Tale of Two Masks: The Good and the Bad

[gregger]

Hi all,

Just passed 90 days of CPAP therapy, and I'm "allowed" a new mask by my insurance. 

So...I'm revisiting this topic after a couple of months, with a chart from last night. You can see I work up with a stuffy nose at 3:00 and had to switch masks.

- I use a cervical collar or "wedge" cushion to keep my mouth from dropping open and my chin from tucking. I sleep with a very flat cushion.
- I still do well (usually <1 AHI) using the Dreamwear nasal mask
- I still do considerably less well using the Dreamwear full face mask, but need to wear it when my chronic nasal congestion prevents use of the former

I wonder if I should try higher pressure when using the FFM. (Have to mess with settings every time I use it.)

My doctor wonders if, when using the face mask, I am breathing in through both my nose and my mouth, and in the process causing conflict at the back of the soft palate....sort of like a swinging gate not settling in one position. Has anyone tried breathing through mouth only and how would I make that happen?

Thanks for any input! I can provide other data as needed.

- G.

[gregger]

Has anyone tried breathing through mouth only and how would I make that happen?

- G.

Ah, I remembered and found this post from Paperboy, from May:

This is what I have discovered. About 50% of patients can’t use a nose or nose/mouth mask.  The problem is often that the air gets pushed in from the mask thru the nose, but then comes out the mouth (open mouth sleeper), often with a lot of mask leaks.  This is because the soft palate in some people is floppy at the back of their throats.  As long as they remain upright, the baggy palate remains down towards the tongue and passage to the nasal cavity remains open.  But upon reclining, the palate falls towards the back of the throat and acts like a flap valve. Air comes in from the nose, but then the palate blocks air flow out thru the nose and forces the mouth open when sleeping. If you have this condition you need to use a mouth mask called the Oracle 452 Oral CPAP Mask. 

Any other thoughts on this, and other ways to get better therapy with the FFM?

Thank you for your input.

[Walla Walla]

If the only reason your using a full face mask is because your nose gets stuffed up I'd try a pillow mask. I've used the Dreamwear nasal and full face mask before and also have gotten stuffy noses with each. However when using a Resmed P10 nasal pillow mask I've never had a stuffy nose. The air pressure is more direct and seems to keep the airway open. I would highly recommend trying the Resmed Airfit P10.

[gregger]

If the only reason your using a full face mask is because your nose gets stuffed up I'd try a pillow mask. I've used the Dreamwear nasal and full face mask before and also have gotten stuffy noses with each. However when using a Resmed P10 nasal pillow mask I've never had a stuffy nose. The air pressure is more direct and seems to keep the airway open. I would highly recommend trying the Resmed Airfit P10.

Thanks Walla Walla. 

Is there an adjustment to machine settings you'd make for the FFM? I sleep on my back with the cervical collar; side sleeping always causes leak issues. 

I do have and occasionally use the Dreamwear nasal pillows (I liked the idea of being able to swap out the Dreamwear nasal mask using the same frame). They seem to push through the nasal airways a little better than the nasal mask but are a little fussier on leak management.

You and Sleeprider have both put in well-argued endorsements for the Airfit P10, noting that it better helps to keep nasal passages open. The only negatives I have read about--lack of adjustment on the headgear, poor longevity of elastic on same, lack of swivel on hose connection, and cheap hose--sound minor and "livable."

Not sure how it does better at stenting the nasal airways, as you folks suggest...but I am willing to give it a try!  (It would be one of several steps on the path to accommodating the chronic nasal congestion / rhinitis. I'm also on daily Zyrtec + daily saline rinse + daily Nasonex...which don't seem to do squat, but my ENT says we should fully exhaust these options before considering septoplasty for my "seriously deviated" septum.)

Thanks again.

[Walla Walla]

As far as the FFM I'd increase it 2cm more than you use for the nasal mask. I believe Sleeprider already mentioned that though.

[gregger]

As far as the FFM I'd increase it 2cm more than you use for the nasal mask. I believe Sleeprider already mentioned that though.

Correct, and at that time I increased the max from 12 to 14. Maybe I need more still with the FFM?

[Walla Walla]

Are you still using the collar with the FFM? If not, that may be the reason for the increase in events.

[gregger]

Are you still using the collar with the FFM? If not, that may be the reason for the increase in events.

Yes, as noted, still use the collar on all occasions!

[Crimson Nape]

Disclaimer: First, this is ALL speculation on my part and I have nothing to actually substantiate it.  

You might be experiencing what I call, "the other side of zero".  (Now, let's see if I can explain my last statement coherently.)  You basically tweak your therapy to reduce the AHI's as much as possible, aiming for zero.   At some point (hopefully) this causes your body  to enter a higher state of relaxation.  Entering this state causes your mind and muscles relax even further, which in turn causes an increase in events. Any adjustments of your pressure, to address this AHI increase, only causes discomfort, sleep disruption or quality.  That's when I know I'm on my sweet spot and these values represent me being on "the other side of zero".   I have noticed that most of my "great sleep"  nights were not at or even near zero.   This goes back to the bottom line, "How do you feel?".

I do realize that I might be a couple bubbles out-of-plumb on this.  

[gregger]

Interesting theory, Crimson, and I do understand that there is a point of diminishing returns....that the "sweet spot" is reached after finding the point when a bit too much of pressure disrupts good sleep. 

My essential question is, looking at the chart I posted a few days ago, why are the FFM results not nearly as good as the nasal cushion, and should I use different settings for the FFM. I guess I can experiment. Frankly a pressure increase doesn't seem a likely answer because it may just make the things I don't like about the FFM worse. 

Meanwhile, today I've ordered the AirFit P10 nasal pillow mask. Hopefully it will work better on nights I have nasal congestion, and the rest of the time I can sleep happily with the Dreamwear nasal mask. 

(As to how I feel? That's another whole thread. But yes, I do understand that success in CPAP is not about chasing zero or falling into the thinking that, unless my AHI is consistently less that a 1, I've somehow failed.)