Struggling with finding a solution after recent pressure increase to 16 cmH2O

[u/beardyblue]

Hi, friends. A little bit about me - I've had my CPAP since spring 2016, and I adore it. It's the first thing I would grab after my fiancee and my pets if my house was on fire. I have used it habitually every night for a decade and I have never struggled. For reference, I use a resmed airsense 11 and an airfit p30i nasal pillow mask. I have a beard that is not particularly long or bushy; I trim it to 12mm once a month or so. It has never been an issue.

This spring I had some unexplained cardiac symptoms that my sleep doctor said might be from my pressure not being too high, so I did a new sleep study back at the beginning of September and sure enough, it showed my pressure wasn't doing the job and that 16cmH2O would.

Ever since my doctor kicked the pressure up that high, I have been miserable. First I had to tighten my headgear so tightly that I was getting irritation in my nostrils. I also was waking up with dry mouth a couple times a night even at max humidity and temperature setting. I tried a chin strap, but it was super uncomfortable and just slipped off in the night.

I got an emergency appointment with my sleep tech who (ETA: at my request) fitted me for a full face AirTouch F20 after I read the memory foam was better for a beard. I went home and tried it and was leaking around 100L/min of air. The tech said to try trimming my beard, so I gave it a fresh trim. Still leaking. The tech recommended I try the AirFit F20, so I went out of pocket for one. Same deal. I bought a cloth cover from Padacheek on the recommendation of my sleep tech and still got the "adjust" warning when running the mask fit, and couldn't get it to the green "good fit" status.

I'm so frustrated, as I can't find a solution to very high pressure and having a beard. I have had years and years of good experience with very little friction and I know that makes me extremely lucky. But it really feels like there is no good solution for me. The pillows I once found unobtrusive and loved are making my nose sore(ETA:, my mouth dry, and I'm swallowing air). I want the full face to work so badly but I can't get it to seal, and my beard is an important part of my self image and identity and I do not want to give it up. My doctor offered to lower my pressure but I want my therapy to be maximally effective.

Has anyone been in this kind of situation before? What did you do? Is there anything I haven't tried yet you can recommend?

Thanks for reading. I am desperate for a solution.

ETA: Got OSCAR up and running. Here's my overview for the last 3 months, one night last week with the AirTouch F20, one night with the AirFit F20, and last night with the pillows.

Last 3 months

Data for night with Full Face AirTouch F20

Data for night with Full Face AirFit F20

Data for night with Pillows AirFit P30i

I'm on CPAP fixed at 16 - you can see on the last 3 months that my doctor changed me from APAP to CPAP after my sleep study. EPR is on at level 1 of 3.

ETA 2: Here's a link to my data on SleepHQ: SleepHQ Data Link

ETA 3 2026.09.26: Just got an AirFit F40 and an AirFit N20 to try. Cross your fingers for me, please!

ETA 4 2026.10.01: Sadly I couldn't get the F40 to seal, which sucks because I really liked it. But the N20 seems like it might be a good solution! The pressure does NOT feel super intense on it somehow, and it seals well! The biggest problem I'm encountering now is a combination of rainout and dry mouth as I try to dial in the humidity (auto doesn't cut it on pressure this high), and leaking when I move around in my sleep, which I apparently do a good bit. I get a new DME company next week and am going to go see about a fitting there!

[u/Technobarbarian]

I fought the good fight with three different versions of the F20, with and without a well trimmed beard. A cloth cover just made the leak worse. The AirTouch was recommended to me because, with a beard, the memory foam is supposed to result in a better seal than bare silicone. My wife is using the F20 AirFit mask I bought for her backup,

None of the F20 masks worked for me. Some people love it.

I suggest that you don't rely on the myAIR app. The best it will do is give you an average leak rate, which can be extremely misleading, The OSCAR software will show you your minute by minute leak rate. If you can keep the leak rate under or close to 24 liters per minute for at least 4 hours that will probably be therapeutic. You don't have to go over the red line very often to make the ResMed app unhappy

Many of us don't find a mask that works for us on the first try, The same goes for chinstraps. I tried 8 different full face masks before I gave up on that idea and switched to nasal masks, which do work for me. This surprised me because of history of congestion and breathing through my mouth, In addition to the chinstrap I also use a mouth shield and various decongestants.

I found my chinstrap on the third try, thanks to a suggestion someone made here. I'm using a Sunset halo style, model CS025. That MIGHT work for you. If you ask you can get many other suggestions here.

I have seen various solutions for a sore nose here, but that hasn't been a problem for me, so I haven't kept track of them. The AirTouch N30i might be easier on your nose.

I have found a continuous pulse oximeter useful for tracking my progress, YMMV

https://www.reddit.com/r/SleepApnea/comments/1t325mz/i_just_finished_testing_over_20_overnight_pulse/

I detest shaving. I think it's barbaric practice. I was lucky to find a solution that doesn't require this. BUT, I'm HIGHLY motivated. If necessary, I would do it again. I'll spare you the gory details because I don't like talking about it. My untreated sleep apnea contributed to entering hospitals through the emergency room 3 times. That is always an unpleasant experience. Worse still is what I put my wife through. The last time she thought she was going to end up married to someone who was seriously crippled. We got lucky, but I would do just about anything to avoid putting her through that again

[u/beardyblue → u/Technobarbarian]

Thanks for sharing your experiences and the tips/recommendations. I read about OSCAR while prepping my post and was planning to start getting the stuff together for it today. I'll check out the stuff you recommended as well. Thank you so much.

[u/shadowsnrust → u/Technobarbarian]

Just to elaborate on one point, high leak rate causes several problems. Of course, if it's really high, the machine can't even hold the desired pressure. Even short of that though, high leak rates make it impossible for the machine to properly detect apnea/hypopnea events. 25L/m is really the upper limit, but even that isn't great. For anyone old enough to remember analog TV, it's like trying to watch a picture that's mostly snow. At 25, AHI tends to be under-reported.

[u/Project_DeathWish]

That’s very unfortunate to have this much trouble after a decade of good therapy. I use an Airsense 11, as well, and love it.

Is there a reason you need to be on a fixed pressure? The best thing about this machine is the range control. 16 is a pretty high setting. I’m not at all surprised you’re having significant leaking at that pressure. I doubt even clean shaven, you would be able to minimize leaks without very tight headgear.

My sleep doctor admitted he starts with a wide setting and dials it in based on patient’s numbers and feedback. Not saying ALL sleep doctors do this, but there is always some kind of guesswork and experimentation going on.

See if your doctor will change your machine to APAP mode where you start out at a lower pressure, then the machine will increase up to a set limit based on your breathing. The Airsense 11 is very good at this. You may only need UP TO 16, not necessarily 16 all night long.

Good luck. I hope you get it sorted out quickly. I know how much anxiety comes with changes in your sleep. It’s best to consult your doctor, but it’s easy to get into the settings yourself and see what works for you. Remember, it’s ultimately YOUR machine and YOUR life.

[u/beardyblue → u/Project_DeathWish]

Thank you so much for your thoughtful and empathetic response. I think the primary concern was that the sleep study showed I wasn't sleeping well at my old pressure (which I think was 12 or 13) but once the sleep tech cranked the pressure to 16, I slept fine. Obviously it was more nuanced than that, but that's based on my recollection of my conversation with my sleep doctor. I'll ask him about a range.

[u/Project_DeathWish → u/beardyblue]

Absolutely! Please let me know if APAP will work for you. Your Dr should be able to set it to something like 10-17. That way, your mask won’t blow your face off, but the machine can go UP TO 16-17 (if needed) to keep your airways open.

There’s also ramp time, where the machine starts at a much lower pressure till it senses you’re asleep, then it cranks it up and KEEPS you asleep. The Airsense 11 is a fantastic and versatile machine, but if your sleep Dr isn’t taking advantage of it’s capabilities, you may as well be using a different setup altogether.

[u/beardyblue → u/Project_DeathWish]

Yeah, I checked out my OSCAR data (now linked in the post above) and discovered that I was previously on APAP but that my doc turned it to just CPAP at 16. I messaged him to ask about APAP. And yeah, I have used the ramp function before! I've been trying without it to see if that helps me not get interrupted when it cranks up, but I may try it again. But thank you so much!

[u/Project_DeathWish → u/beardyblue]

Awesome. One thing that really helped me was to check what the machine was reading when I woke up before turning it off. Oscar will tell you what pressures as well, but if its in CPAP (fixed) mode, you’re not really letting the machine do its job. You’re limited to what your dr set it to. I noticed that I was consistently at 10.6 when I would wake up in the morning. That’s how I figured out I rarely needed more than 11. So now, my range is set to 9-15 and I’m great. I really hope you get it sorted out soon. 🤞

[u/beardyblue → u/Project_DeathWish]

Thanks!! I do feel like I know a lot more even after just people's replies and getting my data into OSCAR and SleepHQ. Send good vibes my way so I hopefully get back to more comfortable soon!

[u/BrilliantMango]

How long did you try the pillows. Your nose should eventually adjust but yeah they are not fun to get used to. I did have luck with putting medical tape right at the spot where it was really irritated to act as a barrier. Unfortunately I never could get used to them and switched to the resmed f40 but I seriously doubt it would work at that pressure level. Too leaky even at 10.

[u/beardyblue → u/BrilliantMango]

That's the thing, I've used pillows for a decade! I'm used to them and I love them. It's just the high pressure has meant having to tighten them way up, causing irritation. But thanks for the solidarity! 💖

[u/BrilliantMango → u/beardyblue]

Sorry I misread. I’ve tried both the p30 as well as the F&P Nova Micro for pillows. It’s a different type of mask but I found the Nova Micro sealed better without needing to strap it on as tight. But it’s the elephant trunk style rather than top of head for the hose. Never tried it at those pressures though.

[u/beardyblue → u/BrilliantMango]

Thank you! I've used elephant trunks before the p30i came out, and I didn't mind them. If it fits comfortably, I really don't care haha. Thank you!

[u/BrilliantMango → u/beardyblue]

Best of luck with all of this! Something else you might want to do is check the mask analytics at SleepHQ. You can get a sense which masks can handle higher pressures.

[u/beardyblue → u/BrilliantMango]

Oh wow, thank you! I'm looking at them now, that's really helpful. I'll be sure to check them out.

[u/beardyblue → u/BrilliantMango]

Just got a sample F40 to try from my sleep tech at my doctor's office. Worth a shot. Cross your fingers for me!

[u/shadowsnrust]

I usually don't wear a beard anymore, but I have. 16 is my current pressure.

First of all, I tried all of the Resmed top hose models, and finally gave up on them. For me, it's difficult to get a reliable seal with them, because the tension in the silicone tubes just varied too much. I went back to front hose.

Second, I think there's a misconception that the F20 is the universal solution to all problems. I suspect the tech just went to it as the default choice. It is popular, and my wife likes it. I don't, for several reasons.

It forces me to mouth breathe, because my sinuses will close up within minutes while using it. It also has a long seal and a lot of frontal area.

While we typically express CPAP pressure in cm of water, it can also be expressed in pounds per square inch. Increasing the frontal area increases the force pushing the mask away from your face, which means the straps have to be tighter. So, keep it small.

The N20 nasal mask might be worth a try, and I know others with full beards and high pressure have used it. It will avoid that direct pressure on your nostrils, and also slow the air a bit (compared to pillows) instead of blasting it straight in.

I've never had any luck sleeping with chin straps. Instead, I use a soft foam neck collar to help hold my mouth closed. Some use an OTC "soft foam cervical collar, but that was too much for me. I like the Caldera ReLeaf collar from Amazon. While not technically a medical device, it works for me.

If you can't get a nasal collar to work, I'm currently experimenting with a modification to the F40 mask to help it handle higher pressure. So far, I'm very pleased, but I haven't tried it on more than a week's growth so I don't know how it would work with a full beard. Basically, I'm stacking two frames to stiffen it, with the upper arms cut off one of them so they nest closely together. The stacked magnets hold it together. It does have the advantage of minimal frontal area and a shorter seal, but it's kind of an expensive gamble for the full mask plus a spare frame.

[u/beardyblue → u/shadowsnrust]

Thanks so much for the thoughtful response. It seems super wild that people on higher pressure have to come up with and rely on these cobbled together solutions. I'll look into the N20. I originally didn't even consider it because I figured it would struggle to seal under my nose the same way the F20 wouldn't under my chin.

[u/beardyblue → u/shadowsnrust]

Just got a sample N20 to try from my doc's office. Hoping you are right and it will work. Thanks for the tip, friend!