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Are pillows inherently better for AHI than FFM's?
#1
Are pillows inherently better for AHI than FFM's?
My nasal pillows often have a higher leak rate than a FFM, when I can get a FFM to work. Nevertheless I consistently have a lower reported AH! with the pillows. I can get my pillow leaks well below the red line, but they're often ~10-15 for longish periods. So I wonder if those leak rates are messing with the AHI report, and in fact I have a higher AHI than is being detected when I use pillows.

Anyway I've run across this in other threads, that people find their pillows giving better ahi. Thoughts? I'm in the middle of a full face mask experiment and find once again that my ahi is higher than with pillows, even with or because of lower leaks. Maybe I'm just getting more accurate reporting?
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#2
RE: Are pillows inherently better for AHI than FFM's?
I'll say no preference on that basis.
Pillows IMHO are preferred because they tend to leak less simply because they have less are to leak from, they are less obtrusive, because of their smaller volume they tend to be quieter because their intentional leak rates are lower needing to move less air and have no contact on the bridge of the nose. The best mask for you is the one that works for you.
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#3
RE: Are pillows inherently better for AHI than FFM's?
The following link to a NIH study discusses this in great detail. Because I have a poor science background, I find it difficult to read BUT very worthwhile to grind through it. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301251/
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#4
RE: Are pillows inherently better for AHI than FFM's?
There's some weak evidence that nasal delivery of all kinds is more effective that oronasal delivery, and there are physio-anatomical reasons to think that such a conclusion is justified.

The problem is that studies that have looked at this effect tend to mix in conflicting factors (e.g., patient choice), and don't really control for the effects of compliance. In general, it seems that people tolerate nasal delivery better, so compliance is better. On the other hand, even if using oronasal delivery requires a higher pressure to achieve the same effectiveness as nasal delivery (and it might), machines generally adjust pressure automatically.

So far as I know, there is no controlled study in which patients were compelled to use a particular mask for a certain number of hours at night, at the fixed pressure. Even if such a study could be carried out, there's no way it could be effectively blinded.

My gut feeling is that the best mask is the one you can tolerate. I would use a nasal mask if I wasn't such a mouth-breather.

BW, DS
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#5
RE: Are pillows inherently better for AHI than FFM's?
If you want a nasal type mask and are a mouth breather, the Resmed F30 and F30i masks are FFMs listed as hybrids. They have a nasal pillow and a mouth covering. You may wish to consider one of these, until the new F&P model is released.
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#6
RE: Are pillows inherently better for AHI than FFM's?
The study cited by clownbell has some interesting aspects to compare efficacy of full face (oronasal) masks and nasal masks, that eliminates bias of personal choice and compliance cited by desaturator above. The paper cites three observational studies and three randomized, crossover studies to draw the conclusion that nasal therapy has a statistically significant better result in AHI and reported comfort than a full face interface.

The authors of this paper do not draw any extraordinary conclusions other than nasal therapy appears to result in better efficacy and adherance as compared to oronasal therapy, and extend that finding to recommend that nasal masks and pillows should be the first choice in therapy, and patients on full-face masks must be monitored.

Quote:Our review suggests two conclusions: first, nasal interfaces (i.e., nasal masks and nasal pillows) should always be the first choice; second, patients using oronasal masks must be monitored because the risks of CPAP treatment failure, nonadherence, and discontinuation are higher. Further studies are needed in order to understand the exact mechanisms by which oronasal interfaces affect the efficacy of OSA treatment with CPAP.

Quote:In a randomized crossover study, Teo et al.( 37 ) evaluated 24 patients with moderate to severe OSA and no history of oronasal surgery or signs of significant nasal obstruction. The therapeutic CPAP level as determined during titration was similar for nasal and oronasal masks. However, the residual AHI was on average 5.7 events/h higher with the use of an oronasal mask than with the use of a nasal mask (p = 0.01). The standard deviation of the residual AHI was on average 3 times higher with the oronasal mask (10.4 vs. 3.4 events/h), indicating a higher variability in the residual AHI. Arousals and leaks were also greater with the oronasal mask.( 37 ) Bakker et al.( 38 ) evaluated 12 patients with severe OSA and showed that changing from a nasal mask to an oronasal mask significantly increased leak and the residual AHI; however, there was no difference between the two types of masks in terms of the CPAP level. Ebben et al.( 39 ) evaluated 55 patients with mild, moderate, or severe OSA. Patients were randomized to CPAP titration with a nasal mask, an oronasal mask, or nasal pillows. The nasal mask and nasal pillows were similar in terms of CPAP levels. Although the oronasal and nasal masks were similar in terms of the residual AHI, the former required higher pressures than did the latter. This difference increased as the degree of OSA severity increased, being +2.8 ± 2.1 cmH2O in patients with moderate OSA and +6.0 ± 3.2 cmH2O in those with severe OSA.( 39 ) Therefore, all of the randomized studies reviewed here showed consistent results, showing that the performance of oronasal masks is worse than that of nasal masks. The studies also show that the performance of nasal pillows is similar to that of nasal masks.
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#7
RE: Are pillows inherently better for AHI than FFM's?
There are multiple studies that indicate FFMs can be less effective. Key word can be and it is a case by case basis depending on the cause of your apnea, anatomy etc.

There are two main differences that can have negative consequences.

1) If your mouth is open in a FFM then pressure is supplied into your oral cavity pressing up on palate and down/back on tongue. This pressure counteracts the pressure being supplied through nasal passage attempting to hold palate, tongue etc forward and out of the way.

2) FFM often apply pressure to lower jaw which can pull it down/back causing restriction.

There are some people like my grandfather that cannot wear a FFM for these reasons (his AHI skyrockets).
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#8
RE: Are pillows inherently better for AHI than FFM's?
(01-22-2022, 12:17 PM)hegel Wrote: My nasal pillows often have a higher leak rate than a FFM, when I can get a FFM to work. Nevertheless I consistently have a lower reported AH! with the pillows. I can get my pillow leaks well below the red line, but they're often ~10-15 for longish periods. So I wonder if those leak rates are messing with the AHI report, and in fact I have a higher AHI than is being detected when I use pillows.

Anyway I've run across this in other threads, that people find their pillows giving better ahi. Thoughts? I'm in the middle of a full face mask experiment and find once again that my ahi is higher than with pillows, even with or because of lower leaks. Maybe I'm just getting more accurate reporting?

Hi hegel,

How bad are your AHI's? What are your comfort levels with each type of mask? what are you trying to achieve? are you at the high end of pressures or low end of pressures? would be some questions to look at.

Leaks of 10-15 should not be a problem, the machines are designed to be able to cope with that.

Generally nasal masks (cushions or pillows) are recommended first, if you can manage mouth leaks this is generally the best option. Oronasal masks are an individual preference and subject to trial and error as you are doing. I had moderate success with my F30i for long while but now am back to the P30i, personal preference.

Again, it depends on the site of obstruction: nasal passages, oropharynx, airways below that in the neck or a combination of these, face/head/neck anatomy, sleeping position.

In case it helps these are my own results:

For 2021 for both masks combined my average AHI = 0.76, average OSA = 1.52, average HA = 1.4, average CA = 2.55.

From 1 Jan to 27 Sep I used oronasal only (F30i or Dreamwear in different sizes) my average AHI = 0.87, average OSA = 1.92, average HA = 1.68 average CA = 2.55.

From 28 Sep to 31 Dec I used P30i only, my average AHI = 0.44 , average OSA = 0.39, average HA = 0.63, average CA = 2.14.

Average 95% Leaks for the whole year with both masks = 5.14
Average 95% Leaks for oronasal masks = 3.53
Average 95% Leaks for P30i mask = 9.74

So: not much difference apart from comfort and lower frustration with the P30i.
You could argue higher leaks with the P30i with Lower AHI but these differences are marginal.

I know if for whatever reason I have to, I can use the F30i again with similar results.
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#9
RE: Are pillows inherently better for AHI than FFM's?
For me; pillows leak much less & result in a lower AHI. It took me a few weeks to get used to pillows though, it was worth it. I was also told that I was a mouth breather, but a few month with a cervical collar solved that problem; it is no longer needed.
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#10
RE: Are pillows inherently better for AHI than FFM's?
I agree with Gideon that it's individual in the end.

The mask that works best for me is the Wisp, which is a nasal mask, and I've tried them all.

Full face masks do not work for me. I get greater flow limitations and centrals with FFMs. I also occasionally get clustering OAs with FFMs as well.

For some reason, nasal masks provides the lowest AHI, and the lowest central. I also tried N20 nasal mask, but it increases centrals compared to Wisp, and I have no idea why.

The important takeaway I get from trying out various mask and pressure settings, the machine's pressure setting doesn't cause same intensity of airflow. With the same pressure, different types of masks causes different airfow intensities. So, you'd still have to adjust the pressure to make-up for using a different type of mask.

For some reason, pillows causes me to wake me up during the night. Much worse when it's on auto settings (I used fixed CPAP pressure for this reason). Nasal just works best for me, and the next person might be different. I am sensitive to pressure increases. It wakes me up. Therefore, I have to use CPAP settings. I don't much benefits from auto settings. I do have to self titrate for find out which fixed pressure works best for me.

Great thing about finding a minimum fixed pressure is that the pressure will not rise due to flow limitations threshold, which may cause mouth leak. I don't get mouth leaks because my pressure is fixed to a minimum that doesn't cause mouthleaks.

In the end, I get no sleep disturbance from the machine now. APAP has been disturbing my sleep for over a year!!

So, it's best to experiment yourself. Try out the various masks to find out for yourself, and figure out the personal causes for the sleep issues.

Another thing that helped me was sleep hygene. Bed is for sleep and sex only. That's the most important rule. Do not read or use electronic devices in bed.
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