Nasal mask & nasal pillows vs full face mask. Asphyxiation?

[Bright Choice]

I just listened to a teleconference with Dr. Steven Park and Dr. Avrim Gold on sleep apnea (focus on UARS aspect). Dr. Gold prefers nasal masks & pillows over full face masks. The conversation went pretty quickly but from what I gathered it is because the air pressure in the mouth can force the tongue backward and increase the resistance. Just curious to know if anyone here has any experience with this concept.

[SleepingUgly]

Just to amend what you said, Dr. Gold said, "My own strong belief is that full face maks are not an effective treatment for sleep apnea or UARS." In other words, they are NOT effective, which is more than just a preference. He has patients who can't breathe through their nose undergo surgery to correct their nasal breathing or use an oral device, NOT a full face mask.

[Wulfman]

I just listened to a teleconference with Dr. Steven Park and Dr. Avrim Gold on sleep apnea (focus on UARS aspect). Dr. Gold prefers nasal masks & pillows over full face masks. The conversation went pretty quickly but from what I gathered it is because the air pressure in the mouth can force the tongue backward and increase the resistance. Just curious to know if anyone here has any experience with this concept.

That makes no sense to me. "That's not logical, Captain." The doctor is full of BS. These pages are full of people who have had lousy therapy because they're trying to use a nasal mask and haven't learned to seal their "pie hole".

The user (preferably) needs to breathe through the nose. The best way to prevent mouth-leaking or mouth-breathing is to train the tongue to stay on the roof of the mouth during the night. If the mouth falls open during the night and the person is using a nasal mask, therapy air will probably be lost out the mouth. If the person has nasal congestion, the mouth may open to breathe in more air.......which compromises the therapy.
The most common time that a tongue can fall backwards is if the person is sleeping on their back, which is typically the worst possible position for a person with Obstructive Sleep Apnea to sleep.

So, the only way that the tongue can be "forced" backwards is if the person is trying to breathe in through their mouth.

Having been a dedicated mouth-breather before starting therapy, I have become a dedicated nose-breather by using a full face mask......and doing nasal cleansing before bedtime and by using "passover" (cool) humidification.


Den

[Bright Choice]

Just to amend what you said, Dr. Gold said, "My own strong belief is that full face maks are not an effective treatment for sleep apnea or UARS." In other words, they are NOT effective, which is more than just a preference. He has patients who can't breathe through their nose undergo surgery to correct their nasal breathing or use an oral device, NOT a full face mask.

Thank you for the clarification SleepingUgly, you certainly heard and understood more clearly than I did. What is your feeling about his comment? I thought I was doing pretty good with a Quattro FX ffm (and controlling leaks really well) but had no understanding of the downside of ffm.

I have an interesting observation but I don't know what it means. Since beginning pap (both cpap and apap) I woke up about half of the time feeling very hungover (no alcohol), foggy and generally crummy. Those feeling would generally resolve by noon or so, but not always. For the past week I turned EPR on, I set it on 2. The first night I though, oh my gosh I am now breathing in fresh and cool air - and, I have not had a "hangover" in the morning. Is there some element of rebreathing that was going on?

Also, I have been wearing my oximeter - the spo2 readings are much better with the EPR on. I was having an average of 2 minutes (up to 5) of spo2 being <88%, now (with EPR) the time <88% is 0.2 minutes on average and I feel much better. What do you think is/was going on? Was I asphyxiating myself? (I modified the subject line here to see if anyone has any input on this rebreathing business)

[Bright Choice]

Dr. Gold also said that if a patient is feeling tired and not responding to xpap, it is either from a titration that is too high or too low or it because of a ffm. ???

[SleepingUgly]

Dr. Gold also said that if a patient is feeling tired and not responding to xpap, it is either from a titration that is too high or too low or it because of a ffm. ???

Yes, he said that.

[happysleeper]

Hi Bright Choice,

I don't think that you have the connection between EPR and rebreathing quite right: Usually with EPR people wind up rebreathing slightly more (if at all), because they are exhaling into a slightly lower airflow, which perhaps allows a little more exhaled air to stay in the tube. With your EPR set on 2, you are reducing the airflow during your exhalation by 2 cm water pressure.

Here's a link to a possible clearer explanation of EPR from the S9 information page: https://www.cpap.com/cpap-machine/resme ... chine.html

Sometimes people have a difficult time sleeping while they are exhaling against a high pressure air flow, so EPR lowers that air flow that they are breathing against. Perhaps you are more comfortable with the EPR on, relaxing further and getting a better sleep quality, which could explain some of your "hangover" relief. If you are feeling better with the EPR on, keep it on!

Happy Sleeper

[Titrator]

Not everyone who is told that they need nasal surgery will get it done. It is a brutal surgery and the price tag for me was $26,000. My insurance covered it, but it was not an easy recovery. I do like it better now that I can breathe through my nose, but I have used quite a few full face masks in my days and they do work. I think what you are hearing is the doctors opinion and he is also referring to UARS, which is a little different than garden variety OSA. Until the FDA comes out and says that full-face masks are not effective and can prove it to me, I am still a fan and use them with patients who mouth breathe during the study.

Titrator
Ted

[Otter]

I started listening to that interview, but haven't found time for the rest yet. Why exactly is it that FFMs are not effective for UARS? Is it a problem with the style of mask, or simply that PAP only treats UARS about 8 hours a day?

[SleepingUgly]

I started listening to that interview, but haven't found time for the rest yet. Why exactly is it that FFMs are not effective for UARS? Is it a problem with the style of mask, or simply that PAP only treats UARS about 8 hours a day?

Search for the thread entitled "Dr. Avram Gold" for a discussion of what he said.

[SleepingUgly]

Not everyone who is told that they need nasal surgery will get it done. It is a brutal surgery and the price tag for me was $26,000. My insurance covered it, but it was not an easy recovery.

Funny, I found my septoplasty and turbinate reduction surgery to be a breeze. I think it often has to do with how up to speed the surgeon is with realizing that packing the nose is more painful, as is splinting, and can find ways to avoid doing that.

[SleepingUgly]

Dr. Gold also said that if a patient is feeling tired and not responding to xpap, it is either from a titration that is too high or too low or it because of a ffm. ???

Remind me why you are on a FFM? I thought you were using nasal and mouthguards and chinstraps and such to control mouth leaks, no?

There is research that indicates that just opening your mouth contributes to airway collapse, even without mouth breathing. One physician patient was written up as a case study of someone who successfully treated his OSA by using a chin strap alone (apparently he was a case of this)! There's a study I used to cite a lot in which they experimentally induced OSA in normal healthy volunteers by completely occluding the nose during sleep; the same was not achieved by occluding the mouth.

My personal experience is that my AHI is higher and my pressure needs are greater with a FFM. Because I haven't achieved nirvana yet with any mask, I can't say whether personally a FFM would be ineffective (only that I can't wear them well because of the landscape of my facial features). But based on research that I've read, and what Dr. Gold reports, my personal first choice would be a nasal interface, assuming I could breathe through my nose. If I couldn't breathe through my nose and had maximized all the nonsurgical ways of achieving that (e.g., treating allergies, nasal steroids, etc.) and I was a surgical candidate (which I was), I would have septoplasty/turbinate reduction (which I did), so that I could breathe through my nose (which I can, with nasal steroids). However, if I was already on a FFM and could sleep well with it, my numbers were good, and I had achieved nirvana (e.g., EDS gone, all symptoms gone), I don't know if I'd bother to change anything.

[Bright Choice]

I ...
or simply that PAP only treats UARS about 8 hours a day?

Now I never took that into consideration. What are the implications of uars during the daytime? Also, does uars in and of itself cause desats at night, or are the desats an indication that something else is going on? Thanks

[Bright Choice]

Remind me why you are on a FFM? I thought you were using nasal and mouthguards and chinstraps and such to control mouth leaks, no?

I changed to Swift LT after the Gold interview. Using it with only chinstrap now and leaks are close to zero. No longer using the mouthguard. It induced aerophagia, but I think that the short time I used it, it helped me "learn" how to place my tongue to avoid mouth leaks.

I am interested in seeing what the new Resmed Mirage FX nasal mask will be like. I did quite well with the Quattro FX ffm.

My personal experience is that my AHI is higher and my pressure needs are greater with a FFM.

I have really no idea what my pressure should be because of what I think is UARS and no AHI component. I hope to see the new Mirage FX in Albequerque - I go there the first week in May.

[SleepingUgly]

I ...
or simply that PAP only treats UARS about 8 hours a day?

Now I never took that into consideration. What are the implications of uars during the daytime? Also, does uars in and of itself cause desats at night, or are the desats an indication that something else is going on? Thanks

UARS and OSA have to do with SLEEP disordered breathing. There are no implications when you are awake.