Do high CPAP pressures normally lead to a FFM?

[sepool]

Hi,

I've been on CPAP for about 3 weeks. My doctor and DME prescribed a FFM (Quattro), the same one I used, I suppose, successfully during my split-night titration.

My pressure is 18. I don't have any problems dealing with the pressure or breathing, etc. I guess I'm lucky in that.

I am having troubles with the mask - but the DME says because of the 18 pressure, I probably won't deal with anything but a FFM very well. Does that make sense? It's not that I have claustrophobia with the FFM, I just wonder if a nasal solution would leak less - at the 18 pressure, though.

I know how to adjust and use the quattro, I just have to have it so tight that during the night, it seems like my face changes, and I have to tighten it again. It leaks between the bottom and the nose area. The mask pressure is also giving me bad swollen lids in the morning, and I'm worried that my eyesight is changing fast.

Thanks for any input - I'm trying to decide whether or not to push for a nasal solution.

Sam

[momadams]

For what it's worth, my pressure is 16 and I have no problems with the Swift or Headrest.
Your eye issue could be from mask leaks directing air toward your eyes - less of a problem with the nasal pillows.
Check with your favorite eye physician; he/she may have some suggestions for nighttime ointments, etc.
Shari

[Snoredog]

These damn DME's must get their training off the box of cracker jacks either that or they have no training.

Your pressure has nothing to do with you needing a FFM. In fact a nasal mask would offer you much better treatment and if your machine is an auto possibly a lower pressure finding as a result.

FFM are used for mouth breathing and are very difficult to stop and prevent leaks, much more surface area to seal, too many moving parts like you mandible, when your mandible drops major leaks occur.

With a nasal interface, there isn't any moving parts to worry about. Most of your apnea, snoring etc. is caused by the tongue relaxing into the back of the throat, when the pressure comes in from the top via the nares it can more easily push against the soft palate and base of your tongue and push it out of the way. When that pressure has to come in via the mouth it has to push the tongue away from the palate then get behind the tongue base to push it out of the way.

If you want a good sealing quiet nasal interface look at the Soyala, just be sure to order it larger than you think you need as it runs small compared to other similar masks.

[sepool]

I really appreciate the quick responses!

I have a not-too-bushy mustache - would a nasal mask work or would it be better to try some kind of pillows?

I am a side-sleeper mostly - I see a lot of posts about side-sleeping torquing a mask.

Sam

[Dustin777]

I am on a vpap machine with the high pressure at 20 and low at 16. I use a resperonics activa nasal mask with a bushy gotee and mustach and have absolutly no problem with leaks!!!! I was told the same thing from my first med supplier and even went as far as shaving off all my facial hair to accomidate. It wasn't until I finally tried the nasial mask that I saw that it worked great!!! Just my 2 cents....

[Wulfman]

Hi,

I've been on CPAP for about 3 weeks. My doctor and DME prescribed a FFM (Quattro), the same one I used, I suppose, successfully during my split-night titration.

My pressure is 18. I don't have any problems dealing with the pressure or breathing, etc. I guess I'm lucky in that.

I am having troubles with the mask - but the DME says because of the 18 pressure, I probably won't deal with anything but a FFM very well. Does that make sense? It's not that I have claustrophobia with the FFM, I just wonder if a nasal solution would leak less - at the 18 pressure, though.

I know how to adjust and use the quattro, I just have to have it so tight that during the night, it seems like my face changes, and I have to tighten it again. It leaks between the bottom and the nose area. The mask pressure is also giving me bad swollen lids in the morning, and I'm worried that my eyesight is changing fast.

Thanks for any input - I'm trying to decide whether or not to push for a nasal solution.

Sam

Have you done the "Teflon tape fix" to the mask yet?

viewtopic.php?f=1&t=33749&p=286741&hilit=Teflon#p286741

viewtopic.php?f=1&t=33452

If it "FEELS" like it's leaking a lot, it's probably the elbow and it'll seem like it's leaking everywhere until you fix it. Then, assuming you have the correct size, you should be able to back off on the strap tension. It actually should seal better with the straps a little looser. In addition, you might want to also acquire an Ultra Mirage Full Face mask.....UMFF. That one may hold up a little better to higher pressures.

Den

[sepool]

Wulfman,

Thanks for your reply. I am aware of the teflon-tape fix for the elbow, but my mask develops leaks during the night on the sides, I can feel the seal vibrating and hear the farting noises there. I only tighten just enough to "stop the farts". At that point, the mask is very tight on the lower corners, very tight on the sides of my mouth.

Does the Ultra Mirage have a different seal shape from the Quattro? I like the way the Quattro deals with jaw drop - I don't seem to ever leak from anywhere but into my eyes or on the sides. The eye leaks are fixed pretty well by the top adjustment, but my eyes are kind of close together, and during the night, the mask rides up my nose up between my eyes.

The ResMed sizing template for the Quattro suggests right between a medium and a large - and I have the medium. I think maybe a large would bother up between my eyes even more so, but it wouldn't ride up - it would start there.

I guess I don't mind trying and buying some different masks to try - the DME doesn't help at all.

Sam

[Wulfman]

Wulfman,

Thanks for your reply. I am aware of the teflon-tape fix for the elbow, but my mask develops leaks during the night on the sides, I can feel the seal vibrating and hear the farting noises there. I only tighten just enough to "stop the farts". At that point, the mask is very tight on the lower corners, very tight on the sides of my mouth.

Does the Ultra Mirage have a different seal shape from the Quattro? I like the way the Quattro deals with jaw drop - I don't seem to ever leak from anywhere but into my eyes or on the sides. The eye leaks are fixed pretty well by the top adjustment, but my eyes are kind of close together, and during the night, the mask rides up my nose up between my eyes.

The ResMed sizing template for the Quattro suggests right between a medium and a large - and I have the medium. I think maybe a large would bother up between my eyes even more so, but it wouldn't ride up - it would start there.

I guess I don't mind trying and buying some different masks to try - the DME doesn't help at all.

Sam

From my experiences of using both, the Quattro has more flexible seals whereas the UMFF has slightly stiffer ones (at least when new). If your measurement (mid-eye line to mid-chin) was right between the Medium and Large sizes (as mine also was), I would suggest getting the Large in the UMFF. I also have a large Quattro and while it does fit OK, it does have different characteristics in how it fits. I wear both masks with the forehead support in the full, upright position and the top straps very loose......and with whatever tension needed on the bottom straps. I feel this allows the upper part of the seal (along the bridge of the nose) to expand better to provide a better seal in that area.
I've also read others who have higher pressures say that the UMFF seems to seal well for them. I WAS prescribed a pressure of 18, but after briefly trying it, I decided to start at a lower pressure (10 cm.) and actually found out that the lower pressures worked just fine for me anyway. I've never had the urge to try those higher pressures with either masks since then so I can't provide any more in-depth experiences with the higher pressures.

CPAPAUCTION.COM usually has quite a few UMFF masks at reasonable prices.

Good luck.

Den

[rested gal]

Hi Sam!

My doctor and DME prescribed a FFM (Quattro), the same one I used, I suppose, successfully during my split-night titration.

IF they started out your titration with a non-FF mask and noticed you mouthbreathing with a regular mask, they may have switched to FF mask because of massive mouth air leaks.

However IF they did, indeed, start your titration right from the get-go with a FF mask, perhaps they assumed your moustache might make the particular nasal masks they had on hand difficult to fit without leaking. In that case mouthbreathing was not the reason for their using a FF mask from the start.

If you do try another type of mask, you're going to have to be a good detective to determine if you have mouthbreathing or mouth air leak issues while sleeping. That will be hard to find out since the very basic machine they gave you (Fisher&Paykel HC234 cpap) does not record any useful data for you to monitor leaks or anything else about your therapy while you sleep. I'd be trying to get them to swap that machine for a cpap like the Respironics REMstar Pro M series machine, which will give you data about leaks, as well as "AHI" -- info about any apneas/hypopneas that sneak through despite treatment.

If I were going to swap for an M series machine, I'd not want the integrated "M" humidifier, though. I'd want a separate F&P HC 150 heated humidifier to use with the M series machine.

the DME says because of the 18 pressure, I probably won't deal with anything but a FFM very well. Does that make sense?

As others in this thread have said, the DME is wrong. Nasal masks (cover only the nose) and nasal pillows masks (two little thingies that fit against the nostrils) can work fine... and for some people even better than a FF mask with its larger perimeter to have to seal, at any cpap pressure. Just depends on the interface, how it suits your face, how it's fitted.

I just wonder if a nasal solution would leak less - at the 18 pressure, though.

Eighteen is a pretty hefty blast of pressure, so whatever mask type of mask you use, you might have to get creative to come up with a "lab rat" fix to make any mask work well for you.
LINKS to Lab Rat Trophy awards
viewtopic.php?t=15104

I know how to adjust and use the quattro, I just have to have it so tight that during the night, it seems like my face changes, and I have to tighten it again. It leaks between the bottom and the nose area. The mask pressure is also giving me bad swollen lids in the morning, and I'm worried that my eyesight is changing fast.

That's not good at all. The suggestions Den gave might help, or a different size might be what you need. But if nothing makes a Quattro work for you, you definitely need a different FF mask or a different type of mask. Do make sure you can monitor for mouth breathing though, if you go for a non-FF mask. Without a machine that can show leak data, you'd just about have to have someone else stay awake all night watching you, to see if you mouthbreathe or let air gush out your mouth during sleep. Massive air leaks out the mouth when not wearing a FF mask will wreck getting effective treatment.

[REMemberWhen]

I too was prescribed at 18 and have a Quattro. I had so many leaks at 18 that it would wake me up so the Dr. lowerd it to 15 after I argued with him for a while. That helped me with the leaks and my numbers seem decent, but I am switching machines tomorrow to an APAP so hopefully that will make a big difference because i will be using the pressure i need at any given time as opposed to a constant 15 or 18 or what ever the setting. I am a severe mouth breather so I need the Quattro. I have a Hybrid that works great at lower pressure but leaks when at higher pressure.