Experiment: FFM + Mouth Tape

[brain_cloud]

OK, having seen a difference in AHI results when using a Quattro FFM and an Activa Nasal mask (using mouth taping), I finally got around to testing FFM+Tape to see what that would yield. I did three straight days with the Quattro and mouth taping and the results are...inconclusive.

In the chart below, I've plotted about a month of Quattro without taping, 21 days (all I have) on the Activa Nasal mask (also using mouth taping), and in green the 3 days with FFM+Tape. I'm pretty convinced that FFM without mouth taping is definitely providing worse results than Nasal mask + taping. But I may do another week of FFM+tape to see if that goes anywhere.

[Jaylee]

Cloudy you are so cute with all of your charts.

What tape are you using?

[brain_cloud]

Cloudy you are so cute with all of your charts.

I certainly am.

What tape are you using?

I discarded the packaging and have to rely on memory. I believe it is a 3M medical kind of tape, 2" wide, and maybe a bit too sticky. It often leaves white traces at the edges when I peel it off in the morning.

[DreamStalker]

You may get a better understanding of the relationship between AHI and mask interface systems if you also plot the leak variability (standard deviation or even daily max-min range).

Because you are using an auto, your AHI values will be influenced by leaks and each mask has different intentional leak designed into it (for CO2 venting) in addition to whatever may be happening with mask seals.

[Joe50]

Since the Mirage Quattro full face mask covers both the nose and mouth it prevents pressure loss from mouth breathing so in my mind it would work the same as putting tape over your mouth. The mask is the tape. I could be wrong! Hope it works.

[CRNA91966]

I agree with Joe, you don't need mouth tape with a full face mask. In fact, you could be at some risk pulmonary aspiration with tape if you were to vomit when sleeping and failed to remove the tape prior to becoming fully awake and capable of removing the tape. I have found a good alternative for those who experience mouth opening and leaking is to apply a pea sized or smaller amount of denture paste on the tongue before going to sleep and pressing the tongue against the roof of the mouth. The tongue will remain stuck and will keep your mouth closed for the entire night. You are however easily capable of opening your mouth if need be.

[jdm2857]

Leak info is essential here.

For example, the tape with the Quattro (FFM) may prevent mouth openings that in turn affect mask seal.

But in the absence of leaks, I can't see why a FFM would yield different AHIs from a nasal mask. Pressure is pressure.

[brain_cloud]

Leak info is as follows: Leak is negligible when using the Quattro, with and without tape. Leak with the Activa happens, but not on a scale to cast the data into doubt. Leak is not a factor here.

Obviously, you are not supposed to need tape or any other artifice to ensure mouth closing when using a FFM. In theory, theory and practice agree; in practice, they don't.

[jdm2857]

Do psychological factors apply during sleep?

[Velbor]

But in the absence of leaks, I can't see why a FFM would yield different AHIs from a nasal mask. Pressure is pressure.

And yet, it is so, as I have repeatedly documented:

AutoPAP, Activa, UMFF and Mouth Taping
viewtopic.php?f=1&t=37954

Respironics :: Activa, UMFF :: ResMed
viewtopic.php?f=1&t=42646

in these and other postings, and as demonstrated with different machine brands.
And mouth taping can make a significant difference as well.
Similar reports have been made frequently on this forum by numerous posters.

I too am at a loss for an explanation, but the data is consistent and overwhelming.
Data refusing to fit our expectations does not disqualify its validity;
it may disqualify the universal applicability of our hypotheses.

Velbor

[plr66]

But in the absence of leaks, I can't see why a FFM would yield different AHIs from a nasal mask. Pressure is pressure.

Yeah, I can't understand that either, but no, I think it is not as simple as "pressure is pressure." Please note my related thread:
viewtopic/t53646/When-leaks-are-under-c ... rence.html
About a year ago, I suggested here that the only thing I could think of, was the possibility of the FFM pressing my lower jaw inward, which might cause my airway to become even smaller and more easily closed than it normally is. I still think that's a good theory, but it would seem that a higher pressure would resolve that problem...

[SleepingUgly]

Cloudy, not that this isn't an interesting experiment in and of itself, but if you are capable of using a nasal mask and getting good results, why not use the nasal mask? I fail to see how the FFM is of any benefit to you.

I have an alternative hypothesis about why FFM can be a problem, but I can't imagine that none of the big wigs in the area of sleep medicine have considered it, so it must be wrong. My hypothesis is that, if opening one's mouth leads to airway collapse in some people (see link below), opening one's mouth, even with a FFM should still cause more collapse than keeping one's mouth shut. Unless you're using an APAP that will adjust pressure adequately for increased collapse, with a set pressure, the pressure could, in theory, be insufficient to compensate for the increased airway collapse caused by mouth opening and/or oral breathing over nasal breathing only. Again, there must be something really wrong with my logic because I have NEVER seen anyone in the literature describe a FFM mask as in any way inferior to a nasal mask.

http://erj.ersjournals.com/cgi/content/full/22/5/827

[torontoCPAPguy]

I taped my mouth and my nose and now have zero leaks, except I fart a lot more.

The data seems to show that the Mirage Activa nosebag is giving you better results; why go to full face mask and try to improve things? The numbers that you are showing are saying that the FFM is giving you worse results, no?

Also, and by the way my wife tells me I whistle in my sleep sometimes so this is an issue for me too albeit a minor one according to my data, have you tried one of the underwear elastic contraptions for keeping your mouth shut and your chin flesh pushed up about a cm.? I am about to order one of those PAPCAP things; although torn between the basic and the one with the headgear for my masks built in (I am afraid that the straps and such will not be as adjustable and as stable on the PAPCAP).

In any event, I have a psychological issue with taping as I had an acquaintance die a few years back after being mouth taped during a robbery and aspirating vomit. I also have a male thing with wearing underwear on my head afer watching "Animal House" on television. Just not me. So that leaves the PAPCAP, which my wife says sounds like a gynecological device of some sort (great! just great!) and looks like a painters cap with velcro strung from it. Or epoxy and dentures. I think I'm going with the PAPCAP and going to rename the thing before anyone sees it.

[brain_cloud]

Cloudy, not that this isn't an interesting experiment in and of itself, but if you are capable of using a nasal mask and getting good results, why not use the nasal mask? I fail to see how the FFM is of any benefit to you.

SU, I'm sure that is how this will play out. Yes, I have a solution. But I'd also like closure on this FFM+tape=NM+tape issue.

I have an alternative hypothesis about why FFM can be a problem, but I can't imagine that none of the big wigs in the area of sleep medicine have considered it, so it must be wrong. My hypothesis is that, if opening one's mouth leads to airway collapse in some people (see link below), opening one's mouth, even with a FFM should still cause more collapse than keeping one's mouth shut. Unless you're using an APAP that will adjust pressure adequately for increased collapse, with a set pressure, the pressure could, in theory, be insufficient to compensate for the increased airway collapse caused by mouth opening and/or oral breathing over nasal breathing only. Again, there must be something really wrong with my logic because I have NEVER seen anyone in the literature describe a FFM mask as in any way inferior to a nasal mask.

I wonder if the mask manufacturers might be privvy to some interesting data on the issue of efficacy differences between and amongst the different types of interface. You would think, for example, that the first time a FFM or nasal pillow mask was marketed, there would be extensive testing and whatnot.

[Jaylee]

Cloudy you are so cute with all of your charts.

I certainly am.

Handsome and modest?