UK Newbie Seeking Advice

New to the forum. Im from England and 49 years old, I am overweight which I’m trying to correct. (Im 238 pounds).

I have a Phillips System One with heated humidifier. I use a full face mask Airfit f20 Large. Im generally a side sleeper, I do turn over in the night

I was diagnosed with sleep apnea 3 years ago and have been using this machine ever since. I do feel things have improved over that time,

I do suffer with large leaks however very rarely am I woken by this. (normally the wife is lol)

Im wondering wether I need to change my mask, if this will improve things.

Below is my latest results, Im wondering if I need to increase the maximum pressure (currently at 17.5 and minimum us set at 9)

Im generally a side sleeper, I do turn over in the night, I wonder if this is when the leaks happen.

I find if I have the mask too tight then I get mouth ulcers. I do use a mouthguard with the machine and again I think this has improved the results for me.

I have read Pugsys tutorial thread but would appreciate your comments and advice to improve my cpap performance.

Your mask is leaking but overtightening won't allow the silicone to inflate as it should and can even create new microleaks. Try is looser for 1-2 nights and see if it helps, but if not you need to try either a liner (see Padacheek.com), a diff. size, or a different mask altogether - there are very many out there, though what access you have in the UK I don't know. PM Rick Blaine who's in the UK and really helpful for patients there, and he can give you an idea of what to do, where to go, how any insurance involved might work, etc. etc. Also, you might want to raise the max. pressure setting by a few cms as it can keep the min. pressure (the one that does the job) from rising when necessary on occasion.

Thanks Julie, will try loosening the the mask for a couple of nights, will look into Padacheek (never heard of it before).

Will send a PM to Rick and raise the max pressure.

Thank you for the advice

Hello, Zebidee. It could be useful to see the pressure changes for the whole night, instead of just the zoomed in portion. Could you repost showing the whole night? And while you're at it, you could turn off the calendar before you take the screenshot (click on the little triangle next to today's date) and also get rid of the pie chart (File ... Preferences ... Appearance ... untick the box).

Oh, one other thing. Could you put information about your machine and mask in your profile? That way everyone who reads your posts can see it.

Hi Zebidee,

Padacheek is located in the US, selling mainly to patients in the US. I don't know if they've ever had (and responded to) requests from people in the UK. Probably not.

But there is a charity called Hope2sleep in Hull, East Yorkshire, and they can supply mask liners. You'll find them under:

https://www.hope2sleep.co.uk/contact.html

Now the first thing I have to ask – because it's not clear from your post – are you someone who gets their treatment from the 'private medicine' sector? Or are you a patient with the NHS?

It makes a difference. For example, if you're a private patient, you'll have likely bought your machine and mask from the clinic where you saw your private doctor.

And when it comes to a replacement machine or an alternative mask, you would probably to go back there.

And you still can. But you should know that both private patients in the UK and NHS patients can go direct to either of the two major manufacturers – Philips Respironics UK in Chichester, or ResMed UK in Abingdon, and buy direct by mail-order. (Provided you have a 'scrip' or prescription.)

Both of these companies have UK-facing websites.

Sadly, the current virus pandemic means that you can no longer try on a range of masks to see which design best suits you. ResMed UK used to run day-clinics where you could try-on all their masks, with the machine running, and with the help of their experienced staff. And they used to offer those in Abingdon or Bristol, two or three times a year. But in the present circs, that has stopped.

So if you do want to try-out different designs of mask, it can get expensive. Most masks, from the majority of manufacturers, come in the £110 to £130 ball park. And if you buy it, and try it, and it isn't quite right – they won't take it back. The only small degree of comfort is: if you are a diagnosed patient, there is no VAT on CPAP machines or masks.

If you are an NHS patient, I'd be asking which foundation trust hospital is the sleep medicine department you go to attached to? Because if you are an NHS patient, you should be in some kind of regular follow-up program.

For most of the NHS, this is once a year. And normally – ie, when there isn't a virus pandemic – you'd go along, they'd weigh you, ask you to fill in the Epworth Sleepiness questionnaire, check your machine, and take the SD card from your machine and plug it into their computer to see how you've been doing.

The follow-up would also include checking out your mask. Did it need any parts replacing? Or even the whole mask replacing? They might even try you out with different designs of mask if your previous best-fit model was no longer supported.

Note that I say 'normally'. Because of the virus pandemic, almost all NHS hospital out-patient clinics are now offering only telephone appointments, unless there is a very pressing case for seeing you in person.

So if you are an NHS patient, I suggest you call up the sleep-medicine department and tell them that – as evidenced by the leaks – mask fit seems to be the problem. And call them even if it's not time for your regular follow-up. They will probably pop a replacement mask or mask part in the post for you.

If it's the mask design that's the problem, I don't know what the SMD in your area will do. They might be offering a few in-person appointments. But you would have ask about those.

The things I know about leaks are:

1. Be scrupulous about washing both your mask and your face daily. Just a trace of oil/ oily skin can be an opening.
2. Use a mask-liner.
3. Experiment, as Julie suggests, with how much wiggle-room you give the cushion. It's supposed to operate like a hovercraft.

OK. This much for now. I notice you are asking about changing machine pressures. I may add a few things about that.

Hello Missemerita

Ive attached another picture of my cpap readings, for some reason I couldnt select my cpap machine its a phillips resmed system one. Ive managed to add my mask to my profile.

Hello Rick

Youve given me a lot of useful advice Rick to which I thank you.

Yes I am on the NHS and I do have annual checks with regarding to my cpap.

I can understand in light of the pandemic you cannot trial masks, I was just wondering which masks people recommend really. Yes the masks are expensive hence me asking for recommendations.

I have had a sleep trial that was 3 years ago when I first started on my cpap journey.

Ive also last year had my adenoids removed and my turbinates reduced, this has made a hell of a difference, i can breath a lot easier and I think this has reduced my apneas.

Hello again Zebidee,

Before we get to possible pressure adjustments, I want to give you some mask information.

At some point, someone at the sleep-medicine department decided you need a 'full-face mask' – ie, one that covers both your mouth and your nose.

And in that category, the AirFit mask frame is one that ResMed is proud of. And it was initially offered with the AirFit silicon mouthpiece and cushion.

But a year or so ago, ResMed offered a variation of the mouthpiece/ cushion – one made of memory foam – which, when it's clipped to the f20 frame, turns it into the AirTouch.

And the memory-foam cushion is very effective at cutting down leaks. I know. I've tried it.

There is only one snag. Unlike the silicone mouthpiece/ cushion of the AirFit, which can last two years, the memory-foam mouthpiece/ cushion of the AirTouch lasts only a couple of months. And then it needs to be replaced. (The frame and the headgear stay.)

So it's excellent treatment – for those who can afford it.

ResMed UK are currently offering a pack of three memory-foam cushions for £84. And a pack of nine memory-foam cushions for £216. Both as special promotions.

AFAIK, these promotions are only available in the UK.

And AFAIK, the NHS is not offering the memory-foam option to patients who have the AirFit frame.