Choosing correct mask, Septum questions

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
beetee
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Choosing correct mask, Septum questions

Post by beetee » Thu Jul 04, 2024 7:07 am

Hi all,

I have an appointment next week to collect my first CPAP machine from the hospital and meet the experts/techicans to discuss it's use and presumably choose a mask.

I have 3 questions relating to this, i hope some of you could kindly help

1. My nose periodically switches nostril for breathing and becomes blocked on one side while open on the other and then randomly swaps throughout the day and/ or night. I still don't understand if this means i have a deviated septum or nasal polyps, and i'm not aware of any way to be able to check this to differentiate between the two.
I have read online that if you have a deviated septum, when you are with your clinician choosing your mask you should not be choosing the pillow or nasal option and instead only be consiering the full face mask option to compensate for having a deviated septum.
Yet when i search and read more online, I found conflicting views on this, with other people saying that if you do have a deviated septum it isn't an issue or a reason to avoid the pillow or nasal masks and they will both be just as effective as the full face mask.

Could anyone please help to clarify this?

2. I have suffered previously with acid reflux (though i now have it under control) & also Irritable bowel syndrome, bloating and general stomach sensitivity, I'm worried about these reports of aerophagia, and I'm reading that using any of the nasal masks reduce the chance of getting aerophagia drastically vs a full face mask.

Is this true?

3. I tend to turn from side to side when i sleep (or at least i think i do) Is it important i use a mask that has the air inlet at the top of head, or is it still possible to wear a mask with the inlet at your mouth, if you frequently turn postions during the night.

Also, other than the above is there anything else besides comfort that needs to be taken into consideration?

Thanks

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robysue1
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Re: Choosing correct mask, Septum questions

Post by robysue1 » Thu Jul 04, 2024 9:58 am

beetee wrote:
Thu Jul 04, 2024 7:07 am
1. My nose periodically switches nostril for breathing and becomes blocked on one side while open on the other and then randomly swaps throughout the day and/ or night. I still don't understand if this means i have a deviated septum or nasal polyps, and i'm not aware of any way to be able to check this to differentiate between the two.
The periodic switching of breathing from one nostril to the other is called the nasal cycle. It's perfectly normal and quite common: Estimates are that at least 70% of healthy adults, including those without any deviation of the septum, will have breathing patterns that include a nasal cycle of periodically switching the "dominant" nostril being used to breathe. Most of the time we're not even aware of the fact that our dominant nostril has switched. And when we are aware? It's often when we're lying down on one side. (And that in turn can lead us to simply turn over to make it "easier to breathe".) There's even a yoga exercise (called Nadi Shodhana Pranayama) that is designed to help people become much more aware of how their normal breathing shifts from one nostril to the other periodically.
I have read online that if you have a deviated septum, when you are with your clinician choosing your mask you should not be choosing the pillow or nasal option and instead only be consiering the full face mask option to compensate for having a deviated septum.
Unless you have been formally diagnosed by an ENT as having a severely deviated septum, I would say you are worrying unnecessarily about whether you can use a nasal mask or whether you will need a full face mask.

Rather than asking, "Do you have a deviated septum?", the tech who sets you up with your equipment is much more likely to ask, "Do you often breath through your mouth?"

Mouth breathing is a problem with using nasal masks: When your mouth opens up, pressure is lost through your oral cavity.

To understand this, it helps to think of xPAP therapy as an intentionally leaky pressurized system comprising your lungs, upper airway, the mask, the hose, and the machine. There is an intentional leak in the system---the air flowing out of the mask's exhaust vents---that is built in so that you do not rebreathe your own exhaled CO2. The machine is designed to pump air into the system at the same rate it is being lost through the intentional leak caused by the exhaust vents. Now if a small additional leak occurs, the machine just increases the air being blown into the system to maintain the desired pressure. But if you are using a nasal mask, when your mouth opens up, huge amounts of air can exit through your mouth (rather than being blown into the upper airway), and this new, large additional leak can be too much for the machine to compensate for: The more air it blows into the system in an attempt to maintain pressure, the more that air simply exits through the mouth.

Now some people do breathe through their mouths because of severely deviated septums. But most people with a deviated septum breath through their nose just fine.

And a lot of people just breathe through their mouth out of habit, even if their septum is not particularly deviated. Sometimes it's because they developed the habit of mouth breathing due to severe allergies. Sometimes it can be due to nasal polyps. Or enlarged adenoids or tonsils. Sometimes the problem is caused by the tongue: In normal nose breathing, the tongue usually parks itself where the tip of the tongue is resting against the roof of the mouth just behind the front teeth and the front of the tongue is touching the roof of the mouth. This effectively blocks off the oral cavity from the upper airway and simultaneously makes it almost impossible to breath through the mouth even if you try to. If there's a problem like a severe tongue tie, that might lead to mouth breathing. But often people who mouth breathe have simply gotten out of the habit of keeping their tongue in place for nasal breathing.

I'll also say that there are people on the forum who have trained their tongue to stay parked on the roof of the mouth to minimize mouth breathing. There are other people who use tape to keep their mouth from dropping open after they fall fast asleep. So even if you are a part-time mouth breather, if you don't want to use a full face mask, insist that the tech set you up with a nasal mask. If the leak data shows you are having real problems with mouth leaks, you can figure out what to do at that point.
Yet when i search and read more online, I found conflicting views on this, with other people saying that if you do have a deviated septum it isn't an issue or a reason to avoid the pillow or nasal masks and they will both be just as effective as the full face mask.
According to the Mayo Clinic, 70-80% of the population has a septum that can be called "deviated", but most of those people have no trouble at all with breathing through their nose in spite of their deviated septum. And if you breathe through your nose most of the time, there is no need to use a full face mask.

So just ignore anybody who tells you that you can't use a nasal mask if you have a deviated septum. Remember: The problems with using a nasal mask are caused by mouth breathing, not a deviated septum.
2. I have suffered previously with acid reflux (though i now have it under control) & also Irritable bowel syndrome, bloating and general stomach sensitivity, I'm worried about these reports of aerophagia, and I'm reading that using any of the nasal masks reduce the chance of getting aerophagia drastically vs a full face mask.

Is this true?
Some folks with a history of acid refux have reported that CPAP has helped their reflux. Others have reported that it's aggravated it.

Some folks (like me) have dealt with severe aerophagia problems without having a previous history of reflux or irritable bowel syndrome related bloating.

Aerophagia is caused by swallowing air while using CPAP. In my case, I developed a genuinely severe case of aerophagia while using nasal pillows. I never had significant evidence of mouth breathing while the aerophagia was at its worst: My unintentional leak line was almost always right at 0 L/min for most of the night with minor blips in the 5-10 L/min range lasting for maybe 5 minutes at a time.

What did seem to cause my aerophagia was that at the start of CPAP therapy I had a hard time keeping my tongue parked on the roof of my mouth in my sleep, and when the tongue slipped, air would rush into my mouth, but I would not open the mouth to let that excess out. Rather when enough air accumulated in my mouth, I simply swallowed it. Adding to the problem was that I also was fighting significant insomnia with numerous arousals/mini-wakes. And with every mini-wake I would tend to swallow and if there was any excess air in my mouth, that air wound up in my stomach.

In my case, I was initially a bit over titrated. Turning on EPR to its max setting of 3 was somewhat helpful, but did not really alleviate the worst of the pain. The PA treating me at the time then switched me to APAP with a narrow setting of 4-9 which helped a bit more without any significant increase in AHI numbers. But after about 8 weeks of PAPing while continuing to have problems with painful aerophagia, the PA authorized a bi-level titration. The switch to bi-level did the trick in eliminating the significant problems aerophagia. (Yes, I still have the occasional night where I wake up bloated from aerophagia, but it's now more like once every 2 or 3 months instead of 4 or 5 times a week.)
3. I tend to turn from side to side when i sleep (or at least i think i do) Is it important i use a mask that has the air inlet at the top of head, or is it still possible to wear a mask with the inlet at your mouth, if you frequently turn postions during the night.
I'm a side sleeper. When I started there were no masks with the air inlet at the top of the head and most of us side sleepers did just fine with masks that have hose attachments at the front of the mask.

For me: I run the hose (in a hose cozy) under the covers and along my body. I basically gently hold the hose--rather like it is a stuffed toy. And when I turn over in bed, the hose turns with me. Other folks using masks with the hose attachment at the front will route the hose up over their shoulder and over the headboard. Or hang it on a hose hanger.

Personally, I have no desire to try a mask with the hose attachment on the top of my head: The side straps are bulkier in order to provide a tunnel for the air to flow from the top of the head down to the nose. I also can't help but wonder if conducted noise would be more of an issue in a mask that has the hose attachment at the top of the head---it seems to me that having the air flow through the side straps along the side of your face could easily amplify and conduct the sound of your own breathing through your skull and into your ears, and "the sound of Darth Vader breathing" is a pretty common complaint among new users regardless of what kind of mask they use.
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ozij
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Re: Choosing correct mask, Septum questions

Post by ozij » Thu Jul 04, 2024 10:10 am

beetee wrote:
Thu Jul 04, 2024 7:07 am
Hi all,

I have an appointment next week to collect my first CPAP machine from the hospital and meet the experts/techicans to discuss it's use and presumably choose a mask.

I have 3 questions relating to this, i hope some of you could kindly help

1. My nose periodically switches nostril for breathing and becomes blocked on one side while open on the other and then randomly swaps throughout the day and/ or night.
Everyone's nose does this.
I have read online that if you have a deviated septum, when you are with your clinician choosing your mask you should not be choosing the pillow or nasal option and instead only be consiering the full face mask option to compensate for having a deviated septum.

There are two major reasons to use a full face mask (FFM):
  • You have to breathe in and out through your mouth because you cannot use your nose for breathing (congestion, nasal polyps, whatever).
  • You can't control the way air leaks out of your opening mouth when you're on CPAP.
FFM is not the only way to manage the latter - but it is the preferred way for some.
Yet when i search and read more online, I found conflicting views on this, with other people saying that if you do have a deviated septum it isn't an issue or a reason to avoid the pillow or nasal masks and they will both be just as effective as the full face mask.
True.
3. I tend to turn from side to side when i sleep (or at least i think i do) Is it important i use a mask that has the air inlet at the top of head, or is it still possible to wear a mask with the inlet at your mouth, if you frequently turn postions during the night.
You can learn to sleep and change positions with a mask that does not have and inlet from the top of the head.
For some of us, restless sleep it the result of sleep apnea, and once our breathing is smooth, we do far less tossing and turning that we used to before therapy.
Also, other than the above is there anything else besides comfort that needs to be taken into consideration?
Comfort first and foremost. But keep in mind that comfort also includes the noise the mask makes when connected to your CPAP machine at pressure, and the way the vented air blow out - at you, your bedclothes or your partner.
Some masks are much noisier, and some vent out much stronger than others. Check that out too.
Insist (if at all possible) on fitting and trying the mask when you're lying down (not sitting), and you may even want to consider bringing along the pillow you use at home.

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Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks.
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vandownbytheriver
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Re: Choosing correct mask, Septum questions

Post by vandownbytheriver » Thu Jul 04, 2024 10:40 am

You're describing my exact situation... nostril switching, reflux, toss n turn.

I've had success with CPAP and now bi-level for 14 years.

If the nostril thing bothers me I fight it with Afrin... not recommended, I know, but you do what you have to do. Nasal cortisone tends to give me sinus infections.

I had bad reflux until I started CPAP... could only sleep on my left side... now I can sleep on either and, with bi-level and higher pressures, even go on my back. It really helps when the pressure outside your stomach is higher than the pressure within. Also, I take 20mg Prilosec OTC every morning... and no frito pie after 8pm. I've had a chronic battle with both sinus and stomach since I was a kid, this is victory for me, a little OTC drugs is not too much to pay.

I've learned to expect the hose, it's part of me now, I hunt for it every time I roll over or adjust, I can often stop mask leaks by tugging on it. I would not like the top-of-head hose thing for this and also for the fact that those masks that do this are inherently louder, the air has to go through side pieces close to your skull, my nasal and FF masks are absolutely silent unless the exhaust hits the pillow etc.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: I use O2Ring, Oscar, SleepHQ, and Cover Roll Stretch mouth tape.

beetee
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Re: Choosing correct mask, Septum questions

Post by beetee » Thu Jul 04, 2024 11:30 am

Thank you all for your specifc and detailed replies, it's very much appreaciated.

Do you guys think its worth buying a second mask type to try it out, or should that be avoided and leave it to the healthcare provider to offer to swap the mask if its not working?

I know its personal preference but which of the 3 types of masks would you guy choose as you can only choose one?

I don't have a partner, and I can't be certain if i am a mouth breather, i think i am, but i'm not 100% sure.
So what i plan to do is use a tripod mount and IR nighttime wildlife camera, to film myself while i sleep for the next few nights before the appointment and see if i can get a better idea of this. The camera turns on and off based on motion/movement and records let say about 10-11, 2 minute film clips over the course of a full nights sleep, Im not sure how accurate the results will be, but hopefully it can provide and insight into whether or not i am mouth breathing, and i can then tell the techican what i noticed from it.

As I'm potentially expecting to be issued with a Resmed machine, i would also assume (for uniformity) that i will be given a resmed mask as well, The reason why i asked about side sleeping was because the way they market there 'Freedom' mask is suggesting to me by its name and description that it's the 'only' one that allows such tossing and turning without disconnecting the pipe or have leak etc
https://www.resmed.com/en-us/sleep-apne ... pap-masks/

Although is seems you guys are saying that you can pick any mask and just have to learn to adjust to it.

I don't want to get ahead of myself, I'm aware my healthcare providers only offer cpap and do not offer bipap, presumably unless you pay for it yourself, The stomach issues i have had over the years have been a nightmare and the Aerophagia does concern me, but either way i guess i need to start with cpap and see how i get on first.

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Miss Emerita
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Re: Choosing correct mask, Septum questions

Post by Miss Emerita » Thu Jul 04, 2024 11:36 am

A few additional thoughts:

Back when, I tried the ResMed AirFit P30i nasal pillow mask but found the rustling sound of the air going through the side-channels maddening.

The Aloha mask is a nasal pillow mask with a short hose that you can route up over your head using a little loop on the top strap. I liked that mask, though it was a bit fiddly to assemble.

If you try a pillow mask, be sure to get a fit pack, meaning all available pillow sizes (S, M, L). You won't really know which works best for you without trying.

Finding the right mask for your unique face and nose can require some trial and error. But here's hoping you find your keeper mask early on!
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ChicagoGranny
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Re: Choosing correct mask, Septum questions

Post by ChicagoGranny » Thu Jul 04, 2024 3:31 pm

beetee wrote:
Thu Jul 04, 2024 11:30 am
i am a mouth breather, i think i am
If you had an in-lab sleep titration, they should have told you whether your mouth opened.
beetee wrote:
Thu Jul 04, 2024 11:30 am
Do you guys think its worth buying a second mask type to try it out
One at a time.
beetee wrote:
Thu Jul 04, 2024 11:30 am
As I'm potentially expecting to be issued with a Resmed machine
Make sure it is a ResMed AirSense 10 or 11 AutoSet, preferably 10. Demand AutoSet!
beetee wrote:
Thu Jul 04, 2024 11:30 am
expecting to be issued with a Resmed machine, i would also assume (for uniformity) that i will be given a resmed mask as well,
That's not at all necessary.
"It's not the number of breaths we take, it's the number of moments that take our breath away."

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vandownbytheriver
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Re: Choosing correct mask, Septum questions

Post by vandownbytheriver » Thu Jul 04, 2024 9:11 pm

I recommend the 10, the 11 has been problematic. Get a 10 while you still can is my recommendation.

IMO Fisher & Paykel make the best masks... my DME only stocked Resmed, so I got a RM mask with my new Aircurve 10. Turned out that an N20 nasal was not going to work, the pressures are too high... so I told them I needed a full-face version. They gave me another mask for free. Tried it (F20 Airtouch), still prefer the F&P mask... I use Vitera and sometimes Evora. Not a fan of the magnets.

The mask will be your most important interface to the machine... take care when fitting, make them let you try several different masks. If you try it for a night or two and find problems go back and get another mask... this is your chance. You can buy masks online but a) you'll need a prescription and b) they're not cheap, at least 100$ for the good ones. I started with a nasal mask around 50 years old, but after I passed 60 I started mouth-leaking... and after raising my pressures I had to go to a full-face mask. Everyone should have a FF mask for times when you are ill, cold, flu etc. I never liked the pillows masks, if you can handle them touching your nose they are supposed to be very comfortable. If you find you are mouth-leaking with a nasal or pillows mask you can use tape to hold your mouth shut... I tape my mouth shut while I'm using a FF mask, no problems with drooling or dry mouth.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: I use O2Ring, Oscar, SleepHQ, and Cover Roll Stretch mouth tape.

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ChicagoGranny
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Re: Choosing correct mask, Septum questions

Post by ChicagoGranny » Fri Jul 05, 2024 5:48 am

vandownbytheriver wrote:
Thu Jul 04, 2024 9:11 pm
The mask will be your most important interface to the machine
And then comes the hose, and then comes the ... Oops, forgot.
"It's not the number of breaths we take, it's the number of moments that take our breath away."

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robysue1
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Re: Choosing correct mask, Septum questions

Post by robysue1 » Fri Jul 05, 2024 8:04 am

beetee wrote:
Thu Jul 04, 2024 11:30 am
I know its personal preference but which of the 3 types of masks would you guy choose as you can only choose one?
Masks are in the nose of the user.

What works well for Person A can be a disaster for Person B. And vice versa. As an example: I strongly prefer nasal pillows masks because anything going over the tip of my nose triggers instant sneezing, but nasal pillows don't. (I think it is a psychological reaction, not an allergic one.) My husband, who is not a mouth breather, started out with a nasal mask because he didn't like the way nasal pillows concentrate the airflow directly into the nostrils. Later he bought a full face mask just in case he needed it for a head cold with severe congestion, and when he tried that mask during his first head cold, he found out that he actually preferred the feel of the full face mask to that of his nasal mask. And ever since then, his daily mask has been a full face mask. He recently tried a newer version of a full face mask without the traditional forehead support, and he didn't like it. So he's back to a traditional full face mask.

I would start the quest for the mask by asking to try on as many masks as possible and with the machine on and at your full therapeutic pressure if possible. Try at least one of each style. You're looking for comfort. If the mask is distinctly uncomfortable, it's not for you. And keep in mind that two similar looking masks may actually feel rather different on your particular face.

Make sure the tech fitting you doesn't adjust the straps too tight. (Many techs seem to think the straps have to be really tight in order to prevent leaks; but most CPAP masks are actually designed with so-called air cushions and need a bit of looseness in order to seal properly and over tightening the straps can prevent the air cushion from fully inflating which leads to the mask leaking.)
I don't have a partner, and I can't be certain if i am a mouth breather, i think i am, but i'm not 100% sure.
Think about your daytime breathing---do you often find yourself breathing through your mouth when you are just sitting down and doing nothing strenuous? If you don't breathe through your mouth during the daytime, then you probably don't mouth breathe at night.

So what i plan to do is use a tripod mount and IR nighttime wildlife camera, to film myself while i sleep for the next few nights before the appointment and see if i can get a better idea of this. The camera turns on and off based on motion/movement and records let say about 10-11, 2 minute film clips over the course of a full nights sleep, Im not sure how accurate the results will be, but hopefully it can provide and insight into whether or not i am mouth breathing, and i can then tell the techican what i noticed from it.
This is overkill. Seriously, you are over worrying about the idea of mouth breathing.

My own advice is this: If you don't mouth breath during the daytime, just assume you don't mouth breathe at night. If you opt for a nasal or pillows mask because they seem more comfortable to you, you can use the leak data from the machine to figure out whether there is evidence of enough mouth breathing (or mouth leaking, which is different than mouth breathing) to warrant switching to using a FFM.

And also keep this in mind: You don't need a perfect excess leak line at 0 L/min all night long for therapy to be working. If you wind up mouth breathing for 5-10 minutes a couple of times a night, that's no big deal in terms of the efficacy of your data. If you mouth breathe for 2 or 3 hours every night, that's enough mouth breathing to warrant using a FFM.

It's also worth noting that inflexible DMEs seem to come in two varieties: There are those DMEs that are adamant that anyone who is not mouth breathing in front of them needs to be fitted with a nasal mask---even when the person knows they mouth breathe at night or when the in-lab sleep test indicated that they mouth breathe at night. And then there are those DMEs that are adamant that everyone who cannot guarantee they never breathe through their mouth ought to start with a full face mask "just in case." Both of these kinds of DMEs don't know diddly-squat about actually using CPAP therapy, and if you wind up with one of them, you need to learn to be polite but firm in your choice of mask if you disagree with the tech when it comes to the choice of mask that you (not the tech) will be using every night.

Do you guys think its worth buying a second mask type to try it out, or should that be avoided and leave it to the healthcare provider to offer to swap the mask if its not working?
Mask manufacturers have an established policy that DMEs are supposed to follow, particularly for new PAPers that allows for at least one or two mask exchanges during the first 30 days. Make sure you understand the DME's mask exchange policy and start there: Pick the mask that seems most comfortable (or "least uncomfortable") and start with that one. Try using it and if it's clearly not working out, then use the DME's mask return policy to swap the mask out.

But having said that, its important to realize that a few people go through a dozen or more masks before finding one that works for them and others luck out and find the first mask they choose to be really nice and have no desire to try others. Most people are in between those extremes.

If you find it necessary or simply preferable to buy additional masks out of pocket, you might find an on-line DME, such as our host CPAP.com, both cheaper and easier to deal with in terms of mask exchanges for masks that are just not working out.

As I'm potentially expecting to be issued with a Resmed machine, i would also assume (for uniformity) that i will be given a resmed mask as well,
Assume nothing about DMEs except that they care about their bottom line (financially) more than they tend to care about their patients needs.

Be sure to ask for (insist on) a Resmed AutoSet over the Resmed Elite for additional flexibility. At this point, I think all current Resmeds will record full efficacy data. (If I'm wrong, somebody needs to correct me about that.)

The reason why i asked about side sleeping was because the way they market there 'Freedom' mask is suggesting to me by its name and description that it's the 'only' one that allows such tossing and turning without disconnecting the pipe or have leak etc
https://www.resmed.com/en-us/sleep-apne ... pap-masks/
The Resmed "Freedom" masks are just masks with the hose connection at the top instead of in the front.

On the one hand, Resmed believes that this hose connection location offers more freedom for turning over in bed. On the other hand, that means the side frames of the mask have air tubing in them for the airflow to get from the top of the mask and down to your nose, and that can mean you're going to have much more conducted noise from the mask---i.e. you may hear the air movement (and hence every breath you take along with fan noise) being amplified by the fact that the noise is being directly conducted through the bones in your head to your inner ears.

Now having said all that: There are people here who love the Resmed Freedom masks (i.e. the P30i, N30i, or F30i) and don't have problems with the conducted noise issues. But there are also plenty of side sleepers who do just fine with masks that connect at the front of the mask. If you find the side frame for the Freedom masks winds up being an issue, don't worry about swapping to a mask that has the hose at the front.

As a side sleeper who uses both the Resmed P10 and Resmed Swift FX nasal pillows masks, I run my hose under the covers and just hug my hose. When I turn, the hose comes with me. Other side sleepers using masks with the hose connection at the front simply run the hose over the headboard or use a hose hanger, and so their set up looks similar to that with a Freedom mask even though the hose is attached at the front of the mask.

As for tossing and turning? Many of us find that once our xPAP therapy is optimized, we do a whole lot less tossing and turning in our sleep because we are sleeping without interruptions by apenas. In other words, our sleep settles down not because we're somehow "confined" by the hose and unable to move around in the bed; rather our sleep settles down because our body is no longer being awakened all night long by breathing problems that trigger real fight/flight responses while we're asleep.

Although is seems you guys are saying that you can pick any mask and just have to learn to adjust to it.
Pretty much. Although we'll all tell you that you have to pick a mask that feels "reasonably comfortable" when you first try it on. Because trying to learn to sleep with a mask that is genuinely uncomfortable makes everything harder. But comfort lies in the nose and face of the CPAPer.

Any mask you choose will have its plusses and its minuses. And sleeping with any mask is not the same as sleeping without a mask. So, yes, there is a learning curve to sleeping with a mask on your face. But for most people, a well chosen mask minimizes the learning curve and after the initial adjustment period most new PAPers are sleeping pretty good all night long with a mask of their choice.

But no-one here can tell you what the best mask for your nose and face is. You're the one who has to try the masks on and see how they feel.

I don't want to get ahead of myself, I'm aware my healthcare providers only offer cpap and do not offer bipap, presumably unless you pay for it yourself,
Bilevel machines (i.e. bipap) require a different script. They are much more expensive and are typically only prescribed under certain circumstances. But if a bilevel machine is prescribed, the DME has to provide one.

You will start out with a generic CPAP script. That's enough for being set up with either a Resmed CPAP, a Remed CPAP Elite, or a Resmed AutoSet. The DME may squawk about setting you up with the AutoSet, but that's the machine you really should be insisting on. If you have not had a titration study done in a sleep lab, then your script may specify an AutoSet set to the default range of 4-20. That seems to be pretty common these days as a way of saving insurance companies the cost of doing the in-lab titration study, which far exceeds the cost differential between an AutoSet and a plain CPAP. (It also saves the patient the discomfort of doing a second sleep test.)

And if you don't know what your script says, contact the doctor's office that sent the script to the DME and ask for a copy of the script for your own records. You need to know exactly what the script reads, both in terms of the description of the machine and in terms of the pressure settings.

The stomach issues i have had over the years have been a nightmare and the Aerophagia does concern me, but either way i guess i need to start with cpap and see how i get on first.
I would suggest keeping a log once you start PAPing. Write down on paper (or in an excel spreadsheet) every incident of stomach problems and when they occur. Also write down notes about any aerophagia you wind up experiencing: What time of night it occurred, a rating of how painful it is, whether it woke you up from a sound sleep, and whether it kept you from getting back to sleep in a timely fashion.

And if it's clear from your log that you are experiencing a lot of painful aerophagia, contact the doctor who prescribed the equipment (not the DME) and let the doctor's office know you are having extreme difficulties with aerophagia. Ask to meet with the doctor or a PA to talk about the aerophagia issue. With enough documentation about the aerophagia problem and what has been tried to alleviate it, the doctor/PA and you can then have a conversation about whether an in-lab bilevel titration sleep study is warranted in an effort to get your insurance to pay for bumping you up to a bilevel machine such as the Resmed VPAP Auto that I now use.

In my case (14 years ago), I had met with the PA in the sleep doc's office a number of times (on "emergency" appointments) during the first 2 months of PAPing with obvious discomfort from the aerophagia along with badly deteriorating daytime functioning while being totally compliant with therapy when the PA told me that she had recommended a switch to bilevel to the sleep doctor and he agreed with that recommendation. So I was sent to the lab for my third in-lab sleep test. The results showed two things: (1) I did better on bilevel in terms of the aerophagia and (2) I was dealing with a massive case of insomnia and my self reporting of how much actual sleep I was getting was vastly overestimating the amount of sleep I was getting. (Most insomniacs underestimate the actual amount of sleep they get every night.) That sleep study led to me being switched to a bilevel machine (a PR System One BiPAP Auto at the time) as well as a coherent, organized CBTI plan for fighting what I now often call my First War on Insomnia. For me to optimize my PAP therapy, it took both the switch to bilevel (to bring the aerophagia issue under control) and successfully treating the significant insomnia.
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beetee
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Re: Choosing correct mask, Septum questions

Post by beetee » Fri Jul 05, 2024 9:32 am

Thanks for that info, a couple of additional points.

While I'm not 100%, It is my understanding that my hospital is due to issue me with a Resmed Airsense 10 Autoset, but i will confirm that next week once I have had the appointment.

I don't breathe through my mouth when im awake during the daytime, and while I appreaciate it's overkill to film oneself, its actually super easy to set up and record and there are no lights on the device to wake you up, so whether i do breathe from the mouth or not, I think there is no harm in having some video evidence to corroborate & reaffirm my understanding of this.

From what i've read online, it seems people usually either like the pillows or full face mask, but i don't seem to hear much love for the Nasal (non pillow mask), I'm aware its just a scaled down version of the the full face mask, are there many people that use or like it?

I will try on all masks, my concern with the pillows mask is the potential intrusive feeling of it being right inside your nostrils, and sometimes i may possibly feel more stuffy and blocked than i actually am. I have anxiety which could worsen this or i'll be fine with it, I will just have to see on the day of the appointment.
The problem is, if i even feel slightly bunged up or blocked in my nose, (even if its not actually as bad as i think) i always start mouth breathing, (possibly as an anxious reaction i'm not certain)

I also tend to be susceptible to frequent viral infections throughout the year, which makes me think (since i only get to choose one mask) that a full face mask might be better for me.
I'm autistic, so sensory overload of any kind is usually magnifed in terms of feeling, though i can certainly adjust to things & have done in the past.

Is the full face mask a bad pick for potential concern of aerophagia, as what i've read suggests those who use any form of nasal mask experience aerophagia far less than those using the full face mask, or is that purely anecdotal?

I'm not sure how long my appointment is, (it wasn't specifed) I would imagine it is between 40 minutes to an hour at most, I'm pretty indecisive so no doubt the time will go fast, hopefully i won't feel rushed and can get what seems to be the right choice, Thanks for the advice on the mask exchange policy, I have written that down along with the other points you guys provided to ask when i attend.

I don't know for sure but as mentioned previously if cpap was difficult for me to tolerate and suceed with, my healthcare providers (NHS UK) do not (as i understand it) give out any bipap machines, only cpap, so i could be wrong, but if it ever came to wanting to try bipap, i would have to buy the machine out of my own pocket.

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ChicagoGranny
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Re: Choosing correct mask, Septum questions

Post by ChicagoGranny » Fri Jul 05, 2024 10:34 am

beetee wrote:
Fri Jul 05, 2024 9:32 am
beetee
Fundamental Rule of Masks: The user will not know which type and model of mask suits him until he uses it for some time.
"It's not the number of breaths we take, it's the number of moments that take our breath away."

Weld3z
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Re: Choosing correct mask, Septum questions

Post by Weld3z » Sat Jul 06, 2024 5:16 pm

Tried 60% of the masks ended with F&P Vitera, GL

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Re: Choosing correct mask, Septum questions

Post by robysue1 » Sat Jul 06, 2024 11:53 pm

beetee wrote:
Fri Jul 05, 2024 9:32 am
I don't breathe through my mouth when im awake during the daytime, and while I appreaciate it's overkill to film oneself, its actually super easy to set up and record and there are no lights on the device to wake you up, so whether i do breathe from the mouth or not, I think there is no harm in having some video evidence to corroborate & reaffirm my understanding of this.
In all seriousness, if I were you, I would just assume that you don't do much mouth breathing at night and not worry with the experiment.
From what i've read online, it seems people usually either like the pillows or full face mask, but i don't seem to hear much love for the Nasal (non pillow mask), I'm aware its just a scaled down version of the the full face mask, are there many people that use or like it?
What other people like is irrelevant for choosing the mask that is best for you.

And there are plenty of people who like nasal masks---particularly the newer mini-nasal masks that use a pillows-type headgear and only cover the tip of one's nose. The Resmed N30i is an example of such a nasal mask as is the Resmed N30. (The difference between the N30i and the N30 is where the hose attaches---the N30i has the hose attachment at the top of the head and shares headgear with the P30i; the N30 has the hose attachment at the front of the mask and shares headgear with the P10.)

I will try on all masks, my concern with the pillows mask is the potential intrusive feeling of it being right inside your nostrils,
That's a common reason for people who start with pillows to swap to nasal masks: Not everybody is comfortable with something sitting right on their nostrils and poking ever so slightly into their nostrils.

But having said that, I'll also add this: If the nasal pillows are properly adjusted, you don't feel them inside your nostrils and the airflow should not be hitting the sides of the inside of your nose.

and sometimes i may possibly feel more stuffy and blocked than i actually am.
Many of us find that our noses feel much less stuffy when we are using CPAP at night than during the day when we're not.

But having said that, I'll also add: The humidifier setting on the CPAP often influences how much nasal congestion you experience. Unfortunately this is another "It's in the nose of the user" aspect of xPAP therapy: Some people (such as Pugsy and myself) have noses that really want the humidifier cranked all the way up to its max setting, and we have to figure out a way to deal with the inevitable rainout issues. Other people find that they get congested when the humidifier is set too high. There are even some people who prefer no added humidity at all. So if the CPAP seems to trigger nasal congestion, then you have to experiment to figure out whether your particular nose wants more humidity or less.
I have anxiety which could worsen this or i'll be fine with it, I will just have to see on the day of the appointment.
The problem is, if i even feel slightly bunged up or blocked in my nose, (even if its not actually as bad as i think) i always start mouth breathing, (possibly as an anxious reaction i'm not certain)
It may be best to try to not overthink this yet. Get the machine and try to sleep with it. If the nose starts feeling congested while you have the mask on and the machine turned on, then turn the humidifier/hose temp to manual and crank the humidity up a couple of notches. See if that makes the feeling of congestion worse or better. If the congestion is worse, then turn the humidifier setting down below its original default setting and see if the dryer air seems to help your nose feel better.
I also tend to be susceptible to frequent viral infections throughout the year, which makes me think (since i only get to choose one mask) that a full face mask might be better for me.
Perhaps. But if you hate the feeling of a FFM when you try one on, then its a bad idea to get a FFM as your only mask "just in case" you get sick. You can always ask for a FFM when you become eligible for a mask replacement. Or you can just buy one out of pocket. (Look for mask sales at on-line DMEs like our host, CPAP.com, and that will help with the cost of a second mask.)

I'm autistic, so sensory overload of any kind is usually magnifed in terms of feeling, though i can certainly adjust to things & have done in the past.
Good luck keeping the sensory overload under control.
Is the full face mask a bad pick for potential concern of aerophagia, as what i've read suggests those who use any form of nasal mask experience aerophagia far less than those using the full face mask, or is that purely anecdotal?
I experienced severe enough aerophagia with a nasal pillows mask to be switched to bilevel by my then sleep doctor. So I'm not sure the mask style has much to do with the risk of aerophagia.

Aerophagia is caused by swallowing air while using the CPAP. If excess air gets into your oral cavity when you are using CPAP, typically one of a couple of things can happen: You don't open your mouth and you swallow the excess air, which can lead to aerophagia OR you open your mouth and the excess air goes out the mouth.

Now if you're using a nasal mask or a pillows mask, you've got a leak as soon as you open your mouth to let the excess air out. But if shortly afterwards you close your mouth and park your tongue up on the roof of your mouth, then the leak is short lived and your tongue effectively blocks additional air from getting into the oral cavity. And as long as the tongue is preventing excess air from getting into the oral cavity, you won't have excess air to swallow.

If you are using a FFM, when you open your mouth up, the excess air will flow into the mask and the pressure between the oral cavity and the rest of semi-closed pressurized system comprising your airway, your oral cavity, your nasal cavity, your upper airway, the inside of the FFM, the hose, and the machine's blower. Once that happens, there shouldn't be any excess air left in the mouth to swallow.
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beetee
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Re: Choosing correct mask, Septum questions

Post by beetee » Sun Jul 07, 2024 6:45 am

Weld3z wrote:
Sat Jul 06, 2024 5:16 pm
Tried 60% of the masks ended with F&P Vitera, GL
When searching online i was only able to find F&P Vitera, there was no 'GL' version