FFM vs. nasal pillows

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novatom
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FFM vs. nasal pillows

Post by novatom » Fri Oct 02, 2015 7:15 am

Has anyone here ever switched from nasal pillows to FFM simply because the FFM is more effective, regardless of leak or comfort issues? I started using nasal pillows when I started CPAP therapy at the beginning of the year. I adapted well to them and have never had problems with leaks. My AHI has remained <5 for the entire time. But I didn't feel that it was all that effective. I still have insomnia problems which I now know CPAP will not resolve, but nevertheless I don't think the quality of the sleep I was getting was any better.

Earlier this week I got a FFM (Qauttro Air) from my DME because I'm experiencing my first cold since starting CPAP. I've been using it for 3 nights and I'm remembering dreams again (I lost that capability early on in my therapy) and I think I'm getting better quality sleep. Even though it's only been 3 nights, I think I'm going to stick with the FFM. I'm also not experiencing leak problems with the FFM either. My AHI for the past three nights has averaged around 1. The FFM did take some getting used to on the first night but I think my experience with using the nasal pillows for the past 9 months helped me adjust quicker.

I've checked my data on Sleepyhead and it looks like I am snoring more with the FFM but other data looks relatively similar to the data generated while using the nasal pillows. One big caveat: I have been sorta cheating by taking a sleeping pill to help me sleep but I was doing that as well with the nasal pillows; not every night but at least a couple times a week. The proof in the pudding may be when I try to sleep without a pill.

I asked this question earlier on this board about whether there is a difference in sleep quality when using a nasal pillow vs. FFM if leak rates are not a factor and I never really felt I got a definitive answer. In my experience at least, I think, leak rates being equal, the FFM is more effective in achieving a better quality sleep.

PS: Don't be fooled by my profile pic. That was a selfie I took at my titration and the only other time I've used a FFM.

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R1200ST
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Re: FFM vs. nasal pillows

Post by R1200ST » Fri Oct 02, 2015 7:24 am

Hi Novatom,

I am a new CPAP user and I am going the other way. I use a FFM and I am going to try a FFM with nose pillow instead of the total nose covering. I am a mouth breather due to deviated septum and chronic sinusitis so just a nose mask will not work for me. But I talked with my ENT and he said to try the FFM with nose pillow.

Next week is when I visit my clinic to get fitted. Only issue I am having with the FFM is NOSE ITCHING! lol driving me crazy. Lots of home remedies which I will try over the weekend but right now I am miserable with it. I think having my nose out of my mask will stop the itch. I feel like a dog with fleas.

Good luck. My leak rates are low, I can move around with no issues, sleep on my back or either side with no issues. Hose does not tangle up. I do have one plastic clip on the top of my head that needs to be better cushioned but that is a issue with the harness not the mask in general. When my CPAP ramps up to 12, there is an increase in lead, but it did not effect my treatment.

So there you go.

R

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novatom
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Re: FFM vs. nasal pillows

Post by novatom » Fri Oct 02, 2015 7:30 am

R1200ST wrote:Hi Novatom,

I am a new CPAP user and I am going the other way. I use a FFM and I am going to try a FFM with nose pillow instead of the total nose covering. I am a mouth breather due to deviated septum and chronic sinusitis so just a nose mask will not work for me. But I talked with my ENT and he said to try the FFM with nose pillow.

Next week is when I visit my clinic to get fitted. Only issue I am having with the FFM is NOSE ITCHING! lol driving me crazy. Lots of home remedies which I will try over the weekend but right now I am miserable with it. I think having my nose out of my mask will stop the itch. I feel like a dog with fleas.

Good luck. My leak rates are low, I can move around with no issues, sleep on my back or either side with no issues. Hose does not tangle up. I do have one plastic clip on the top of my head that needs to be better cushioned but that is a issue with the harness not the mask in general. When my CPAP ramps up to 12, there is an increase in lead, but it did not effect my treatment.

So there you go.

R
Good luck! I know that is the way most people go. My DME told me on my first day that they always try people out on the nasal pillows if the patient thinks that they are not a mouth breather and can handle it. Go with the least intrusive first and if that doesn't work, move up to the nasal mask or FFM. I just find it interesting that if the leak rates are the same, why am I getting better quality sleep with the FFM? Isn't the effect the same, or am I maybe getting more air fed through my passageways with the FFM than with the nasal pillow? Frankly, I think that's the reason.

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KeepSmiling
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Re: FFM vs. nasal pillows

Post by KeepSmiling » Fri Oct 02, 2015 8:30 am

novatom wrote:


Good luck! I know that is the way most people go. My DME told me on my first day that they always try people out on the nasal pillows if the patient thinks that they are not a mouth breather and can handle it. Go with the least intrusive first and if that doesn't work, move up to the nasal mask or FFM. I just find it interesting that if the leak rates are the same, why am I getting better quality sleep with the FFM? Isn't the effect the same, or am I maybe getting more air fed through my passageways with the FFM than with the nasal pillow? Frankly, I think that's the reason.
For someone with a higher pressure nasal pillows/prongs are not recommended.

I am used to seeing nasal mask tried first then going from there. A good DME not even sure if they are qualified RTs or not would look at a persons facial features, how the person sleeps etc before just handing a mask of any type.

How in the world is more air going into to your nose with a full face mask instead of with nasal pillows unless this is a machine that plays with delivery of air. My machine is much older and has no mask settings. I know that the ResMed I am helping a family member with has a setting to set the type of mask. I do not know if this effects the air being delivered. I would expect tubing size would change air pressure being delivered if the machine is calibrated for one size and a different size tubing is used. Edit to add, I think length of hose may also effect pressure delivered to mask. I would assume a machine sending the same amount of pressure of air from machine to mask would not feel the same if the tube is 6 feet as 10 or 12 feet, unless an adjustment is made. I may be wrong. Ii do not remember Bernoili's therooy, or even the name. Fluid course was 30+ years ago. I should do a google search. Next time I need to buy a hose,I may not shy away from a longer one. Rolling my eyes at myself.

As for the masks, It could just as easily depend on how soundly you sleep in one. If one mask was not as comfortable or you could not move the way you wanted to or the masked or tubing moved, that may disturb sleep for someone.


If a full face mask lets you get into a comfortable sleeping position and you can get a good night sleep. Do not let the amount of variables keep you from fun dreams. Enjoy it.
Last edited by KeepSmiling on Fri Oct 02, 2015 8:59 am, edited 1 time in total.

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chunkyfrog
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Re: FFM vs. nasal pillows

Post by chunkyfrog » Fri Oct 02, 2015 8:58 am

Nasal pillows are easier to fit. Manufacturers are lazy, and cheap.
With full face masks, I have had to "settle" for a near fit or a non fit.
Until the designers try harder to make a ff mask that comes in my size/shape, I can not wear one regularly.

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nanwilson
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Re: FFM vs. nasal pillows

Post by nanwilson » Fri Oct 02, 2015 9:02 am

KeepSmiling wrote:
[color=#FF0000 wrote:]For someone with a higher pressure nasal pillows/prongs are not recommended[/color]

I am used to seeing nasal mask tried first then going from there. A good DME not even sure if they are qualified RTs or not would look at a persons facial features, how the person sleeps etc before just handing a mask of any type.

How in the world is more air going into to your nose with a full face mask instead of with nasal pillows unless this is a machine that plays with delivery of air. My machine is much older and has no mask settings. I know that the ResMed I am helping a family member with has a setting to set the type of mask. I do not know if this effects the air being delivered. I would expect tubing size would change air pressure being delivered if the machine is calibrated for one size and a different size tubing is used.

As for the masks, It could just as easily depend on how soundly you sleep in one. If one mask was not as comfortable or you could not move the way you wanted to or the masked or tubing moved, that may disturb sleep for someone.


If a full face mask lets you get into a comfortable sleeping position and you can get a good night sleep. Do not let the amount of variables keep you from fun dreams. Enjoy it.

Keepsmiling, you are doing it again......Anyone that wants to can wear nasal pillows or prongs, if it works for THEM, saying that it is "not recommended" is totally wrong and an old wives tale to boot. You have been told by members that use higher pressures that they CAN and DO use pillows or prongs, even at pressures higher than 20. You are misleading new members with that statement.
Started cpap in 2010.. still at it with great results.

SewTired
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Re: FFM vs. nasal pillows

Post by SewTired » Fri Oct 02, 2015 9:33 am

If you are doing better, go with what works. So long as you aren't having too many major leaks, you should be fine.

I am now having my first head cold since starting CPAP as well, but unwilling to deal with a FFM, I have Sleepweaver nasal masks (Elan and advance ZZ. They leak a little more than I want, but are comfy on my nose and more importantly, on those swelling sinus cavities in my upper cheeks. My DME doesn't let me try out masks, so I don't want to blow my mask allowance on something that may or may not work especially as I've shelled out for both Sleepweavers on my dime. I'm going to search a local place with a good cash price to try out FFM just in case these don't work out for the problem.

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Re: FFM vs. nasal pillows

Post by LSAT » Fri Oct 02, 2015 10:07 am

SewTired wrote:If you are doing better, go with what works. So long as you aren't having too many major leaks, you should be fine.

I am now having my first head cold since starting CPAP as well, but unwilling to deal with a FFM, I have Sleepweaver nasal masks (Elan and advance ZZ. They leak a little more than I want, but are comfy on my nose and more importantly, on those swelling sinus cavities in my upper cheeks. My DME doesn't let me try out masks, so I don't want to blow my mask allowance on something that may or may not work especially as I've shelled out for both Sleepweavers on my dime. I'm going to search a local place with a good cash price to try out FFM just in case these don't work out for the problem.
DMEs can return used masks for credit. If they will not let you try masks they are being lazy. Most DMEs will allow try ons and in home trials. I have been dealing with my DME for 5 years and occasionally when I want to try a new mask there is no problem. Confront your DME and be prepared to switch vendors. Also...cpap.com offers low cost return insurance for most masks.

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KeepSmiling
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Re: FFM vs. nasal pillows

Post by KeepSmiling » Mon Oct 05, 2015 4:03 pm

nanwilson,

According to CPAP.Com:

If you are using an auto Cpap machine is not suggested that you use nasal pillows or prongs with pressures over 15cm. The small diameter of the pillows will sometimes throw the auto-titration off on an automatic Cpap machine.

I was surprised at this for the Resmed Airsense 10 which has a pillow setting, but I was told the same thing.

---


Also, higher pressure may cause nose irritation in some users.

One person I know was told by their doctor not to use direct air into the nose because the small spot the air blows into can cause a hole in their nose. It could all be false. I am glad that other members here have not had issues.


nanwilson wrote:
KeepSmiling wrote:
[color=#FF0000 wrote:]For someone with a higher pressure nasal pillows/prongs are not recommended[/color]

I am used to seeing nasal mask tried first then going from there. A good DME not even sure if they are qualified RTs or not would look at a persons facial features, how the person sleeps etc before just handing a mask of any type.

How in the world is more air going into to your nose with a full face mask instead of with nasal pillows unless this is a machine that plays with delivery of air. My machine is much older and has no mask settings. I know that the ResMed I am helping a family member with has a setting to set the type of mask. I do not know if this effects the air being delivered. I would expect tubing size would change air pressure being delivered if the machine is calibrated for one size and a different size tubing is used.

As for the masks, It could just as easily depend on how soundly you sleep in one. If one mask was not as comfortable or you could not move the way you wanted to or the masked or tubing moved, that may disturb sleep for someone.


If a full face mask lets you get into a comfortable sleeping position and you can get a good night sleep. Do not let the amount of variables keep you from fun dreams. Enjoy it.

Keepsmiling, you are doing it again......Anyone that wants to can wear nasal pillows or prongs, if it works for THEM, saying that it is "not recommended" is totally wrong and an old wives tale to boot. You have been told by members that use higher pressures that they CAN and DO use pillows or prongs, even at pressures higher than 20. You are misleading new members with that statement.

KeepSmiling
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Re: FFM vs. nasal pillows

Post by KeepSmiling » Mon Oct 05, 2015 4:38 pm

For two nights I used the Nasal Aire II Prong Mask instead of my Hybrid (both by Innomed) since I need a new Hybrid. I did not seem to go into a deep sleep. The first night I thought it was because I had not adjusted the mask right. Last night I had no issues with leaks or anything.

Now it dawned on me something to do with CO2 in a larger mask helping with breathing. I would need to look it up. I guess there is a reason I have been using the hybrid for almost 10 years straight.

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Re: FFM vs. nasal pillows

Post by Pugsy » Mon Oct 05, 2015 4:52 pm

KeepSmiling wrote: According to CPAP.Com:
I read what you quoted and that is the first I have ever heard of any such mode of operation limitation.
I have written to the forum owners for clarification on this point that you quoted. Nothing I have ever seen in any nasal pillow mask literature or machine literature has ever mentioned anything like that and I don't know where they got their information or maybe the information is way old and needs to be updated.
KeepSmiling wrote:One person I know was told by their doctor not to use direct air into the nose because the small spot the air blows into can cause a hole in their nose. It could all be false.
This one is false. Totally false. Even at max pressure these machines can't even blow up a balloon.
Even if the air blowing was a pin hole size of a laser it couldn't blow a hole in a person's nose unless there was some serious nasal damage done from something else...like snorting drugs or something.

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KeepSmiling
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Re: FFM vs. nasal pillows

Post by KeepSmiling » Mon Oct 05, 2015 5:07 pm

Pugsy wrote:
KeepSmiling wrote: According to CPAP.Com:
I read what you quoted and that is the first I have ever heard of any such mode of operation limitation.
I have written to the forum owners for clarification on this point that you quoted. Nothing I have ever seen in any nasal pillow mask literature or machine literature has ever mentioned anything like that and I don't know where they got their information or maybe the information is way old and needs to be updated.
Yes, I would also like clarification.

After I saw nanwilson's response to me, I contacted CPAP.com by chat and I asked about the higher pressure and pillows. That was the response, so I asked again and mentioned the Resmed AirSense 10 by name since I know it has a pillow setting.

I would hate to be giving wrong information.

I should ask ResMed about their auto machines.

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Re: FFM vs. nasal pillows

Post by KeepSmiling » Mon Oct 05, 2015 5:12 pm

Pugsy wrote:
KeepSmiling wrote:
KeepSmiling wrote:One person I know was told by their doctor not to use direct air into the nose because the small spot the air blows into can cause a hole in their nose. It could all be false.
This one is false. Totally false. Even at max pressure these machines can't even blow up a balloon.
Even if the air blowing was a pin hole size of a laser it couldn't blow a hole in a person's nose unless there was some serious nasal damage done from something else...like snorting drugs or something.
No drug snorting.

Corticosteroids nose spray for a few months.

Smoker when CPAP started.

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Pugsy
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Re: FFM vs. nasal pillows

Post by Pugsy » Mon Oct 05, 2015 5:29 pm

KeepSmiling wrote: No drug snorting.

Corticosteroids nose spray for a few months.
I have heard of only one cpap user who said they ended up with a hole in their nose and this person said that her doctor blamed in on cortiocosteroid use. I don't even remember which mask was used.
The openings for the nasal pillows aren't tiny at all.
I just don't see how it would be even physically possible for the air to be directed at so much force to damage the nasal cavity unless there was some serious issues with the nasal cavity from some other reason.

As far was what you were told by someone at cpap.com....I looked all over for that documentation but couldn't find it. I would think that if there were problems with apap mode and nasal pillows at higher pressures there would be some sort of warning or comment either with the mask or the machines and I have never seen such a statement anywhere and I have done a lot of reading.
I don't have any idea where that person came up with that statement.

Now about drying out of the nasal mucosa...yeah, that's a given but that can happen no matter what mask is used. That's why we have the humidifiers to use.

I have been using nothing but nasal pillows for well over 6 years now and my pressures routinely hit 20 and above and I have always used some sort of auto adjusting pressure mode whether it was my first APAP or my now ASV machine. Other than my nose liking lots of humidity...I have zero nasal issues and I am pretty sure that my various machines have handled my pressures and therapy just fine.

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Re: FFM vs. nasal pillows

Post by popcpoo » Mon Oct 05, 2015 8:57 pm

A sleep tech at the doctor's office recommended nasal pillows when I had a large sore on my nose. My machine is set for 20-25 cm H2O IPAP. Obviously they work with higher pressures. I couldn't use them because I am a mouth breather.