Schwartz.World!

Here I am 2 months into using CPAP and it hasn’t gotten that much easier for me. I’ve made progress, but I get the sense it’s going to be a long hard road. Luckily, I am incentivized to do the work, since I literally cannot sleep without the mask.

There are a few challenges, some of which have been made worse by the Covid pandemic. It took me almost 2 months to realize I was putting my mask on too tight, and in many cases having it sit too high on my face. This would not have happened pre-Covid, as someone would have come to my house to go over everything with me, instead of having to learn everything from YouTube videos.

Pressure Settings

Through trial and error and monitoring my data in OSCAR, I’ve come to the conclusion my ideal pressure range is between 11-14. Any lower and I wake up with apnea events, any higher and I wake up feeling over-inflated. Luckily, it’s easy to access the device settings and adjust one’s own pressure, and titrating it myself is proving to be simple and positive. It’s definitely an improvement over the old flow of “message my doctor and three days later she adjusts pressure”.

Shaving

Of the four masks I have at home, I’ve had the most success with my full-face mask. In order to acheive this success, I’ve had to shave every night before bed. This sucks. Sucks sucks sucks. I’d like to switch to a nasal pillow to combat this.

Mask fit

At the present I have tried 4 masks:

• Resmed Airfit F20: This has been my greatest success once I finally learned to shave daily, not over-tighten and not fidget so much. Aside from the need to shave, I wake up feeling very claustrophobic, and have trouble convincing myself to wear the mask back to sleep. It’s also finicky enough that putting it on again requires actually taking everything off.

• Resmed AirFit N30i: I actually like this mask. The hose connects on top of your head, which is nice, and I can breathe through it. The only real downside is that it chafes the underside of my nose quite badly. I’ve had a heck of a time getting it to fit loosely enough but still secure.

• Resmed AirFit F30i: Garbage. Worst of all worlds. I chafes my nose, leaks around my cheeks and feels uncomfortable. Hard pass.

• Philips Nuance Nasal Pillows: More garbage. It feels great when the nose holes line up perfectly, but it’s very hard to get it to sit on my nose without overtightening. The cushions don’t really go inside your nostrils, and I find it hard to get feedback on the fit without getting up and turning the lights on. I couldn’t go more than 20 minutes with this mask on.

The Fitting

I drove out to my DME supplier today for a long overdue “fitting”. I had complained to my doctor that I was having trouble, and she asked them to do a fitting which they are only now starting to do. All the other masks I got were sent to me by the DME without any real discussion of pros/cons, or given to me as samples by my doctor.

I drove out there for a fitting and was shocked by how unscientific the process was. The woman basically asked me which mask I wanted, whereas I assumed they had some metric for fitting you.

My doctor had mentioned trying on multiple masks, but I was informed I got one chance to pick a mask and what I picked was what I got. I asked if she would show me how to wear it, and was told that she would show me on a mannikin head. This is understandable with Covid, and yet I probably would have chosen to do the meeting over video if this had been made clear. Quite the opposite, I’d been led to believe that with all the staff being vaccinated, they were actually fitting people.

Truthfully, I got a little emotional about it. I haven’t had a good nights sleep in months. The last thing I want to do is be in an office with someone mucking around my face, but Covid is not the only risk factor here. The woman saw my response and backtracked, offering to fit me. Ultimately, it wasn’t that helpful to watch her read through the instruction booklet that came with the mask. I don’t know what I was expecting.

“Here,” she showed me. “It comes with 3 different sizes so when you figure out what size you are, you can just order that size next time”. What do you mean when I figure it out? Why did I drive 40 minutes for this?

The True Value of the Appointment

The one thing I did get out of the “fitting” was a certainty that the process of finding a mask is completely trial and error based. If there is such a thing as an expert or someone trained in fitting a mask, I have yet to meet them, despite talking to 3 different reps at the DME, and none of them even pretended to have a metric for mask selection. At least when you get “fitted” for a pair of running shoes they pretend to know what they’re doing.

I took home a Resmed P10 and an initial test at home makes it seem like it works well, but I still have to actually try it tonight.