Hybrid Mask Adjustments: Just One Man’s Opinion

roster · Post by **roster** » Mon Oct 16, 2006 5:12 pm

Hybrid Mask Adjustments: Just One Man’s Opinion at One Point in Time (updated 12/28/2006)

If you are a mouth-breather or mouth-leaker and don’t like mouth taping or chin straps or traditional full face masks, then the Hybrid mask may be the solution for you.

Three critical things to do: watch the manufacturer’s video, watch the manufacturer’s video and watch the manufacturer’s video.

I am 95% convinced that the Hybrid will fit most people and provide appropriate therapy if you can get the right combination of:

• Chin flap or no chin flap. I cut the chin flap off. The rest of the discussion assumes the chin flap has been removed.
• Mask size. In my case the large appeared to be the correct size. After some trial and error, I finally got the medium to work. It is barely wide enough to cover the corners of my mouth but it works and is not uncomfortable.
• Pillow size. The medium pillows “appear” to be the correct size and some trial and error confirmed that they are.
• Pillow height. Pillow height depends on the mask size and the distance between the top of the mask when it is in place and the nose openings. Select a pillow height that will provide a snug fit to the outside of the nostrils. When in place between the outside of the nostrils and the top of the mask, the pillows should be compressed about 50% of their normal height.
• Top strap of headgear. This strap should be adjusted fairly loose. It is to provide some upward stability to the headgear.
• Top side straps. These straps provide stability of the mask on the upper lip and pull the pillows against the nostrils. They should be adjusted evenly on each side to assure the mask is centered on the face. The top side straps are critical to preventing leaks between the pillows and the nostrils. They should be adjusted snugly.
• Bottom side straps. These should be adjusted snugly to provide stability of the mask on the chin. They should be adjusted evenly on each side to assure the mask is centered on the face.

Adjust the headgear in this order:

• Place your xpap on a counter with a mirror.
• Place the pillows in the mask and twist them into the openings so that they align well with your nostrils.
• Place the mask (with pillows already attached) into the hard shell. Make sure the rim of the mask is inserted completely into the groove all the way around the shell.
• Attach the top side straps to the shell.
• Slide the headgear onto your head and place the mask on your face in a position that appears to be leak-free and comfortable.
• Attach the bottom side straps to the shell.
• Make sure the mask is centered on your face. As noted above each set of side straps should be adjusted evenly on each side of your face.
• Check that the pillows create a seal with the nostrils that appears secure. Use thumb and forefinger to adjust each pillow into the opening of the nostril.
• When everything looks and feel “right”, turn on the xpap machine to the maximum pressure you will be using. Check for leaks. You can place your two index fingers over the exhaust ports and listen for leaks elsewhere in the mask. Don’t do this too long because you aren’t breathing fresh air when the exhaust ports are blocked.
• The pillows should not be separated (cut apart) unless you have two very different sizes of nostrils. I know many patients cut the connector between the nasal pillows. Personally I think this is a mistake. I find the connector adds considerable stability to the pillows, particularly preventing them from flaring out to the sides of the face. The pillow openings are not round; they are oblong so you may need some adjustment (reorientation) to align the axes of the oblong openings with the axes of the nose openings. Place the pillows in the mask and twist them into the openings so that they align well with your nostrils. In my case the pillows both need to be twisted slightly inward so that when adjusted the connector is no longer straight but forms a slight arch out toward the mask shell.

• If you get the adjustments right, there should be no need for dental floss or rubber bands to hold the pillows.

• When you arise in the morning only unclip the bottom side straps. Leave the rest of the headgear as is.

• I remove the mask from the shell one morning per week and wash it briefly in warm soapy water. Rinse well and leave it in a safe place to air dry during the day.

It took me about five nights to get an adjustment that works very well. I find that the headgear needs readjusting every few weeks. I am not sure if this is because the headgear is stretching or the velco slips slightly.

I have used the Hybrid Mask 3 months and 16 days. It is trouble free most of the time. For the litmus test, I am beginning to feel better and have had some wonderful dreams most nights for about two months. It has been ten or more years since I had dreams like this.

Don’t forget three more things: watch the manufacturer’s video, watch the manufacturer’s video and watch the manufacturer’s video. Call their customer service number if things don’t work well for you immediately.

Good luck.

Update 1/17/2008: I have been using the Hybrid about 18 months now. Occasionally I would get a leak from a nasal pillow getting pushed out of my nostril when I rolled around in bed. About a month ago, I took a leg out of a lady's pair of tights and tied it in a circle. This is a Rested Gal technique for some of her masks.

I place the tights leg on my head after the mask goes on, positioning it under my ears. I pull the tights over the nasal pillows. This works great and the nasal pillows never pop out. I also don't even notice the tights on my face.

Did I mention that a pair of Pad A Cheeks helps with comfort? I wouldn't be without them.

Link to illustrations from Rested Gal showing ladies tights fix: viewtopic.php?f=1&t=36928&p=322402#p322402

bdp522 · Post by **bdp522** » Mon Oct 16, 2006 5:24 pm

Wonderful post Rooster! I will disagree with the pillows not being cut apart. I tried everything and couldn't get them close enough together for my nose without cutting them and then using the dental floss to hold them closer. Other than that you got it all exactly right!

Brenda

roster · Post by **roster** » Mon Oct 16, 2006 8:00 pm

bdp522 wrote:Wonderful post Rooster! I will disagree with the pillows not being cut apart. I tried everything and couldn't get them close enough together for my nose without cutting them and then using the dental floss to hold them closer. Other than that you got it all exactly right!

Brenda

Brenda,

To explain further my point, "• Place the pillows in the mask and twist them into the openings so that they align well with your nostrils. "

For me also, the pillows were too far apart when inserted into the holes in the mask. So I rotated the right pillow clockwise and the left pillow counterclockwise. This placed them closer together. Also the openings in the pillows are oval instead of round. The rotating made the oval pillows fall in closer alignment with my oval nostrils.

When I look at the plastic strip that connects the two pillows it is bowed out away from my face due to the rotating of the two pillows.

In case you did not guess, the "busybody" part of me does not like that people are resorting to dental floss. I believe you can experiment and get the right adjustment without floss.

On the other hand, your therapy takes priority and if that means using dental floss then go right ahead. BTW, is that waxed, mint flavored?

rooster (of the species which doesn't have teeth so has no use for dental floss)

neverbetter · Post by **neverbetter** » Tue Oct 17, 2006 12:34 pm

Great information, Rooster. What a wonderful product to work with.
I have not yet cut my chinflap as I have a nice fit with minimal leakage.
I am intrigued, however, buy the prospect of making the mask a little lighter. Guess I'll have to buy another mouth cushion and try it.

roster · Post by **roster** » Tue Oct 17, 2006 3:17 pm

neverbetter wrote:Great information, Rooster. What a wonderful product to work with.
I have not yet cut my chinflap as I have a nice fit with minimal leakage.
I am intrigued, however, buy the prospect of making the mask a little lighter. Guess I'll have to buy another mouth cushion and try it.

Which size mask are you using? I started out with the chin flap and only the large mask would fit me. I cut the chin flap off of the medium mask and it fits me well with the chin flap removed.

The chin flap was causing a red rash on the underside of my chin and the mask made me feel hot. Removing the chin flap eliminated the cause of the rash and the mask felt much cooler and lighter.

I agree that you should not remove the chin flap from a mask that is working for you. If you have a mask one size smaller maybe you want to "do surgery" on it.

Keep us updated.

rooster

track · Post by **track** » Wed Mar 07, 2007 12:19 pm

Rooster...I am planning on ordering one of these mask. I am right at the maximum mouth width for a medium and the minimum for a large. MY concern is there is no chin measurement....that would seem to be an important measurement given the mask fits over the chin

roster · Post by **roster** » Wed Mar 07, 2007 1:05 pm

track wrote:Rooster...I am planning on ordering one of these mask. I am right at the maximum mouth width for a medium and the minimum for a large. MY concern is there is no chin measurement....that would seem to be an important measurement given the mask fits over the chin

Oh the supplier made that easy for us; the mask comes with all three sizes (s/m/l face cushion/chin flap and s/m/l nasal pillows).

Scuba_Steve · Post by **Scuba_Steve** » Sun Mar 18, 2007 7:34 am

I think I'll go through Rooster's process and maybe even add the Benzoine for good measure. I love the design of this mask, I just need to get it to fit. Thanks again everyone! I'll report my success, or lack thereof, in a few days.

OwlCreekObserver · Post by **OwlCreekObserver** » Fri May 04, 2007 6:26 pm

Rooster, I finally worked up the courage to pull my hybrid out of the drawer and perform chin flap surgery on it. I threw it in the drawer about a week after I received it because it would start leaking as soon as I dropped off to sleep, it was way too confining, and it caused a rash under my chin. It broke my heart because I'd had such great hopes for it, but it just wasn't working for me.

As you suggested, I removed the medium flap instead of the large that I'd been using.

It worked! No more leaks, sore chin, overheating, etc.

I'm evaluating another mask for the next few weeks so I can only use the Hybrid for naps at the moment. But so far, it's performing exactly as I hoped it would when I first ordered it.

Brilliant!

OCO

hayeswildrick · Post by **hayeswildrick** » Sat May 05, 2007 1:48 pm

Has anyone had this problem?

When I put on my Hybrid at bedtime, it fits snug and no leaks. No matter what position I lie in, the seal is secure.

But most nights, sometime around 4 or 5 in the morning, I wake to find that I'm leaking around the pillows. At this point it seems like I have to fiddle and fiddle to get them to seal properly, and if I move my head again, one or the other comes loose.

I tried using a bit of lanolin on the pillows, which makes my nares feel great, but it hasn't changed this pattern for better or worse.

Otherwise, mask is unmodified.

Any suggestions?

Jeff

Guest · Post by **Guest** » Sat May 05, 2007 2:00 pm

Rooster....what sort of pressures will the hybrid withstand without leaking? Have you tested it at pressures of 15 or above?

roster · Post by **roster** » Sat May 05, 2007 2:21 pm

Anonymous wrote:Rooster....what sort of pressures will the hybrid withstand without leaking? Have you tested it at pressures of 15 or above?

My pressure is 10; no reason for me to test any higher. I am sure it will leak at 4 if you don't have the right fit and adjustments.

Maybe someone who is using it at a higher pressure will chime in.

gill · Post by **gill** » Sat May 05, 2007 5:38 pm

Thank You Rooster! I've just got a Hybrid to try, you may just have saved my life!
Gill

roster · Post by **roster** » Sat May 05, 2007 6:00 pm

[quote="hayeswildrick"]Has anyone had this problem?

When I put on my Hybrid at bedtime, it fits snug and no leaks. No matter what position I lie in, the seal is secure.

But most nights, sometime around 4 or 5 in the morning, I wake to find that I'm leaking around the pillows. At this point it seems like I have to fiddle and fiddle to get them to seal properly, and if I move my head again, one or the other comes loose.

.................

Jeff

hayeswildrick · Post by **hayeswildrick** » Sun May 13, 2007 2:46 pm

An update on fitting...

Last week I tried cutting off the chin cup on a medium mouthpiece. It seemed very comfortable and I slept well through the night. My only complaint was that I woke several times with the blowfish effect.

After three nights I took a look at my Encore numbers and was shocked to see that they were MUCH worse with the modified Hybrid.

With a chin cup my AHI has been running about 1.8. Without the cup it soared to between 3.9 and 4.5!

So, it's back to using the mask as designed for me.

Anyone else had this experience?

Jeff

Hybrid Mask Adjustments: Just One Man’s Opinion

Hybrid Mask Adjustments: Just One Man’s Opinion

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Additional Comments: Strictly a side sleeper