I was told I'm a mouth breather in my first sleep study in 2008. My experience bears this out. Frequently I go to bed with a stuffed up nose. I can't even move enough air to trigger my auto on. When first diagnosed I used the Quattro FFM mask, but the hard plastic in the frame caused the skin on the bridge of my nose to break down badly. Nothing helped; the comfort pads only caused leaks. I was still putting pressure on the sore and it got so bad I reluctantly took three weeks off to let it heal. In one night with the Quattro it started to break down again. I tried many different masks and was unsuccessful with all of them, perhaps with what I know now about mask fitting some would have been satisfactory. I finally settled on the Respironics FitLife Total Face Mask. It took some work and the use of silicone sealant (Macks ear plugs) at times to make it work, but I really liked the mask. The past eight months I began to have problems with the mask- it would ride up to my mouth during the night. At my dental appointment six months ago I did not notice any dental changes. During the past month I became aware that my bottom teeth had been pushed back and the front teeth seriously crowded. My profile had changed, I now have a slightly recessed chin. At my dental check up this week I talked to the dentist and he referred me to an orthodontist. My appointment is next week. A month ago I changed to a nasal mask when my nose is clear and the Quattro FX when it is blocked and I can't trigger the auto on. I have no trouble with leaks and fit with either mask. The gel on the nasal mask does not bother the bridge of my nose. The FX is a dream mask!
I have advocated the use of silicone sealant to improve the fit and stop leaks from a mask- in the past Macks (silcone earplugs you roll into a string and place around the mask where it fits the face), more recently the sealant scuba divers use. Now with my experience with "smashed face syndrome" I've reconsidered. I believe (generally) there is no substitute for a proper fitting mask ( Pad-a-Cheek and Quietus lines are fine). When I got the FX a month ago the tech at the DME helped me with fit. I finally learned how to fit the mask comfortably and allow the cushion to fill with air to form a seal. YouTube videos helped. I was then able to properly adjust the nasal mask. I have very little problem with leaks. Since I am prone to tooth movement I will take both masks to the orthodontist for evaluation- I do not want to worsen the problem. My teeth and mandible have shifted back 1/4 inch mainly (I figure) in the past eight months when I began to have trouble with mask fit. I know many people are successful with nasal pillows; I don't like them. When I use the nasal mask I use a chin strap. My leakage is minimal. I have called the interface the achillies heel of CPAP treatment. I know successsful fit can be difficult. I was in the dark for five years, my own fault. One of the big mistakes I made, in spite of knowing better, with leaks I would tighten the mask down instead of reseating. It took me several nights to get the fit right on the two masks I am now wearing. This is going to be an expensive mistake. I relate this experience for the few people who it may affect. I'm sure some people can use a sealant and not encounter problems.