Choice of Mask

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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pdeli
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Choice of Mask

Post by pdeli » Sun Jul 06, 2014 4:40 pm

I am mostly using a nasal mask, but dry mouth is a big problem, but not so much when I tape my mouth (most always).

When I use a Full Face Mask with it's greater face contact, it seems to eliminate dry mouth, but my AHI always increases from < 1 to 3-6. I'm planning to set up a mask fitting appointment, but it seems to me that the more face contact, the greater likelihood of discomfort.

So the dilemma here is that more discomfort (FFM) = higher AHI, and and less discomfort (Nasal) equals more very dry mouth. Also, the tape often doesn't completely eliminate dry mouth.

I also think that I get less leaks from a FFM, but why do I care about nasal mask leaks if my AHI is usually < 1?"

Any input here? Thanks.

Phil

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Re: Choice of Mask

Post by Wulfman... » Sun Jul 06, 2014 4:54 pm

pdeli wrote:I am mostly using a nasal mask, but dry mouth is a big problem, but not so much when I tape my mouth (most always).

When I use a Full Face Mask with it's greater face contact, it seems to eliminate dry mouth, but my AHI always increases from < 1 to 3-6. I'm planning to set up a mask fitting appointment, but it seems to me that the more face contact, the greater likelihood of discomfort.

So the dilemma here is that more discomfort (FFM) = higher AHI, and and less discomfort (Nasal) equals more very dry mouth. Also, the tape often doesn't completely eliminate dry mouth.

I also think that I get less leaks from a FFM, but why do I care about nasal mask leaks if my AHI is usually < 1?"

Any input here? Thanks.

Phil
This seems to be a common "predicament" with many users.
Some need to bump their pressure settings a bit when going from nasal to FF masks.
In some cases, if they're losing their therapy air out their mouths, it may skew the data.

Personally, I've always used a full face mask and have never used a nasal mask, so I really can't relate to some of this. But, I've followed many threads on the forum. In nine years using full face masks, my AHI has pretty consistently been below 1.0 and in more recent years, has averaged below 0.5. (shutting off C-Flex also helped)


Den

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Lukie
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Re: Choice of Mask

Post by Lukie » Sun Jul 06, 2014 6:54 pm

I have been in the same predicament as you. A full face mask does leak a bit more than a nasal but with a nasal you lose air out of your mouth if you have helicopter lips like mine even with a chin strap. My AHI is also a bit higher with a full face mask but I have cut it down by wearing a chinstrap and a remzzs with it. If your AHI is less than five the bottom line is which method gives you a better night's sleep. Right now I seem to sleep longer with a full face mask. I wake up fewer times and sleep longer. My AHI is under five so I am not going to be a purist and sacrifice my hours of sleep. The AHI may be higher because I enter into more REM with the full face so that is good.

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pdeli
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Re: Choice of Mask

Post by pdeli » Sun Jul 06, 2014 7:23 pm

Oh yeah, I forgot about chinstraps.

I had told the Res. Therapist about the mouth taping and she went a little nuts. She came up with a "newer" strap, which was pretty tight, both around my chin, but also around my head. So I tried the thing but it did nothing for the mouth breathing mainly, I think, because you can breath through clenched teeth, and you can even talk through clenched teeth (admittedly not particularly well).

The problem I believe is the fact that it is the back of the throat that opens (or collapses?) and lets air in to the mouth. Keeping the mouth closed is only marginally effective I think. In fact, the best idea I think, is to push the lower jaw back, not up. That's what dental appliances do in order to keep the passage clear.

But again, why would I care about leaks with an AHI around 1.0? So also again, which mask?

Phil

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pdeli
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Re: Choice of Mask

Post by pdeli » Sun Jul 06, 2014 7:42 pm

Pardon me, I misspoke. The dental appliance pushes the lower jaw forward, and this keeps the airway open. Just a little backwards from the earlier post.

Phil

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palerider
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Re: Choice of Mask

Post by palerider » Sun Jul 06, 2014 7:46 pm

you could try a simple anti-teeth grinding mouthpiece to help keep your jaw aligned when you using the ffm, instead of letting it push your jaw back.

that should help with the ahi on the ffm

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pdeli
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Re: Choice of Mask

Post by pdeli » Sun Jul 06, 2014 10:01 pm

Thanks, I'll probably wear my dental appliance if and when I get a good fitting Full Face Mask.

What I'd really like to figure out is how to wear the least facial contact mask (nasal pillows), but yet not dry out my mouth.

Do we all basically agree that with an AHI around 1.0, mask leakage is pretty much irrelevant?

Phil

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Pugsy
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Re: Choice of Mask

Post by Pugsy » Mon Jul 07, 2014 7:11 am

pdeli wrote: Do we all basically agree that with an AHI around 1.0, mask leakage is pretty much irrelevant?
No. Leakage is never irrelevant until we know exactly how much leakage we are talking about here.
Are we talking big massive leaks or small leaks? If some big massive leaks...how long do they last in large leak territory.

You have a PR S1 machine....large leak territory is somewhere up around 80 to 90 L/min in terms of Total Leak numbers.
If you stay well below 80 L/min Total leak for the bulk of the night then I would/could say that leaks were irrelevant as long as they don't wake you up.

If you spent half the night with leaks up over 100 L/min with AHI of 1.0...the machine can't do it's sensing job good with leaks that big so the AHI of 1.0 could be simply from the machine being clueless.
Stay out of large leak territory for the bulk of the night and we can trust the AHI because we know the machine is able to do its job sensing and reporting. Short lived large leaks aren't going to put the AHI into much question...it's prolonged time spent in large leak that creates the potential problem with data accuracy.

I mouth breath...sometimes...I know I do and I still use a nasal pillow mask and I don't tape my mouth (used to but it was a PITA and I got lazy) but my time in large leak territory is for the most part very minimal. Some nights I don't go there at all...had a night not long ago where my leak line was nearly flat. Some nights I go into large leak territory but I am only there for maybe 15 minutes. Most nights I will see some mouth breathing evidence but it stays below large leak territory so I don't worry about it.

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CaptPat
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Re: Choice of Mask

Post by CaptPat » Mon Jul 07, 2014 4:48 pm

I started with a nasal mask and after some trial and error ended up with nasal pillows and a ruby adjustable chin strap -- most nights leaks are negligible. I do use a ffm for those congested nights ...

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pdeli
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Re: Choice of Mask

Post by pdeli » Mon Jul 07, 2014 7:14 pm

Pugsy,

I don't know if it makes a difference, but it appears that I have the same machine as you. (Unless your terminology means the same thing.)
I have no explanation as to why this is so confusing, but it is.
Here's what I think I see on the week long data that the RT produced last time on EncorePro. Of 7 days, the minutes in Large leak were zero minutes for 6 days, and one day was 16 minutes. I can't correlate this Encore with the new Sleepyhead 9.6 because the new SH is different from the previous version and this leak business has always sent me in circles.

Going back to this mouth breathing for a moment, when I say mouth breathing, for me that means the back of my throat opens, my mouth opens (a little), and air escapes. Never any inhaling. Is that what we're talking about when we say mouth breathing?

Last night I tried my dental appliance (again) and ended up waking up 4 times (usually Once is max), and an AHI of 2.67. No tape! Something was disruptive, but I don't know exactly what. Before Cpap, the dental appliance was not a problem.

Wednesday I have a "mask fitting" appointment, so maybe i'll be able to get some help there.

Oh yeah, I've never had my tonsils out and I'm wondering if that has any impact in all this.

Phil

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Pugsy
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Re: Choice of Mask

Post by Pugsy » Mon Jul 07, 2014 8:50 pm

pdeli wrote:Here's what I think I see on the week long data that the RT produced last time on EncorePro. Of 7 days, the minutes in Large leak were zero minutes for 6 days, and one day was 16 minutes. I can't correlate this Encore with the new Sleepyhead 9.6 because the new SH is different from the previous version and this leak business has always sent me in circles.
The 6 days with zero minutes in large leak...if leaks (whatever the cause) didn't wake you up...then leaks are a non issue.

16 minutes of large leak on one day...not a big deal either no matter how high it went. The machine can do a decent enough job even in large leak territory until it reaches 100 L/min or so. Even if you did go that high...16 minutes isn't that big of a deal.

You can use Sleepyhead and just eyeball the Total leak line (that would be the top line). You don't have to do fancy calculations. If you don't hit 80 to 90 L/min....you didn't hit large leak territory. If you did and didn't stay there long it still isn't the end of the world.
That's really all I ever do when I want to evaluate the leak line. I just look at the graph and have an idea where large leak territory begins and if I don't reach it I don't bother looking further. If I do happen to reach large leak territory I just eyeball the approximate time I spent there and sort of mentally file it away. I am not going to tape or do the chin strap for 15 minutes of large leak....been there and done that and found out that doing either bothered my sleep quality a lot more than 15 minutes of big leak might bother things.
pdeli wrote:Going back to this mouth breathing for a moment, when I say mouth breathing, for me that means the back of my throat opens, my mouth opens (a little), and air escapes. Never any inhaling. Is that what we're talking about when we say mouth breathing?
Maybe mouth opening would be a better term than mouth breathing...it really doesn't matter if we are inhaling or not...if the mouth opens and air that was supposed to be going down the airway tries to enter the mouth and wants to exit through the lips...therapy pressure can potentially be lost. It isn't always 100% lost though. I did an experiment once and the amount of leak with minor mouth breathing (inhale and exhale) showed up on the leak graph as a 6 L/min leak.

Questions for you? How bad is your leak if you don't tape or do the chin strap or the dental appliance?
Does it wake you up?

I guess I am trying to figure out if whatever mouth opening you are doing is really so bad that you need to do anything. My leak lines aren't real pretty but I sleep well and I don't really care about 10 minutes in large leak territory. I have enough issues not related to OSA that mess with my sleep quality so I sure don't want to add another annoying "thing" to my face just so I have a nice pretty leak line.

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Re: Choice of Mask

Post by robysue » Mon Jul 07, 2014 9:40 pm

pdeli wrote: I don't know if it makes a difference, but it appears that I have the same machine as you. (Unless your terminology means the same thing.)
I have no explanation as to why this is so confusing, but it is.
Here's what I think I see on the week long data that the RT produced last time on EncorePro. Of 7 days, the minutes in Large leak were zero minutes for 6 days, and one day was 16 minutes. I can't correlate this Encore with the new Sleepyhead 9.6 because the new SH is different from the previous version and this leak business has always sent me in circles.
In Sleepy Head 9.6 the PR Large Leaks are EASY to SPOT!!!!

There's a LL line on the event table IF you have a Large Leak scored AND there's a gray background on the Flow Rate curve.

AND there's a LL line in the AHI data in the Daily Data view.

Here's a (marked up) picture of one of my very rare Large Leaks as flagged in Sleepy Head 0.9.6:

Image

And if you click on the Events tag you can even see exactly how long (in seconds) each Large Leak lasted:

Image

Hopefully this will help you pinpoint those Large Leaks more accurately since you are using SleepyHead 0.9.6 now.

In my own opinion the fact that SH 0.9.6 shows the Encore Large Leaks is a HUGE plus!

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Re: Choice of Mask

Post by pdeli » Thu Jul 10, 2014 12:06 pm

Robysue,

God, your stuff is both detailed, helpful, and clear. I should put you an my Christmas card list. Thanks.

In answer to your questions, I tried not taping my mouth last night (with the Nasal Mask, I never use a chin strap, and no dental appliance), and this AM SH reported AHI = 1.20 (Hypopnea = .80, and Flow Limitation = .80, + "Other") and no large leaks. Dry mouth has existed for several days now, so I suspect that something other than open mouth may be involved (general dehydration or Food?). So this is one day in a row! If these numbers continue, I'm finished talking about this.

My wife was a great supporter of the "tape the mouth" routine, and she suggested a 24 hour trial. I didn't go for that of course, or her Duct Tape all around the head suggestion. Women . . . . .

So except when air passing out of my mouth (lips fluttering, etc) wakes me up, I have no sense of any other disturbances. IOW, when I do wake up, I mostly don't know why, so I just go back to sleep.
The previous night with dental appliance, AHI = .76, Large Leak = 3.90 on the "Details" tab, but under "Events", there were 5 events totaling 1106 (1106/60=18.4 Min?), the largest of which was 380. I don't know how to reconcile the 3.9 with 18.4.

So my appointment yesterday at the new sleep lab location for a "FFmask Fitting", resulted my current mask being "OK". The RT offered me a heated humidity attachment, but I declined. She also said that I should raise my Humidity from 2 to 5 for the next 30 days and report back to her on any changes. I had stupidly been trying to ween myself from humidity in anticipation of having to spend a lot of time in Italy looking for distilled water. I ended up with more distilled water than I would ever need, but I never raised the humidity back up. Also, there's a little laziness involved in re-filling the tank.

When I asked the RT about tonsil removal combined with a newer dental appliance as a possible way to escape the C-Pap routine, she set me up with an appointment with the Sleep Lab Doc. Actually, this is what I really wanted in the first place because after that appointment I should end up with the ability to email any questions that I have directly to him (vs my original overloaded Sleep Lab Doc.). Changing Sleep Lab locations is not particularly a straight forward process in this area's Kaiser system.

The RT also said that I was spending too much time on the details, then I asked her if too many Large Leaks would effect the reliability of the AHI readings. "Well, yeah that's true" she replied." I am pretty much done with my self-imposed C-PAP studies, but I just want to really understand what's going on.

Also, I've noticed that two or three times a night I reach Max IPAP pressure. Currently my settings are IPAP = 10.5 and EPAP = 6.0, PS = 4.5. I'm thinking of increasing the IPAP another .5, but I'm concerned about getting air in my stomach again. Any thoughts?

Robysue, I noticed in your last post that on the chart date you went to sleep around 3:30 Am, and ended up with 6 hours sleep. Is this your routine?

Phil
--------------------------------------------------------------------------------

robysue: Questions for you? How bad is your leak if you don't tape or do the chin strap or the dental appliance?
Does it wake you up?

I guess I am trying to figure out if whatever mouth opening you are doing is really so bad that you need to do anything. My leak lines aren't real pretty but I sleep well and I don't really care about 10 minutes in large leak territory. I have enough issues not related to OSA that mess with my sleep quality so I sure don't want to add another annoying "thing" to my face just so I have a nice pretty leak line.

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Re: Choice of Mask

Post by palerider » Thu Jul 10, 2014 12:53 pm

pdeli wrote:My wife was a great supporter of the "tape the mouth" routine, and she suggested a 24 hour trial. I didn't go for that of course, or her Duct Tape all around the head suggestion. Women . . . . .
just be thankful that she hasn't thought to superglue your lips shut while you're asleep... (or sew 'em shut)

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Re: Choice of Mask

Post by pdeli » Sat Jul 12, 2014 3:14 pm

I think I made a great discovery, at least for me.

The RT doesn't like me taping my mouth and she said that I should try increasing the humidifier to max, and try to sleep without the tape.

In the end, I found that for the first two nights, I had absolutely NO dry mouth at all, and my AHI was < 1, and maybe 1 short large leak in one of the two nights. I was amazed and somewhat confused.

I've been struggling with these C-Pap issues for over a year trying to figure things out. My latest challenge was Dry Mouth, which was obviously the result of me allowing air to escape through my mouth during the night.

Last night, the 3rd night, I kind of (almost) woke up, but I was very aware of my mouth opening and air passing out, but I was in a real dead sleep and although I tried to wake up, I couldn't fully wake up. I managed to turn over on one side, and it was then that I realized that whenever I wake up from mouth breathing, I'm always, always, on my back.

I hadn't previously put all that that together, but now I'm pretty sure that if I can stay on my side all night, as I did during the first two no-dry-mouth nights, I can stop chasing my tail on this stuff. So maybe the fun is over! I hope so.

We'll see how things go in the week ahead.

Phil

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