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first night - mask question, red welts on nose

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first night - mask question, red welts on nose

Postby RM2017 » Wed Mar 09, 2011 11:11 am

I've posted on here before about the nightmare DME I was dealing with and delays in getting my machine. I ended up switching DMEs and that brought more delays, but now 2 months after being diagnosed I finally got a machine(with full data!) yesterday. I'm not sure how the night went. I recall waking up once or twice when the air pressure seemed to go up. I don't feel any different this morning than I normally do, but the thing that concerned me was I woke up with two large red welts on either side of the bridge of my nose. Does this mean I had the mask on too tight, or is this normal. The mask they gave me with the machine is a Mirage Micro(size medium). They did include a switch to make it a large. Would that help with this problem? I was already concerned about the mask as I didn't do well with a nose only at my study. They had to go through 4 different full face masks before they found one for me. I told them all this on the phone, but of course they only brought a nose mask anyway. My mouth wasn't dry this morning(they therapist said that would be a sign I was mouth breathing) so maybe a nose only mask will work for me. I just don't want to walk around looking like I was in a bar fight every day. Any insights are greatly appreciated, as always.


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Postby robysue » Wed Mar 09, 2011 12:37 pm

Short answer is that yes, the red welts may indicate you had the mask adjusted to tight.

Or it could be you've got sensitive skin and need a bit of time for the skin to adjust.

In no particular order here are some suggestions to try:

Mask liners and nose pads for the current mask. Google "CPAP mask liners" and "CPAP nose pads" and you should get some useful links. If not, PM me.

Loosening the mask somewhat.

Trying a FFM like the Resmed Quattro FX that does not have a nose bridge piece. Or a hybrid mask like the InnoMed Hybrid or the Resmed Liberty. These combine a nasal pillows interface for the nose with a mouth mask for the mouth, and they don't have anything covering the top of your nose at all---the pillows fit against (not in) the base of the nostrils.

Trying a nasal mask may or may not work---they often have the same nose bridge piece the FFM do. The nasal pillows masks, on the other hand, don't touch the top of the nose or the bridge of the nose. So you might give one of them a try if you aren't sure if you are a mouth breather or if you're willing to try chin straps or mouth taping. But watch the leak line just to make sure you're not leaking air out the mouth since you went through several FFM during your titration study.

Good luck
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Postby Janknitz » Wed Mar 09, 2011 12:42 pm

I'm guessing that the mask was too tight around your nose.

Look carefully at the mask--it has a double wall of silicone which is meant to act as an air cushion around your nose, especially at the bridge of the nose. In order to get that air cushion fully inflated so that it hugs your nose, it has to actually fit quite loosely up at the top. If you cinch it down tightly, it cannot inflate.

Try this.
To prepare, dial the forehead piece all the way out so it tilts away from the bridge of your nose, like this \{. Loosen all the straps. Now:

1. Lay down in your bed.
2. Place the mask over your nose, but tilt the bottom of the mask out away from your face and the top in toward your nose like this /{ with your hand.
3. Turn the machine ON. Ideally, it should be at your highest pressure, ramp turned OFF.
4. Use one hand to gently push the mask on to your face, just enough to stop the leaks.
5. Gently tighten the top straps, but they should still be pretty loose. That cushion of air around your nose should be really full of air to stop any leaks.
6. Tighten the bottom straps as needed. They should not be uncomfortably tight, but they should be tight enough to stop any leaks.
7. Now move into your ideal sleeping position. Readjust the straps as necessary, remembering that the top straps should be loose enough to allow full inflation of the air cushion around your nose. Mine are so loose I can easily stick a finger between the forehead pad and my forehead.

Hopefully this will relieve the pressure around your nose, while giving you the best seal possible.
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Postby Vicki » Wed Mar 09, 2011 1:24 pm

Also, make sure the mask is truly at the bridge of your nose, up between your eyes. Often when people have trouble, it is because the mask is actually too far down on the nose.

Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.
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Postby RM2017 » Fri Mar 11, 2011 1:06 pm

Thanks for the suggestions. I tried adjusting several times, but I'm still having the same problems after night three. I tried putting a band aid over the bridge of my nose last night but that didn't really help. I've been looking online and seeing gel liners that go over the bridge of the nose as well as the mask pads. I guess those are long term solutions, but they are expensive and I think I might need to try a full face mask. I'm going to call the DME today to see if they will exchange this one for a ffm without any hassles. Do you think changing out the liner to the large instead of the medium would make a difference?
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Postby Janknitz » Fri Mar 11, 2011 1:16 pm

I bought one of the gel pads and cannot get a good seal with it, but other people report it helps.

ANY mask that hits the bridge of your nose like that may be problemmatic. FF masks, having more surface area, are more difficult to seal and tend to cause more problems at the bridge of the nose.

If you are not mouth breathing, I'd suggest you look at a nasal pillow mask like a Swift FX or Swift LT. These do NOT go on the bridge of your nose and they are very comfortable and seal well.

The major mask manufacturers allow DME's to return masks that don't work out for patients. So your DME should trade the mask out with no difficulty. Notice I say "should". it does require some paperwork and time to get the refund from the manufacturer, and some DME's would rather hassle you than bother with the paperwork. If your DME gives you guff, remind them that you know the manufacturer will take returns, and that you can always find another DME with a better mask policy if they are not going to work with you to find a successful mask. The mask is the key to good therapy, so it's important to have a DME that will work with you on this.
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Maybe it's not too tight

Postby PhDCow » Sun Mar 13, 2011 8:50 am

On Tuesday, I was fitted with an Easy Life and I loved it. Wednesday morning, the bridge of my nose was red, so I loosened the straps that night. Thursday morning, the bridge of my nose was red and started to hurt, so I tried readjusting it. Friday morning I woke up with blood on my pillow and the bridge of my nose ripped to shreds.

Of course I was there at the DME when they opened on Friday morning. After the RT being appropriately horrified, he took a look at the mask. The benefit of Easy Life is how flexible it is to keep a good seal. I was fitted correctly. However, there's a little lip that folds over on the mask. We figured out that the skin on my nose was getting caught under that lip. After breathing, which moved the mask each time, over an entire night, the skin couldn't take any more irritation. We both agreed that I had the straps adjusted correctly. It was a feature on the mask.

Needless to say, I'm wearing a bandage over the carnage until it heals. I was fit with an Activa LT, which was my very first mask. The design isn't the same at all and even the seal is better.

Just sharing my story to explain that there could be another reason.
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