New to CPAP (5 Nights) FFM vs. Nasal Pillows Mouth Breather

[Angeltam]

I'm new to CPAP - tonight is night 5. I have a FFM FlexiFit HC431 Full Face CPAP Mask with Headgear that isn't the most comfortable thing in the world LOL ... I'm able to wear it about 5 hours a night. Sometimes I wake up like I'm choking and then coughing. My AHI is running 0.43 with leaks of 5.89 and pressure of 5.15.

I get a new RT tomorrow who is suggesting nasal pillows and says the mask I currently have is bulky. I sleep in a semi water bed and on my side and back. I snore when I'm on my back and I've been known to grind my teeth. I'm wondering what the best nasal pillow choice or mask choice for me might be and if to try a chin strap or what.

Any ideas are welcome. I'm determined to make this work. I used to enjoy sleeping and I want to again. I did find using aromatherapy essential oils close to the intake filter helped me finally get to the 5 hour mark past just 2 or 3 hours. They seem to help calm me. Also, I stopped worrying about leaks so much unless they were blowing in to my already dry eyes and focusing on just sleeping. I feel very restricted in this FFM as far as being able to turn my head and am concerned about the repercussions to my possible TMJ with a FFM. This mask comes under the chin a little tho so it does seem to keep my mouth closed.

[LSAT]

If you are having so many problems with the FF mask, go ahead and switch. What's the big deal? FF mask is only important if you are a mouth breather with huge leaks.

[hyperlexis]

I'm new to CPAP - tonight is night 5. I have a FFM FlexiFit HC431 Full Face CPAP Mask with Headgear that isn't the most comfortable thing in the world LOL ... I'm able to wear it about 5 hours a night. Sometimes I wake up like I'm choking and then coughing. My AHI is running 0.43 with leaks of 5.89 and pressure of 5.15.

I get a new RT tomorrow who is suggesting nasal pillows and says the mask I currently have is bulky. I sleep in a semi water bed and on my side and back. I snore when I'm on my back and I've been known to grind my teeth. I'm wondering what the best nasal pillow choice or mask choice for me might be and if to try a chin strap or what.

Any ideas are welcome. I'm determined to make this work. I used to enjoy sleeping and I want to again. I did find using aromatherapy essential oils close to the intake filter helped me finally get to the 5 hour mark past just 2 or 3 hours. They seem to help calm me. Also, I stopped worrying about leaks so much unless they were blowing in to my already dry eyes and focusing on just sleeping. I feel very restricted in this FFM as far as being able to turn my head and am concerned about the repercussions to my possible TMJ with a FFM. This mask comes under the chin a little tho so it does seem to keep my mouth closed.

Your AHI is very very low. Plus, your pressure is really very low anyway. It takes a while to get used to therapy -- any therapy using any masks at all. So there is a learning curve to all cpap therapy. Who fit you withe the F&P mask? Did the MD think you needed one because of mouth breathing? That's a good indication to use a FFM. Especially if you have allergies or congestion. With a nasal mask or pillows, you have to be able to keep your mouth closed while sleeping, or else use a chin strap -- which can be more uncomfortable than the full face mask itself. Some other good, less bulky FFMs to try include the Quattro Air, the Quattro FX and the Amara Gel. The Hans Rudolph V2 is also excellent for mouth breathers but is a tad bulky. F&P has released a brand new, smaller full face mask called the Simplus which has gotten good reviews but is not yet out in the US. ( http://www.fphcare.co.nz/sleep-apnea/ma ... p-simplus/)

You have only been on the mask for 5 days. Generally, it's best to give any mask a thorough test for at least a few weeks if possible. Some mask cushions actually break in and become more comfortable with time. They wont get any smaller, but at least more comfortable. Most DMEs take a mask back with a full refund within 30 days, so you do have some time left to make a decision.

Good luck whatever you decide!

[Pugsy]

Check with your DME about the time frame where you can freely swap or try different masks. Use the time to try as many masks as you can or want to try. Don't spend an inordinate amount of time with any mask while you are able to try different masks. You can always go back to a prior choice. Most of the time it is 30 days from the time you first got the equipment. Don't spend 2 weeks on a mask when you aren't happy with it. Try something else while you can do it without it costing you anything.

If you normally can breathe through your nose just fine during the day then there's a good chance that you might be able to make a nasal mask work and it's worth a try. Now if you can't breathe through your nose much at all then you will have trouble with any mask where you have to keep your mouth shut because you need to breathe through your mouth. If that's the case you will need to stick with some sort of full face mask but again....try something else while you can.

[Angeltam]

LSAT - Some of the posts I've read - it is a "big deal" if you breath thru your mouth with nasal pillows. That it makes therapy not successful. I'm not getting leaks with the FFM but nasal pillows could be a whole different ball game. I've read that leakage with nasal pillows isn't accurate if you open your mouth. I'm trying to figure out the best route.

Hyperlexis - Thank you for your suggestions. The prescription said mask of patient's choice. I really didn't have a "sleep doctor". It was more an allergist that ordered her first home sleep study. And the RT that put me in the first mask wasn't the picture of professionalism and seemed very rushed (even to the point of not wanting me to take time to put the mask on and off by myself) and certainly didn't like me asking questions because it interrupted "her speel" LOL I'm not very confident in her knowledge. She had not even viewed my sleep study. I did request another RT who told me on the phone that if I learned to sleep with my mouth closed nasal pillows were less obtrusive. She comes out tomorrow. I appreciate the mask suggestions.

Pugsy - Yes I'm going to ask tomorrow how long I have to try out masks. Also, how often they replace filters, hoses, etc. I was kind of thinking like you .... if I only have 30 days to settle on one then I want to try a nasal one and see if I can keep my mouth shut and then try a Quattro or another highly rated FFM if the nasal pillows don't seem to work for me. I can usually breath thru my nose. My only worry is that I snore on my back and my mouth comes open a little. Yea some of those chin straps look uncomfortable but this full face mask is really bulky in that I can't even turn my head much. I know there is an adjustment period. But like you said I want to get the most comfortable one for me that I can within the time frame. Thank You!

[JamesW6175]

I have been a CPAPer since last October and use a FFM(see equipment at bottom of post). It takes time to get use to the mask, so hang in there. I am a side and stomach sleeper, use a CPAP pillow since the wife said I snored and stopped breathing for a time when I was asleep. Since I have been on the CPAP machine, it has helped lots. Tried extra pillows or a wedge pillow to raise your head , this should help your snoring.

[hyperlexis]

LSAT - Some of the posts I've read - it is a "big deal" if you breath thru your mouth with nasal pillows. That it makes therapy not successful. I'm not getting leaks with the FFM but nasal pillows could be a whole different ball game. I've read that leakage with nasal pillows isn't accurate if you open your mouth. I'm trying to figure out the best route.

Hyperlexis - Thank you for your suggestions. The prescription said mask of patient's choice. I really didn't have a "sleep doctor". It was more an allergist that ordered her first home sleep study. And the RT that put me in the first mask wasn't the picture of professionalism and seemed very rushed (even to the point of not wanting me to take time to put the mask on and off by myself) and certainly didn't like me asking questions because it interrupted "her speel" LOL I'm not very confident in her knowledge. She had not even viewed my sleep study. I did request another RT who told me on the phone that if I learned to sleep with my mouth closed nasal pillows were less obtrusive. She comes out tomorrow. I appreciate the mask suggestions.

Pugsy - Yes I'm going to ask tomorrow how long I have to try out masks. Also, how often they replace filters, hoses, etc. I was kind of thinking like you .... if I only have 30 days to settle on one then I want to try a nasal one and see if I can keep my mouth shut and then try a Quattro or another highly rated FFM if the nasal pillows don't seem to work for me. I can usually breath thru my nose. My only worry is that I snore on my back and my mouth comes open a little. Yea some of those chin straps look uncomfortable but this full face mask is really bulky in that I can't even turn my head much. I know there is an adjustment period. But like you said I want to get the most comfortable one for me that I can within the time frame. Thank You!

If you are getting your CPAP Rx from an allergist, then I'd imagine you have nasal allergies and congestion, correct?

My MD and DME/RT knew I had allergies and started me on a full face mask as a result, only graduating me to a nasal mask once I got used to therapy. It was a good route for me because I originally did a lot of mouth breathing while asleep because of habit and congestion. Eventually nasal breathing became a lot easier so I added nasal masks and pillows for occasional use when I feel the urge. So this may work for you or may not -- but I would definitely recommend finding and keeping a good quality, comfortable full face mask as a backup, even if you eventually switch to a nasal mask for daily use. Because with allergies or colds, you will definitely be glad you did.

[sawinglogz]

If you like pillows but are a mouth breather, you might try the various hybrid masks. I prefer them to FFM, but everybody's different.

[Angeltam]

They told me I have 30 days to find a mask and they usually will try up to 3 but the first one counts as 1. Today she set me up with a Wisp Nasal CPAP Mask with Headgear and a chin strap and believes I will be able to train myself to not breath thru my mouth. It sure felt comfortable compared to that FFM I've tried for the last 5 days. She also explained compliance is an average which was nice to hear considering I started out at 2 and 3 hours the first 3 nights. I think I would like to get that 3rd mask and either go with one of the Quattros or Hybrid to have as a back up if I get a cold etc.

At least this RT was extremely knowledgeable and patient. That makes a world of difference.

As far as the allergist Hyperlexis... I tested not allergic to anything. Was mainly there to check food and environmental allergies. And I don't have a single allergy according to the allergist. I do get a stuffy nose on occasion and feel I am sensitive so I use saline. I need to find a good sleep doctor to review my stats and take over my care of the Cpap therapy.

If I open my mouth while using the nasal pillows will that show up on the leak rate in the software or on the machine? I need to figure out how to know if I'm successful

[Pugsy]

If I open my mouth while using the nasal pillows will that show up on the leak rate in the software or on the machine? I need to figure out how to know if I'm successful

Leak is leak no matter what the source.
Mouth breathing leak is sometimes fairly easy to spot though. The machine does not have the capability to tell the difference in what causes leaks...it just reports the leak.
Not all mouth breathing equals totally trashed night as far as leak goes. It all depends on how much mouth breathing and how long.
I sometimes mouth breathe. I know this because I wake up mouth breathing but most of the time I rarely get to large leak territory and since the wake ups are rare and the time spent in large leak territory is minimal to none, I choose to ignore it.
For me the problems with a full face mask are greater than the minor issues with sometimes a little mouth breathing.

[johnthomasmacdonald]

I find that i do best with switching between a couple of them - i use a ffm quatro mirage, a resmed nasal mask and the Swift FX nasal pillows - all have pluses and minuses but i find that i get the same ahi with all and the advantage for me is that since each attaches to different area of my face, it gives the skin a bit of a break in which to recover - i mouth breath but i find that the ultimate chinstrap keeps my mouth shut - last night i used it with the swift FX nasal pillows and had an ahi of 0.0

[Angeltam]

Pugsy - Thank you for the clarification that it will show up as a leak at least. I appreciate the explanation that some mouth breathing doesn't equate to a completely bad night. I will be able to look at my stats in the various software and see. What is considered large leak territory in your opinion? So I know kind of what to watch for as far as leaks.

johnthomasmacdonald - The switching of masks around sounds like a potentially good idea so the face doesn't get sore. I also like the idea of having a choice if need be. Ultimate chin strap - I'll check that out. I think I saw a post on that one somewhere else in the forum. I've heard the ruby one mentioned as well. The one my provider gave me today doesn't look as fancy LOL but whatever does the trick. I'm hoping I wont need a chin strap for long or at all.

Thank You for the input.

[Pugsy]

What machine are you using?
Where did you get this data that you mentioned?

My AHI is running 0.43 with leaks of 5.89

I did some discussion about various leaks in the SleepHead tutorial thread.
viewtopic/t88983/Pugsys-PointersSleepyH ... nding.html

Large leak territory varies with the machine used and whatever is used for reporting. Some machines report total leak which is the mask's expected vent rate plus excess leak.
The ResMed machine however reports only excess leak. So where did you get the 5.89 number?

It would help us if we knew what machine you were using. Could you please add your equipment to your profile when you have time?

[Angeltam]

Sorry I thought I was displaying my machine and mask. I added it in the control panel. I'm using Rescan and Sleepyhead. Let's see if this post displays my equipment

[Angeltam]

I think I got those stats from ResScan if not then from Sleepyhead. Still trying to figure out Encore Basic and if it is compatible with my machine. I have the Resmed S9 and it's showing a smiley face all the time. Not sure when it goes sad tho. I'm anxious to get new data with the new nasal pillows vs. FFM.