Is it so unusual to use a full-face mask? My doctor says so...

[CPAPQs4All]

I am curious: does anyone have a very rough idea what percentage of CPAP users use full-face masks?

I am non-Japanese person living in Japan.
My Japanese sleep doctor gave me the impression full-mask users are as rare as a white rhino!

He told me that nearly all his patients with nose issues such as deviated septum see an ENT specialist (for nasal steroids or surgery) and nearly all become able to use nasal devices. Failing that, he said they use a mouthpiece. He said almost none of his patients use full masks. I researched a bit and found that deviated septums (septa?) are rare for East Asian people. The vast majority of my doctor's patients are Japanese. However, I am sure that I am not the only Westerner he treats. There seem to several full face mask users in this forum.

[LSAT]

I would estimate that 40% of CPAP users wear Full Face Masks. There have been some surveys taken on this web site.

[robysue1]

Here in the US there seems to be a tendency of sleep docs (who prescribe masks) and respiratory therapists (who actually fit masks) to ask the question, "Do you ever breathe through your mouth?" right at the very start of xPAP therapy---as in when a patient goes in for their titration study or when they're first given an APAP for a home titration.

And a lot of people answer that question with "Sometimes" or "Now and then" or "Once in a while" because they know they might breathe through their mouth when their noses are seriously congested from a head cold or when their allergies are particularly bad. After hearing those kinds of answers, far too many sleep docs and RTs immediately jump to "Then you will have to use a full face mask" here in the US without bothering to follow up with any kinds of questions about what triggers the mouth breathing or whether it's a common problem or a fairly rare problem for the patient.

Fact is that some people do predominately breathe through their mouths and they do need a FFM. Many others only occasionally breathe through their mouths and they actually do ok with a nasal mask or a nasal pillows mask. Some people find using a FFM more comfortable when they are sick with a head cold and have a lot of congestion, but a lot of people don't find their insurance willing to pay for two masks up front, and a lot of people either can't afford or simply don't want to pay out-of-pocket for supplies their insurance ought to pay for. So I do think here in the states there are a lot of people using FFMs, and some of them probably don't need to use a FFM.

But here's the thing: Mask comfort is important. A few people, like my husband, actually find a FFM more comfortable than nasal masks or nasal pillows masks even if mouth breathing is not a big issue for them. But many people who do a bit of mouth breathing find that nasal masks are more comfortable than FFM and through some combination of fixing their nasal congestion problems, practicing keeping their tongue in place, using chin straps or cervical collars, and mouth taping figure out a way to use a nasal mask while keeping the leaks under control.

[KittyMom22]

I'm new to CPAP and I use a full face mask because I tend to be congested and I often breathe through my mouth.

[babydinosnoreless]

I am a daytime mouth breather. I was surprised that a nasal mask actually works better than a full face mask for me. I don't tape my body just somehow manages to keep my mouth shut at night when I'm asleep. I'm glad I tried tho. Would not have gotten used to a ffm I don't think.

[lazarus]

Becoming that way. Sounds like an up-to-date doc to me:

Are there patients who truly need full-face masks to succeed? Absolutely, say Genta and Hevener, though the percent is probably much smaller than you’d think. Hevener estimates it to be about 9% to 11%. . . . But, for about 90% of patients, nasal masks are the best choice.--Sleep Review; "The Fallacy of Full-Face CPAP Masks (Editor’s Message)" Sree Roy, May 20, 2021,https://sleepreviewmag.com/sleep-treatm ... pap-masks/

Current evidence comparing nasal and oronasal [full-face] masks for OSA treatment: most studies suggest that nasal CPAP results in better adherence, lower residual apnea–hypopnea index (AHI), and higher therapeutic levels as compared with oronasal CPAP. However, oronasal masks can be effective for many patients with OSA.--https://www.atsjournals.org/doi/10.1513 ... 2007-864ST

I really think so.

[zonker]

I really think so.

also-

[ChicagoGranny]

does anyone have a very rough idea what percentage of CPAP users use full-face masks?

You need to use what you need to use, not what some study or some doctor says to use. I've had a lot of bad advice from the two sleep doctors (USA) I have used. Thankfully, I now have a nice family doctor who writes anything my DME needs to file the insurance claims. He knows almost nothing about CPAP and trusts me to manage my sleep apnea.

[clownbell]

Agree with Lazarus' comment above. I have read an article in the website of the National Institute of Health (here in the US) that reached similar conclusions.

My mouth tends to fall open when I become completely relaxed while sleeping. My provider insisted that I would need FFM. I have decided that, for me, taping is a better option. Nasal pillows are so much more comfortable, for me. Other people have other preferences, and that's fine.

[SleepGeek]

He told me that nearly all his patients with nose issues such as deviated septum see an ENT specialist (for nasal steroids or surgery) and nearly all become able to use nasal devices. Failing that, he said they use a mouthpiece. He said almost none of his patients use full masks.

I have a deviated septum and find nasal pillows a better choice for me. No steroids and I won't use a mouthpiece. I'm at a high pressure too but it's that pressure that opens up my sinuses even if/when I have a cold.

fwiw - when I started it was common for the RT to insist that pillows would not work at any pressures >10cm so I started with a FFM. After getting used to nasal pillows I tried my old FFM and promptly removed it.

It's much easier to seal leaks when the mask has less surface area contact to leak thru.

Any chance you can find another Dr.?

[CPAPQs4All]

OK, thanks for all of your input.

I will persist a bit more with the nasal mask.
I was told I have a significantly deviated septum. I'm not sure how bad "significant" is and I can breathe through my nose sometimes.
However, I felt as though I was making too much effort to breathe with a nasal mask in my last attempt.
My nose is not in a good state at the moment.
I tend to get reflux/LPR if I eat too much too late in the evening, which the doctor said accounts for my blocked nose and ears popping.

[LSAT]

does anyone have a very rough idea what percentage of CPAP users use full-face masks?

You need to use what you need to use, not what some study or some doctor says to use. I've had a lot of bad advice from the two sleep doctors (USA) I have used. Thankfully, I now have a nice family doctor who writes anything my DME needs to file the insurance claims. He knows almost nothing about CPAP and trusts me to manage my sleep apnea.

Ditto for me...I haven't seen a "sleep doctor" since I went on CPAP 14 years ago

[CPAPQs4All]

He told me that nearly all his patients with nose issues such as deviated septum see an ENT specialist (for nasal steroids or surgery) and nearly all become able to use nasal devices. Failing that, he said they use a mouthpiece. He said almost none of his patients use full masks.

I have a deviated septum and find nasal pillows a better choice for me. No steroids and I won't use a mouthpiece. I'm at a high pressure too but it's that pressure that opens up my sinuses even if/when I have a cold.

fwiw - when I started it was common for the RT to insist that pillows would not work at any pressures >10cm so I started with a FFM. After getting used to nasal pillows I tried my old FFM and promptly removed it.

It's much easier to seal leaks when the mask has less surface area contact to leak thru.

Any chance you can find another Dr.?

Hi SleepGeek,
I read that many people have a slightly deviated septum. Did the doctor tell you how deviated your septum is?
Do you find that you cannot breathe through your nose at certain times of day?
I was told the body alternates between right and left nostrils every few hours.
My left nostril usually works fine.

[SleepGeek]

Hi SleepGeek,
I read that many people have a slightly deviated septum. Did the doctor tell you how deviated your septum is?
Do you find that you cannot breathe through your nose at certain times of day?
I was told the body alternates between right and left nostrils every few hours.
My left nostril usually works fine.

No I didn't get any numbers. But will add that the wife can't breath thru one nostril but refuses a FFM or nasal pillows, she just won't using anything but a nasal mask.

Give it a try you just may like it.

[CPAPQs4All]

Hi SleepGeek,
I read that many people have a slightly deviated septum. Did the doctor tell you how deviated your septum is?
Do you find that you cannot breathe through your nose at certain times of day?
I was told the body alternates between right and left nostrils every few hours.
My left nostril usually works fine.

No I didn't get any numbers. But will add that the wife can't breath thru one nostril but refuses a FFM or nasal pillows, she just won't using anything but a nasal mask.

Give it a try you just may like it.

Thanks,
I was told I have a significantly deviated septum. I'm not sure how bad "significant" is and I can breathe through my nose sometimes.
However, I felt as though I was making too much effort to breathe with a nasal mask in my last attempt.
My nose is not in a good state at the moment.
I tend to get reflux/LPR if I eat too much too late in the evening, which the doctor said accounts for my blocked nose and ears popping.
I guess I will keep trying a bit longer.