The Challenge of Mask Fit
I have talked about mask fit before (here and a little bit here) but I believe that we can never talk about it enough. Mask fitting is one of the most important parts of a titration study. It will be what determines success. It is one of the biggest challenges you face since many patients will make decisions that may not be right for him or her.
Everyone has a favorite mask but I find that it is essential to give the patient at least two choices. Sometimes it can take five or six masks before the patient finds one that he likes. The one thing that will help for the DME company and billing is if you document all the trial masks. This is especially true if you are going to switch to Bilevel therapy.
Last week, we had several different patients who had mask challenges. We had a man with a full beard who would not wear a nasal mask or pillows. We finally got him on a FFM but the leak was ridiculous. He was placed on Bilevel because that seemed to work better. Ultimately, he was not completely titrated but he was significantly better and he said he felt better. I am hoping that he will trim his beard.
Another patient had failed CPAP previously. The patient was originally placed on pillows because she was claustrophobic. The truth is that most patients who have this problem do not do well on pillows because they cannot breathe through their mouth. It actually makes them more claustrophobic. She was placed on a FFM which she did very well on and thanked us the next morning for helping her. I have also had success with the Fitlife mask for the claustrophobic patients.
My final patient will never use a CPAP or Bilevel. He refused to even try on a mask. In the end he walked out AMA. Unfortunately he had severe CSA and he has very little options for treatment.
What ultimately is the cause of success for therapy? When I talk to other techs I have heard that it has to do with how open minded and determined the patient is. Those who come in with a closed mind will never accept therapy and even if they feel better will not use it and find multiple excuses why they cannot use it. However, anyone coming in with at least a little bit of an open mind will usually be successful.
What tips do you have for techs to help them make the CPAP experience more successful?