Choosing correct mask, Septum questions

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

Post by beetee » Sun Jul 07, 2024 6:59 am

Thanks RobySue.

I still confused as to whether the mask choice is purely based on comfort or if it can affect the how well the cpap works.

''Now if you're using a nasal mask or a pillows mask, you've got a leak as soon as you open your mouth ''--- So presumably based on this statement,,,,

Even if you don't breathe through your mouth all the time, opening your mouth (unknowningly) even for short intervals throughout the night is presumably changing the operation of the machine from being postive airway pressure to negative airway pressure due to the small mouth leaks, which i then would assume requires higher pressure (possibly uncomfortably so) to counteract that problem or is that not correct?

''''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.''

Does this mean that the FFM is advantagous when it comes to mouth leaks and effectivness of the machine?

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ozij
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Re: Choosing correct mask, Septum questions

Post by ozij » Sun Jul 07, 2024 8:43 am

beetee wrote:
Sun Jul 07, 2024 6:59 am
I still confused as to whether the mask choice is purely based on comfort or if it can affect the how well the cpap works.
CPAP is meant to help you sleep.
You won't sleep well if your mask is too uncomfortable.
When I have mouth leaks, they wake me up, they make a noise, they dry out my mouth terribly, and I really mean terribly.

Usually, I prefer pillows masks and I handle mouth leaks by taping my lips shut.
But sometimes the tape becomes uncomfortable, and I switch to a full face mask for a while.

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robysue1
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Re: Choosing correct mask, Septum questions

Post by robysue1 » Sun Jul 07, 2024 11:25 am

beetee wrote:
Sun Jul 07, 2024 6:59 am
Quoting robysue1: ''Now if you're using a nasal mask or a pillows mask, you've got a leak as soon as you open your mouth ''--- So presumably based on this statement,,,,

Even if you don't breathe through your mouth all the time, opening your mouth (unknowningly) even for short intervals throughout the night is presumably changing the operation of the machine from being postive airway pressure to negative airway pressure due to the small mouth leaks, which i then would assume requires higher pressure (possibly uncomfortably so) to counteract that problem or is that not correct?
You have a common misunderstanding on what happens when the machine detects a leak: It does not increase the pressure just because there is a leak.

But yes, modern CPAP and APAP machines are designed to compensate for small and medium sized leaks: They maintain the current pressure setting by simply blowing more air into the leaky "system" comprising your lungs, upper airway, nose, mask, hose, and the machine's blower unit. And until the leaks are pretty massive, the machine can still do a decent job of tracking your breathing and responding (if running in Auto mode) to an apnea or hypopnea.

Now when a Resmed AutoSet is compensating for a leak, some people do find the additional airflow (not additional pressure) into the mask uncomfortable. The fix, is to deal with what's causing the leak, and it's not always mouth breathing. Once the leak is fixed, the airflow goes back down to the normal airflow needed to maintain the current pressure setting.

It's also important to understand that modern Resmed AutoSets are programed to reduce the pressure in the presence of a very Large Leak in the hopes that the reduced airflow into the mask may help the mask's air cushion reseal itself. Leaks have to be extremely large and somewhat prolonged before this happens, so you don't see this with every single large leak.

It's also important to understand that short lived leaks, even if they are officially "Large Leaks," do not affect the overall efficacy of your CPAP therapy. And small leaks (ones that are well under Resmed's Large Leak definition of 24 L/min) do not affect the overall efficacy of your CPAP therapy even if they last a long time.

In general there are only two times where leaks are a problem that must be addressed:

1) The leaks are both prolonged and large enough (>= 24 L/min) to be flagged as "Large Leaks". By "prolonged", Resmed's engineers and programmers define Large Leaks that last at least 30% of the night to be serious enough to have a negatively effect on the efficacy of the therapy. Around here, most people would be a bit more stringent than that: Most people around here would get concerned if multiple Large Leaks occur every night and the longest ones last at least 30 or 40 minutes---particularly if you don't remember anything about the leaks.

2) Leaks are waking you up OR preventing you from getting (back) to sleep---regardless of how small the leaks are. Here the problem is not that the leaks are affecting the efficacy of your therapy. The problem is that the leaks are interfering with the quality of your sleep by causing you to be in bed lying awake fighting leaks instead of being asleep.


From a purely practical point of view: If you have a few individual Large Leaks that last more than 10 minutes or so and they don't wake you up or cause you to have trouble getting (back) to sleep, then trying to eliminate the last of the leaks may be a no-win scenario: Eliminating the very last bit of leaking may involve things that create more discomfort than the leaks, and that additional discomfort can lead to overall poorer quality sleep than you get while just tolerating a bit of leaking.

Remember: The goal of CPAP is not to have the perfect leak line and the perfect AHI and the perfect MyAir score. The goal of CPAP is to get a good night's sleep and wake up feeling reasonably well rested in the morning.

beetee wrote:
Sun Jul 07, 2024 6:59 am
Quoting robysue1: ''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.''

Does this mean that the FFM is advantagous when it comes to mouth leaks and effectivness of the machine?
Yes and no.

What I mean by that:

In theory if you have problems with keeping your mouth shut while you are asleep, then using a FFM makes it much easier for the machine to maintain pressure when you do open your mouth.That's because an open mouth simply adds the oral cavity to the semi-closed pressurized system. The "space" that has to be pressurized has increased very slightly, but the air that escapes through the mouth is not lost to the system---provided the FFM is well sealed against the PAPer's face.

And that's the rub: FFMs are by their very nature more difficult for many people to get them fitted so they seal properly. Since FFMs have a much larger footprint on the face, there are more places where the seal can simply spring a leak that has nothing to do with mouth breathing. One obvious problem with the larger footprint is that it is easier to knock the mask while moving around in bed and trigger a leak. Another common problem that affects FFMs far more than nasal masks or pillows masks are leaks caused by facial relaxation where the mouth doesn't actually pop open. When we are deeply asleep, the muscles in our face relax. In particular, the muscles around the jowl, lower jaw, and chin can relax enough to cause a FFM to spring a leak around its edge even if the person is not opening their mouth. And sometimes those facial relaxation leaks while using a FFM are just as long and just as large as a "mouth breathing" leak using a nasal mask or pillows mask would be.

In other words, as long as the FFM's seal is maintained, yes, the FFM is more effective in the presence of mouth breathing. But FFMs are harder to seal and hence more prone to run-of-the-mill mask leaking. And the mask leaking from a FFM can be aggravated by facial relaxation even when your mouth doesn't pop open to let air out. More over, depending on the style of the FFM, some people attempting to use them will have more problems with things like air leaking into the eyes or more skin problems caused by the larger mask cushion. And all of this can mean that a FFM winds up being less effective (overall) because the other problems caused by the mask outweigh the benefits of using a FFM because there might be some mouth leaking.

The upshot of all this is:

If you find a FFM to be uncomfortable for whatever reason and you do not mouth breathe most of the time, then it is probably best to start with a comfortable nasal mask or a comfortable pillows mask. You will be more comfortable when trying to get to sleep with the mask on your nose, and that in turn will help you actually use the machine every night, all night long. There is nothing less effective than a CPAP machine that is NOT used because the person doesn't like the feel of their mask on their face.

On the other hand, if you are a dedicated mouth breather---i.e. someone who breathes through their mouth most of the time, a full face mask is going to be the only kind of mask that allows you to breath in what you think of as your "normal" way to breathe. But most people are not dedicated mouth breathers.
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Weld3z
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Re: Choosing correct mask, Septum questions

Post by Weld3z » Sun Jul 07, 2024 12:33 pm

beetee wrote:
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
GL = Good luck, because finding the perfect mask is the hardest thing.

beetee
Posts: 6
Joined: Thu Jul 04, 2024 6:35 am

Re: Choosing correct mask, Septum questions

Post by beetee » Wed Jul 10, 2024 5:56 am

Thanks again for all the information : )