Quattro FFM help

As a norm, I'm a mouth breather, and started my therapy with the Quattro, and remain a fan of this mask. I do use the mirage shallow full face on occasions (when my mask needs to dry after cleaning overnight), but as a whole, I prefer the Quattro, and especially appreciate the forehead tension bar adjustment for the best fit. As others have posted, a simple wash in Dawn is all thats required. Good seal, good fit, but this is a personal journey, as I've discovered well on this site.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): mirage, seal

Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

http://www.AdvansCPAP.com

AdvansCPAP.com wrote:Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

http://www.AdvansCPAP.com

Why/what exactly is not accurate?

Why do they use these data to titrate in lab setting?

AdvansCPAP.com wrote:Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

http://www.AdvansCPAP.com

I strongly disagree with your statements that I've bolded.

One does not HAVE to breathe through their mouth when using a full face mask. For those of us that have been notorious mouth-breathers, it's a security measure to ensure that in case our mouths fall open during the night, we're "covered". I personally have become a better nasal breather since using my UMFF with cold humidification (pass-over). Also, the thought of something stuck up to or in my nose (pillows or prongs) when I'm trying to sleep is not appealing at all. And, to wear a nasal "mask" is still leaving the offending orifice (mouth) at risk for leakage.

They're not a LAST resort and from the many, many cases of mouth-leaking/breathing people who come here wondering why their therapy isn't working tells me that they were set up for failure in the beginning.

I'll trust the data from my machine(s) to a greater degree than I would a sleep study.....and in particular, the sleep study I had. I get to monitor the effectiveness of my therapy each and every morning. If they weren't that accurate, the companies wouldn't have built this technology into the machines. They are, after all, FDA approved devices. The companies have promoted this technology to the doctors and we see more doctors prescribing them......unfortunately, they send them out with the widest range of pressures and that is definitely a mistake.

Den

DreamStalker wrote:

AdvansCPAP.com wrote:Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

http://www.AdvansCPAP.com

Why/what exactly is not accurate?

Why do they use these data to titrate in lab setting?

carbonman wrote:
With the Optilife pillows, my AHI has been below 2 for the past two weeks.
This is my first FFM.
Thoughts/comments/suggestions:
on increase in AHI.
Tweaks to make this mask work.

You most likely did better with the Optilife over the FF because there is simply more leverage for the CPAP pressure to splint your airway open, in this case the tongue, air comes in from the nares on the optilife pushing against the back side of the soft palate, it can better leverage the tongue out of the way.

When that same pressure enters via the mouth with the FF, it has to go up over the tongue separating the soft palate and base of the tongue and finally push the tongue out of the way.

If you are using the auto it will take more pressure to perform the same job as opposed to nasal interface unless you close your mouth with the FF and take delivery of pressure via the nares.

CPAP for me generally clears any nasal congestion and if you have been at this any length of time you learn best treatment is obtained using a nasal interface for that reason.

Wulfman wrote:

AdvansCPAP.com wrote:Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

http://www.AdvansCPAP.com

I strongly disagree with your statements that I've bolded.

One does not HAVE to breathe through their mouth when using a full face mask. For those of us that have been notorious mouth-breathers, it's a security measure to ensure that in case our mouths fall open during the night, we're "covered". I personally have become a better nasal breather since using my UMFF with cold humidification (pass-over). Also, the thought of something stuck up to or in my nose (pillows or prongs) when I'm trying to sleep is not appealing at all. And, to wear a nasal "mask" is still leaving the offending orifice (mouth) at risk for leakage.

They're not a LAST resort and from the many, many cases of mouth-leaking/breathing people who come here wondering why their therapy isn't working tells me that they were set up for failure in the beginning.

I'll trust the data from my machine(s) to a greater degree than I would a sleep study.....and in particular, the sleep study I had. I get to monitor the effectiveness of my therapy each and every morning. If they weren't that accurate, the companies wouldn't have built this technology into the machines. They are, after all, FDA approved devices. The companies have promoted this technology to the doctors and we see more doctors prescribing them......unfortunately, they send them out with the widest range of pressures and that is definitely a mistake.

Den

AdvansCPAP.com wrote:Hello Den,

Thank you for your input.

I understand all of the comments you made and it is great you are doing well with the full face mask. If you're satisfied with your machines data, even better. If you don't like Nasal pillows, no problem. It doesn't mean others won't like it too.

The OP stated he used a nasal pillow style mask before the FF and had good test results. Once switching over to the FF = poor sleep quality, no?
His initial post was based on only ONE night on a new mask.

If you use a nasal mask in conjunction with a heated humidifier (not passover/ cool (which is about 50% less effective) Depends on what you're trying to achieve....could be much MORE effective than heated and a chin strap, the majority of mouth leaks are solved. Not all, but most.

I'm sorry you had a poor sleep study as it is difficult to find a lab with a good sleep tech these days. Most of them are not trained well and have no formal sleep disorders education or licensing. Mine was three years ago and from what I've read here during that period, there are far too many other people who have been in the same boat. Makes one wonder if it isn't a money scam in far too many cases.

As for the machines titrating accuracy..if they were that good, sleep techs would be obsolete and doctor's wouldn't hear pts complaining they are still not sleeping well with their auto's. I realize their accuracy is based on airflow, but when used on a consistent basis, the user can establish some norms. Some insurance providers (like Kaiser) are trying to cut the sleep studies out of the eauation FDA approved or not, doesn't mean they work for every patient. The majority of people do well enough on auto's to feel better than without it of course...about 75%. What about the other 25%? They still don't feel rested. What is the doctor supposed to tell them? A smart doctor will have the pt go through a full night sleep study in well run lab to monitor exactly why the pt isn't sleeping well.

Of course companies will promote them and try to get doctors to prescribe them. You know why? I do. MONEY. There are LOTS of money grubbers in this industry and far too many patients are getting screwed which machine will have the latest and the greatest feature will get attention. The more machines they sell, the happier the shareholders are. It's just a business of making money at the end of the day whether people want to hear it or not.

Auto are great as long as the pts are happy. But when the pts are not rested..it's easy to know why. I happen to prefer single pressure on my machines, including my Autos. So do many others here

Den

AdvansCPAP.com wrote:

DreamStalker wrote:

AdvansCPAP.com wrote:Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

http://www.AdvansCPAP.com

Why/what exactly is not accurate?

Why do they use these data to titrate in lab setting?

Why/what exactly is not accurate? - The reason is because Auto's are only relying on the pt's air flow and snoring to determine when to increase or decrease the cpap pressure. These sensors are set to adjust the machine when a preset value is reached..ie 20% decrease in airflow, then increase pressure.

The problem is everyones apnea is different. What if one pt's 10% decrease in AF cause him to wakeup and have desats and an EEG arousal? That event would be ignored by the machine and left untreated. The machine doesn't monitor his EEG, respiratory effort, SaO2 saturation or EMG movements. In the lab setting all the parameters are monitored and is used to determine what a real apnea is. The tech should have enough knowledge to make the appropriate adjustments to pressure levels.

Why do they use these data to titrate in lab setting? - MONEY. It is more cost effective than paying a lab, Dr. and tech to run a full blown overnight study. They rather send you home with a auto titrating machine and hope you do not complain you're still tired.

Perhaps what you meant to say then is that CPAP data is not as comprehensive as a lab study? I won’t argue that but not being comprehensive does not make the CPAP data inaccurate. As you correctly pointed out, everyone is different and not everyone can replicate their normal sleep behavior in a foreign sleep environment such as a sleep lab … and furthermore that one single night will most likely not represent the average condition of any one person’s sleep characteristics and never will for most. And one must remember, it is difficult to find a lab with a good sleep tech these days right?

Also, from posts on this forum, the norm seems to be to send the patient home with a dumb machine incapable of providing monitoring data for the patient, doctor, or any other person in the sleep health system and then hope the patient does not complain. The real money grubbing scam is for the sleep health industry to keep bringing patients in for numerous sleep lab studies.

While relying only on CPAP data is not ideal, it is better than hoping to hit the bull’s eye with a one night sleep study … it just does not happen often enough for nearly enough OSA patients. Collecting several nights, weeks, or even months of CPAP data eventually will get the patient to the bull’s eye optimum machine pressure settings and also allows the patient to diagnose and correct mask/mouth leaks without having to go in for endless and expensive sleep lab studies ... or worse yet giving up on the whole process.

Finally, a significant flaw in the paradigm of the sleep health profession is that they treat to mitigate snoring and daytime sleepiness when the real co morbidity that should be focused on is hypoxemic hypoxia.

Snoredog wrote:
You most likely did better with the Optilife over the FF because there is simply more leverage for the CPAP pressure to splint your airway open, in this case the tongue, air comes in from the nares on the optilife pushing against the back side of the soft palate, it can better leverage the tongue out of the way.

When that same pressure enters via the mouth with the FF, it has to go up over the tongue separating the soft palate and base of the tongue and finally push the tongue out of the way.

If you are using the auto it will take more pressure to perform the same job as opposed to nasal interface unless you close your mouth with the FF and take delivery of pressure via the nares.

CPAP for me generally clears any nasal congestion and if you have been at this any length of time you learn best treatment is obtained using a nasal interface for that reason.

SD, I totally agree w/all of your observations.
Infact, it is what I expected.

I used the same settings again last night, without the
chinstrap, and got exactly the same results. AHI 3.8
I don't think the chinstrap has anything to do w/outcome.
Now, w/that said, I did have many more leaks last night,
as compared to the first night....so...
it could be that the chinstrap helped to stabilize my jaw and
mouth, and kept the leak rate down. Thoughts.
I tried to keep my mouth shut and also opened it, just to
experiment. Just to get the feel of it both ways.

I will adjust the pressure tonight and we shall see.
Thanks! for your input.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, AHI, auto

carbonman wrote:

Snoredog wrote:
You most likely did better with the Optilife over the FF because there is simply more leverage for the CPAP pressure to splint your airway open, in this case the tongue, air comes in from the nares on the optilife pushing against the back side of the soft palate, it can better leverage the tongue out of the way.

When that same pressure enters via the mouth with the FF, it has to go up over the tongue separating the soft palate and base of the tongue and finally push the tongue out of the way.

If you are using the auto it will take more pressure to perform the same job as opposed to nasal interface unless you close your mouth with the FF and take delivery of pressure via the nares.

CPAP for me generally clears any nasal congestion and if you have been at this any length of time you learn best treatment is obtained using a nasal interface for that reason.

SD, I totally agree w/all of your observations.
Infact, it is what I expected.

I used the same settings again last night, without the
chinstrap, and got exactly the same results. AHI 3.8
I don't think the chinstrap has anything to do w/outcome.
Now, w/that said, I did have many more leaks last night,
as compared to the first night....so...
it could be that the chinstrap helped to stabalize my jaw and
mouth, and kept the leak rate down. Thoughts.
I tried to keep my mouth shut and also opened it, just to
experiment. Just to get the feel of it both ways.

I will adjust the pressure tonight and we shall see.
Thanks! for your input.

That has been my experience with use of chinstrap ... for me chinstraps are only useful to stabilize the jaw for use with FF masks ... cuz they sure don't stop air from slipping by the teeth and through flapping lips.

AdvansCPAP.com wrote:Hello,

From what I read, I understand you were using a nasal pillow mask and doing well. Then switched to a full-face mask and use a chinstrap at the same time and get poor quality of sleep?

If I'm correct, the first thing is to not use a chinstrap with a full face mask because it defeats the whole purpose of that mask. You're supposed to breathe with your mouth with that mask and not have it closed.

Full face masks are notorious for leaks compared to nasal masks or nasal pillows. Those are the last resort type of masks unless you absolutely cannot inhale through your nose.

I would suggest Nasal Pillows such as the Swift along with a heated humdifier and if needed, a chin strap. Most people are good to go after that. If not, go back to what you were using before, as the full-face mask will only cause more problems.

I also wouldn't rely on the data coming off your CPAP. They are not accurate and will never be for most. If anything it is just mediocre.

FWIW, I am a new pap'er. The only way to know what is going to
work for me, is to try it. I need to have a FFM option incase
I have a cold or sinus infection, sometime.
I need to know if, for me, a FFM is going to be better than
nasal pillows. Never know til you try.
I want to be as educated as possible and know about every
option I have available to me.

As far as data reliability, what would you suggest that
pts. use, to be involved w/their therapy, on a daily basis?

WOW......I seem to really be struggling.
I set my min. pressure up to 9.5 last night.
It was a disaster. Leaks went up to 40.
AHI was 10.9.

This mask is proving to be difficult to get fitted.
It is creating a bruse on the bridge of my nose.

For some reason, I want this mask to work.

Thoughts/comments/suggestions

carbonman wrote:WOW......I seem to really be struggling.
I set my min. pressure up to 9.5 last night.
It was a disaster. Leaks went up to 40.
AHI was 10.9.

This mask is proving to be difficult to get fitted.
It is creating a bruse on the bridge of my nose.

For some reason, I want this mask to work.

Thoughts/comments/suggestions

Back off on the tension on your headgear.....particularly the upper straps. Too tight can mean more leaking, too. That mask seems to seal better if it's a bit looser......in my experience. On the other hand, depending on where your pressures went during the night, there could be a combination of factors affecting the leakage. In Auto mode, leaks and snores can raise hell with pressures and mask seals.....it can be a self-feeding-frenzy.

Den

carbonman wrote:WOW......I seem to really be struggling.
I set my min. pressure up to 9.5 last night.
It was a disaster. Leaks went up to 40.
AHI was 10.9.

This mask is proving to be difficult to get fitted.
It is creating a bruse on the bridge of my nose.

For some reason, I want this mask to work.

Thoughts/comments/suggestions

As Den mentioned you have to be careful when tensioning up the straps on the UltraMirage cushion (Quattro is the same), if you over tension the straps it will crush the inner cushion leaving a "crease" in the membrane, when that happens air can escape from the crease rapidly.

Pay special attention to the changes made to the machine and the mask. Machine changes may NOT be the reason you feel so bad, it can be with the CO2 retention characteristics of that mask.

For example, the Optilfe may exhaust or flush out much more Co2 that you exhale than the Quattro. Some mask interfaces have a tendency to "vacuum" Co2 out of your airspace even as much as vacuuming it out of your lungs. Your body needs some Co2 retention. There is a fine line between exhausting too much and too little. When you retain too much you can awaken feeling really uneasy or like the walking dead as I refer to it.

Quattro may be a engineering marvel in your eyes, but if that engineering doesn't agree with your CO2 retention level requirements individually there may not be anything you can do to make it work where it leaves you feeling refreshed.

As mentioned in other threads, I could NOT use that mask because of that very reason, every time I woke after using it I felt really uneasy a feeling I didn't like, I actually felt better fighting onset events and apnea all night.

The way that Quattro exhausts CO2, it does something screwy in that area for me, I woke up in the middle of the night which I rarely do any more and left feeling very uneasy. Several other nights attempted use produced the same result, it was like I was rebreathing in a bag all night long. Then it started leaking from the elbow that is when I tossed in the towel on that interface. I paid $238 for it, so I don't throw that kind of money around easily.

You may be able to get a handle on the leaks and using it, but once you do and you still wake up feeling bad it just may be the flow characteristics of the mask causing it and you won't be able to change that. I think I got about $90 back when I sold mine, person that bought it from me couldn't use it either and I think they sold it to someone else (I think Wulfman has it now LOL)