful at getting any kind of sleep. Once you start using CPAP the brain will start a "re-programing" process. First will be the adjustment to having something on your face. It's not natural to have something on our face when we sleep. At the same time our brain recognizes a certain level of airflow and depth of breathing as being a normal breath. Once you place air pressure to the upper airway the brain tends to make you think you aren't getting enough air where in actuality the gas exchange in the lower airways is actually better. Try sticking your head out the car window while driving 50 mph. Or ride on a motorcycle with an open face helmet and no faring. The sensation and result is the same. At first it feels weird like you can't catch your breath. But the longer you ride or have your head out the window the easier it gets because the brain registers the CO2 levels as staying normal and in some cases improved. Your "ventilation" is good. Once you get past that initial adjustment it becomes second nature and even gets to the point of your subconscious triggering anxiety if you don't wear your mask at bed time. Just like the way it was programmed to make you feel more comfortable to lay on your side to sleep and open your mouth to breath now.

I digress. Yes use a chin strap to start. Or a full face mask if that doesn't work. Then once you have become comfortable and compliant. Then see if you can graduate to a simple nasal mask. As far as the Vista mask goes. It's a good mask. But keep in mind that, although mask may look cool, it doesn't mean it will work for you. Everyone's face is different. Have the DME bring several options. Personally I have had more success with the Activa than the Vista on my patients. But again, everyone is different. So try a few. And don't let the DME provider fool you into thinking that you are stuck with a mask. ResMed and Respironics both have a 30 day mask guarantee. If for any reason the mask you initially get set up with doesn't work. Either due to seal or discomfort, to include pressure sores and skin irritation, they will replace that mask with the DME company at no cost. So you have the option to change your mask.

The goal is to make you,the consumer and patient, comfortable so you will use and benefit from the PAP therapy.

Neal

Renee said:

• ▶ Reply

Permalink Reply by Renee on October 22, 2009 at 5:03pm

Hi Neal,

OK, now I think that I am sooo ready for APAP that hopefully it will be really smooth sailing / sleeping.

Why I mentioned Bi-Level . . . in addition to the physical annoyances that I experienced at my sleep studies, afterward I was contacted by the receptionist and told that I was to start using CPAP - but she would not provide me with any verbal or written info about my results and said that it was not their practice that I should speak with a doctor. But since I wouldn't start CPAP without knowing something about my condition, the doctor asked me to come in and she explained my sleep study results and said that she wanted me to switch to Bi-Pap in a month or so after my next sleep study test.

However, since then having read about APAP on the SG forum, I had thought that APAP might very well work for me - although I did not yet have the handy, concise, complete explanation you provided me with today - thank you for that. Also, as I had relayed to you, I am consulting with another sleep study center on Nov 2 which was recommended by folks on SG and hoping to switch to their program where I think I will have more of a sense of confidence in their program and so at this time I am actually not anticipating switching to Bi-Level.

For now I'm planning to simplify: just get sleeping with the Activa LT and APAP . . . just that one step.

Thank you for all of the info you have provided and for your wonderful generosity and support.

My Very Best,
Renee
___________________________________________________________

Again I would stay away from nasal pillow systems. The Liberty mask is a good mask. However, it's a niche' mask. I would suggest the Quattro. And why are you already thinking you might go to BiLevel? The EPR (expiratory pressure relief) on the Autoset II has 3 levels. Call it a poor mans BiLevel if you will. It will allow up to 3 cmH2O of relief upon exhalation. And typical delta or Pressure support in BiLevel settings is 4 cmH2O. There comes a point of over thinking things. Keep it simple. Give what you start with a chance for a few weeks first. THen fine tune from there before you start thinking about thinking of changing theraputic modalities. BiLevel, although very effective, is a expensive up grade if not needed.

Good luck and take a deep breath! lol

Neal

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