I’ve been sleeping with a CPAP device for several years and during the entire time I’ve always used a full-face mask. It’s worked alright but I still have several bad nights every now and then along with several moderate sleep nights. I know what it’s like to have great sleep so I’ve been aware for a while that perhaps it was time to try something new.
I’ve been managing obstructive sleep apnea for several years and I’ve learned a great deal over time. One of the more recent things I’ve come to realize in the past couple of years is that CPAP machine stats aren’t the only factor that should be used to determine how effective a treatment is working.
If you take the time to browse CPAP patient forums you’ll soon learn that the various machines calculate statistics in different ways. Between two different models in the same line I can estimate there’s at least a difference of two or three units for the value of the nightly AHI numbers. For example, my wife’s S9 appears to be lower than my own S8. Obviously I can’t account for the difference in severity between our cases of sleep apnea but I’m fairly certain, based on forum posts, that the S9’s reported numbers are typically lower. In my opinion, lower values reported by the S9 make it more difficult to pin-point problems because it offers a narrower range in which swings can be detected.
There are several factors to consider. For example, though an AHI may appear low this can be misleading if the leak rate is very high. I consider the AHI value more reliable when I have a very low leak rate.
One should also be mindful of the fact that home devices do not track the same array of data that is gathered in a sleep study. It’s possible that some information won’t reveal problems that might be obvious when compared against data collected in a lab setting (O2 levels, sleep stages, etc).
Sleep stats aren’t enough and simply don’t reveal everything. The quality of the sleep isn’t something that I can track at home. Yes, I can see if there were severe problems with leaks or high AHI values, but my machine can’t really track sleep stages (these can only be inferred to a minor degree) or the quality of my sleep.
I think most experienced CPAP users will agree that statistics are helpful but the most important factor for determining effectiveness is simply how good you feel in general.
With my machine I’ve learned that I’ll feel alright with an AHI below 3 and I typically feel very good if it’s below 2. Anything consistently above a 4 will begin to wear me down. Note that these numbers are well within the “normal” range.
Updated 06/25/2012: But the stats can be very helpful at times as well. If you look at the pressure a machine is using to stop events then you may figure out that your lowest pressure setting should be increased. Over in relevant forums many users have stated that what often happens is that a machine doesn’t ramp up to the necessary pressure in time to stop many events. For example, if your minimum pressure is 6 (with a max of 15) and the majority of your logged events require a pressure of 12 then it’s possible that there are several events at or above that pressure and the machine simply isn’t ramping up enough in time. For example, if the machine is at 6 and only reaches 9 before the event naturally ends (your brain tells your body to breathe, thus disrupting your sleep) then it may not be effective enough. In such a case it may be wise to have your lowest pressure increased to a value closer to the average pressure needed to prevent events.
For a while I was using a ResMed Mirage Quattro Full-Face mask with my CPAP machine. It worked well for me. It certainly worked better than my first one, the ResMed Ultra Mirage.
Several months ago my wife got her first CPAP machine and mask. She’s been using a ResMed Quattro FX Full-Face mask and over a few months I noticed her sleep stats were very good. In fact, they were consistently very good. However, during the same time I was struggling with my ResMed Mirage Quattro. It was not consistent. Sometimes I managed to have very good sleep a few nights in a row and then another night I might experience high leaks and sleep so bad I didn’t have the energy to do anything more than watch TV.
I decided to go ahead and get a Quattro FX and it turned out to be a very good decision for me. When I bought the mask I was sized for a medium, instead of a large as I have for previous masks. The first few nights were a bit of a hit and miss but now my sleep is fairly consistent. I’m even getting a combined AHI below three and four on a regular basis.
Overall, the mask is more comfortable than the Mirage Quattro, though this is entirely dependent on one’s facial characteristics and ears. Yes, ears. If the base of my ears were a quarter of an inch higher I probably couldn’t use the mask. It fits fine when I put it on at night but sometimes in the morning I’ll realize that it slid down slightly and rubbed against my ears.
I’m still using Lansinoh with the new mask, which still helps with the mask seal.
This mask is a vast improvement. I’ve slept so well that I’m no longer reviewing every stat and trying to find various tweaks to help me sleep better. I still check my stats each morning but I don’t bother to log them in a spreadsheet every day.
Updated 06/20/2012: From the beginning I’ve been replacing the mask seal and headgear very frequently. Sometimes I had to change them almost once a month (which adds up to about $85 for both replacements). No more. I’m going to wear out the mask seals as long as I possibly can. The headgear may be a bigger problem but I’m going to stretch it to the max.
Updated 07/18/2013: I stopped using a full-face mask and switched to an Aloha Nasal Pillow. It required some adjustment but it is much more effective, leaks have become rare problems, and the replacement parts are considerably less expensive.
For a couple of months I’ve been using Lansinoh HPA Lanolin to reduce leaks around the mask silicone seal. It’s been very effective, especially since I have beard that would otherwise lead to increased leaks.
My experience with replacing the gear this time was a little bit different. Instead of improving my stats they actually decreased a bit. It seems that I was actually doing well with the older seal and headgear when combined with the Lansinoh. The headgear probably isn’t as much of a factor – I suspect the biggest difference is caused by using a new seal.
A new seal is much firmer than an older one. The longer a seal has been used the softer it becomes. Without Lansinoh (or a similar oil) an older mask seal would tend to leak more. However, the firmness of the new seal actually seems to create a less efficient seal. This isn’t what I expected and though it’s an inconvenience now I’ve learned something valuable – I can probably use an older seal with the oil indefinitely.
Is it less expensive to use Lansinoh with an older mask? Yes, if it works for you. A new seal for my mask costs about $55. If I use one tube of Lansinoh each month then it will cost me about $12 per month. In addition, using the Lansinoh seems to extend the usable life of the seal. I’m not sure how long a seal can be used with Lansinoh but I suspect it can easily last a year.
How effective this trick is will vary from person to person. If you’re interested in trying this then I suggest that you just buy one tube before stocking up. I also don’t recommend trying this for the first time with a new mask seal. The Lansinoh probably can’t be cleaned from the seal completely so start with an older mask seal.
Updated 06/20/2012: I haven’t figured out the perfect amount of Lansinoh to use each night but I have made progress on cleaning the oil off older mask seals. The oil really sticks and can even stain so avoid getting it on any clothing that you plan to wear in public again. I’ve previously tried dropping older mask seals into boiling water for a few minutes. It did get some of the oil off the masks but it also coated the pot that I used, which required a lot of scrubbing to clean out.
This weekend I tried a different approach. I gathered up a couple of masks (the same ones I had tried to clean with hot water) and dumped them into a mix of bleach and hot water in a plastic bowl and let them sit for a while. That seemed to do a good job of removing the oil from the masks and also breaking it down so the container wasn’t coated with residue. I’ve only done this once so I don’t know if it will be a good idea in the long term but the masks that I had used were old ones that I would have thrown away anyway. In this case, I’ll probably try reusing them. So far, the bleach didn’t seem to harm the mask seals.
Last week I ordered a Pad A Cheek Mask Liner to use with my ResMed Mirage Quattro mask. It’s a fabric liner for CPAP masks that’s made by a third-party. Ideally, it will reduce leaks around a mask seal while also increasing comfort. At $15 it’s a reasonable price. Unlike the RemZZZs mask liners, which are intended to only be used for one night, this liner is much more durable and can even be washed by hand.
The new liner was waiting for me when I returned from a work trip. This morning I unpacked the liner and gave it a try.
Unfortunately, it’s not going to work for me. Despite reading forum posts in which some users with facial hair reported that it improved their seals, I found that it did the opposite. In fact, as soon as I turned on my CPAP I immediately noticed bad leaks around my beard. These leaks were worse than using the mask without the liner.
For individuals without facial hair this seal may indeed reduce leaks and improve comfort. I may suggest this type of liner to my wife for use with her ResMed Quattro FX mask. She’s been satisfied with the RemZZZs liners but the Pad A Cheek may prove more comfortable and much more durable.
So far the most effective method I’ve found for establishing a better seal around my beard is to use Lansinoh HPA Brand Lanolin on the silicone mask seal.
Updated 11/11/2011: I also purchased one for my wife, which is made for a Resmed Quatrro FX. She’s had a chance to use it a few nights and so far she loves it. For her it’s much more comfortable than the RemZZZs, which moved around too much. I checked her machine stats. The leak rate was higher than I’ve seen for her, but her AHI was still very good and she said that she slept fine and didn’t notice any leaks.
In my efforts to improve the effectiveness of my CPAP treatment I started searching the cpaptalk.com forums for new tips. I came across one that seemed a bit odd, but does seem to be effective. In one post, and also in several others, many individuals recommended using Lansinoh Lanolin to create a more effective seal between one’s face and the silicone mask seal.
Since my obstructive sleep apnea is severe I must take my CPAP with me any time that I travel. Otherwise, I’ll feel terrible the next morning. Unfortunately, the device came with a soft case that doesn’t provide the device, and more importantly the mask and hose, any protection from being damaged.
This week I decided to purchase a hard shell case that would offer more protection. I didn’t want to have to keep asking others to be careful about putting their luggage on top of the CPAP case. It wouldn’t take much to break the mask or hose (though the device itself would probably fine).