Nasal mask, CPAP and high-ish pressures...

[Tatooed Lady]

The Boyfriend's mom is on straight CPAP, had been at 11cm til getting a new doc sticking fingers in the mix. Her new "prescription" is for 16cm. As a bonus, she was told that she won't be able to use the nasal mask she is used to wearing, because "the pressure is too high" and the whole mouth breathing thing. So she had a FFM shoved at her, which she is struggling with, due to leaks, etc.

Now...she has SUCCESSFULLY USED a nasal mask to this point. The doc/DME/powers that be NEVER told her about headgear to keep the mouth shut. She has no clue how to check Her results, was only told to bring the card every x months...this woman might not be ALL there...but she is bright enough to use a complicated sewing/embroidery machin and digital camera...I'm thinking if I can get some quiet time with her, I will show her my equipment, and suggest things to bring up with the doc. Maybe she's not "manual mode wing ding" material...but come ON! And people wonder why so many fail a fairly simple therapy??

I don't have specifics on what nasal mask nor FFM...but does anyone know of a mask that won't take 16cm?

[OkyDoky]

Unless her data showed large leaks from mouth breathing with the nasal mask, there should be no reason she couldn't try to continue using it again without any additional straps. I use bilevel 11/15 with the P10 without leaks. If you could take a look at her SD card it might give you some answers.
Sounds like the doctor just thinks you must use a FF mask with higher pressures, but many here prove that isn't true.

[Pugsy]

but does anyone know of a mask that won't take 16cm?

No, they all are rated to at least 20 cm and some to 30 cm pressure (even the Respironics Nuance gel nasal pillows has up to 30 cm I think in the literature).
This "your pressures are high so you can't use a nasal pillow mask or nasal cushion mask" is nothing but an old wives tale started god knows when by someone who doesn't have a clue what can or can't be done.

I see pressures over 20 cm often and I have no problem.
Now the mouth opening thing...that's not just a problem at higher pressures...if someone is going to open their mouth they are just as likely to do it at 5 cm pressure.

Total BS this old wives tale and probably a huge factor in cpap therapy failure when someone gets a full face mask thrust on them and they can't make it work and they give up.
We have people using bilevel pressures in excess of 20 all night long having great success with nasal interface (both pillows and cushion) all over this forum. It's not just me.

[Tatooed Lady]

That's what I thought...I use the swift fx with upper pressure around 13.5, with about as much trouble as when it was at 6-7. She was FLOORED when I showed her my mask...and explained what my settings are.
Friggin medical quacks.

[Pugsy]

You know I don't know when or where that "you can't with higher pressures" thing started. Maybe it was true back with the very first nasal pillow masks for some strange reason and these people haven't grown with the times. When I had my sleep titration study I insisted on nasal pillows after a very brief trial of a nasal pillow that the pressure of it congested my nose so badly that I couldn't breathe at all after about 5 minutes with it on and I knew there would be no sleep with the nose so congested.

The dumb ass tech I had (dumb ass for multiple reasons and not just the mask reason) well his solution was "you gotta use a full face mask if you can't breathe through your nose" and I said (by this time the nose cleared up immediately upon the mask removal so I knew it was the mask pressure that was causing the congestion) "well if the pressure on my nose causes congestion even with a full face mask there won't be any sleep with it either". I was already going to have trouble sleeping in the lab anyway (another long story). I had to pretty much tell him to bring me a nasal pillow mask or I was walking out the door. It was the Optilife and too big but I got it done.
Afterwards the tech tells me...you are the first that I have had use the nasal pillows for the titration study.
Well dumb ass...if you would let people try something it just might work.
This was just 6 years ago and not at the very beginning of nasal pillows being on the market. Now granted the improvements since then have been huge and I came home with the Optilife and never used it again because by then I had done my research and had settled on the ResMed Swift LT which was at that time the latest and greatest from ResMed. I fired my first DME (lied to me about what the machine they were going to give me would do and refused to get me what I wanted) and found a machine locally on craigslist that was price right at what my co pay would be...so then I went to another DME and they had the Swift LT in stock and they didn't care where I got my machine from...and the rest is history.

The second DME never said "you can't do so and so"...they only said "it may present challenges at higher pressures but then so will any other mask" "we are here to help you make it work if you need us".

I cannot believe a doctor being so stuck in the dark ages but I guess they are out there. Knowing what I know now and if I had a doc that was so much in the dark ages I don't know how much I would want to rely on someone like that if I was having significant problems. I have zero patience for doctors of any kind that are stuck in the dark ages and are inflexible about getting out.

[popcpoo]

My DME said I could use nasal pillows if I wanted to. I was having trouble with the FFM making my nose sore. I tried the nasal pillows, but I am a mouth breather, and could not keep my mouth closed. I kept experiencing large leaks and my AHI went up. My EPAP is 15 - 20 and my IPAP is 20 - 25. I go over 20 quite often. I found the nasal pillows to be very comfortable, but I could not control the mouth breathing, and went back to a FFM.