Would someone please shut my mouth?

[KSMike]

Some may remember a thread I started about the ongoing problems I've had with the fit of my Ultra Mirage FF. An update is that while I can have a good night with it now and then, it's never repeatable no matter how I try to do all the same things. I was getting less and less sleep, not more.

I finally broke down and bought a 2nd mask, a Swift LT. I had avoided anything other than a FF because I'm a mouth breather when asleep. The Swift was like being let out of jail. It was the closest I've come to feeling "normal" since starting PAP. However, the predictable problem is a severe one - my mouth wants to open. If I could fix that, I think my leak number would go virtually to zero.

Expecting this problem, I also bought a Respironics chin strap, thinking it would be a sure (if undesired) fix. In addition to being (IMO) very difficult to put on in the correct position, it made me hot, it irritated my skin, made it difficult to get the Swift to fit right, and above all - it did nothing to keep my mouth shut. I know some folks use tape and others use various things to "glue" their lips together. Before I resort to those kinds of tactics, are there any other suggestions?

I'm quickly becoming desperate. Realistically, if I can't get this system to become fairly hassle-free soon, I think my days of PAP will be limited. Without it I may snore like a freight train and my health may be compromised, but at least when I wake up I don't feel like I haven't slept in a month.

Any advice greatly appreciated.

[deerhound]

Mike, have you tried the Quattro mask? While I haven't reached perfection, I have been getting more good nights in a row using the quattro than the UMFF.
Dale

[KSMike]

Thanks, Dale. I think the reason I didn't go with the Quattro in the first place was that when I went through the sizing guide it told me there wasn't a size that would fit. Which I found odd, but at the time I just accepted it and moved on.

[sleepyangler]

I use a swift LT along with a pap-cap2 and have a perfectly flat leak line. Not sure if it will work for you but the papcap isn't all that expensive and certainly not too much to pay to keep the benefits of cpap use.

http://www.pur-sleep.com/products/produ ... category=6

[deerhound]

I would love it if there was a quattro size between large and medium. Right now the large is working best for me. Its funny, I have gotten my best night from my UMFF but haven't been able to repeat it. The medium quattro seems to crowd my mouth and it presses my cheek against my back teeth causing some discomfort. The large doesn't cause as much discomfort but it is harder to get and keep a seal. Both quattros seal much better on me than the UMFF. I tried a Liberty for a couple of days but I couldn't keep a seal when I rolled to my side. I'm going to try a Hybrid sometime in the future. I think I can live with the large quattro if it is as good as it gets, however I am searching for better.

Dale

[SleepyInIndy]

When I first started using a chinstrap, I also had a few issues with keeping it in place. As I moved around, it wanted to slip off the top of my head.

I finally decided to try the pap-cap from sleepguy. There were a couple of models that were fairly inexpensive. It looks like a chinaman's cap with a chinstrap that fastens to the cap with velcro. What I have found is that the strap does not try to slide off the top of my head while I sleep. If you are having trouble with the strap staying in place, you might consider it. Depending on how much you 'chinch' it up, it should do a good job of keeping the mouth closed.

Now keeping the tongue in place might be a different issue. Fortunately, I seem to be able to keep the tongue behind the teeth, sealing the airway.

A pap-cap is definitely cheaper than another mask unless your insurance is still paying. YMMV but I do like it. However a good ff mask that works is invaluable for those nights when needed.

John

[ozij]

A non-taping alternative -- viewtopic.php?f=1&t=37039&p=322350&hili ... eg#p322350

O.

[Mtnviewer]

I have the same mouth opening problem and because of that during my initial trial with CPAP, I gave up as air was constantly leaking out of my mouth and chin straps didn't work for me. I now use a dental appliance and I also use the Quattro FF Mask. Occassionally my lips will open to mouth breath, but my jaw at least always stays closed. Either one by itself doesn't seem to work for me. I also on occassion use a soft cervical collar as I still believe that my head droops forward and that too closes the airway. I've also added a piece of stiffer blue foam to it which also helps. I don't seem to get hot with the collar or I sleep with my window open to cool the room. But I've been trying to use the collar less than I did.

I tried the route of the dental appliance alone (the Klearway, though I don't recommend it really) and after much experimentation with it and not as much recuperative sleep as I hoped for, I finally insisted that the orthodontist that invented the Klearway, drill holes into it so that I could sew it tightly shut, as I found it normally allowed me too much movement and even some slight jaw opening. He hated to do it and we had quite a scene in his office about it, but by doing so, it was the best thing that the appliance did for me, though it still didn't eliminate apneas or my fatigue, but reduced both. And that (along with bite change from jaw advancement that I didn't need) is why I found that the Klearway was overkill and WAY too expensive at $2000+, just to keep my jaw closed. After this one wears out, I'll try a cheaper alternative in the $75-150 range if possible.

The combination of the oral appliance and APAP has given me some great nights sleep and some not so great, but always better in combination than with just one or the other by itself.

[kebsa]

I used the basic chinstrap from respironics and i found it was quite ineffective- it kept sliding off apart from anything else! i have opted to try a different type of chin strap- its called the Ruby and is made of neoprene- the only potential problem is that it is not adjustable it comes in small medium and large. i ordered the medium at first but had to return it for the large- it is far more comfortable than the other strap- gradually i seem to be getting used to nose breathing after a lifetime of being a mouth breather. There are quite a few different types of chin straps around and that is an easy option if you find one to suit you

[KSMike]

Good thoughts, all.

When I do the sizing guide for the Quattro, the resulting message is:

"Given your measurements, the Mirage Quattro Full Face CPAP Mask with Headgear is not the ideal mask for you."

Does anyone know how accurate this statement is, or what it's really based on? It's hard to imagine that a large Quattro is much different in size than a large UM.

[rested gal]

KSMike, I don't know about the difference (if any) in the size of a Quattro compared to an Ultra Mirage FF mask. I've used an Ultra Mirage FF, but have not used a Quattro.

I'll say this, however. I've never thought the sizing guide was very good about what masks it "recommends" or leaves out of the "recommendations" after a person puts their info in. The only way to know how accurate it is for you is to actually try a mask it said "nope" to. But, that can be an expensive way to go about finding a mask.

I personally wouldn't be scared away from a mask that was not "recommended" for me by the sizing guide. The guide also doesn't take into consideration the many tweaks or minor fixes people can do to make a mask work better for them.

Just my opinion of course. Each person's results with the sizing guide's accuracy in predictions can be different.

[luke]

I've had the small Quattro for a while now and like it. Lately it's been giving me a pretty good
leak line although about 6 weeks ago I went through a period of time when the leaks were just driving
me crazy ! I never really found out what was causing the leaks then but maybe the mask and my face
were breaking into each other....plus the fact that I've backed down on the pressure to just barely enough
pressure to do it's job.
Then a few weeks ago for the heck of it I ordered a UMFF in small size. I then compared the 2 side by side.
They both had roughly the same vertical dimension but the Quattro is 1/2 inch wider than the UMFF....1/4 on ea side.
The UMFF doesnt seal as well for me. I attribute this to the Quattro (being wider) sits around my cheek bone
and not on top of it. This fact IMHO makes the Quattro more stable on my face and therefore less leaks.
Also....I had a problem with my jaw dropping open on my FFM (either one) and puffing air out both sides
of the lower part of the mask so I wore a chin strap. I did this for a few weeks and decided it was ridiculous
to wear a FFM and a chin strap at the same time. So I went back to just wearing the Quattro with the original
headgear and lo and behold after checking my leak lines I had apparently stopped opening my mouth after falling
asleep. I figured I must have trained myself to keep my mouth shut.

Hope that helps....Bill

[Slinky]

That "basic" Respironics chin strap? Its a white, silky, chin cradle w/a strap similar to headgear material. It comes w/4 small velcro squares. I use one velcro square on both of my mask headgear lower side straps. I can place the velcro square forward or backward of center to where my chin is most comfortable. I leave the velcro squares ON the headgear straps. When I put the chin strap on I then use the other 2 velcro squares to hold the chin strap ends together on top of my head. I find it stabilizes headgear, mask and chin strap for a great fit.

By the way, during my titration they gave me the black chin strap w/the hole for the chin. Tech's comment: "PT STILL OPENS MOUTH WITH CHIN STRAP" (I was probably still cussing out the sleep doctor).

[Sleepy Boy]

Hi Mike: I tried that "measuring system" at home for the Quattro. It also said it wasn't the mask for me. But when I went to the DME, and they measured me-I took a medium. And I really like it, getting the best sleep since I've been on cpap. I had 2 chin straps, tape, dental strips, none worked for me. Not to say that all of that doesn't work--it just didn't work for me.Thanks, Larry

[KSMike]

My thanks to all of you for your thoughts on this!

The chin strap I tried was the Respironics deluxe or premium or whatever it's called - the wide black one with the strap that goes around the back of the head.

Larry's experience with sizing on the Quattro is very surprising to me. I assumed that since the sizing guide said it was not a good fit, that it meant the large wasn't large enough. So now I'm really at a loss as to what it means, and whether I ought to take a chance on it, and what size. This is becoming very expensive, just throwing money and trying additional masks. If I do decide to try the Quattro, what size should I go with, since the sizing guide doesn't want to tell me? (I'm in a large UM.)