Is there a mouth-only mask?

[McSleepy]

I've used nasal pillows since I started CPAP. The main reasons are: I sleep on my stomach and my pressure is pretty high (trying 13/19cm currently, I've been to 25). Anything large with seals all around, like a full-face mask, would not work for me because of major leaks (even if I could tolerate a large contraption on my face, as I laid my face down on the pillow, the mask would shift and the high pressure would easily break the seal). Also, I've spent long years trying to teach myself not to open my mouth to breathe and it would be quite a departure to go the other way. Is there anything that you know of that will interface directly with the mouth, specifically, going inside the mouth (to keep it open and get the pressurized air directly inside, counteracting my instinct to keep the mouth shut), like a diver's SCUBA mouthpiece? It would also require the nose to be shut close, but that is easily achieved. I'm tempted to try my mouthpiece, but I thought I'd see if there is something specifically designed for the purpose.

McSleepy

[postitnote]

I've used nasal pillows since I started CPAP. The main reasons are: I sleep on my stomach and my pressure is pretty high (trying 13/19cm currently, I've been to 25). Anything large with seals all around, like a full-face mask, would not work for me because of major leaks (even if I could tolerate a large contraption on my face, as I laid my face down on the pillow, the mask would shift and the high pressure would easily break the seal). Also, I've spent long years trying to teach myself not to open my mouth to breathe and it would be quite a departure to go the other way. Is there anything that you know of that will interface directly with the mouth, specifically, going inside the mouth (to keep it open and get the pressurized air directly inside, counteracting my instinct to keep the mouth shut), like a diver's SCUBA mouthpiece? It would also require the nose to be shut close, but that is easily achieved. I'm tempted to try my mouthpiece, but I thought I'd see if there is something specifically designed for the purpose.

McSleepy

Our host has what you are looking for. I remember reading about it. You have to wear nose plus!

[teachcsg]

You could look into the Resmed Liberty mask or the Fisher Paykel Oracle mask. I have only used the oracle mask once or twice on patients and I seem to remember only one of them having success with it. We dont use it much.
We have used the Liberty mask more often (still sparingly) with some success.

Good luck!

[JDS74]

McSleepy,

Yep, the Oracle 452 mask is just as you described. I have been using one for over 5 years.
Check out the link in my signature block and the feel free to PM to me for any follow-up questions.

You should be able to order one on online for about $70 or so. Last ones I purchased were $67.50.

[McSleepy]

Thank you, very much! The Oracle 452 looks exactly like what I was thinking. I will order one and see if I can make it work.
McSleepy

[archangle]

There's info on the Oracle mask in the Useful Links in my signature line below. In theory, you should learn to use it without the nose plugs. It's sort of hard to live with for many people, but does have some advantages.

The Liberty mask is not a mouth only mask, but it might work where the standard full face mask doesn't.

[McSleepy]

I called my DME today and they had an Oracle in stock, so I swung by and picked it up. I'll give it a try tonight since my nose is still plugged up. I'll let you know how it goes.
McSleepy

P.S. My DME is pretty cool. They do have a lot of issues, but they are quite understanding, overall. I have a 2 year-old prescription that pretty much says "any mask he wants", so they made a copy and handed it back to me, no attempts to "appropriate" it. Also, no attempt to sell me other masks or do "fitting", or give me hard times when I tell them I'll be setting my own pressures and stuff. In fact, the technician sais "I can see this ain't your first rodeo", so she just handed me the mask. Same with the machine back in November. She also said she had never seen this mask before and didn't know how to use it, anyway.
MS

[chunkyfrog]

I would imagine the Total Face mask would work, too.

[McSleepy]

I would imagine the Total Face mask would work, too.

No, not at all - as I said in my first post, I can't have a big thing around my face, and I can't rely on my sleep-conscious switch between whatever hole (mouth, nose) is available for breathing.
McSleepy

[McSleepy]

All right, here's my report: the first night was not successful. I didn't quite get to falling asleep and gave up after an hour of trying (took some decongestants and went back to my other mask). The main problem: moisture distribution : too much in one place, too little - in another. I'll explain. And, JDS74, I know you said to ask questions in PM, but if you don't mind, I'd like to keep them open to all others for input. If you do, I'll PM you then.

Since I knew this was going to be a big problem, I started this thread by explaining that I sleep on my stomach, face laying on a soft down pillow. The Oracle 452 seems to be designed for people sleeping on their back. Here's one difference from what I was imagining: the grip of a SCUBA mouthpiece is 4mm thick and you are biting hard on it, so your mouth (jaw) is barely open. The base of the small piece of the Oracle is 11mm and the design does not really encourage you to bite it. The result is your mouth is cracked wide open while using it. Combine that with being mostly upright when diving vs face down while sleeping (for me), and the result is... uncontrollable drooling. I hadn't even fallen asleep and become completely relaxed and my mouth was being stretched wide with no way of stopping the flow of saliva. I had the adjustment ring as tight as possible and the top was probably tight enough to become uncomfortable in the long run, while the bottom (where the saliva would escape) not tight enough. I even tried rotating the elbow to the hose down to see if it was pulling it, but that wasn't it. I didn't want to continue this experiment and was too tired to keep trying. It wasn't just the discomfort of feeling the wetness, I was concerned the saliva might start getting into the exhaust vent.

That was the "too much" moisture part. The "not enough" was the top of my tongue and the roof of my mouth drying out. I had the humidifier cranked up to the max (6.0 / 6.0 on the H5i), to no avail. I can imagine that if you sleep on your back the saliva would not only not go out but may actually get distributed and moisten your mouth, thus alleviating the problems I'm having.

The other problem is pressure. Not really a problem, just another set of variables to make my trial-and-error experimentation rather involved (at the cost of my sleep). I lowered the pressure to 18/13cm but I could have gone lower. Maybe I could have even used the "auto" mode (which I can't use otherwise because I can't set rise time in auto mode, but that's a whole another story). I feel that if I were forced to use this, I could make it work but I'm skeptical about getting good quality sleep on a nightly basis. If I had to sleep on my back for some reason (like last year when I broke my shoulder), this could be much better than my other mask (lowering the pressure would prevent aerophagia in the absence of pressure on my stomach).

I plan to give it another go tonight, even though my congestion seems to be almost resolved now - I should be prepared for next time, as rare as those are for me. Maybe I could also get from you some ideas that I hadn't thought of.

McSleepy

[JDS74]

Sorry the first night didn't go well.
A couple of observations from your description:

The mask adjustment ring is not intended to clamp down tight. That leads to discomfort. You only need to tighten enough to feel snug.

At the pressures you are using, the head gear is entirely optional. Don't tighten more than will allow you to easily slip two or three fingers under it.

This mask doesn't do well if it is being pressed on. How do you avoid that while on your stomach? Does sleeping on your side or back cause problem, pain, etc.?

The humidity issue can be better if you preheat. One study I saw indicated that cpap humidifiers could take as long as 60 minutes to reach the indicated setting. Do you have a hose insulation wrap? Even with a heated hose, it can help.

I don't know what you can do about the saliva issue. For some, it does go away after a while. I never had that problem but I don't stomach sleep.

[McSleepy]

Sorry the first night didn't go well.
A couple of observations from your description:

The mask adjustment ring is not intended to clamp down tight. That leads to discomfort. You only need to tighten enough to feel snug.

At the pressures you are using, the head gear is entirely optional. Don't tighten more than will allow you to easily slip two or three fingers under it.

This mask doesn't do well if it is being pressed on. How do you avoid that while on your stomach? Does sleeping on your side or back cause problem, pain, etc.?

The humidity issue can be better if you preheat. One study I saw indicated that cpap humidifiers could take as long as 60 minutes to reach the indicated setting. Do you have a hose insulation wrap? Even with a heated hose, it can help.

I don't know what you can do about the saliva issue. For some, it does go away after a while. I never had that problem but I don't stomach sleep.

Thanks for the input. I had read your detailed post about how to go about this and I was prepared. I started with the adjustment ring at its loosest since it wasn't allowing any leaks. But then the saliva started leaking and I kept tightening it, which helped temporarily, but as I was relaxing, it would still get around it. Even at its tightest, though, it remained quite loose at the lower end, near my chin. So I did go through just about the whole range.

As for the head gear - I actually kept it very loose, it was barely doing anything. I also read how chin straps should not be worn, so I didn't wear mine, but now I think maybe it could help. I'll consider trying.

I must have had sleep apnea since I was a kid and I got used to sleeping on my stomach - probably to alleviate its effects. Now, I can't fall or stay asleep in any other position. With my regular mask, only a narrow band in the middle of my face is occupied, so a slight tilt of the head (molding the pillow with my hand) helps me maintain a flat prone body position. Then I alternate left and right, and that's all the movement I have. With this mask I need to tilt my head a little more but it's not too bad. The front of the mask is touching the pillow/bed but it is not resting on it. I think it maintains its correct position, not much different than if I were sleeping on my back. It's just gravity - it lets saliva pour down instead of around the mouth and back down the throat. Also, at those pressures, and with my hiatal hernia, the only way I can prevent air continuously entering my stomach is by putting pressure on my stomach. But, since I feel that breathing through the mouth allows much higher volume, I could achieve eth same flow at much lower pressures, so I'd just need to determine what the lowest pressure to keep my air passages open would be necessary. I can go through some of the stages of sleep forcing myself on my back, so that'd be a worthy experiment.

Last night I started the humidifier about an hour before I went to bed. There was not condensation inside the hose, so either the H5i does not deliver enough moisture or my needs are higher. The latter is much more likely - with my 7-liter vital capacity and emptying a whole tank at less than full heat in under 8 hours.

This will be challenge, like most cases discussed on this forum, but I'm not giving up.

McSleepy

[JDS74]

Don't use a chin strap. Fisher-Paykel says its a NO-NO.

The effect is to move your jaw slightly backwards which increases the possibility of additional obstructive events and the need for higher pressure to compensate. If you suffer from aerophagia (swallowing air), this will make that worse. The one night I tried, my OSA events got huge. That's why I did the research and found the Fisher-Paykel reference.

The solution is a soft cervical collar that supports your jaw from below without moving it backwards.
I started out using a towel folded and wrapped around my neck to see if it would work so for tonight, you might try that.
By soft cervical collar I mean really soft not anything like EMS use to immobilize your neck. Depending on your neck size, you might want to start with a 2.5 inch one. To guage whether this width will work for you, lie down on your back and measure the distance from your chin down to the plane of your collar bone.

[pippincat]

I had tried nasal pillow mask only and it caused a sore nose and nose bleeds. I have been using the Mirage Liberty mask ever since. It doesn't really bother your nose as you can use your mouth for majority of therapy. I love that mask. No need to cover your nose as the nasal pillows do that. Super comfortable. I highly recommend it. I have been using it for over 10 years. Good luck!!!

[McSleepy]

Next day update: this time I managed to stay on it for most of the night but it was far from a success. Here's the breakdown.

My nose felt better so I started the night on my nasal-pillow mask, but the nose plugged up after only an hour, so I decided it was time to continue the experiment. I stayed on the Oracle through the next 6.5 hours but I don't think I had much of slow-wave or REM sleep. A couple of things I did to help with the seal: number one, I reduced the pressure drastically. I set the S9 to auto, with EPAP min to 8cm, pressure support of 5cm (left IPAP max at 25cm). I had a few apneas tagged as "obstructive" (one at 38 seconds), of which I am not very convinced (I think it was a central), but I'm not worried about that, I am confident I can eventually adjust them down to zero. Another thing I did was shave the week-long stubble I had going on and put on some lanolin around the mouth - if not to help with the seal, to alleviate any chafing from the saliva. I started with laying on my side, but even at those low pressures I could feel my stomach filling quickly with air, so I turned on my stomach. This time the seal was acceptable and there wasn't any noticeable amount of saliva exiting the mask, although there was some "bubbling" that caused the need to adjust the tightness with the screw. I forgot to mention yesterday that the air was blowing mucous through my nose and last night this was probably the main factor waking me up. I know you pointed out that nose clips is what worked for you and that was my first thought, too. I'll get some of those when I get a chance.

As of now there are two big problems that I'll need to resolve. The first is quite straight-forward and I alluded to it yesterday: after only 6.5 hours at maximum humidification, I woke up to a bone-dry tank, which I had never had before. And I think it had run out much earlier as I felt the dryness much before I got up. I think the H5i is rather small but my problem is that I turn around a large volume of air. I'd need a tank at least twice that size to get me through the night. The house humidity level is at 35% (we have an automated system), recommended by the HVAC people, so unless I turn the house (or large bedroom) into a rainforest, I'll need a different solution.

The second problem is a little more complicated. It stems from the open mouth and position of the device in the jaw. It is just not normal to have the mouth so open. What makes it worse is that what keeps it open is in the middle and is rather thick. As I pointed out earlier, the SCUBA mouthpiece has a 5mm standoff but it is also on the sides - one on side, right behind the canines, so as you bite the piece, your front teeth (incisors) end up even less than 5mm apart, but most importantly, there is no pressure on them. The Oracle piece sits between your incisors and unless you keep your mouth open even wider, it would put pressure on your sensitive incisors and also displace your jaw in whichever way it would naturally move. In my case, with my chin resting on the pillow/mattress, it tends to go in bad ways. I used to have those issues years ago and since then I have used a chin strap and dental guard (that I mold myself) to keep my jaw in check. It would be quite a feat to come up with something that would work together with the Oracle. I know Fisher and Paykel warns against chin straps, but that is because a generic one could easily make things worse, in the general case. Knowing my anatomy, their warning is meaningless because the effects they describe are exactly what the Oracle is causing me right now: my jaw position that works well for my breathing is being disrupted by the Oracle and I will need something to correct that. But I know I'd need a very elaborate dental guard / strap to bring the jaw back to the position that works for me.

So, at this point the Oracle is a work in progress. For those who see this and have not followed the entire thread: I am perfectly fine with my nasal-pillow mask and I have been for a dozen years. I am just trying to develop an alternative option for those days when I cannot breathe through my nose (bad congestion, injury or other factors, like surgery).

McSleepy