My Fitting Guide for the RespCare/Innomed Hybrid mask

[briank]

Here are my observations so far on trying to achieve the optimal fit with this mask. (This is a work in progress.)

There are five crucial surfaces on this mask:
1,2) Left and right nasal pillows
3) Upper lip portion of oral cushion
4) Lower lip portion of oral cushion
5) Chin flap

You will almost certainly have to use a mirror, at least initially, to optimally fit the mask.

You may have to stretch the connecting tab between the nasal pillows (or cut it completely) in order to get the optimal (rotational) angle for your nostrils. Make sure you have inserted the pillows with the connecting tab away from your face. The size lettering for both the connecting tab and oral cushion should be upside down from the wearer's perspective.

Try to use the tall rather than short pillow position if possible in order to reduce the chances of having the pillows pop out or lose seal with jaw movement. You may have better luck positioning the pillows in your nares if you manipulate the second rather than top level of the pillows.

As you place the upper lip seal, pay some attention to keeping the mask level. Otherwise, the chin flap will end up off center and will apply uneven pressure on the left and right sides of the chin.

I think the lower lip seal deserves a lot more attention than it receives. RespCare basically just says to tilt the mask into the upright position after placing the nasal pillows.

If the seal is not firmly against your chin, you may still get a seal from the chin flap, but it will be a poor seal that leaks easily on the sides and tends to feel more "drafty" than normal on your chin.

There seems to be a "sweet spot" that will improve your lip seal, reducing mouth breathing and resulting dry mouth. However, if the seal is placed too low on the chin, jaw movement is much more likely to compromise the nasal pillows.

Making a conscious effort to keep track of where you place the lower lip seal will help you find the position that works best for you.

Because of the resistance of the chin flap on the skin, it should be gently folded toward the front while positioning the lower lip seal rather than trying to simply slide it under your chin. Do not try to force the chin flap too far onto your chin. This will put the top of the mask out too far compared to the bottom and result in top and side leaks (and possibly nasal pillow leaks).

I hope this helps others who are using or evaluating this mask.

PS - See also Rooster's post here viewtopic.php?t=14422

[LinkC]

Thank you, Brian!

I have discovered a few of those observations on my own, and you've given me several more to think about.

I cut the pillows apart to get a good nostril seal. (and still find I have to use an elastic band to pull them toward my face)

[briank]

Rooster likes to remove the chin flap from the oral cushion on his hybrid, so I thought I would add my comments on trying this.

First of all, unlike removing the entire oral cushion from the mask frame, complete removal of the chin strap is irreversible and the only repair is to completely replace the oral cushion.

Before you take that step, you might want to try bending the chin flap toward the front of the mask and taping it there (to the front of the mask) with several pieces of tape. You will probably experience a worse seal if you try wear the mask under pressure this way, as it will tend to twist the bottom mask skirt a bit, but it should give you at least some feeling for the changed dynamics of the mask.

In addition to the obvious effect of removing the chin support, removing the chin flap will allow the mask to move much more freely with your face as your muscle tension or jaw position changes.

My opinion is that whether removing the chin flap helps or hurts your cause will be very dependent on the individual, just as any other aspect of mask selection.

[briank]

I'm actually now moving away from using this mask, as I'm finding it very difficult to get a good seal on a consistent basis.

Shaving before use and frequent cleaning seems to help, but it's still a nuisance.

[LinkC]

But what are your numbers? That's far more important than a perfect seal...

(For the record, my leak rate AND AHI are consistently lower with the Hybrid than with any other interface I've tried.)

[briank]

... and now I'm coming back to it again. It seems to be "in the cards".

The only other FFM that I've been able to wear with anything approaching comfort and a good seal is the F&P Forma (well, that's not strictly true, there was the FitLife, too*), but that also turns out to be in the category of masks that changes the bite alignment between my upper and lower teeth.

The good news is that it appears that leaving the crown strap loose (on the Hybrid) until getting the proper side strap adjustments may be helping to get a better, more stable fit with fewer leaks. I may also have had the headgear too high before when I was having problems.

* The FitLife was OK on my back, but lost seal when side sleeping (as I had expected it would). Furthermore, it was so loud, it was like trying to sleep on the tarmac at O'Hare.