22 March 2019

Stop CPAP Mask Problems and Issues


“If you are going through hell, keep going.”
- Winston Churchill (Former British Prime Minister – 1874 – 1965) 

To stop CPAP mask problems and issues, I went back to using an “old” nasal mask being ResMed Mirage Micro and to use a Bilevel or BiPAP auto adjusting machine. It is an “old” mask as the mask is no longer manufactured by ResMed although the mask and cushions are available online. A picture of the mask is at the end of the blog post.  

Masks are very personal. A great mask for one person may be a terrible mask for someone else. No matter what mask you end up with, by stopping mask problems and issues in particular leaks and constantly waking up, you will not be losing quality sleep and waking up tired and unrefreshed each day. 

As noted in CPAP Air coming out of the Eyes, one of the hardest and most difficult aspects of using a sleep apnea machine is to find your “perfect” mask. A mask that is properly fitting and comfortable will strongly enhance a person’s experience, acceptance and long-term use of the sleep apnea machine. Otherwise you may end up being one of the 80% non-compliant, failing and non-successful people on sleep apnea therapy as detailed on Why is CPAP Compliance Rate Low? 

At the sleep medical specialist and equipment supplier, make sure they explain and you try the different types and brands of masks. Use a mask that is comfortable and suits your style of sleeping. This is critical as it is you who will be sleeping with the mask each day not the equipment supplier. It is best that the equipment supplier have a return policy should the mask not meet your satisfaction. 

The sleep staff need to ask you questions including what sleep positions you sleep in and whether you move from side to side and lie on your back, what pillow you had and whether you may need to change, are you claustrophobic wearing the mask and do you want to read a book with your mask on before going to bed? 

Due to smallness, I recommend you first try with nasal pillows and nasal masks. Generally, the smaller the mask is, the smaller the leaks. I look at leaks in an earlier blog post Stop CPAP causing Mask Leaks: Use Bilevel. 

Be aware, there are conflicts of interest in the sleep apnea industry. Avoid them at all costs as it may be to your detriment. The blog post details my first mask and personal experience and how I had no choice in selecting the mask.

There are many reasons for using an “old” mask and a bilevel auto adjusting machine. 

1. To reduce mask leaks showing on my machine each morning to zero even though I use maximum pressure up to 17 cmH2O. For some of you, leaks from the mask are going to make you frustrated and drive you crazy. Just when you go to sleep as well as during the night, the mask may leak, waking you up constantly. 

Using a bilevel machine has assisted greatly in reducing mask leaks to zero. More details are at the above blog post and Guide to Success using CPAP and Bilevel. In these posts, I detail the 4 steps that I believe are The Secrets to Success to using a sleep apnea machine. 

2. For a ResMed machine, once leaks are constantly over a certain level being 24 litres per minute during the night, your sleep therapy will be less effective than it should be and may lead to sleep disruption and constant waking up during the night. Should this happen, you will wake up tired and not refreshed in the mornings. 

The ResMed machine will blow more air to compensate for the leaks and so you end up going around in a circle with mask leaks. More air may lead to more mask leaks and more waking up during the night. By using a bilevel machine, I have reduced substantially the likelihood of mask leaks occurring by reducing the median/ average pressure and tidal volume of air. 

3. The mask does not leak when the pressure moves from a low EPAP (exhale pressure) of 4.2 cmH2O to my maximum pressure of up to 17 cmH2O and vice versa. It does not lose its seal even though the range of pressure is quite large. 

An issue I found with other masks is that when the pressure went above 11 cmH2O, the mask would begin to leak. Once the pressure went above 12 cmH2O, the mask would leak badly. The bilevel machine allows me to have a large difference between inhale and exhale pressure reducing mask leaks and enabling me to optimize my sleep and wake up feeling energized and refreshed.  

4. As noted in the blog post Why NOT to use a CPAP Humidifier? by having zero or minimal leaks, even though I do not use a humidifier and have maximum pressure up to 17 cmH2O, I do not have a sore throat and dry mouth each day due to CPAP air. In addition, by not using a humidifier has simplified my sleep apnea therapy. I no longer need to obtain clean water and to remember to fill the humidifier with water.  

5. I have been using the same mask cushion with the sleep apnea mask for more than 5 years and still have Zero leaks showing on my machine each morning. This particular mask has saved me a lot of time and money as I do not need to regularly obtain new mask cushions. My first mask, the ResMed LT Activa would completely “lose” its seal after 3 to 6 months and leak badly. 

When a senior executive at ResMed asked me what mask I was using and I advised ResMed Mirage Micro, the reply was “That was a good mask!” Why is this mask no longer manufactured by ResMed? Is it because not enough patients needed to change their mask cushions on a regular basis and ResMed was not making enough money? 

6. When using the “old” mask, I stopped having skin rashes. My first mask, ResMed LT Activa would give me skin rashes from the mask cushion. Changing to an “old” mask stopped the rashes overnight. Did ResMed change the silicone formula in the Activa mask? 

7. The mask is very comfortable and seals easily. It is a small mask and not heavy and bulky making it comfortable to sleep with on a normal pillow. With the forehead support, the mask does not lose its seal and leak when moving a lot in bed such as side to side or lying on my back. The forehead support is of great benefit and you are able to adjust the support and together with the mask cushion have maximum comfort for you. 

8. For those people who have CPAP air through the eye tear duct and air coming out the eyes, the nasal mask allows me to cover a portion of both nostrils at the middle section of each nostril with medical paper tape. By doing so, I have reduced the volume of air coming out the eyes by an estimated 3% to 4% as well as to stop nasal congestion and nose bleeding. 

Whatever mask problems you are having including other CPAP side effects and issues, keep going and using your sleep apnea machine. Some patients on the sleep apnea forums have tried more than 10 different masks! There are hundreds of different masks available and there is a “perfect” mask for you to stop mask problems and issues. 

Below is a picture of the ResMed Mirage Micro mask.









Should you be having issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.  

“Have courage. Be adventurous and Go for it! Overcome your fear.”
- Mrhelpful

09 March 2019

Conflicts of Interest. Avoid!


“As long as Greed is stronger than compassion, there will always be suffering.”
- Rusty Eric 

It’s probably apparent to other people, there are Conflicts of Interest operating within the sleep apnea industry. Avoid them at all costs as it may be to your detriment.

Some years ago, I went to a sleep equipment shop to buy a battery power backup should there be a power blackout and I had no access to electricity. As a result I would not be able to use the sleep apnea machine and have a great night’s sleep.

I had gone into the shop with the intention of buying a ResMed battery system. The staff explained the advantages of an alternative system. The backup battery system that was recommended for power blackouts was better and much cheaper than the ResMed setup. In fact it was approximately one third of the price. I thanked the staff for their honesty as they could easily have sold the more expensive and less useful ResMed battery system. 

I asked the staff “Why not put on their website the advantages of this particular backup system versus the ResMed battery backup system?” The reply was and I quote “If we did that, ResMed would stop selling to our shop!” 

Another great example of Conflicts of Interest was when I was first diagnosed with obstructive sleep apnea in 2010 and I went to receive my machine and mask and other equipment. In the previous blog post Stop CPAP causing Mask Leaks, I mentioned that Masks are very personal. A great mask for one person may be a terrible mask for someone else. My first mask, a nasal mask, ResMed LT Activa whilst liked by many people was to me a terrible mask. In fact, it was and still is the worst mask I have used. The mask did end up in the garbage bin.

Why was this particular mask, my very first mask? I had no choice. The staff did not show me any other masks despite me asking about them. I asked what about nasal pillows and other nasal masks? What about a full face mask? What about other brands of mask? The staff advised that based on my facial features, this is the best mask for you. I asked again why? The answer was the same as the answer that I was given a few moments earlier. 

The ResMed LT Activa mask was heavy and bulky. Lost its seal after 3-6 months and gave me skin rashes. When moving from side to side, the mask would lose its seal and leak due to the mask hitting the pillow or the hose pipe pulling on the mask. I would wake up continuously during the night. The mask cushion would also go up and down like a yo-yo and make a noise as the pressure increased and decreased. 

I thought the sleep medical specialist and staff knew what they were doing. Masks are very personal. A mask that suits one person may not suit another person. Have a mask that you feel comfortable with and suits your style of sleeping. The staff did not ask about what sleep position I slept or what pillow I had. No. They advised that this is the best mask for you! 

There are other questions they could have asked such as whether you move from side to side and lie on your back, are you claustrophobic or do you want to read a book with your mask on before going to bed? 

Due to smallness, I recommend you first try with nasal pillows and nasal masks. Generally, the smaller the mask is, the smaller the leaks. At the equipment supplier, make sure they explain and you try the different types and brands of masks. Use a mask that is comfortable and practical to you. This is critical as it is you who will be sleeping with the mask each day not the equipment supplier. Details of my "perfect" mask are at Stop CPAP Mask Problems and Issues. 

Where are the Conflicts of Interest?

After I saw the sleep specialist and received a ResMed CPAP machine, you walk down the hallway within the same business premises and you see staff to be supplied with a ResMed mask and get some initial training. The training was basic and not extensive. How to put the mask on? How to fill the humidifier with water? Do not touch the settings on the machine! 

Some months later, I was advised by staff that the Sleep Medical Specialist only dealt with ResMed machines and ResMed equipment. The specialist in the room next to my specialist only dealt with Philips Respironics machines and equipment.  

The medical specialist had no intention of offering or allowing me to try any other brand of equipment or mask or a different mask as no doubt it wasn’t in their interest to do so. There is only one logical reason why the medical specialist would do such a thing. Money! 

How did the Sleep Medical Specialist determine that a ResMed machine and mask was better than a Philips Respironics machine and mask or any other Brand and vice versa? What evidence and research studies did they base their decision on? There are many different Brands and hundreds of different masks available. Why pick this particular mask over all others? 

Avoid Conflicts of Interest by the medical specialists and equipment suppliers. Find another sleep specialist and equipment supplier should they not wish to spend time to explain things to you and allow you to try different masks. 

As many of the Sleep Medical Specialists are not educating themselves and their patients, it will be up to you to educate yourself! By doing so, you will have one of the secrets to success to successful sleep apnea therapy.

Should you be having issues with your sleep apnea therapy; CHANGE what you are doing. Get involved in learning about your sleep apnea therapy. Do not become one of up to 80% non-successful, non-compliant and failing patients as detailed on Why is CPAP Compliance Rate Low? 

It is YOUR therapy 

It is YOUR machine 

It is YOUR life! 

You only have one opportunity at life. Make the most of each and every day, free from pain and suffering. Achieve success using the sleep apnea machine and have a great night's sleep.

Should you be having side effects and issues with your sleep apnea therapy, CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.

“Have courage. Be adventurous and Go for it! Overcome your fear.”
- Mrhelpful