Fact or False Belief?

[jnk]

http://www.resmed.com/au/patients_and_f ... leaks.html

...as per Resmed....
"Your supplier can help you resolve these problems."

Problem solved .....now wasn't that just too easy.

This cpap....there really is nothing to it.

Well, the supplier CAN. But probably WON'T.

It's a little-known fact that DME actually stands for "Do-nothing Middleman Ephemerae."

Fact, or true belief?

[Raj]

LoQ, I believe that all your conclusions are pretty much on the money with the caviat that there's enough variation in humans for people to react to xpap therapy in very different ways. In my case, I can often tell, even in a shallow sleep, that air escaping from my mouth has nothing to do with a need for more oxygen, and everything to do with a combination of relaxation and air pressure.

[trike-mike]

I am still pretty much a newb and learning but I happen to be in a process which has me looking at numbers rather closely and involve both a FFM (Quattro) and nasal pillows (Swift FX) essentially back to back. I'm trying to baseline with my shiny new APAP in absence of attentive care from my sleep clinic and going cautiously. I did attempt to be rigorous and use ONE mask but just couldn't do it. So, was between the FFM and the nasal pillows.

I only have 6 days of data so far so it is hardly conclusive but (and this is only for me, you understand):

With no taping or chin strap with the nasal pillows and I do not see an appreciable difference in the leak plots between the two. Average Leak rates are consistently low with only one flier so far above 3l/m. The FFM is sometimes higher than the nasal pillows, sometimes not. To me this indicates that I, at least, am not losing therapy through my mouth. There are some small and very short-lived rises that seldom pass 10l/m with both masks but that's it.

The other assertion I have seen in conjunction with the whole FFM vs nasal mask is that it takes higher pressure for the same therapy with the FFM. I do NOT know what might cause that but very early and limited evidence seems to support this. Interestingly enough, my AHI and VS numbers are significantly higher on the nights with the FFM.

As I said, this is based on little evidence but with changing only that one variable (the mask) it is what I am seeing consistently.

[cflame1]

Mike,
Even if you never get it down to one mask completely... it's my opinion that people should have more than 1 type of mask. I'm all for everybody at least having 1 FFM or hybrid to get them through illnesses and times that the nose is completely clogged and you can't get it unclogged.

[carbonman]

Ephemerae."

.....I like it.....sounds so...so.... important.....

....but cuts like a knife.


Very nice.

[trike-mike]

Mike,
Even if you never get it down to one mask completely... it's my opinion that people should have more than 1 type of mask. I'm all for everybody at least having 1 FFM or hybrid to get them through illnesses and times that the nose is completely clogged and you can't get it unclogged.

Which is precisely the reason I have both. I did try to be rigorous for my data gathering exercise but... failed miserably.

[Janknitz]

The fact that so many sleep techs seem to believe the assertion in the first paragraph makes me wonder. Do they believe that because they see it empirically in the lab when they do titrations, or do they believe that because that is what they were taught?

LoQ, I've had EXACTLY this same question. If you believe what the sleep techs say, then so many people who are taping, using chin straps, and suffering with FF masks don't need to be. But the sheer numbers of people who find that they cannot avoid losing air through their mouth belies the sleep techs' assertions.

However, in my case, I was surprised to find it WORKED. I was certain that I was a dedicated mouth breather, but I decided to try first a nasal mask and finally nasal pillows when I just couldn't deal with the pressure on my nose from the FF and nasal masks. To my utter surprise, I had no mouth leakage. (It also took some good "nasal hygiene") So I'm not ready to write off the sleep techs' assertion, either.

The only other factor I can think of is that the sleep lab is a very artificial sleep environment, and maybe people in a sleep lab setting don't end up in the same positions, with the same firmness or softness of pillows, mattresses, drink alcohol or ingest other chemicals before bed, etc. that would contribute to a more relaxed jaw and/or lips.

It is all very curious, though.

[chunkyfrog]

I am coming to believe that many providers want to sell us ALL nasal masks/pillows at the outset;
knowing full well that many of us will be forced to purchase full-face masks from them later--more $$$$!
I guess that the best advice for a patient looking forward to titration to start out with a NASAL mask--if they come in to switch you to a full-face, that's the only way they will let you know that's what you need.

[idamtnboy]

I am coming to believe that many providers want to sell us ALL nasal masks/pillows at the outset;
knowing full well that many of us will be forced to purchase full-face masks from them later--more $$$$!
I guess that the best advice for a patient looking forward to titration to start out with a NASAL mask--if they come in to switch you to a full-face, that's the only way they will let you know that's what you need.

What do most sleep centers do during the titration? When I had mine the tech gave me both nasal pillows and FF masks to try during the night. I chose to go w/ NP and that is what the doc prescribed.

[chunkyfrog]

Good point; I also was much more a nose breather at first--after a while, I began relaxing more and breathing through my mouth-
-or rather letting air out that way. So, I guess that won't work either. . .

[Catnapper]

I can tell my experience, and you can decide how that fits the fact or false belief question.

I was definitely a mouth breather at night before cpap. I started cpap and immediately stopped breathing through my mouth while I sleep. As evidence I can show you over 4 years of data from my software showing leaks that are appropriate for my mask at my pressure. There are few, a very few, leaks that go high for a minute or two, and then disappear. That could be the result of moving in my sleep that disturbs the seal on my mask. Apparently I wake up sufficiently to reset the mask and the leak goes away. I admit there is the possibility is that I open my mouth for just a minute but quickly close it. I am also convinced that I keep my mouth closed because I never have the dreaded dry mouth, nor do I drool on the pillow.

Is that training or sufficient air? Whichever it is, I am glad it works. I do notice that my tongue stays at the roof of my mouth and makes the seal. I also think my lower jaw moves forward to open my throat a bit.

Catnapper - Joanie