FFM and effects of flow limitations

I was reading in an article that stated that a FFM will tend to push the jaw in and back and cause the tongue to push back in the mouth. This article on the web did not have any source listed with it, so I don't know how true it was.

Has anyone seen anything along these lines? It seems to make sense to some degree, but I would love to see some professional journal discuss this with stated sources. Anyone know of any?

BTW, here is where I saw this http://www.binarysleep.com/phpbb2/viewt ... 7861#77861

John

I wore a full face mask every night for almost 9 months, and I can't say that I disagree with anything the sleep tech says in that post. Also, since I was titrated on a FFM, according to him I would have needed less pressure with a nasal mask. That, as it turns out, is almost, but not exactly, my experience. I was titrated at 14 cm w/FFM and, while I achieved AHIs of less than 5 with that pressure, I also had a snore graph that was off the charts. When I tried auto pap of 14-20 cm, the snore went away but average pressure was around 19.

I've already told you the rest in another post, but I'll repeat it here: a few weeks ago I switched to a nasal mask and found that I was able to do very well (AHI consistently less than 1) with hardly any snoring at my original titrated pressure of 14 cm. And 14 cm does feel better than 19, if you happen to wake up in the middle of the night.

What he says about the FFM is also my experience. It's true that you often have to tighten them down more to eliminate leaks, and it creates a pressure on your jaw. How much that moves your jaw and tongue I couldn't say.

I can tell its pushing back my jaw but the fix for me is sleeping on my side. If I sleep on my back no amount of pressure can keep my airway open with a FFM on.

I also think this is true. Didn't snore much before xpap. Now with the FFM I'm constantly snoring. With the bottoms straps pulled very tight to stop leaks I can feel it push my jaw back and the airway restricting more. Would like to try a nasal mask but have a deviated septum so that's out. Am thinking the hybrid may be the way to go.

Kody wrote:I also think this is true. Didn't snore much before xpap. Now with the FFM I'm constantly snoring. With the bottoms straps pulled very tight to stop leaks I can feel it push my jaw back and the airway restricting more. Would like to try a nasal mask but have a deviated septum so that's out. Am thinking the hybrid may be the way to go.

Kody - have you tried a nasal mask? I also have deviated septum but do regular saline rinses (daily when needed) and I can breathe through my nose enough to use nasal mask. I often have at least one nostril blocked for several hours each day but the rinses help and open things up. You could try one out through cpaplibrary.com's Mask Trial Program for a minimal cost to you of $14 (pays shipping both ways) and you can try a mask for a week. I tried 3, my favorite and the one I use now is the Mirage FX.

Kody, I have a deviated septum (ds) as well, but I have been toying with the nasal mask idea too. The last few nights I have been trying to go to sleep with my mouth closed with my FFM and for the most part, I have been okay. Last night was a little hard as my nose was a bit stuffed up, but the other nights I found it wasn't that bad.

I have a hybrid mask on order that I am going to try and one of my thoughts is that the nasal pillows concentrate the air into the nose, so it should be easy enough to breath through my nose most times.

I'm not sure how bad your ds is, but you may just want to give it a try one night when you go to bed with your FFM and see what it feels like to breath just through the nose.

John

RandyJ wrote: Kody - have you tried a nasal mask? I also have deviated septum but do regular saline rinses (daily when needed) and I can breathe through my nose enough to use nasal mask. I often have at least one nostril blocked for several hours each day but the rinses help and open things up. You could try one out through cpaplibrary.com's Mask Trial Program for a minimal cost to you of $14 (pays shipping both ways) and you can try a mask for a week. I tried 3, my favorite and the one I use now is the Mirage FX.

Randy, how hard was it for you to learn to keep your mouth shut with the nasal mask? I heard someone say that the pressure will keep it shut, but that just doesn't make a whole lot of sense to me (esp with the pressure I am at).

John

Most nights I start out breathing through both my nose and mouth in the FFM. Seems as soon as I relax more, (and I think the humidifier helps with this part also); I go to sleep breathing just through my nose. Not sure if it stays that way all night long or not. Just feels kind of reassuring knowing that if my nose happens to clog up while sleeping I will still be able to breath through my mouth. My Wife has an extra nasal mask I have thought about of trying it some night. John let us know how the Hybrid Mask works for you when you get it. What is the theory behind using this kind of mask? You breath through your nose and if it clogs up, you automatically switch to mouth breathing?

Kody, I'm not sure what the theory is for the mask, but the theory for me is to see how I adapt to nasal pillows with a backup of the mouth mask. I know I could have done the mask trial thing, but I really didn't want to go that route.

Perrybucsdad wrote:
Randy, how hard was it for you to learn to keep your mouth shut with the nasal mask? I heard someone say that the pressure will keep it shut, but that just doesn't make a whole lot of sense to me (esp with the pressure I am at).

John

John - I found that I didn't have to learn at all. From the first night I have kept my mouth closed naturally without the need of anything to keep it closed. I had even prepared for the worst - I ordered an expensive chin strap that now I don't need, and I bought a roll of the painter's tape that is highly recommended for taping, and haven't needed either of them. Leak rate is very good, so I'm not opening my mouth.

Before I go to sleep I can feel that the pressure wants to keep my mouth closed, and it seems it's not dropping open at any point after falling asleep, either.

If the tongue is kept (stays) in position to block the doorway from the airway to the mouth then most people won't find the pressure trying to exit through the mouth prematurely no matter what the pressure. Tongue to the roof of the mouth trick does work for most people (unless tongue is small and oral cavity is large or whatever). Easy to do while awake.. Not so easy to remember to do while asleep and have no control over things. I have noticed that during the day when I breathe through my nose that my tongue just automatically goes to the roof of my mouth position.

Even with cpap on and at full pressure my tongue can block the attempted exit of the air through the mouth if I open my mouth. In other words, I can open my mouth with cpap on and have my tongue in place and zero air will escape my mouth.

Again easy to do while awake but asleep is another matter and this is where the brain has to learn a new habit..keeping the tongue acting like a door.