Oracle 452 Lessons Updated

This is an update of a prior post from some time ago.
It needed some current information changes.
https://www.cpap.com/productpage/fisher ... -mask.html

Thank you.

Here are some lessons I learned on the use of this oral only mask made by Fisher-Paykel.

01) The mask needs to be adjusted carefully to avoid being too tight and making your lips feel lousy in the morning. There is a small adjuster ring that allows you to adjust the distance between the inner mask (the part in your mouth) and the outer mask (the part that presses on your face.) The pressure between the two has nothing to do with leaks but everything to do with comfort. The inner piece called the Snap Flap I think, seals against leaks by being pushed by air pressure against the inside of the lips. The outer flap keeps the mask positioned and correctly aligned. Try to make the adjusted distance just close enough to provide a snug fit and not so close that you lips are overly compressed. If you wake up in the morning and there are compression marks on your face, you have the ring adjusted much to close.

02) The mask is an oral mask only – there is no involvement with your nose. F-P supplies some nose plugs so that you don’t blow air out of your nose at night. They indicate that over time, you can learn not to use them. Just recently, this started working for me. I experimented with all three sizes of plugs and nothing was comfortable and worked well. My nose was sore in the morning. So … I tried swimmers nose clips and acoustic ear plugs and some other stuff without success. In desperation, I dropped by my doc’s office and asked if I could have a couple of the nose clips he uses when testing for lung capacity. They worked like a charm and I have been using them ever since.

It has been reported that some people experience some irritation with the pads on this nose clip. I never did but my suggestion to cope with this problem is to carefully clean the foam pads to remove any accumulation of debris and skin oils. Cleansing your nose and mouth area before bed time will likely also help.

The arms of the nose clip may lose their spring after a long period of use. In this case, slip a rubber band around the arms tight enough to bring the foam pieces together. Leave it this way during the day and remove the rubber band at night. Adding a rubber band and using it that way is really too much pressure.
If the clip is too tight, then place a small block between the foam pads during the day (perhaps a half inch thick) to cause the arms to relax just a little. Adjustments like these provide for increased comfort.

After some period of use, the foam pad gets loose and can come off at night. I just put a drop of Gorilla Glue on the post where the pad fits and replaced the pad. Now they never come loose. When asked for a sample to see how they work, I already have applied the glue before sending them out.

Here is a source:
Spirometer Nose Clip Source
If this links ever gets broken, please send me a PM. In the mean time, you can search for "Disposable Spirometer Nose Clips".
While my supply lasts, just drop me a PM with your snail mail address, and I'll snd you a couple.

03) This mask in an oral appliance. It’s in your mouth for several hours each day. That means wash it every day when you get up. Just like brushing your teeth in the morning. Facial masks can go a while between cleaning – not this mask --- every day!

Use a mild soap and rinse thoroughly!! I currently use just running hot water and rub until the mask squeaks.

The inner flap just pulls off of the outer flap and mouthpiece. The swivel diffuser snaps out of the outer flap assembly. Do not remove the adjuster ring, it’s a real PITA to get back on and adjusted correctly. Only wash the inner flap and the outer mouthpiece assembly. If you wash the swivel diffuser, you should remove the diffusing filter and replace it after all is done. I have recently looked at the recommendations of F-P on cleaning the Oracle 2 mask. They recommend mild soap and water and a moderate temperature not to exceed 10 minutes immersion. In addition, they recommend sterilizing the mask using an antiseptic mouth wash diluted about 15 to 1 with warm water. Again, not to exceed 10 minutes immersion. The individual parts should be left to dry and only assembled when they are completely dry - about 1 to 2 hours later depending on your humidity. If you don't get the parts actually dry, the little water that remains between the inner flap and the hard plastic mouth piece won't dry by itself. This will result in tiny bubbles when you use the mask. My Respironics machines recognizes those bubble sounds and categorizes them as vibratory snoring.

When re-installing the inner flap, be careful to make sure that the little ears are correctly seated within the inner flap. If they are not fully seated, some leaking will occur.

I find that sometimes the "ears" on the hard mouthpiece that slip into the inner flap, don't always get in just right. If you hold the ends of the inner flap and pull them directly apart, the "ears" will snap into place.

04) F-P supplies a head piece (a strap) that goes from the mask around your neck to hold everything in place. They call it optional and I didn’t use it at all. However, if your pressure is higher than mine (IPAP max 19 EPAP min 15.5) then you may need to use the strap. My machine went nuts a couple of times and ramped the pressure above 20 and the mask leaked like a sieve and blew off once, literally. Philips-Respironics replaced the machine after this happened again.

The strap will prevent that problem. The second problem you might have is your cheeks puffing out. That’s a bummer and feels strange. The strap goes directly from the edge of the outer flap, across the cheek at about the tooth line and presses in so that won’t happen.

in getting ready for my ASV machine, Respironics 960 AutoSV Advanced, I started using the strap loosely and started using a very soft cervical collar. These two things stopped all major leaks.

05) Cleaning the area of the face on which the outer flap rests helps a great deal with controlling leaking.

06) Last but not least, this mask is a miracle for me because I have severe claustrophobia and can’t wear any of the full face or nasal masks.

07) On the issue of dry mouth:

Oral masks of any type are blowing air into the throat and not through the nasal passages. The body is designed to take air in through the nose and not through the mouth. The nose has special structures that help increase the humidity of the air we breathe and to not themselves dry out. Unfortunately, the mouth doesn't. So it takes extra effort to make sure the air coming in through the mouth is wet enough to combat this problem.

In addition, because of the very high humidity level you will be using, rainout in your hose and mask may be a problem. I added a wrap for my hose that provides extra insulation so the water doesn't precipitate out before it gets to me. You can get one online or at your DME for about $15 USD. This won't be a problem with the new 60 series heated hoses.

Set your humidifier setting to the highest it will go. If that doesn't solve the problem completely, get an evaporative humidifier from Walmart, etc. and have that going on all night. Don't get the heated one, they use too much electricity nor get one of the "Cool Mist" ones because they spray water into the air together with the minerals that are in the water. When the water evaporates, the minerals precipitate into a fine white powder that gets everywhere and into the filters of your CPAP machine. Because this powder is so fine, I suspect it gets through the original gray machine filter and directly into your lungs. I think the ultrafine filters will stop it but why take a chance.

I have started using a second heated humidifier (F-P HC 150) in series with the PR Heated Humidifier and a Hybernite heated hose to supply enough humidity to last the whole night. My current rate of water consumption is about 70 mL per hour and the PR only holds 325 mL. Your mileage will vary as to how much you need. Putting another one in series disables the PR heated hose, thus the Hybernite hose. With my settings, the PR tank is empty in the morning and the F-P tank is almost empty.
EDIT:

Link to external humidifier design:
Here is my setup to solve this problem

08) Filters - I use the gray filter that comes with the machine, the ultrafine filter that now comes with it, and a bacterial filter that fits between the CPAP hose and the short hose on the mask. EDIT: because of the high humidity level, the bacterial filter get soaking wet and I discontinued use of it. These three block most everything. I change them once a month. For a while, you should check each week as the dust and pollen situation in your house may be different from in mine. As the car salesman once said, "Mileage may vary."

09) Chin Straps: the manufacturer of this mask advises not to use a chin strap with this mask. A chin strap puts pressure on the jaw and pushes it backwards. This movement, even though very small, increases the occurrence of obstructive events and then requires higher pressures to correct. The solution to leaks in the middle of the night with this mask caused by jaw drop as you get fully relaxed is the use of a soft cervical collar. A cervical collar provides support for the jaw without putting any pressure to move it in any direction. Since using a soft cervical collar, my unintentional leak rate has hovered around zero. Over time the cervical collars do lose their ability to hold the jaw up and do need to be replaced. You'll know because the leak rate will increase.

Thanks JDS for a very thoughtful insight into this mask. I'm sure that those individuals trying this mask will benefit greatly from your wisdom!

There have been some recent interest in the Oracle mask so I made some edits on this post to include a link to the humidifier solution and some slight editing.