So, I'm wearing my skullcap today because
I'm here to talk about CPAP masks. And by the way, it is a skullcap.
Happy little skulls on it. When I started CPAP therapy six months ago, I didn't even know what
I didn't know about CPAP masks. My sleep doctor didn't tell me, my Durable
Medical Equipment provider didn't tell me. And that's a real shame, because in my opinion, it is the single most important factor
in whether or not you succeed at CPAP: Finding the right mask is crucial.
You have to find one that fits. You have to find one that doesn't leak. You have to find one that doesn't
try to rub your nose off your face. And that's not easy! So, six months
later, I don't claim to be an expert but I have learned a lot, and that's
what I'm here to talk about today: All of the things I've learned in the
past six months that I wish I had known when I was prescribed CPAP. So come on. Maybe you'll learn something. When I was prescribed CPAP, I
was told to come to an address and pick up my machine and not much else. I showed up and they handed me my CPAP, and they handed me my mask, and they said "put
on your mask, push the button, go to sleep"… I think they did put the mask up to my
face to make sure it was the right width but beyond that, not much help, nothing. So anyway, what I know now is that this
is the Philips DreamWear full face mask and it's so-called because it covers
both your nose and your mouth. That's what's considered a full face mask. When I saw this for the first time, I simply
thought, "Oh, OK, yeah, that's a CPAP mask." And the reason I thought that is because
it's the exact same mask that my dad used. I didn't realize there was really any variety in CPAP masks, much
less the variety that actually exists. So I guess that's the first
thing that I wish I had known: that CPAP masks come in all shapes and
sizes, all kind of different forms, and if the first mask they give you
doesn't work... well, you've got options. One of the things I really like about
the DreamWear full face mask is that it's really easy to put on. You just slip it over your head,
put your nose in the cradle here, take these two straps and they magnet in place. You can adjust these straps. You can adjust these straps. You don't want it to be too tight; you just want
it to be tight enough to make an airtight seal and you're probably having trouble hearing me
right now, so I'll take this off, but... yeah. So, what's the problem with it?
Why did this mask not work for me? Well, two things: One, this glorious beard. As you might imagine, full
face masks of this sort -- and I'm going to get rid of the headgear
and just talk about the mask part – they don't seal really well against beards. I managed to work my way around
that by buying some beard wax that would smooth down my beard
and make a pretty good seal here, but this mask still didn't work for me. Why didn't it work for me? Well, because I kept opening my
mouth in the middle of the night. So, a full face mask is supposed
to accommodate for that. It's supposed to cover your nose and your mouth, so that if you open your mouth
and breathe through your mouth, you're still getting your
therapy, your prescribed pressure. My problem is I would wake up in the middle of
the night chewing on the bottom of this thing. My mouth would pop open and I would I would
basically just eat the bottom of the mask. That would cause runaway leaks. I couldn't get
the right pressure, the right therapy because there's air leaking out everywhere. So that led me on a search, a journey,
for a mask that would work for me. The one thing I figured out that
I had to do, really quickly, was find a way to keep my mouth closed at night. There are a number of methods for doing that. Some people recommend a soft cervical collar… [Terrible Darth Vader impersonation]
Luke, let me look at you with my own eyes. No, no, I'm sorry, not comfortable. Other people recommend what's
called a boil-and-bite mouth guard. That did not work for me either. It
was really, really uncomfortable. Now, other people recommend
a chin strap. I tried that. Every chin strap I tried -- and I tried so
many different kinds -- would pull my jaw backwards, that way, instead of keeping it up and my airway would collapse. Some people recommend denture cream. In fact, Jason -- TheLankyLefty27 --
just did a video about this yesterday. That really works for some
people. It did not work for me. So, what did work for me? It's a technique called "Mewing." Meow? No, not that kind of mewing. It's a technique that was
developed by Dr. Mike Mew, who popularized a concept called
"orthotropics," I believe it is. Anyway, what it basically boils
down to is tongue posture. Now, a lot of people will tell you the trick is to put the tip of your tongue
behind your top teeth and suck. That's not quite right. What you actually want to do is lift your
tongue up into the roof of your mouth, such that everything from the
tip to the back your tongue is firmly planted in the roof of your mouth. This technique was originally developed
as an alternative to orthodontics, and the claim is that it will
basically reshape your jaw, reshape your teeth, reshape your
face, so you don't need braces. I'm not sure I believe that. In fact,
I'm pretty skeptical of that claim. But I will say this: I made a deal with myself.
If I could keep my mouth closed for two nights in a row, I would graduate
to a different kind of mask: A nasal mask, not a full face mask. It took me about two days of
practicing during the day, and what I had to do was use my Navage, which is
a nasal irrigator, like three, four times a day to keep my sinuses open,
and also use a nasal spray – sea salt nasal spray -- just to make
sure nothing was closing up in my nose. And I just practiced during the day,
planting my tongue in the roof of my mouth, making it a habit, getting used to breathing
through my nose, which I've never really done. It took about two days of practice during the
day, and then about four days later, I did it: Two nights in a row with no mouth
popping open, no mouth leaks. So, yeah, I thought, "Great, great, great,
I can get rid of this full face mask." "I don't have to worry about my beard anymore." And that leads me to the
second thing I wish I'd known: Most DMEs will allow you to trade
in the first mask that you're given, any time within the first 30
days, for a different mask. If the mask you're given
doesn't work for you, at most providers you have the opportunity to turn it
in and get a completely different kind of mask. Most of the time, they don't
even make you trade it in; they just give you another mask
for free within the first 30 days. Nobody told me that, so, um, yeah -- I had
to go out and buy my own replacement mask. Which leads me to the third thing I wish
I had known right from the giddy-up: The DreamWear mask from Philips Respironics is -- a lot like the new masks
from ResMed -- a modular system. This is almost exactly the same mask
that I showed you just a few minutes ago. The nasal mask pops out… Full face mask pops in like that… The headgear is different, but
yeah, otherwise it's the same. You can see: swap out the headgear, swap out the
face mask, and you've got an entirely new mask. So, this is the next mask that I
graduated to. This is what's called the Philips DreamWear nasal mask. You can see, instead of the full face interface, it's just got a little piece that goes under
your nose and I'll show you how that works. Way more comfortable, way less restrictive. You can talk -- maybe not with your CPAP running,
but, you know, until you get it all hooked up, you can talk. Here's the crazy thing: if you
just went out and bought this… Number one, you would need
a prescription to do so. Number two, this would cost
you $110, something like that. You don't need to buy this the whole thing. Since these are modular systems,
you can just buy the pieces parts. And here's the thing, let's go over the
pricing for this. This whole thing: $110. Let's look at the price of the
components bought individually. About $7. Um… about $10. Also about $10. About $15. So, you're talking a little over… what? Uh, $10, $20… So, it's just
over $40 for this whole thing. And you don't need a prescription for that. And you get the exact same thing that you would
get for $110 buying it all together in one bag. That's just crazy. So here's the thing: I
liked a lot about this mask. It only had one problem for me. You can see here, this piece, it
goes right in front of your nose. That piece chewed my nose up. I would wake up every morning and just have
cuts right here, almost like paper cuts. It chewed up this piece, it chewed up the inside
of my nostrils. It was really, really painful. It was worth it, though, because I
didn't have to worry about my beard. I didn't have to worry about mask leaks. The whole Mewing thing had allowed me to keep
my mouth closed in the middle of the night. There's trade-offs to everything. If I hadn't
been able to find another mask that worked for me, I'd still be using this, and just
hope that my nose toughened up. But then I found out, in addition to the nasal
mask, there's also something called nasal pillows. You'd think that would be called a pillow,
because your nose just rests on it. But no. Nasal pillows are these things
that go up in your nose. This is called the Philips DreamWear gel nasal
pillows, and I'll show you what that looks like. So, you can see these little pieces
just sit and sort of plug your nostrils. This one is called the gel nasal pillows because
you've got these little gel-filled things, right? I hate this mask more than I hate
anything in the entire world. If I could beat the person who designed this
to death with wet spaghetti, I totally would. So that was right out, and I went back to
simply the nasal mask and dealt with the bleeding nose every morning, which was fine. About the second month of my therapy,
Philips introduced a new nasal pillow. It's called the silicone nasal pillow.
You can see the difference here. This is the gel and this is the silicone. So, the silicone nasal
pillows have these neat little ribs inside that sort of keep it from collapsing. They've got a neat design
that is just really flexible and really nice. So let me show
you what this is like when it's on. So, you can see here the pillows don't go
up into your nostrils. Not far, anyway. They just sort of sit under your nostrils. When I found this mask, it was sort of like… I sort of felt like the first time I
met my wife: it was love at first sight. This was amazing. I woke up the next
morning, no pain and irritation here, no bleeding, no chapping, nothing. Here's the interesting thing, though: a few months
later my wife was diagnosed with sleep apnea and so I sort of wanted to tell her
all of this stuff that I've learned, and so I let her try out all of my masks. And I started with this one, because obviously,
it's just the best mask in the world. And she hated it -- HATED IT -- so much. I let her try the gel pillows, despite the fact
that it felt cruel to do so, and she was like, "Oh, god, that's way better!" Wait, what?! No! This is the worst thing ever
made. And she was like, "No, that's fine." I let her try the full face mask.
She was like, "Yeah, that's OK." And then I let her try the nasal mask,
the one that just tore my nose up and she was like, "YES, THIS! This is great!" It doesn't tear her nose up, because everybody's
nose is shaped differently. Everybody's face is shaped differently. And that's why I think CPAP
mask reviews are stupid. I mean, just think about these four masks and
sort of the difference between me and my wife. The full face mask, I guess I would give it a C-. I mean, it seems well designed. It just
doesn't work for the shape of my face, and when I opened my mouth, I
would chew on the bottom of it. I tried the larger version; It was even worse. My wife would give it, I
don't, know maybe a B? B+? So, the nasal mask. I would
give it a, I don't know, a C+. Pretty well designed. Pretty
comfortable. But it just ate my nose up. My wife, I think she'd give it an A, you know? The gel nasal pillows: I would give it an F------. My wife would give it, I
don't know, a B? B+, maybe? The silicone nasal pillows: A+++++++++ for me. The only reason I don't give
him more pluses is because it's by Philips and I hate Philips, and it
pains me that I have to give them my money. But it's just perfect. My wife would give it, I don't know, a D? D-? So you can see: what works for one
person does not work for the other. And that's true of the whole you know
"keeping your mouth closed" techniques, too. Mewing doesn't work for my dad. Perfect for me. Chin strap doesn't work
for me. Perfect for my dad. Soft cervical collar doesn't work for
either of us, but it works for some people. Denture cream: no to everybody I've ever
known, but obviously it works for some people. So, the key is: find what works for you. If you've been prescribed a
full face mask, or if you think, "Oh, I need a full face mask because I've been
breathing out of my mouth my entire life"… OK, but you haven't been on CPAP your entire
life, and chances are good, if you could just find a way to keep your mouth closed, you're
getting plenty of air through your nose. That may not be true if you have a deviated septum
or if you have sinus problems or things like that. But I guarantee you for, I don't know, maybe
85, 90% of people watching this right now you can get away with some form of nasal mask.
You don't need a full face mask, because -- and this may not be true for everyone, but in
my experience -- a full face mask didn't work when I opened my mouth. It was just like I
said: I ended up chewing on the bottom of it. I alluded to this a second ago, but
after the whole #Foamgate thing, and just the horrible way that Philips has
treated me and everybody affected by this since I don't want to give Philips
a dime of my money anymore. And the truth of the matter is, they make most
of their money on masks, not the machines. Machines? Pretty tight margin. I think that's one of the reasons the DreamStation
2 is such a cheap piece of crap because they're not going to make money off of
it anyway, so cut costs as much as possible. But they make most of their money on
masks, because you need masks quite a bit. So, anyway, I recently tried to replace this with this. And I know what you're thinking:
"They're the same picture." Actually, it's not. This is a Philips silicone nasal pillow, and this is the ResMed P30i nasal pillows.
Very similar in a lot of respects. One thing I really, really like about the
ResMed is that it has this accordion at the top. So, with the Philips masks, I'm
sort of a weird in-betweener. I was originally prescribed a medium
frame. That proved to be too small for me. But the large, what I'm using now,
is just a little too big for me. So I guess I need a medium-large? I don't know. They don't make that. They
make small, medium, and large. Medium's too small. Large is too big. What I like about the ResMed, though, is that
it's got this accordion stretchy bit at the top, so really, this only comes in
two sizes: Small and Regular. Sorry, Standard. Standard's a great fit for me I want to love this mask so bad. I've never wanted
to love something so much in my entire life. So what's the problem? Well, you
can start to see it if you compare the nasal interfaces for both
the ResMed and the Philips. So, let's look at the Philips first. It's
all silicone. Super flexible, super soft, if I roll over my sleep, it kind
of bends and conforms to my face. Again, those ridges inside
give it a lot of structural integrity without really making it stiff, so you get a good fit, but it feels super soft. By contrast, the ResMed nasal pillows are sort
of unflexible, unyielding, they don't bend much. And that's for a couple of reasons. First: they put their clips on the mask
itself instead of the frame. See, with the Philips, the little clip goes into
the mask. On the ResMed, the clip is on the mask. And that makes it structurally
rigid, and also very hard. There's also this diffuser here,
which adds stiffness and rigidity. I think a bigger problem is… I don't
know if you can quite see that but… Yeah, there's actually a pillow within
a pillow here. It's basically two nasal pillows, one wrapped around the other one. And the inside one is really,
really stiff, so overall… do I have this on the right way? Yeah. So overall, I've got this hardness
right here that I don't like, and I've got the stiffness in the nasal
pillows that just wears my nostrils out and I wake up again with nosebleeds and chafing. And look: I'm not saying that having a hard,
rigid mask is bad. I'm saying it's bad for me. My buddy Dr. Jenkins also uses ResMed masks,
and he swears by the stiffness of their masks. He doesn't really like the soft
silicone of the Philips masks. They don't work for him. They work for me. So, again, don't let anybody
tell you what's right for you. You can look for advice, you
can look for descriptions, but I read so many comments on Facebook, where
people are saying, "Hey, I'm having trouble breathing out of my nose, I'm having
trouble keeping my mouth closed." And there'll be like 49 dudes
-- it's always dudes – saying, "Oh, get a full face mask! Get a full face mask!" Well, they're just not right
for everybody, and in fact I kind of think they're not right for,
like, I don't know, most people. Because most people can learn to
breathe completely out of their noses. Maybe not all day, but certainly
while they're wearing their CPAPs. So, let's summarize here. What are the things that I wish I'd known
about CPAP masks before I started CPAP therapy? A Number One: there are all different
kinds of shapes and sizes of masks, and chances are really good you'll be
able to find one that works for you. Number Two: at most DMEs, with most
masks, you have 30 days to say, "Hey, hi, this this doesn't work for
me. Can I try something else?" Number Three: at least if you limit yourself
to Philips and ResMed, the masks are modular, so if you have a full face mask and you decide you
want to try nasal pillows or a nasal cushion, it's going to cost you, let's say, 25 to 30 dollars
to just change it into a different kind of mask. You have to be careful if you're buying on Amazon,
because there are some counterfeit sellers. But if you do your research and sort of read
the reviews and find people who say, "Oh, this seller works for me…" I think CPAPSupplyUSA is the one that I
typically use when I'm buying from Amazon, they've always been legit. But yeah, you can swap one of these masks
for a different type of mask entirely for not a lot of money. Uh, what number am I up to now? I don't know
I'm just gonna count when I'm doing the editing and I'm just gonna say "next
thing" now if that's okay. So, next thing: find a technique that
works for you to keep your mouth closed. Maybe it's a boil-and-bite mouthguard. Maybe it's
a soft cervical collar. Maybe it's a chinstrap. Maybe, like worked for me, it's Mewing. I
don't know. But don't let anybody tell you, "This is the only way that works." As has been demonstrated in my family, what works for one person does not work for
the other. Find the right solution for you. Perhaps most importantly: don't give up. There are so many different
kinds of masks out there. I have barely scratched the surface here, and
I'm mostly sticking to the Philips DreamWear and the ResMed masks, because they're the
most common, they're the easiest to find, generally the most affordable, too. But there are so many different kinds of masks. There are masks with memory foam instead of
silicone. They're a little harder to clean, you have to replace them a little more.
But that's all that works for some people. There are masks that are like
cloth bags. It's just an inflatable cloth balloon thing that fits over your face.
That's the only thing that works for some people. There's this thing called the Bleep
DreamPort, which is not a mask at all. They're basically like two big Band-Aids that
you stick to your nose, and the nasal pillow kind of port thing goes right in your nostrils,
and you got an elephant trunk coming off. Speaking of elephant trunks, there
are a lot of masks that have them. What do I mean by "elephant trunk"? The hose comes off the front of the
mask instead of the top of the head. You know, it's funny. My
dad just had to change DMEs, and when he was telling them what he
wanted and everything, they were like, "No, you don't want the mask that connects at the
top of your head. Those are just terrible." He was like, "Yeah, I do.
I love that kind of mask!" DMEs and sleep doctors, it turns out,
are really, really bad about this. They're bad about saying, "Hey, I think this is
what works, so I'm going to force this upon you." But you've got options. Exercise them. Fisher & Paykel makes these really cool masks that
have a stabilization bar that goes right here, and there's a strap, and what that
does is, it keeps your mask from falling off to the side when you're using it. That's great! There are literally masks
that cover your entire face! I don't know why those aren't called
full face masks, but whatever. Maybe they are, but typically speaking, the
full face mask is either one that goes like this or like this. So, the terminology can be confusing. Anyway, if you're just getting started
with CPAP, I hope you learned something. I hope I helped you out on your journey, and I
hope maybe you don't make the same mistakes I did. Anyway, thanks for joining me
and I'll see you next week!
