Why do some people hate full face masks?

I am a successful CPAP user - down to about one detected event / night, which is considered normal.

I use a full face mask (Resmed Silicone F20) that completely covers my mouth and nose. (NOT one of the useless PR "full face masks" that don't cover both, which I also tried.) If adjusted right, it also creates a little tension around the mouth that keeps my mouth closed.

I don't understand why such masks aren't more popular, especially among people who sometimes open their mouth. And I assume the masks that just touch the bottom of the nose are relatively less effective, require more pressure, and don't badly, requiring more pressure and noise, with mouth breathers.

Is there a good reason?

It doesn't leak - once I learned to adjust it. So my machine can be set to a lower pressure, and makes essentially no noise.

I looked a bit here at the complaints people have about such masks. Most of the problems mentioned are cosmetic (it leaves lines on their face, or makes them puffy) or comfort. I suspect poor adjustment, or people pick the wrong size mask.

The sleep specialist at the hospital where I had my sleep study insisted full face masks are bad and completely outdated, and made me wear a nose mask that physically hurt to wear, and didn't really work for me. I was told I was supposed to learn to keep my mouth closed while I was asleep. No explanation was given on how I was supposed to do that. I got almost no sleep (maybe 15 minutes top) that night. Fortunately, the very elaborate machines at the hospital completely misread my lack of sleep, and decided CPAP works well for me.

Something my ENT says is very common among her patients. She says her patients get much better and more reliable results, in her opinion (which doesn't match what some nominal experts say) and are more successful in going to sleep, by using a simple (WatchPat brand) home test, but my insurance wouldn't cover it, and wouldn't have accepted its results.

(I looked at the description of the WatchPat devices. Obviously overpriced for a basic accelerometer to measure breathing and activity, possibly an orientation sensor, and a pulse/oximeter. I think there really should be two accelerometers, mounted on an adjustable strap placed around your abdomin and back, so it could still detect breathing if you turn over on your stomach. But otherwise, it would have been a lot more comfortable and effective than all the stuff they put on me at the hospital. E.g., the sensors they put on my back at the hospital meant I couldn't sleep on my back, which is where I am most comfortable. The WatchPat doesn't have an EEG - but frankly, after seeing how badly the hospital EEG detected my sleep state, and getting similarly poor results from the ZEO sleep manager home EEG I bought, I don't see that as a loss. I sometimes turn over in my sleep, so I don't think an orientation ["activity"] sensor is useful either.) The hospital equipment also put oxygen sensors outside my nose. Interesting idea, but not useful if you open your mouth to breath out, and I assume it is really the oxygen level in your blood stream that matters.

With regards to masks, the durable equipment provider was much more helpful and I think knowledgeable than the hospital tech (they even came to my home to help), though I needed several more tries to find the right mask and I had to figure out I also needed a dental guard, wedge pillow and neck brace, a different brand CPAP that could breath in my rhythm (for some reason the Resmed adjusts better to my rhythym than did the PR machine), and I needed to set the default pressure down to the minimum, instead of the high pressure the hospital used to compensate for using a leaky nose mask. (Maybe a bigger wedge wouldn't eliminate the need for my CPAP. Some day I will test that.)

In contrast, I assume a full face mask of the right size that covers the mouth and nose without leakage or excess pressure anywhere would work for almost everyone without problems, and would need less pressure which would in turn produce less noise.

Is there something about them that some people can't stand, that isn't a matter of adjustment and sizing?

The biggest complaint I have about the F20 mask is the instructions that came with it about fitting. They are nearly incomprehensible and maybe misleading. Also, it was initially a bit hard to figure out which strap went where. Each strap end and the buckle it goes through should be labelled with a unique letter, and that should be explained. And it should also be explicitly explained that it is much easier to adjust if the free end is on the outside. They should also provide a link to a very clear video.

I had to figure out for myself how to size and adjust the mask. I figured out sizing from OSHA publications about masks to keep out dust and chemicals, and still had to guess a bit.

I find the optimal way to adjust it for me is to iteratively adjust each strap so you have the minimum tension on each that makes it stay on and doesn't leak. It's really that simple. (It might work a little better for some head shapes if there were a way to adjust the distance between the two straps on top. And maybe there should be an adjustment for the mouth-closing force the mask applies.)

But if people here tried those things on such masks, and were still unhappy, I'd like to understand why.

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

I don't understand why such masks aren't more popular, especially among people who sometimes open their mouth. And I assume the masks that just touch the bottom of the nose are relatively less effective, require more pressure, and don't work at all with mouth breathers.

Is there a good reason?

For the same reason that everyone doesn't drive the same car, or wear the same style of clothes. Different preferences, along with the fact that different faces are ... shaped differently.

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

off topic stuff

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

instead of the high pressure the hospital used to compensate for using a leaky nose mask.

pressure is NEVER increased to 'compensate' for leaks. NEVER More pressure is used solely to open airways.

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

In contrast, I assume

We all know the old saying about assuming...

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

a full face mask of the right size that covers the mouth and nose without leakage

FFMs are harder to prevent leaks with than nasal masks, and much harder than pillow masks.

Force=pressure times area, so the force that is required to hold a FFM on someone's face is *MUCH* greater than the force required to resist the tiny contact patch a nasal pillow mask has.

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

Is there something about them that some people can't stand, that isn't a matter of adjustment and sizing?

It does not matter, you like your mask I like a P10 or a Bleep, go with what you like, be happy.

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

I am a successful CPAP user - down to about one detected event / night, which is considered normal.

I use a full face mask (Resmed Silicone F20) that completely covers my mouth and nose. (NOT one of the useless PR "full face masks" that don't cover both, which I also tried.) If adjusted right, it also creates a little tension around the mouth that keeps my mouth closed.

I don't understand why such masks aren't more popular, especially among people who sometimes open their mouth.

Is there a good reason?

It doesn't leak - once I learned to adjust it. So my machine can be set to a lower pressure, and makes essentially no noise.

I looked a bit here at the complaints people have about such masks. Most of the problems mentioned are cosmetic (it leaves lines on their face, or makes them puffy) or comfort. I suspect poor adjustment, or people pick the wrong size mask.

The sleep specialist at the hospital where I had my sleep study insisted full face masks are bad and completely outdated, and made me wear a nose mask that physically hurt to wear, and didn't really work for me. I was told I was supposed to learn to keep my mouth closed while I was asleep. No explanation was given on how I was supposed to do that. I got almost no sleep (maybe 15 minutes top) that night. Fortunately, the very elaborate machines at the hospital completely misread my lack of sleep, and decided CPAP works well for me. Something my ENT says is very common among her patients. She says her patients get much better and more reliable results, in her opinion (which doesn't match what the other nominal experts say) and are more successful in going to sleep, by using a simple (WatchPat brand) home test, but my insurance wouldn't cover it, and wouldn't have accepted its results. (I looked at the description of the WatchPat devices. Obviously overpriced for a basic accelerometer to measure breathing and activity, possibly an orientation sensor, and a pulse/oximeter. I think there really should be two accelerometers, mounted on an adjustable strap placed around your abdomin and back, so it could still detect breathing if you turn over on your stomach. But otherwise, it would have been a lot more comfortable and effective than all the stuff they put on me at the hospital. E.g., the sensors they put on my back at the hospital meant I couldn't sleep on my back, which is where I am most comfortable. The WatchPat doesn't have an EEG - but frankly, after seeing how badly the hospital EEG detected my sleep state, and getting similarly poor results from the ZEO sleep manager home EEG I bought, I don't see that as a loss.)

With regards to masks, the durable equipment provider was much more helpful than the hospital tech (they even came to my home to help), though I needed several more tries to find the right mask and I had to figure out I also needed a dental guard, wedge pillow and neck brace, a different brand CPAP that could breath in my rhythm (for some reason the Resmed adjusts better to my rhythym than did the PR machine), and I needed to set the default pressure down to the minimum, instead of the high pressure the hospital used to compensate for using a leaky nose mask. (Maybe a bigger wedge wouldn't eliminate the need for my CPAP. Some day I will test that.)

In contrast, I assume a full face mask of the right size that covers the mouth and nose without leakage or excess pressure anywhere would work for almost everyone without problems, and would need less pressure which would in turn produce less noise.

Is there something about them that some people can't stand, that isn't a matter of adjustment and sizing?

The biggest complaint I have about the F20 mask is the instructions that came with it about fitting. They are nearly incomprehensible and maybe misleading. Also, it was initially a bit hard to figure out which strap went where. Each strap end and the buckle it goes through should be labelled with a unique letter, and that should be explained. And it should also be explicitly explained that it is much easier to adjust if the free end is on the outside. They should also provide a link to a very clear video.

I had to figure out for myself how to size and adjust the mask. I figured out sizing from OSHA publications masks to keep out dust and chemicals, and still had to guess a bit.

I find the optimal way to adjust it for me is to iteratively adjust each strap so you have the minimum tension on each that makes it stay on and doesn't leak. It's really that simple.

But if people here tried those things on such masks, and were still unhappy, I'd like to understand why.

I agree with most of your assessments, thoughts and reasoning.

The mask I'm using after all these years is the one I started with.
I knew going into this that I was a mouth-breather and to go with some kind of nasal mask would be an exercise in futility. So, I did my homework and came up with the "ResMed Ultra Mirage Full Face" mask.
A little over a year later I bought a "Respironics Comfortfull 2" mask.....there was NOTHING "comfortable" about it.
I've also had some success with the "ResMed Mirage Quattro"......but never permanently migrated to it.

I've seen people who claim that a full face mask makes them claustrophobic.......but then they end up using chin straps and taping their mouths shut.......so much for claustrophobia.

So, enjoy your success and stick with what works best for you.
The equipment and settings we use is/are very individualistic and the users need to find out what works best for THEM.


Den

.

I used a FFM for months, then when I grew my beard out I had issues with leaks and didn’t want to futz with it, so switched to nasal pillows. It’s all a matter of preference and comfort, but I would happily switch back if I chose to do so. I don’t need another religion, I get enough guilt from the one I have.

Why do some people think that because they like something everyone else in the whole world should feel like they do about it and we, who don't like what they like, are the crazy ones who have something wrong with us or we just aren't trying hard enough?

They just can't stand to be 'alone'!

palerider wrote: ↑

Sun Jan 23, 2022 3:16 pm

pressure is NEVER increased to 'compensate' for leaks. NEVER More pressure is used solely to open airways.

But to keep the airways open, you need to have enough pressure inside your airway to open it. If a lot of the air leaks, the CPAP machine must apply more air pressure to provide the same pressure within the airway.

But your point about a given FFM not fitting some faces masks sense. The question is how to determine the face shape, and provide a mask that fits it. I picture an optical sensor that scans the face shape, but that would cost a lot of money. Perhaps a smartphone app that guesses the 3D shape by having you turn your head while the phone stands still in a stand? And the mask maker would have to have a bunch of mask shapes to send. For that matter, the F20 only comes in 3 sizes - probably not enough for everyone.

That kind of fitting would make sense for non-full-face masks too.

Obviously, silicone dive masks have to seal nearly perfectly - but they use a fair amount of pressure - including water pressure at depth. And its true divers don't all find the same mask style works for them. At least pre-Covid, divers and snorklers often went into stores and tried on many to find one that fit.

I think EMTs use full face masks on patients in ambulances. But they probably use more pressure too, that people would find uncomfortable long term.

It is true that the F20 is one of the more expensive masks - perhaps because it uses more material to make a bigger mask.

I suppose for people who are allergic to Silicone, other less conforming substances have to be used - requiring even more sizes and shapes.

I hadn't thought about beards.

I guess this is a lot like sports equipment. You can't find equipment that makes everyone happy. But the hospital tech should have let me try other masks, when I told her the one she made me use hurt.

Ugh. Full face masks are the last resort for people who can't get anything nasal to work.

camper wrote: ↑

Sun Jan 23, 2022 3:42 pm

palerider wrote: ↑

Sun Jan 23, 2022 3:16 pm

pressure is NEVER increased to 'compensate' for leaks. NEVER More pressure is used solely to open airways.

But to keep the airways open, you need to have enough pressure inside your airway to open it. If a lot of the air leaks, the CPAP machine must apply more air pressure to provide the same pressure within the airway.

But your point about a given FFM not fitting some faces masks sense. The question is how to determine the face shape, and provide a mask that fits it. I picture an optical sensor that scans the face shape, but that would cost a lot of money. Perhaps a smartphone app that guesses the 3D shape by having you turn your head while the phone stands still in a stand? And the mask maker would have to have a bunch of mask shapes to send. For that matter, the F20 only comes in 3 sizes - probably not enough for everyone.

Obviously, silicone dive masks have to seal nearly perfectly - but they use a fair amount of pressure - including water pressure at depth. And its true divers don't all find the same mask style works for them. At least pre-Covid, divers and snorklers often went into stores and tried on many to find one that fit.

It is true that the F20 is one of the more expensive masks - perhaps because it uses more materials to make a bigger mask.

I suppose for people who are allergic to Silicone, other less conforming substances have to be used - requiring even more sizes and shapes.

I hadn't thought about beards.

XPAP machines compensate for leaks with more VOLUME......NOT PRESSURE.
And, APAPs don't increase pressure either.......they keep the pressure the same until the large leaks end.

Den

.

loggerhead12 wrote: ↑

Sun Jan 23, 2022 3:49 pm

Ugh. Full face masks are the last resort for people who can't get anything nasal to work.

To quote Dirty Harry........"A man's got to know his limitations."

Den

.

Wulfman... wrote: ↑

Sun Jan 23, 2022 3:50 pm

XPAP machines compensate for leaks with more VOLUME......NOT PRESSURE.

Basic physics: to force more air through the tubes, as well as into the nose if air leaks out the mouth, you need to generate at least a little more pressure at the machine. Which makes it noisier.

I'm not certain how big the air resistance is in the tubes, so that may not matter much, but the nose has relatively small openings, and perhaps a partially obstructed airway does too. Which is why you hear a noise when you breath in rapidly through the nose. And part of why wind (music) instrumentalists and singers are generally taught to breath in through the mouth. (I wonder if that is how I got in the mouth breathing habit, or if it was genetic. A lot of the way I breath was trained rather than natural.)

In contrast, I assume a full face mask of the right size that covers the mouth and nose without leakage or excess pressure anywhere would work for almost everyone without problems, and would need less pressure which would in turn produce less noise.

Your basic assumption is incorrect. FF masks are designed to fit the mythical average person. The rest of us - many to most of us - have trouble.

I started out with an expensive professionally recommended FF mask. What misery! It was all pressure, pain, and leaks! My leak rating was 33! There was no way to get the thing to fit right. I did my research, decided to go with a minimalist mask, and had my sleep team order me the Resmed P10 pillows mask. Problem immediately and dramatically solved: no pain, no pressure, and blessed sleep. Leaks dropped to 2-3. Events range from 0.2-1.9 per hour. We did not need to increase my therapeutic pressure. I now sleep 7.5-9 hours per night.

The P10 is so silent, I hear nothing. I cannot feel my mask. When I close my eyes, I don't even know it is there. Often, I forget I have it on. I can sleep on my stomach, side, or back. I can wear my glasses. Heck, I can do pretty much anything with it on.

It's all a matter of different strokes for different folks. You keep your FF and more power to you. Me, I'll stick with pillows.

camper wrote: ↑

Sun Jan 23, 2022 3:42 pm

palerider wrote: ↑

Sun Jan 23, 2022 3:16 pm

pressure is NEVER increased to 'compensate' for leaks. NEVER More pressure is used solely to open airways.

But to keep the airways open, you need to have enough pressure inside your airway to open it. If a lot of the air leaks, the CPAP machine must apply more air pressure to provide the same pressure within the airway.

NO!
That is NOT how it works. the machine maintains the called for pressure, if there is more leak, then it will generate more air flow, but it never increases pressure. In fact, modern machines will actually reduce pressure in an attempt to get the mask to seal.

camper wrote: ↑

Sun Jan 23, 2022 3:42 pm

But your point about a given FFM not fitting some faces masks sense. The question is how to determine the face shape, and provide a mask that fits it. I picture an optical sensor that scans the face shape, but that would cost a lot of money. Perhaps a smartphone app that guesses the 3D shape by having you turn your head while the phone stands still in a stand? And the mask maker would have to have a bunch of mask shapes to send. For that matter, the F20 only comes in 3 sizes - probably not enough for everyone.

I used a FFM for 5 years, then I found something that I LIKE BETTER. Why shouldn't personal preference enter into your thought processes?

camper wrote: ↑

Sun Jan 23, 2022 3:42 pm

Obviously, silicone dive masks have to seal nearly perfectly - but they use a fair amount of pressure - including water pressure at depth.

Counteracted by the air pressure at depth.

camper wrote: ↑

Sun Jan 23, 2022 3:42 pm

I hadn't thought about

A lot of things.

camper wrote: ↑

Sun Jan 23, 2022 3:42 pm

But the hospital tech should have let me try other masks, when I told her the one she made me use hurt.

And here we come to the meat of the matter, and something about which I agree with you completely

camper wrote: ↑

Sun Jan 23, 2022 3:59 pm

Wulfman... wrote: ↑

Sun Jan 23, 2022 3:50 pm

XPAP machines compensate for leaks with more VOLUME......NOT PRESSURE.

Basic physics: to force more air through the tubes, as well as into the nose if air leaks out the mouth, you need to generate at least a little more pressure at the machine. Which makes it noisier.

You don't understand as much as you think you do.

You'd learn more if you would listen to people that know more than you do.

camper wrote: ↑

Sun Jan 23, 2022 3:59 pm

I'm not certain

Hang on to that, you just MIGHT learn something instead of arguing with those that know more than you do about the subject.

camper wrote: ↑

Sun Jan 23, 2022 2:52 pm

In contrast, I assume a full face mask of the right size that covers the mouth and nose without leakage or excess pressure anywhere would work for almost everyone without problems, and would need less pressure which would in turn produce less noise.

I think I missed addressing one fact here that you've got backwards.

A FFM often requires a higher pressure to open the airway than a nasal or nasal pillow mask because the FFM will push back on the jaw, further narrowing the airway.

MANY people report needing a lower pressure after removing that backwards pressure on their jaw, thus allowing the airway to open up a bit more.