Hello all!
After living in denial for years, I finally went in for a sleep study on Friday. After about an hour and 45 minutes, the tech woke me up and put me on CPAP and nasal pillow gear. After switching the machine to BiPAP and putting on a chin strap, my REM deprived body dove straight into REM. When the tech woke me up the next morning, he asked how long I thought I had slept. I answered 8 hours? He replied 4. The best 4 hours of sleep I can remember!
   Enough babbling, I just wanted to ask advice on headgear, machines, etc. so I can be a prepared customer when the Supply rep comes calling or the Doc recommends equipment. Items to avoid, recommendations, etc will be GREATLY appreciated. I have a mustache, that will make a difference on some headgear selection.
   Thanks in advance for your info,
   Mick

welcome low lead (interesting ID...do you frequent Delphi forums??),

I have a moustache and use the Mirage Swift nasal pillow system...i love it!  it does tend to make the 'stache stick out in all directions the next mornign but a bit of warm water will straighten things out     

I have never used any other mask, with the exception of the full face mask during the sleep study   I am a relative newbie here but there are others that will help with a wider range of advice than i have.

Respects,
Bruce


_________________
It's different when you've got a Harley-Davidson...

the machines vary a lot in cost so it depends on what your insurance will pay for, as for the mask, a full face mask seems best but hopefully the mask person will have a good selection of masks of different brands and types and will take time in fitting you
some nose only masks work OK with a mustache

low_lead wrote:

Hello all!
After living in denial for years, I finally went in for a sleep study on Friday. After about an hour and 45 minutes, the tech woke me up and put me on CPAP and nasal pillow gear. After switching the machine to BiPAP and putting on a chin strap, my REM deprived body dove straight into REM. When the tech woke me up the next morning, he asked how long I thought I had slept. I answered 8 hours? He replied 4. The best 4 hours of sleep I can remember!
   Enough babbling, I just wanted to ask advice on headgear, machines, etc. so I can be a prepared customer when the Supply rep comes calling or the Doc recommends equipment. Items to avoid, recommendations, etc will be GREATLY appreciated. I have a mustache, that will make a difference on some headgear selection.
   Thanks in advance for your info,
   Mick

Hi Mick,

MASKS are everything. Get that aspect right before they try to flog you the bells and whistles. If the mask ain't right, nothing will be right. Make the rep suffer. 'Is that all you have ?'

If you are a natural mouth breather, then the full face mask is worth considering, otherwise look at the nasal masks first. A moustache should not make a huge difference. Try as many as possible on. Good ones that come to mind are the ResMed Ultra Mirage and the Activa (fairly dear). Fisher and Paykell have a very good Flexifit (reasonable price), with a similar full face mask. Personally I use the Ultra Mirage with the Flexifit as a back up/alternative. Its really a very personal thing, but don't be fobbed off with the likes of 'its all we have' or stuff like that.

If these don't work there are interfaces called Nasal Pillows or Adams Circuits which are placed into your nostrils. If going down that road make sure to get the large size pillows, otherwise the nares of your nose might become inflamed. Failing these there is an oral device called the Oracle. I have not heard many success stories with it.

When you have the mask/interface sorted, then and only then look at machines. There are basic nuts and bolts machines and like motor cars you can get GTS models etc. Basic CPAP machines blow air at a continuous pressure (non stop), all of them have a ramp feature to allow a slow build up to the full pressure. Auto adjusting machines adjust pressure based on an algorithim and only squirt in sufficient pressure to clear each event. There are 2 types of algorithim with pluses and minuses in both. Both types have a tendency to not clear all events. Bi Level machines (expensive), air in at high pressure with a drop in pressure for exhalation.

If the mask/interface is not right, it won't make much difference what type of machine you get, as you will have serious problems. If the mask is right, then everything works out fine.

Daniel


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Thanks to all of you for your advice! Being new to this, I would assume that the equip rep will bring various masks for me to try? I will do a search for dealing with these "salesmen" to avoid getting an Edsel. All I need is a Volvo. Nothing pretty or fancy (they tend to be $$ and break easy). Thanks Daniel, the automobile analogy was right up my "alley". I was expecting a call from my doc in a couple of days, from my searches I see 2-3 weeks is not unusual to wait for a diagnosis?

Daniel is right; masks are everything!  It's amazing how a tiny difference from one mask to another makes a huge difference in comfort and controlling leaks.  Make sure you try out masks hooked up to your CPAP machine, preferably with you lying down as you'd sleep.  I've always gone to the supplier (rather than having him visit my home), so that can be a challenge.  Don't be afraid to try on more than one mask; you really want to be comfortable with what you get.

Most masks use a seal with a double set of silicone membranes which inflate with air, providing the seal.  Strapping them down too tight will cause leaks, so keep that in mind.

I don't have to worry about a mustache, so I don't have any suggestions there - but presume it's only a potential problem with a nasal mask.  I did, however, have a great experience with the lightweight, easy to adjust, Mirage Swift nasal pillows.  Two "issues:" it did take me a week to get used to it (other masks took one night to feel comfortable), and it blows air onto my spouse (all masks have to blow air out, else you'd be rebreathing the same air).

My supplier steered me away from a full face mask, saying they're heavy and have about the same potential for leaks as nasal masks.  I think I'm glad, especially after the ultra-lightweight Mirage Swift.

After my first sleep study, I waited about a month until I saw my sleep doctor again, then was scheduled for a titration sleep study (you've already had that).  About a month after my second sleep study, I received my equipment.  You're wait isn't too bad - but I know you can hardly wait until you start treatment!

hi Mick,

Quote:

I would assume that the equip rep will bring various masks for me to try?

Nope, not necessarily.  Well, they might have one or two or three for you to look at.  If you're lucky, they'll actually be good masks, but too often they will be rather cheap ones (though the price tag will be sky high.)   Doesn't really matter how many they present to you if they are not good masks in the first place.  

Daniel and the others are telling you right - the mask is almost everything as to whether cpap treatment will be as effective and as comfortable as possible.

Effectiveness:  A leaky mask is a real treatment wrecker.

Comfort:  No matter how nice a mask might feel when they "fit" it with you sitting up, there's a huge difference in how different masks seal when you're lying down...especially as the night wears on.  

Best way to be fitted for a mask is by making the final adjustments with you lying down and with a cpap machine hooked up blowing your prescribed pressure.  Toss and turn.  Use your favorite sleeping positions.  Have a pillow with you so you can test what happens when the pillow starts shoving the mask sideways.  If the mask leaks during your test drive, don't let them tell you, "Oh, you can make more adjustments easily."  If they can't get it comfortable and non-leaky on you during a fitting where you are actually trying out sleep positions, it's not going to get better at home.  It will be worse.  If they start cinching the straps down tight to hold a seal, tell them you don't want that mask; you want to try another size or another mask.

Sounds like a lot of trouble to go to?  That's not anywhere NEAR the trouble you'll go through if you let them get away with a couple of minutes fitting while you're sitting up.  You're likely to be stuck with one mask for a number of months.  Those nights can get very long and frustrating if you end up with a mask that doesn't suit you as well as possible.

Some masks with good track records for most people are these:

ResMed Activa nasal mask - covers the nose and seals great with straps worn very loose.

ResMed Swift nasal pillows interface.  Make sure they give you all three sizes of nasal pillows for this mask, as that's the way the manufacturer sells it....with all three sizes.  Don't let them give you just the size they think fits you and withhold the other two sizes for their own stash.  Why would you want the ones that aren't your size?  On general principles, because your insurance (you, ultimately) have paid for them.   They can also be useful for trading purposes in the future... "I have a set of unused "Medium" Swift pillows I'd trade for "Large".  You'll get PM's.  

Puritan Bennett Breeze nasal pillows interface.  Get the pillows that are bigger than what the DME, or you, think would fit...they shouldn't have to be crammed up in your nostrils.  They'll seal better if the sit more to the outside.  They'll be more comfortable that way, too.

If they don't bring out those particular three masks for you to try, ask for them specifically.  If they don't carry those or are unwilling to order them for you to try later, that would be a big red flag in my mind as to the kind of products they do carry or the service they're willing to provide in getting you fixed up with a really good interface you can live with.  Literally.

Ask them to tell you the name of the manufacturer of each mask they want you to try.  This is just my opinion, but if the manufacturer's name is Respironics, pass on that mask, no matter how much the supplier might praise it; "this is our most popular", "this works great for almost everyone", "this is the newest design", "we never get complaints about this one", blah, blah.  That manufacturer makes very good machines...and very leaky and/or uncomfortable masks, imho.

If the manufacturer is ResMed, do try on those masks.  They have perfected the art of designing good sealing cushions and comfortable, wellmade masks.  Again, just my opinion.  Everyone's mask mileage varies.  A mask I might love could be one that doesn't suit someone else's face and sleeping style at all -- and vice versa.

Good luck!  

WOW! Thanks to all for the excellent advice! The supply company actually called on Friday to set up an appointment (1 week after my study!). I will call them today with your information and advice in hand for a "script". Will post the results.
Thanks again,
Mick

Well, I picked up my machine (ResMed VPAP III), mask (ResMed Activa), and chin strap. Went to bed, put the gear on, ramp set on 30min., and... the #@*% thing would not let me breathe normally! I am a deep breather, and the machine would shift to exhale mode about 3/4 of the way through my inhalation. The result? Hyperventilating trying to match the short cycle. About 1:30 I gave up, pulled it off, and SNORED the night away! After reading the manual and some info on the ResMed website, I believe it is set on "timed" breathing rates instead of "Spontaneous".  Will call my supplier and find out. Overall, a disappointing first night... but I'm not giving up this easy!

Thanks for the advice, and a WONDERFUL website!