Is there a mouth-only mask?

OK, there is another poster I have corresponded with who experimented with modifying the Oracle mask to deal with the issues you describe.

They cut the piece that is inserted into the mouth. And used the rest of the mask. If you want to try that, I can send you the spare parts.
Send me a PM with a snail mail address and tell me which size internal flap you are using.

BTW, here is a link on increasing the humidifier tank volume. Don't know if the same idea ca apply to your CPAP.

viewtopic.php?f=1&t=103558&st=0&sk=t&sd=a

Thank you, so much! You are very kind. I was already in the middle of designing those solutions. My nasal mask is heavily modified. I also appreciate the offer for the spare parts - I'll send you a PM shortly.
McSleepy

McSleepy wrote:Thank you, so much! You are very kind. I was already in the middle of designing those solutions. My nasal mask is heavily modified. I also appreciate the offer for the spare parts - I'll send you a PM shortly.
McSleepy

I believe I am the one he mentioned, and I am still working on adjustments, but I have it going better. I also learned, even without the modification, that I could get the mask to seal even with the mouthpiece not really inside my mouth. Kind of sticking out in front of my teeth. No the way you are supposed to, but functional. I sleep with my mouth open all night. I am a mouth breather during most of the day too. But I learned a long time ago to barely keep my mouth open as it looks bad while awake to have your mouth hanging open. So, it feels really weird for me to have my jaw open as far as this mask wants. I understand they want the mouth to stay open, but it would have been nice for them to have options as I can breathe through my mouth with my teeth just about closed, no problem. There is also less drooling with the mouth less open.

It takes a bit of work, but it can be modified down. I have no need for the headgear or nasal plugs, so this mask ends up being really bare bones, nothing to mess with. I do have some drooling with it, so I keep a towel nearby. I sleep on my side, so not quite the same as you, but it does tend to leak a little. I do get dry mouth also, but I get that with my full face mask as well. Some days worse than others. I have no idea how to fix that. I keep my humidity at 5 and I can make it all night on one tank of water. MOst of the the time, the dryness isn't bad enough to bother me. It's just something that I am aware of.

Zoocrew:

Nice to hear from you. Glad that things are going well with the mask.
Thanks for the post.

I had forgotten about being able to use the mask with the inner hard mouthpiece outside of the teeth as Zoocrewphoto is doing. That happens to me occasionally but I readjust to the "normal" position. Get a soft cervical collar and leaks will get near zero.

I have enclosed the hard mouth piece, the adjustment ring and a small inner flap. The mouthpiece has been used but I washed it again this morning. The inner flap is unused but I washed it again anyway. You should be good to go without ruining your mask by chopping into it.

In the mail today.

Be careful with how much you remove from the hard mouthpiece as the inner flap will need support.

Thank you, very much! I'll post back here when I get something done.
McSleepy

Here is the promised update. First, thank you, once again, to JDS74 for donating the materials.

To recap, my main problem with the Fisher & Paykel Oracle 452 is that it makes me keep my mouth open, without the possibility to close it temporarily (e.g., to swallow or redistribute saliva), and on top of everything, it props the mouth wide open by pushing the incisor teeth apart. This not only has the potential to displace one's incisors but to allow the jaw to slide the wrong way (could be backward, forward or even sideways), thus causing TMJ pain. I had already dealt with that and the only thing that helped keep my jaw in check was a mouth guard together with a DIY chin strap.

So, I decided to make some modifications to address the above problem and here is the first iteration. I tried it for one night and it wasn't a great success but it certainly was a step forward. The goal here was to remove the part of the mask's mouthpiece that protrudes inside the jaw (behind the teeth line). The Oracle has this rigid base to which an inner soft piece attaches and an outer soft piece is screwed on to keep a tight seal on the lips.

First, I used a coping saw to cut the portion that enters the mouth and then used a rotary tool with a cutter bit to shape it and smooth it out. Here is the result, side-by-side with the unmodified piece:




Notice how the squid-tale shaped pieces are intact, because that is where the soft piece attaches. The latter has a protrusion that goes over the part that I cut out from the rigid piece, so I also cut that portion of it with a pair of small, round-tipped cosmetic scissors:




And here is the same thing as seen from above:




Again, I took special care to avoid cutting into the opening for the squid-tale shaped tabs. When assembled the whole thing looks like this:




... also, a view from above:



... and one more view:



Now, it is probably natural for most to keep the mouth open to breathe but I thought I'd give it a little incentive and also, since I normally use a mouth guard to keep my jaw in check, hope to achieve the same in this situation, so I made a mouth guard in such way that 1) the teeth will rest on it in the back (the strong molars) and 2) by cutting the portion in front of the incisors, I left room for air to enter the mouth:




... and from below:



This is made from regular silicone dental trays, usually sold for tooth-whitening purposes, and are very cheap ($5 for a four-pack at Amazon: http://www.amazon.com/gp/product/B003UP ... UTF8&psc=1). I use hot water (dip quick lest it melts into a blob) and shape with my mouth and fingers. Then, I cut out the front portion, leaving enough to keep the two sides together.

Ideally, this would be part of the mask mouthpiece so it doesn't move around, like this:




With this modification, I can still close my mouth if I need to swallow or swish around the saliva, but the mouth normally stays just open enough to be able to breathe. I set my pressure to min EPAP of 9 cm H20 and pressure support of 5 cm, and still had several obstructive apneas recorded that night (the longest at 30 seconds), but I'm still far from comfortable with it. Even though my nose started out dry when I went to bed, a few hours into the night mucous started blowing through the nose plugs. I have some clips on order, which should address that problem but it seems like the back-pressure promotes the production of mucous because I never have that much. There was also some leaks in the beginning, experienced as "bubbling" in the mouth, between the lips and mouthpiece, but that somehow went away later in the night. That right there tells you that I kept waking up quite often through the night and ended up sleeping no more than 6 hours, but I did catch some dreams, so I definitely had an REM phase. When I woke up there was some minor jaw discomfort, which is not clear whether with longer sleep, several nights in a row, might accumulate to become TMJ pain. I also have a soft cervical collar on order, upon the advice of JDS74, and will see if that would help.

Another issue contributing to the leaks is the fact that I sleep on my stomach and the angle is not optimal. With my nasal mask, I can rest its edge on the pillow/sheets and it will actually support the mask. I have it modified so that the exhaust vent routes the air up above my head. The Oracle's vents are right there and I can't do that (unless I modify it the same way). The problem here is that the Breeze has this arched stem where the hose is routed. With the Oracle, the hose is free to go anywhere it feels like. When I'm on my stomach, with my regular hose support (by the way, the hose of the Oracle is shorter, so I had to deal with that, too), the hose would take various angles and pull the mask, causing leaks. It seems like I may need to find a way to support the hose on my head (same route as the Breeze), which will require something else on my head as the Oracle does not have anything of its own.

There is one other problem that can be overcome but will always be there: the fact that your nose is plugged and the mouth is solidly sealed and you don't have the freedom to do anything other than breathe calmly. This is exacerbated by the actual knowledge of it (psychology!) and, in my case, by my large vital capacity, so if I occasionally need to run a large volume of air, quickly, there is really no way. That night (I'm still not fully recovered from the chest cold) I had to cough in my sleep and I just couldn't inhale or exhale that large amount, so quickly, and I woke up confused and panicked, and could barely recover to remove the strap and the mask, and expectorate the saliva that had entered my trachea. By the way, that strap is necessary in my case - I tried without it but the mouthpiece tends to get blown away, as well as my cheeks stretching from the pressure. Also, the quick-release that seemed to work in the "dry" when I first played with it, isn't so "quick" when you need it.

As far as humidity goes, I left the H5i at 5/6 and the tank lasted the 6 hours but it felt quite dry, albeit, bearable. The H5i is integrated with the S9 such that the tank is fully enclosed by the machine housing, making it very hard to tap for external hoses. It is not so bad as it is, plus it is not impossible to come up with some engineering solution for extending the capacity of the tank, so I don't consider this a major problem.

So far it is not working very well overall but I'm giving it a good effort. When I receive the new nose plugs and collar I'll give it another try and see what is left to make it work. I'll report back here when I have some news.

McSleepy

McSleepy:

That is a tremendous job of modification to meet your needs. Thanks for posting the images of what you did.

Two comments:

1) On one end of the head gear is a small loop. I am right handed so I always place this look on the right side. A left-handed person might choose to have the loop on the left side. To remove the mask quickly, just hook a finger in the loop and pull down. It will release immediately.

2) It may be that, if all else fails, sleeping on your side will turn out to be necessary. If the intent is to use this mask only during periods of congestion, that may not be too much of a burden.

While this is the only mask I use, if anyone can breathe through their nose at night with any form of a nasal mask and don't have severe claustrophobia issues, that is a better way to go. The nasal passages are designed to supply adequate humidity while the oral passage is not, hence the need for extra humidity levels that this mask requires.

It looks like I'm still dragging this cold, so last night I felt too congested to use my nasal-pillows mask and decided to give the Oracle another go. Here's how it went.

First, I'll mention that there are a lot of variables with this mask. For example, the strap attachment mechanism is made of light plastic and is very primitive. The quick release mechanism, as I mentioned in a post above, does not always work as intended. Once again this morning after I tried tugging on the loop, it did not unlatch easily - I had to pull several times, in different directions before it finally opened. Also, this mask is very high-maintenance - I can't just pull it out in the morning and drop it in the bedside drawer (where my machine stays) and relax for a while before I get up; or stash it in the bag and leave, if I'm on the road. I have to get up and carefully remove it so that the accumulated saliva doesn't spill out, then take it to the bathroom and disassemble and wash all components, and leave them out to dry.

Second, in my case there are a lot of adjustments (other than the modifications I showed in the previous post) that I need to make. I really cannot sleep but on my stomach, even for a short time. Even if I were to ignore the aerophagia from not putting pressure on my stomach (thus helping keep closed the lower esophageal sphincter; as I mentioned, I have hiatal hernia), if I truly want to fall asleep, I need to be on my stomach. This is something I've done all my life, probably promoted by my OSA, and I can't just change now. In the few instances in my life when I could not sleep on my stomach (my knee-replacement surgery and when I had a broken shoulder), I could not sleep, at all. In other words, unless something is preventing me from turning on my stomach, thus preventing me from sleeping, I will be on my stomach. And if anything is making this troublesome, like a mask that doesn't work well in that position, then my sleep is disrupted.

A couple of things I did to alleviate that. One is I used my chin strap to hold the mask in good position as one of the worst problems I had before was trying all night to keep the mask straight so it won't leak too much (and wake me with the constant bubbling). It's a strap that I made myself and consists of two loops to keep the jaw up and back, but also I added a loop to hold the hose, which tended to run around my face (imagine, with my face-down sleeping position). It also supports the bottom of the mouthpiece and helps keep my jaw from moving too much as my head rests partly on the lower jaw. This was an improvement and not a problem, at all, with apneas - I also raised the pressure a couple of centimeters but in the end, my data showed a single OA of 16 seconds for the night - a vast improvement from previous nights with the Oracle.

I will try again when I receive the nasal plugs (the mucous leaking from the nose was again a major annoyance) and the cervical collar; although I'm starting to get doubts about whether I can really wear even the softest one - last night I was thinking about it and noticed that the way I keep my head, I have my lower jaw propped against my clavicle; I don't see where the collar would fit. And, again, trying to completely alter my sleeping position to accommodate something temporary would be inconceivable.

Overall, I did sleep about 7 hours, but I kept waking up very often to have had a real good quality sleep. I'll keep trying to address the remaining problems so that I do have this alternative option, and also hoping my research would help someone else trying to make the Oracle work for them.

McSleepy