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Adventures in Sleep

The Shell Game

Published February 17, 2009 9:32 AM by Amy Reavis

Every time I get a new patient I think "What mask I am going to use?" I think about what we have available now, what we used to have available, and who is going to perform the study.

Everyone has a favorite mask. Everyone who has been in the field for a long period of time has seen their favorite mask change over time.

When I was first doing home care for Bane Respiratory many years ago, I had specific masks for specific types of patients. I always started with the nasal mask except if the patient was claustrophobic or had fragile skin.

Then we would get into some of the stranger masks out there. I had a mask I used specifically for my little old ladies who went to the hair dresser once a week. (These little ladies were always my favorites)

Back then, I would use mostly the new gel masks that you had to boil to make fit. It served two purposes. One, to get the mask fit properly and two, I would see what medications they were taking and make sure they did not have three bottles of the same med by different names that they were taking. If I was calling a doctor's office in the middle of the day, they know I was calling because I had just found someone who was overmedicating themselves. It was always about patient care.

If I had one of my little old ladies who did not want to muss their hair, I would break out a mask that was a cross between a wrestler's headgear and Princess Leah's hairdo. But oh, the things you could do with it to get a patient to wear their CPAP or BiPAP. I almost never put the straps where they were supposed to go. This way I had one strap across the forehead and one at the back of the neck and the nasal cushion secured using Velcro around the hose. The great part was that this mask was one of the first where a patient could wear glasses so they could read in bed before lights out.

Full face masks to this day I use whenever someone is claustrophobic and the wires do not bother them. This means it is not having something touching their face that keeps them from wearing the mask but it is a control issue. When you tell someone to breathe through their nose only you take away some of their control. With a full face mask and having the patient hold it to their face they are in control and they learn to adjust to using CPAP. I have many successes that way.

In the end, choosing masks is all about how much communication I have with the patient. I will always give them at least two choices, I will always listen to their fears and any health issues and I will always look at my biocals for upper airway resistance. Then I give choices. This is how I find the pea under the shell almost every time.

posted by Amy Reavis


You should try to reschedule your follow up appointment as soon as possible.  There are many things your physician may suggest to make your treatment more bearable.  Ask about EPR (expiratory relief on your machine) or a lower pressure or perhaps a different type mask/interface or all of the above.  After the doctor goes over the results of your study, you may find you have more issues while on your back rather than your side, ask about positional treatment devices and a lower CPAP pressure.  There is a good tee shirt called REM A TEE (google the vendor) to assist with positional components.%0d%0a%0d%0aJust some thoughts for you.

Susan March 11, 2009 8:40 PM

Amy help!!!

My husband who has been a succassful no worries/problems CPAP wearer for over 10yrs. is making me crazy during this adjustment period! I have been wearing my mask for 7 or 8 days now for up to 4 hours. The main issue is the doctor whom I've yet to see face to face (only went to the sleep study) set my machine to an 11 which even at the study I could not tolerate! I remember the technician saying I'll turn it down to 8 maybe you will be more confortable. I was only able to wear it for a short time (at best an hour or two) during that time.

I've set my machine at a 6 which I know this is a no-no but I could not tolerate the other higher settings and didn't want to wait for the doctor's visit etc. (I'm exhausted!). I'm attempting to titrate myself up to the "8" setting or possibly higher trouble is "Mr." whi is trying to "help me" is making me nuts! How long did you sleep? Put the mask back on Blah- blah- blah and I'm feelign like a failure insteda of feeling like I'm making progress! I have a Res Med Escape @ with the humidifier and I think I'm making progress but... What do you think?

Suzanne , Optician March 9, 2009 11:13 AM
McKinney TX

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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