Frequently Asked Questions

Equipment

BiPAP

What is a BiPAP?

A BiPAP is a Bi-Level Positive Airway Pressure machine by Respironics. The BiPAP provides higher pressure for inhalation and lower pressure for exhalation. BiPAPs are often prescribed for individuals who have tried a CPAP machine and could not tolerate it.

How do CPAPs and BiPAPs differ?

The primary difference between CPAPs and BiPAPs is that CPAPs provide a single continuous level of pressure during both inhalation and exhalation. A BiPAP provides higher pressure for inhalation and lower pressure for exhalation. BiPAPs are often prescribed for individuals who have tried a CPAP machine and could not tolerate it.

How can I get a BiPAP?

BiPAPs are available by prescription only. If you think you will benefit from BiPAP therapy, please consult your physician.

Do I need a prescription for a BiPAP?

Yes. A prescription is required for all sleep therapy equipment and masks.

BiPAP ST

Do you carry BiPAP STs?

Peak Sleep does not carry or service BiPAP STs.

Cleaning & Replacement

Why do filters become dirty?

The filter in your CPAP machine and in some masks needs to be changed regularly and immediately if they become significantly discolored. The filters get dirty with time as the air we are breathing is not 100% clean. When the air is drawn in the back of the machine, the filter traps dirt and dust particles so you do not breathe them in, thus discoloring the filter.

How often do I need to clean my equipment?

Please follow the manufacturer’s guidelines for cleaning your equipment. These guidelines were included with your equipment and may also be found on the Equipment page of this website.We recommend the following cleaning schedule:Tubing – Weekly – Wash, Rinse Well, Air DrySponge-type Filters – Weekly – Wash and Rinse WellDisposable Filters – Every 2 weeks – Discard and ReplaceHumidification Chamber – Daily – Empty and Air Dry

How often should I replace my filters?

Please follow the manufacturer’s guidelines for replacing your filters These guidelines were included with your equipment and may also be found on the Equipment page of this website.Based on Medicare standards, we recommend the following replacement schedule:Disposable Filters – Replace every 2 weeksReusable Sponge-type Filters – Replace every 6 months

How often should I replace my humidifier chamber?

Please follow the manufacturer’s guidelines for replacing your equipment. These guidelines were included with your equipment and may also be found on the Equipment page of this website.Based on Medicare standards, we recommend replacing your humidification chamber every 6 months.

How often do I need to clean my mask?

Please follow the manufacturer’s guidelines for cleaning your mask. These guidelines were included with your mask and may also be found on the Mask page of this website.We recommend washing your mask weekly in warm, soapy water using a mild dish soap; rinse well in warm water; air dry.

Why should I replace my mask?

Masks and other supplies should be replaced on a regular basis to ensure that the mask is clean and is in good shape. It is critical to your therapy that your mask fits well. Dirt, debris or mask deterioration may compromise your therapy.

How often should I replace my mask?

Please follow the manufacturer’s guidelines for replacing your mask. These guidelines were included with your mask and may also be found on the Mask page of this website.Based on Medicare standards, we recommend the following replacement schedule:Mask cushions or nasal pillows – Replace Every MonthMask – Replace Every 3 monthsHeadgear and Chinstrap – Replace Every 6 months

CPAP

What is CPAP?

CPAP stands for Continuous Positive Airway Pressure, the most widely prescribed treatment for Obstructive Sleep Apnea.

How does CPAP work?

Using a steady stream of pressurized air delivered by a specially fitted mask through your nose, CPAP prevents the uvula and the tissues around the soft palate from obstructing your airway.

What are the elements of a CPAP system?

A CPAP system consists of a blower, tubing, and a specially fitted mask and head gear, all designed to provide a continuous stream of pressurized air and ensure normal breathing and sleep. In addition, a heated humidifier unit may be integrated into the system to warm and moisten the pressurized air flow and enhance patient comfort. The system may also include a supplemental O2 supply to provide an enhanced flow of oxygen.

Do I need a prescription for a CPAP?

Yes. A prescription is required for all sleep therapy equipment and masks.

Features

Do you have SmartCards?

Yes. If your physician requires a SmartCard, we can provide a machine with a SmartCard.

What is C-Flex?

C-Flex is a setting on most Respironics M-Series CPAPs, which reduces the level of pressure during exhalation.

What is Ramp?

Ramp is a feature on most CPAPs that slowly increase the pressure until it reaches the prescribed setting. Using the ramp feature may help ease you into your therapy as you fall asleep. You can press the ramp button as many times as necessary.

Heated Humidifier

Do I need to use a heated humidifier with my CPAP?

It is recommended that every patient uses heated humidification in line with their CPAP machine as it may make treatment more comfortable. CPAP therapy can at times overwhelm the nasal airways affecting its ability of adding heat and moisture to the incoming air. The use of a heated humidifier will lessen any airway irritation that causes unpleasant nose and throat symptoms.

I live in a humid environment – do I still need to use heated humidification?

Often houses in humid environments have air conditioning systems that reduce the temperature and humidity of the air. The only way to sufficiently heat and humidify the air from your CPAP is to use a heated humidifier.

What level of heated humidity should I use?

The right level of humidity depends on your preference. We recommend starting at a level of 1 and increasing as necessary for comfort.

How do I prevent water from collecting in my CPAP tube?

Water collecting in your tube is a result of condensation formed as the room temperature decreases during the night. Condensation in the delivery tube will cause tube vibrations and disruptive gurgling noises as the air passes through which can disrupt your sleep. More importantly condensation can affect your therapy by causing an unstable mask pressure. It is therefore important to prevent condensation forming.

Can germs pass from the humidifier to me?

No, using a heated humidifier in line with your CPAP therapy will not cause you to get sick or give you germs. Most heated humidifiers are passover humidifiers that do not produce aerosols. Moisture is added in the form of water vapor. Water vapor is very small which means it is impossible for water vapor to transport bacteria or viruses. The figure below clearly demonstrates the size of water vapor, bacteria and viruses. The important thing to remember is that all consumable equipment (especially your mask) needs to be cleaned and replaced thoroughly on a regular basis to ensure it does not become a desirable environment for bacterium to live and grow.

Do I need to use distilled water in the chamber?

It is strongly recommended that you use distilled water in your humidification chamber as it is free of minerals and will prolong its life and prevent mineral buildup on the inside making it appear dirty. Distilled water is “pure” and therefore the most suitable to use. However, the use of normal tap water will not harm you, but may cause your chamber to deteriorate at a rate faster than expected. (Note: if your chamber begins to leak replace it immediately)

Do I need to remove the humidification chamber from the CPAP when filling it with water?

Yes, for your safety the humidification chamber should be removed for filling and then re-inserted onto the heater-plate. It should also be removed for emptying.

Do I need a prescription for a Heated Humidifier

Yes. A prescription is required for all sleep therapy equipment and masks.

What is a Heated Humidifier?

The heated humidifier is an add-on to your CPAP or BiPAP. The heated humidifier uses a water chamber in conjunction with a heater plate, which warms the water that is delivered. Heated humidification may increase your comfort and adherence to your therapy.

Pressure Change

How do I change the pressure on my CPAP/Bi-PAP?

The pressure setting on your CPAP or BiPAP is prescribed by your physician. Usually, this pressure was determined to be your ideal pressure setting during the “Titration” portion of your sleep study. If you think that the pressure is incorrect, we will need to get a new prescription from your doctor. Once we have the new prescription, Peak Sleep will either send you a new Smart Card with the updated setting or a replacement machine.

Troubleshoot

My CPAP/BiPAP is not working properly.

If your CPAP or BiPAP is not working properly, you may troubleshoot from the equipment page or contact us and we will help troubleshoot.

My mask is broken, can I get a replacement?

If your mask is broken, please contact Peak Sleep at (866) 908-8222.

Mouth Leak

Mouth leak occurs when someone using nasal CPAP therapy attempts to breathe out of their mouth and the pressurized air from CPAP escapes through the mouth. The result is a high unidirectional flow of air through the nose and out of the mouth, which can disrupt sleep and cause excessive drying of the airways.To help to reduce mouth leak and its side effects, we recommend using a heated humidifier. Research has shown that heated humidification can reduce the incidence of mouth leak by half. Heated humidification also alleviates upper airway drying caused by mouth leak.

Gurgling or Condensation in Tube

Condensation can accumulate in your tubing as a result of the temperature difference between the inside of the delivery tube and your room. Condensation can cause disruptive gurgling noises and mask pressure instability that adversely affects your therapy. Try turning down your humidifier setting and to keep your delivery tube under your bed-covers.

Skin Abasions/ Forehead Dents

Damage to the skin on the nasal bridge or forehead is caused from excessive tightening of your mask. Loosen the straps on your mask. You should not have to tighten your mask excessively to prevent leaks into or around the eyes. If your mask is not sealing well it may need replacing.

 

General

Traveling

Can I travel with my CPAP?

You should always take your CPAP or BiPAP with you when traveling. If you are traveling out of the country, you will still need to use the correct plug adaptor to fit the power outlet in the country you are visiting.

Respiratory Therapist

Can I talk to a Respiratory Therapist?

As part of Peak Sleep’s superior service, Respiratory Therapists (RTs) are available to help you with any aspect of your therapy Monday through Saturday. Our RTs are truly sleep therapy experts. They are also on call for emergencies.

 

Insurance

Billing

Do you bill my insurance?

Yes. Peak Sleep will take care of all the paperwork necessary to bill your insurance.

Why doesn’t the website show any pricing information?

peaksleep.com does not show pricing information to avoid confusion. Different insurance plans vary widely in their coverage and deductibles. We bill every insurance the same amount (as required by Medicare). The amount that patients are responsible for varies so dramatically that we do not want to mislead patients either way. If you have questions about the pricing and your responsibility, please call us at (866) 908-8222.

Coverage

What does my insurance cover?

Every insurance plan has different benefits and deductibles. Your coverage will depend upon your benefits and where you are in your yearly deductibles. If you would like to know the details of your coverage, please call us at (866) 908-8222. We will contact your insurance to determine your current benefits.

What does my insurance cover?

Every insurance plan has different benefits and deductibles. Your coverage and the amount for which you are responsible depends upon your benefits and where you are in your yearly deductibles. If you would like to know the details of your insurance coverage and your responsibility please call us at (866) 908-8222. We will contact your insurance to determine your current benefits.

Do you take my insurance?

Peak Sleep accepts most major insurances, including Medicare. We are always adding new insurance plans to our list. Please call us at 866-876-2727 to confirm that Peak Sleep can bill your insurance for you.

What insurances do you take?

Peak Sleep accepts a wide range of insurances, including Medicare. We are always adding new insurance plans to our list. Please call us at 866-876-2727 to confirm that Peak Sleep can bill your insurance for you.

Eligibility

How do I know what supplies I am eligible for?

When you go to the re-order supplies page, the chart at the bottom shows the replacement schedule accepted by Medicare and most major insurances.

Update

My insurance has changed.

If your insurance has changed, please give us a call at (866) 908-8222. We will be happy to update it in our system.

 

Mask

Availability

peaksleep.com does not have the mask that I use. Can I still order it from you?

Peak Sleep carries a wide variety of masks. If you do not see your mask on peaksleep.com, please call us at (866) 876-2727. Our care team will determine if we have the mask in stock or if we can get it for you. If we do not carry your mask, our team will be able to recommend a comparable (or possibly better) mask for you.

Cleaning & Replacement

Why do filters become dirty?

The filter in your CPAP machine and in some masks needs to be changed regularly and immediately if they become significantly discolored. The filters get dirty with time as the air we are breathing is not 100% clean. When the air is drawn in the back of the machine, the filter traps dirt and dust particles so you do not breathe them in, thus discoloring the filter.

How often do I need to clean my equipment?

Please follow the manufacturer’s guidelines for cleaning your equipment. These guidelines were included with your equipment and may also be found on the Equipment page of this website.We recommend the following cleaning schedule:Tubing – Weekly – Wash, Rinse Well, Air DrySponge-type Filters – Weekly – Wash and Rinse WellDisposable Filters – Every 2 weeks – Discard and ReplaceHumidification Chamber – Daily – Empty and Air Dry

How often should I replace my filters?

Please follow the manufacturer’s guidelines for replacing your filters These guidelines were included with your equipment and may also be found on the Equipment page of this website.Based on Medicare standards, we recommend the following replacement schedule:Disposable Filters – Replace every 2 weeksReusable Sponge-type Filters – Replace every 6 months

How often should I replace my humidifier chamber?

Please follow the manufacturer’s guidelines for replacing your equipment. These guidelines were included with your equipment and may also be found on the Equipment page of this website.Based on Medicare standards, we recommend replacing your humidification chamber every 6 months.

How often do I need to clean my mask?

Please follow the manufacturer’s guidelines for cleaning your mask. These guidelines were included with your mask and may also be found on the Mask page of this website.We recommend washing your mask weekly in warm, soapy water using a mild dish soap; rinse well in warm water; air dry.

Why should I replace my mask?

Masks and other supplies should be replaced on a regular basis to ensure that the mask is clean and is in good shape. It is critical to your therapy that your mask fits well. Dirt, debris or mask deterioration may compromise your therapy.

How often should I replace my mask?

Please follow the manufacturer’s guidelines for replacing your mask. These guidelines were included with your mask and may also be found on the Mask page of this website.Based on Medicare standards, we recommend the following replacement schedule:Mask cushions or nasal pillows – Replace Every MonthMask – Replace Every 3 monthsHeadgear and Chinstrap – Replace Every 6 months

Fitting/ Adjustment

How important is the mask’s fit?

Mask fitting is an essential element of a patient’s success with CPAP therapy. It must fit snugly without any leaks. A proper mask fit helps make CPAP treatment more effective and encourages patients to follow doctors’ orders.

How do I adjust my mask?

Each mask has unique straps for adjustment. Please see the materials specific to your mask for adjustment tips. These materials were provided with your mask or can be found in the Masks section of this website.

New Masks

Can I try a different mask?

We are more than happy to help you find the perfect mask. If you are unhappy with your current mask or simply would like to try something different, you may order the new mask the next time that you are eligible for a new mask and headgear. Your eligibility for any new mask depends on your insurance. If you would like to get a new mask and pay for it out-of-pocket, please call us at (866) 908-8222.

Prescription

Do I need a prescription for a Mask?

Yes. A prescription is required for all sleep therapy equipment and masks.

Troubleshoot

My CPAP/BiPAP is not working properly.

If your CPAP or BiPAP is not working properly, you may troubleshoot from the equipment page or contact us and we will help troubleshoot.

My mask is broken, can I get a replacement?

If your mask is broken, please contact Peak Sleep at (866) 908-8222.

Mouth Leak

Mouth leak occurs when someone using nasal CPAP therapy attempts to breathe out of their mouth and the pressurized air from CPAP escapes through the mouth. The result is a high unidirectional flow of air through the nose and out of the mouth, which can disrupt sleep and cause excessive drying of the airways.To help to reduce mouth leak and its side effects, we recommend using a heated humidifier. Research has shown that heated humidification can reduce the incidence of mouth leak by half. Heated humidification also alleviates upper airway drying caused by mouth leak.

Gurgling or Condensation in Tube

Condensation can accumulate in your tubing as a result of the temperature difference between the inside of the delivery tube and your room. Condensation can cause disruptive gurgling noises and mask pressure instability that adversely affects your therapy. Try turning down your humidifier setting and to keep your delivery tube under your bed-covers.

Skin Abasions/ Forehead Dents

Damage to the skin on the nasal bridge or forehead is caused from excessive tightening of your mask. Loosen the straps on your mask. You should not have to tighten your mask excessively to prevent leaks into or around the eyes. If your mask is not sealing well it may need replacing.

Types

What kinds of masks are used for CPAP?

There are three basic kinds of CPAP masks:–A nasal mask, which covers only the nose. This is the mask used by most CPAP patients. –A full-face mask, which covers both the nose and the mouth. This is effective for patients who breathe mostly through their mouths and those who have allergies affecting their nasal passages.–Nasal Pillows, which are inserted directly into the nostrils. Patients sensitive to enclosed spaces often prefer this option.

 

Sleep Apnea Basics

Definitions

What is apnea?

Apnea is the cessation of airflow (breathing stops) for at least 10 seconds.

What is hypopnea?

Hypopnea is an episode of diminished breathing during sleep, caused by a partial airway obstruction, and resulting in arousal. Usually accompanied by at least a 4% decrease in O2 saturation. Hypopneas may be as serious as apneas and have the same troublesome effects.

What is Central Sleep Apnea?

Central Sleep Apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. It is not unusual for patients to have some Obstructive Sleep Apnea and some Central Sleep Apnea. Patients with Central Sleep Apnea may benefit from oxygen therapy. Please consult your physician.

Diagnosis

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is used to determine your level of daytime sleepiness. High scores on this assessment may indicate a sleep disorder. Click here to take the Epworth Sleepiness Assessment.

What is a Sleep Study or Polysomnography?

Polysomnography is the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep with physician review and report. It must include sleep staging, EEG (electroencephalogram), EOG (electro-oculogram) and EMG (submental electromyogram). It must also include the additional parameters of sleep: airflow, respiratory effort and oxygen saturation. The study may be performed as either a whole night study for diagnosis or as a split night study to diagnose and initially evaluate treatment.

What is a split-night study?

A sleep study in which the first half of the night is used to determine AHI while off CPAP device and second half of night is used to test and titrate CPAP device.

What is titration?

Titration is the process used to determine proper CPAP pressure. Titrations are generally performed in the sleep lab once OSA has been indicated. During this process, patients are fitted with a mask and are put on a CPAP. CPAP pressure is then slowly increased until the patient’s snoring, apnea events and/or arousals are eliminated. The CPAP pressure setting is often 2 points above this threshold.

Obstructive Sleep Apnea

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea, also called OSA, is a disorder in which patients are repeatedly aroused from sleep, though not necessarily to full awakening, because they have stopped breathing for at least 10 seconds. Obstructive Sleep Apnea is a condition with a wide range of serious health effects from fatigue and impaired alertness to a heightened risk of heart disease and stroke.

What is the physical cause of Obstructive Sleep Apnea?

In OSA, the muscles of the soft palate around the base of the tongue and the uvula relax, obstructing the patient’s airway. This obstruction induces hypoxia, a reduced level of oxygen in the blood. The airway obstruction also increases the stress on the heart, elevates blood pressure, and prevents the patient from entering “REM sleep” — the restful and restorative stage of sleep.

How do I know whether I have Obstructive Sleep Apnea?

A medical evaluation is required to diagnose OSA. But symptoms include excessive snoring, significant daytime drowsiness, impaired reaction times, and difficulty maintaining alertness and concentration.

Who typically experiences Obstructive Sleep Apnea?

There is no cut-and-dried profile for OSA patients. But those who experience the condition may share some characteristics: –They maybe be middle-aged or older.–They may appear to be unusually cranky or moody due to fatigue.–They may be heavy snorers.–They may be tobacco smokers or ex-smokers. –They may share some of these physical characteristics: overweight, large (barrel) chests, large necks, heavy jowls, dark circles under their eyes.

Are men more likely to develop Obstructive Sleep Apnea?

Before age 50, men are more likely than women to suffer OSA. Research suggests the risk for women increases after menopause.

How many Americans suffer from Obstructive Sleep Apnea? How many get treatment for it?

The National Heart, Lung, and Blood Institute estimates that 18 million people suffer from OSA in the United States. But only one OSA sufferer in 10 is currently getting treatment.

Is there a connection between obesity and Obstructive Sleep Apnea?

Research shows a strong connection between obesity and OSA. As many as 70 percent of obese people suffer from OSA. Also, OSA worsens with increasing obesity.

Is there a connection between heart disease and Obstructive Sleep Apnea?

OSA is known as a significant risk factor for cardiac disease. Among cardiac patients, between 30 and 50 percent suffer from Obstructive Sleep Apnea. OSA is believed to increase the risk for congestive heart failure by two to three times compared to the general population.

Is there a connection between Obstructive Sleep Apnea and strokes?

Yes: about 60 percent of stroke patients have been found to suffer OSA. Obstructive Sleep Apnea is believed to increase the risk of stroke by one and a half times compared to the general population.

Besides cardiac problems and strokes, what are some of the other health risks associated with Obstructive Sleep Apnea?

OSA has been shown to be a factor in hypertension (high blood pressure). Due to the fatigue associated with the condition, people suffering OSA have been shown to have three times the risk of non-sufferers of car accidents.

How is Obstructive Sleep Apnea treated and managed?

Several methods and techniques have been found effective in the treatment and management of OSA:–Due to its high correlation with obesity, diet and exercise programs are often effective in relieving OSA symptoms.– Continuous Positive Airway Pressure, or CPAP, is the most widely used technique for treating OSA. CPAP works by delivering a constant flow of air to the patient’s airway during sleep, thus preventing abnormal breathing. –For the most severe cases, surgery may be recommended to relieve OSA symptoms.

How Common is OSA?

OSA affects up to 10% of the adult population. An estimated 20 million people in the US alone have OSA and many of them are unaware of their condition. So, if you feel you may have the symptoms, you are not alone.

What are the Symptoms of OSA?

Snoring, a choking sensation during sleep, breathing pauses during sleep, excessive fatigue and morning headaches are all possible symptoms of OSA.

 

Therapy

Sleep

Will I experience a difference in my sleep pattern after beginning Sleep Therapy?

It’s common for Obstructive Sleep Apnea patients beginning CPAP to experience several nights of unusually deep, restful sleep. Patients may only notice the difference on the first night of treatment when sleep often seems intense. Once a patient’s sleep “debt” has been overcome, sleep patterns will return to that of a normal, healthy sleeper.

Usage

How often do I need to use my CPAP/BiPAP?

You and your family should begin to notice immediate improvements once you start your treatment. However it is important to continue using your CPAP every time you sleep in order to maintain the improved quality of life.

When will I start to notice an improvement once I start using CPAP?

You and your family should begin to notice immediate improvements once you start your treatment. However it is important to continue using your CPAP every time you sleep in order to maintain the improved quality of life.

Hospital

If I go into to hospital for any reason should I take my CPAP system with me?

Yes, if you stop using CPAP when you sleep your general well being will deteriorate. If you are having surgery for any reason it is important to inform your surgeon and anesthetist that you use CPAP treatment.

Illness/Cold

Can I still use CPAP if I have a cold?

If you experience a common cold you can still use your CPAP as long as you find breathing comfortable. If you find breathing difficult or you experience a middle ear or sinus infection you should consult your physician before continuing treatment.

Side Effects

Does CPAP Therapy have any physical side effects?

Most patients typically experience some degree of nasal congestion when beginning CPAP therapy. About 10 percent of CPAP users will continue to have some congestion after the first six months of treatment. Heated humidification can be very effective alleviating these conditions.

What other some of the other issues CPAP patients might experience?

If a patient’s therapy calls for higher air pressures, they may be disturbed by the noise from the blower unit, suffer a sense of claustrophobia, or experience heightened nasal irritation. These CPAP side effects can be minimized with appropriate equipment selection and heated humidification. In some cases, patients have been able to reduce the required pressure by having oxygen bled into the CPAP.

Why does my nose and throat become dry and irritated after using CPAP?

One of the key functions of the nose is to warm and moisten (humidify) the air we breathe. CPAP treatment can at times overwhelm the ability of the nose to do this job. Inadequate levels of humidification can result in unpleasant irritation or congestion of the upper airways. If you do not currently have a humidifier with your CPAP call your healthcare provider to arrange one. If you already have a humidifier try turning up the setting a little to increase the heat and moisture.

Troubleshoot

My CPAP/BiPAP is not working properly.

If your CPAP or BiPAP is not working properly, you may troubleshoot from the equipment page or contact us and we will help troubleshoot.

My mask is broken, can I get a replacement?

If your mask is broken, please contact Peak Sleep at (866) 908-8222.

Mouth Leak

Mouth leak occurs when someone using nasal CPAP therapy attempts to breathe out of their mouth and the pressurized air from CPAP escapes through the mouth. The result is a high unidirectional flow of air through the nose and out of the mouth, which can disrupt sleep and cause excessive drying of the airways.To help to reduce mouth leak and its side effects, we recommend using a heated humidifier. Research has shown that heated humidification can reduce the incidence of mouth leak by half. Heated humidification also alleviates upper airway drying caused by mouth leak.

Gurgling or Condensation in Tube

Condensation can accumulate in your tubing as a result of the temperature difference between the inside of the delivery tube and your room. Condensation can cause disruptive gurgling noises and mask pressure instability that adversely affects your therapy. Try turning down your humidifier setting and to keep your delivery tube under your bed-covers.

Skin Abrasions/ Forehead Dents

Damage to the skin on the nasal bridge or forehead is caused from excessive tightening of your mask. Loosen the straps on your mask. You should not have to tighten your mask excessively to prevent leaks into or around the eyes. If your mask is not sealing well it may need replacing.