Need Help With Full Face Mask

[Whipper]

Some of you have helped me recently and would know my background experience. For those who do not, let me begin with a brief introduction.

I have been using CPAP since January 2017. I have a Dreamstation APAP and for most of the last year I have used the Dreamwear cushions and then the gel cushions when they came out. I tried the Resmed P10 but did not like the hose off of the nasal cushion. Also, when using it, I get about the same results as the Dreamwear gel cushion anyway. I also tried the Simplex FFM, but did not get as good of numbers with it and had more leaks, so I gave up on it.

Basically, results with the Dreamwear gel have been very. My AHI is normally under 1.00 and my RDI is around 2.00 or less. My best results come with a pressure range from 8.5 cm to 10. I know it’s a narrow range, but it works best for me as I think pressure spikes may have been waking me sometimes, and a fixed pressure is not enough. I only get these results because of wearing a chinstrap rather tightly and taping with Microspore 3M tape. The only chinstrap that works for me is the Resperonics white one that looks somewhat like an Ace bandage. I tried others but, either they can’t be tightened enough or they don’t work well with the Dreamwear frame at the top of my head. I also tried a soft cervical collar but it didn’t work as well either. I have been working with my ENT doc because of congestion and frequent flow limitations. Recently, he gave a script for a steroid to add to a nasal rinse (Neilmed) twice a day. He said that his group has been having great success with this approach, but its too early to tell if it will help me. He believes I mouth breath because of nasal congestion.

I can’t say that I wake up many mornings feeling like I had a great night’s sleep, however I know that the therapy is making a big difference. I’m almost 70 and work out heavily in the gym aerobically and with weights and resistance machines. Prior to being diagnosed, I was struggling to maintain my workout levels and was often tired during the day, but after 6 months of dialing in my therapy, my energy levels and workout levels have skyrocketed and most days I am not tired. I also had acid reflux which is now gone and I was up 4-5 times a night compared to 1-2 (sometimes 0) with CPAP. I’ve also lost 15 pounds and have maintained that level.

When the new Dreamwear FFM came out, I was intrigued and decided to try it. Basically I did so because of comfort. The chinstrap and taping are often uncomfortable (the Resperonics chinstrap hardens after a couple of weeks whether I wash it or not and will feel very rough on my face) and I thought the FFM would free me from taping and wearing a chinstrap. The Dreamwear FFM is very comfortable and I fall asleep easily. However, I wake up with a horrible “desert” mouth and have to get up and rinse to go back to sleep (the same as with the cushions if I don’t wear a tight chinstrap and tape). The results have been mixed. After increasing the pressure by 1 cm to a range of 9.5 cm to 11, I can get comparable results to the cushion, but only for a session or two a night (I haven’t slept through the night with the FFM). The other sessions have high AHI’s with clusters of apneas (normally obstructive) and RERA’s as measured by the Dreamstation. Flow limitations are generally lower and my tidal volume is in the 450 range compared to 350 with the gel cushion.

My question is this: what can I do to make the Dreamwear FFM work. I would like to not have the dry mouth, but I could tolerate it with better results. It is very comfortable and my perceptive sleep quality seems as if it would be acceptable. I have posted a typical night with the gel cushion, chinstrap and taping and a typical night with the FFM.

Thank you in advance for any suggestions or perceptions.

Typical night with gel cushion, chinstrap and taping (8.5 cm - 10 cm) / Typical night with FFM (9.5 cm - 11 cm):

screenshot-20180519-145237.png (111.17 KiB) Viewed 1341 times

[Pugsy]

The dry mouth is from the mouth breathing. With the tape and chin strap you pretty much force the mouth to stay shut and there's no mouth breathing. Obviously with the full face mask the reason we use them is to not lose the therapy pressure when mouth breathing.
Unfortunately the mouth breathing that we now allow dries out the mouth.
It takes very little mouth breathing to dry out the mouth for some people for various reasons.

Some people have had some good luck by increasing the humidity levels being delivered by the humidifier. Some people don't have good luck with more humidity or they already are using maximum humidity.
Sometimes more humidity actually makes any nasal congestion worse for some people but some people find that more humidity actually helps reduce nasal congestion and anything that helps reduce nasal congestion has the potential to reduce mouth breathing.
So if more humidity makes the congestion worse then you might try less humidity and/or if more humidity helps with the congestion then you might try more humidity if you can.

Some people have dry mouth and nothing they do helps very much so they end up using one of those products designed for dry mouth and they might have to try several different brands and types before they find one that seems to help them the best.

For the slightly increased AHI that you seem to have you need a little more pressure. If it were me I think I would just try increasing that maximum just a little because it looks like your machine wanted to go higher during the cluster but couldn't. Maybe if it could go higher for that short period of time then the cluster of events wouldn't happen. So you wouldn't have to use more pressure for very long.
It's common to sometimes need a little more pressure when going from a nasal mask to a full face mask. Not sure why unless the full face mask straps pull the jaw back just a little and alter the airway position just enough to cause it a bit more difficult to keep that airway open.

If increasing the humidity doesn't help or can't be done because already at the max or causes more congestion then I think if it were me and I really wanted to keep the mouth shut and I didn't have to have it open (and that must be the case or you wouldn't have success with the tape and chin strap) then I might consider just a little tape without the chin strap and just enough to maybe give a gentle reminder to the lips to stay closed. I wouldn't try to totally eliminate any chance of mouth breathing like I would if using a nasal mask but I would try to reduce the mouth breathing in hopes that I could get it reduced enough to not have the mouth get so dried out.
People do use tape and/or chin straps with full face masks for the dry mouth issues. They do it because the dry mouth is just so annoying to them. Maybe they never could find a mouth hydrating product that worked well enough for them.

So...maybe increasing the humidity might be an option...maybe some sort of mouth hydrating product...maybe using tape in a limited fashion.

I have no idea if more humidity will make your nasal congestion worse or reduce it but it's something you might try if you haven't already. There is no right or wrong. There's just what the individual prefers.
I have known husbands and wives both on cpap and one prefers maximum humidity and one prefers little or no added humidity.
Same house of course but one person's nasal mucosa likes one thing and the other person's mucosa likes something totally different.

[Whipper]

Thanks for the input Pugsy. I'll give your suggestions a try!

[JDS74]

One other suggestion not covered by Pugsy, sometimes a soft cervical collar instead of a chin strap will work better.
Chin straps do have a tendency to move the jaw back somewhat and increase the frequency of OSA events. Cervical collars don't do that.

Is your water reservoir empty in the morning? If not, then an increase in the humidity setting may help unless it increases your congestion.
Getting more humidity after that point is possible. I use about 1.5 to 2 times the water that can be in the DreamStation water chamber but its complicated.

[Whipper]

I will try a soft cervical collar again. Wow on your water usage! Do you have to refill during the night? I suppose so.

[JDS74]

No refill during the night. I have installed a second humidifier in series with the DreamStation so that I have double the capacity.
Unfortunately, this disables the heated hose option for the CPAP. Hence, I also use a secondary heated hose with its own power supply.
The net result is a system that can supply a relatively high humidity for about 9 hours before it runs dry.
Mouth breathers using CPAP machine need to be aware that excessive time with dry mouth can lead to substantial tooth decay - in my case three root canals and crowns before I got the humidity thing fixed.

It is complicated but with a parts list eminently doable.

[Muse-Inc]

Might try my FFM covers mouth and uses pillows: RespCare/Innomed Hybrid ($119 from our host cpap.com). You get 3 sizes of pillows and mouth cushions and a fitting CD. I love it! Works well with low to high pressures. Many of us make an extra strap if pillows popping out is an issue. In the beginning, I had lots of congestion issues and ran my humidifier on the high end; now I do not need it in warm weather.

[Whipper]

I gave the Dreamwear Full Face Mask another try starting on May 20 and implemented Pugsy’s and JD's suggestions. I settled on a pressure range of 9.5 – 12.5, set humidifier at 5.0 fixed (highest) and wore a soft cervical collar. Look at these results!

May 20 – June 5 (17 nights) AHI .27, RDI .64 , FL .22

And, I am much more comfortable having ditched the chinstrap and mouth taping.

Thanks Pugsy and JD!