Question about hybrid masks.....

With any luck the DME will get my S9 Autoset today so I have a last minute mask question. I'm pretty sure I'll need a full mask like the Quattro FX I used in the titration test because my nose frequently closes up when I lay down making me a mouth breather. My question is about hybrid masks - if/when my nose closes up will it cause a leak around the nose or will it be OK since there's normal air flow through my mouth?

Thanks,

Randy

First of all the Quattro FX and a "hybrid" mask are 2 different types of full face masks. And within the "hybrid" category, you have 2 brands, the InnoMed Hybrid and the Resmed Mirage Liberty. Hybrids have a mask portion that goes over the mouth combined with nasal pillows that come out of the top of the mask. The Quattro FX on the other hand is a full face mask that completely covers the nose and the mouth.

Any full face mask will accomodate breathing through the nose or the mouth. If you were to use a hybrid, I don't envision your nose "closing up" since provided you are breathing through your nose, the air pressure would likely keep the sinus passages open. If somehow you do stop breathing through you nose though, the hybrid does still allow breathing through the mouth.

I have used both the Resmed Mirage Liberty and the Resmed Quattro FX. I own and use the Liberty currently but am thinking of purchasing the Quattro FX the next time my insurance company allows for a new mask purchase. Sometimes it can be a little tricky getting the nose pillows on the Liberty to seal completely, although I am getting low leak rates with mine. Some customer reviews say the Quattro FX can be susceptible to leaks too above the bridge of your nose, but when I tried it, it sealed well for me.

If you're debating between the Quattro FX and a hybrid and you're getting it from a DME, you should be allowed to do a free mask exchange within the first 30 days which I would recommend taking advantage of so you can see for yourself which, if either of these masks works better for you.

direct answer. no, one or both of your nostrils clogging up does not automatically cause a leak.

Well, I too went with a FFM because I believed I was a mouth breather, but please consider the following. Your body is designed to breath through your nose. the only reason you will breath through your mouth is if you can't move a sufficient amount of air, in a sufficient amount of time, to make you brain happy. With sleep apnea your brain is under the impression that it is simply not getting enough air through your nose, and so it opens your mouth. Your nose filters, humidifies and raises the temp of the air entering the lungs. The mouth is terrible as it brings huge blasts of cold, unfiltered and dry air into the lungs. It is a path of last resort, and that is why apneics (like myself did) usually say they are mouth breathers. Hell, we would suck air in through our eyeballs if we could, we are suffocating, what do you expect?

With CPAP on we are going to take the air you normally breath, and compress it (so to speak). You will be getting more air per breath than you normally would without CPAP. Add to that fact that the pressure will keep your airway open where it was closed before and you will find that you just won't need to breath through your mouth.

Now on occasion some people will have their mouth fall open during their sleep, so there is a possibility that you may need a chin strap on you to help keep your mouth closed. Its just an elastic band that helps to softly hold ou mouth closed.

In a worst case scenario (because you have a sever deviated septum, or other you can't keep your mouth closed any way) you may need a FFM. This is a last ditch effort I am finding more and more as for any given pressure necessary to keep your airway open on a nasal mask it seems that a FFM requires more. Sometimes significantly more. This is because a FFM places pressure against the jaw, pushing the airway closed by moving your tongue closer to the back of your throat. Besides that fact, FFM have a propensity towards leaking, which requires us to tighten them down harder than nasal masks, making the pressure necessary to keep your airway open even HIGHER than it would be if it sealed perfectly withou issue.

Now, I said early on that I do have a FFM (Quattro FX) and I do like it, but this morning I cancelled my order for a Hybrid (it was on backorder for over a week) and ordered a nasal pillow to try. For the past few nights I have been trying to keep my mouth shut with my FFM on just to see if I can do it. And guess what? I can breath. Granted, last night I had a hard time on the expiration portion, but I am also on a fairly high pressure (17cm). I turned my ramp on, and I fell asleep fairly quickly (and comfortably). I was shocked too to find out that when I woke up, my mouth was still closed. Now I have no way of really knowing if I kept is shut the whole time (as I can't look for mouth leaks as I had a FFM on and it won't show), but I do have a deviated septum (and according to my Dr it is fairly significantly deviated) and I can breath just fine through the mouth.

So, just think about it, and see if maybe you are not fooling yourself on what you need, and from what I hear, nasal masks are less prone to leaks compared to the FFM.

John

John,

That's a great post... I've been on CPAP since July and have tried all masks... I liked the pillow, but mouth breathe. I tried not doing it, but at the pressure I was titrated at (7cm) I found myself grasping for a good breath, so I'd open my mouth. My wife said she'd wake up to a tornado sound coming from me. I switched to a FFM and seem to be OK, although I mouth breathe a lot.

I'm gonna see an ENT soon to find out what's up with my nose.

I've also self-titrated and moved my pressures up. I wonder if I should try the pillow again (I have the Opus 360)

Scott,

I guess the moral of the story is many of us who mouth breath think we have to have a FFM, but that is not always the case. Now sometimes there is a problem that really limits us getting air in through our nostrils. As I said, when I lay down, I have a hard time breathing with just my nose. Part of it is I'm trying to catch my breath (for whatever reason) and the other is due to the high pressure.

Good luck with the ENT... Even though I know I have a deviated septum, my doc said even if he did surgery it may not fix my sleep apnea. I'm thinking it would allow me to breath through my nose better, but there are also risks with the surgery. One thing the doc did do though was prescribe Flonase which I use just before bed and it tends to open up my nasal passages a bit.

John