[Treatment] Are pillows more effective for treating apnea’s than FFM’s.

[Rcgop]

Looking for y’all’s experience when changing mask types. Even when changing brands. I can understand different types/brands will have different leak and fit characteristics but can they give different results given the same pressure and EPR? Of course assuming leaks are under control and the machine is set to the correct mask type.

[SarcasticDave94]

Yes I suppose it's possible, but maybe not by much. The full face has more volume inside the cushion, maybe that'll play into the equations a bit.

[Coffee Man]

Yes, several studies show nasal mask interfaces are more effective. I need to increase my pressure setting to get the same AHI when I use a full task mask compared to nasal.

https://pubmed.ncbi.nlm.nih.gov/29198305/

From the article: Conclusions: The CPAP adherence did not differ between the three different mask interfaces but the residual AHI was lower with NM than ONM and patients reported greater mask comfort, better sleep, and overall preference for a NM. A nasal mask with or without chinstrap should be the first choice for patients with OSA referred for CPAP treatment

[srlevine1]

The answer varies by individual. It is a matter of face geometry, mask fit, physiological factors, and most importantly, pressure.

If a mask is comfortable and delivers sufficient therapy results over a period of time, settings and mask experimentation are voluntary activities that should include long-term record keeping to determine trends, not spot results.

Moreover, if a mask is comfortable, you will probably wear it longer than one that requires re-adjusting.
BTW: If you are going to play mask games, consider the adaptation of alternate headgear. I found that the Respironics headgear used with my ResMed mask gives a slight improvement when I have long hair. I still need to keep my beard trimed.

[Geer1]

Yes mask choice can have a significant effect. I first realized this when helping improve my grandfathers settings/results. With a nasal mask he mouth leaks a lot but with a full face mask he has uncontrollable apnea no matter how settings are adjusted. This phenomenon depends on the individual because it depends on what causes their obstruction/restriction.

There are a couple of reasons that cause nasal masks usually have better effectiveness then a FFM.

1) FFM have a lower strap that can pull chin back/down. For people prone to that issue (some people with positional apnea) this can be a serious issue. I use a FFM and I am aware of the pressure it applies on my lower jaw although I don't think it has an effect on me.

2) Nasal masks only apply pressure to airway/back of tongue which holds airway open. Pressure applied into mouth with a FFM counteracts some of the nasal pressure by pushing back on palate and tongue compressing the airway.

Below is an interesting study I found on the topic. Figure 3 shows the theory supporting reason 2 and Figure 4 shows scope images of the increased restriction when using a FFM on that specific patient.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301251/

On the flip side a FFM can be more effective for some users that struggle with mouth leaks/breathing, nasal congestion etc. I also think I do better with it because of humidity and less venting/noise on my specific mask.

There is a bit of a science behind mask selection but for the most part it is trial and error to find what does and doesn't work.

[clownbell]

It makes sense to me that the results would vary depending on the individual. In my case, I had a lot of leaks with both nasal and FFM no matter what I did. I found the right-for-me pillow mask and the unintentional leaks have virtually disappeared, which means the therapy is more effective. In my case, it is the Fisher & Paykel Brevida. I tried the P10 and DreamWear pillows without success, then the Brevida. There's just something about that F&P sealing technology. Call it Secret Sauce -- but it works for me.

[Rcgop]

Thanks for the good comments and article links. They helped a bunch. It explains what has been happening to me. In my overly zealous quest for perfection, I started raising my pressure, then leaks got to the point I could not stand, then I went to a FFM, then I raised pressure and so on and so on. All the time things got worse. Now I understand pressure can have a negative effect too. 

Here is my last FFM OSCAR chart. 
Pressure=10 EPR=3 w/4 inch collar

   

Here is 1 day later with lower pressure and P-10
Pressure=8 EPR=2 w/3 inch collar

   

[Geer1]

Yeah that looks better, I am guessing mostly due to change back to a nasal mask providing more help with your positional style apnea. I think positional apnea is often an indicator that a FFM may be detrimental at least I have noticed that in a few peoples data now. You do have some periods of obvious flow limitation/snore that might be helped by slightly higher pressure or EPR back to 3 but it is a balancing game to find what works best.

I ended up making similar changes with my grandfather (changing back to nasal mask and limiting his pressure). When the pressure becomes too high its too tough to exhale so he would mouth exhale/leak and wasn't effective, we eventually found a sweet spot to try and maximize pressure/treatment without causing leaks. Didn't per say fully treat his apnea but it gave the best results, like you say sometimes you have to settle for good enough rather than chase perfection and make it worse.

[Rcgop]

Here is more proof that the mask type can make a difference. 

   

I think it is obvious when I lowered the pressure and switched back to the pillows.

[tierdal]

Everyone here is more knowledgeable than I am but I'll tell you this : my pillow had way way way way less leaks than my FFM. It surprised me honestly

I'm talking orders of magnitude more. Like from 30 with pillow to 90+