Full Face Mask Experiment

Mikesus · Post by **Mikesus** » Wed Mar 02, 2005 4:42 am

Well I noticed that if I tighten down my Ultra Mirage FF mask, my AHI tends to go up, or the pressure needed to handle events seems to go up. I think I might have an explanation. (SWS PLEASE weigh in on this!)

If I tighten the lower straps, the bottom edge on the mask tends to push my jaw inward (back towards my throat) In thinking about what SWS said in another post about the best position for opening the airway, (head tilted back like you are about to receive mouth to mouth) I am now thinking that the jaw moving back like that would make the airway collapse more often, hence the higher pressure and or higher AHI... So if this is the case (BIG IF HERE) then too tight of a full face mask *might* reduce the effective therapy...

I am thinking too hard here?

JoeA · Post by **JoeA** » Wed Mar 02, 2005 11:48 am

Mike:

You have noticed exactly what I have noticed. Anything that changes the position of your lower jaw effects the size and or numbers of obstuctions. Dental appliances that are used to treat mild OSA make the lower jaw protrude. Tight chin straps, and Full face masks will tuck in the lower jaw inward and may result in increasing pressure requirements or inducing events.

When I got my FP HC431 FFM I noticed immediately that I had the worse nights of sleep in years, despite zero leaks!

My wife said I was soring and Snorting INSIDE the Mask, as if I was not getting the correct pressure.

One night I hooked up the mask to My old Respironics Bipap-S and started to play with the pressure. I had to dial the machine up 2CM to 17/13 from 15/11 to get a decent nights sleep. The 15/11 was dialed in using a Nasal Interface and Chinstrap.

Ever since my last sleep study where I was determined to be mouth breathing I have had a hellaceous time fighting my equiptment.

Bottom line....don't do anything that changes the position of the airway!

Tight Chin Straps that pull the chin inward, A large fluffy bed pillow, sleeping on your back or overtigtening a full face mask all involve this, and may interfere with therapy.

I have two BiPap Machines a 5+ year old BipapS that Resipronic says they have validated with FF Masks.

And a Puritan Bennett Good Knight 425 that was ONLY validated with a Nasal Interface. I wonder if they do titration studies with Full Face Masks???

I have been on the phone alot with Fisher and Paykel....Mostly because I found that the HC431 to be the most comfortable, leak free, non shifting, non face torturing, interface I have ever used, but, it screwd up my therapy to the point I became a shuffling Zombie again.

Mikesus · Post by **Mikesus** » Wed Mar 02, 2005 4:19 pm

Thanks for the validation... Pressure for me seems to go 2 - 3 cm/H2O higher also...

-SWS · Post by **-SWS** » Thu Mar 03, 2005 2:39 pm

Mikesus wrote:Well I noticed that if I tighten down my Ultra Mirage FF mask, my AHI tends to go up, or the pressure needed to handle events seems to go up. I think I might have an explanation. (SWS PLEASE weigh in on this!)

If I tighten the lower straps, the bottom edge on the mask tends to push my jaw inward (back towards my throat) In thinking about what SWS said in another post about the best position for opening the airway, (head tilted back like you are about to receive mouth to mouth) I am now thinking that the jaw moving back like that would make the airway collapse more often, hence the higher pressure and or higher AHI... So if this is the case (BIG IF HERE) then too tight of a full face mask *might* reduce the effective therapy...

I am thinking too hard here?

Mike, I'm definitely not an expert in this area, but I agree with your logic. Mandibular realignment devices (MRD's) can alleviate apneas in some patients by pulling the jaw forward. It makes good sense to me then that pushing the jaw in the opposing direction should theoretically cause or exacerbate a few apneas in those same mandibular-affected patients.

wading thru the muck! · Post by **wading thru the muck!** » Thu Mar 03, 2005 3:40 pm

I would concur that for those of us who don't have the stereotypical recessed lower jaw found in many OSA sufferers, the pressure of a full face mask on the lower jaw could very well change the geometry of our breathing passages resulting in more severe obstructions. Do you think Docs/RTs/DMEs take this into account when patients on fixed pressure machines are swiched from a nasal mask (used during Lab titration) to a full face mask. I doubt it!

On the same subject, My concern regarding MRDs is what resultant problems may occur from having the position of ones jaw "repositioned" eight hours of the day. Seems it could cause all sorts of problems for those of us with proper jaw/bite alignment.

-SWS · Post by **-SWS** » Thu Mar 03, 2005 3:54 pm

wading thru the muck! wrote:On the same subject, My concern regarding MRDs is what resultant problems may occur from having the position of ones jaw "repositioned" eight hours of the day. Seems it could cause all sorts of problems for those of us with proper jaw/bite alignment.

Wader, to be perfectly honest I've been tempted to try an MRD. However, exactly what you mentioned (possible MRD side effects) is precisely what has made me the MRD chicken that I am today. Quite often MRD patients need an hour or more after waking up in the morning to get their bite realigned for the day. Permanent TMJ sounds like a hightened long-term risk as well using an MRD.

However, to be perfectly two-sided in my views, CPAP has both side effects and contraindications as well. What prescription or therapeutic device doesn't, though, when you really stop and think about it?

wading thru the muck! · Post by **wading thru the muck!** » Thu Mar 03, 2005 4:05 pm

-SWS,

The pain of TMJ is one side effect I don't wan't to have to live with. We are all getting our cpap therapy to rid us of chronic daytime sleepiness. In return I don't want to trade it for a chronic headache to go with the pain in the ass of wearing the hose.

Liam, to cut you off at the pass, I do know that one doesn't wear the hose in ones ass.

Mikesus · Post by **Mikesus** » Thu Mar 03, 2005 4:14 pm

wading thru the muck! wrote:-SWS,

The pain of TMJ is one side effect I don't wan't to have to live with. We are all getting our cpap therapy to rid us of chronic daytime sleepiness. In return I don't want to trade it for a chronic headache to go with the pain in the ass of wearing the hose.

Liam, to cut you off at the pass, I do know that one doesn't wear the hose in ones ass.

Yeah just think of the aerophagia you would get from that!!

ablemonk · Post by **ablemonk** » Thu Mar 03, 2005 5:15 pm

For anyone who is a mouth breather or has nasal congestion or sinus problems I strongly recommend the Fisher-Paykel Oral Oracle 452 from cpap.com---$99.00. With a good humidifier it has been a lifesaver for me (recurrent sinusitis and mouth breather).

Mikesus · Post by **Mikesus** » Thu Mar 03, 2005 5:17 pm

Looked at that, but don't like the idea of a nose plug...

rested gal · Post by **rested gal** » Thu Mar 03, 2005 5:25 pm

That's wonderful that the Oracle works well for you, ablemonk. If I ever get around to having the one inch nub inside the redesigned, improved Oracle cut off more flush with the inner flap, AND if I'd get around to finding more comfortable nose plugs than what F&P ship with it, I think I'd probably use the Oracle quite a bit. The concept is good, and the design of the new one is definitely worlds better than their original one. I just keep forgetting to get mine fixed the way I want it. It's been easier just to place my Activa over my mouth since the top of the shallow cushion just happens to block my nostrils off perfectly. *note to self - get that Oracle fixed*

ablemonk · Post by **ablemonk** » Thu Mar 03, 2005 10:23 pm

Don't blame you for being upset with the nose plugs.
They are not helpful. When I tried them they backed out in about 30 seconds. So I used 1" Transpore white tape over the nostrils for about a week and after that I was confidant that the vast majority of my breathing was through my mouth anyway and I stopped using any kind of nasal blocker. Or go to the YMCA and get swimmers' nose plugs. It took me awhile to learn how to screw and unscrew the mouthpiece holder to get the right tension. The mouthpiece sometimes slips off due to saliva and the pieces need to be washed in Palmolive, dried and reinserted.
The Oral Oracle is not without its problems and discomforts but it is better by far than all the rest I have tried especially if you have the problems I enumerate, I.E. recurring sinus infections, nasal blockages, eye irritation from escaping air around the nose, etc.

Liam1965 · Post by **Liam1965** » Fri Mar 04, 2005 6:50 am

I'm sorry, I may have missed this, but what is an "MRD", other than a French version of SHT, which I suspect most of us say on first learning we're going to have to be tethered to our bedpost every night for the rest of our lives?

Liam, returning from the Big D, which in this case, ain't Dallas.

wading thru the muck! · Post by **wading thru the muck!** » Fri Mar 04, 2005 8:19 am

MRD = Mandibular Repositioning Device

Liam, we missed you

Full Face Mask Experiment

Full Face Mask Experiment

Re: Full Face Mask Experiment

Mouth breathing may be an asset

Fisher-Paykel 452 Oral Oracle

Machine	Mask