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Conflicted about using the F&P Pilairo Q Diffuser System
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critterdoc Offline

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Post: #1
Conflicted about using the F&P Pilairo Q Diffuser System
A significantly larger degree of expiratory resistance was immediately perceived when comparing an F&P Pilairo Q Pillow Mask to my current F&P Simplus Full Face Mask even with the entire Diffuser System (fabric filter & cover) of the Pilario dismounted.

The Pilaro Q feels more comfortable when fitted to my face but the increased resistance to expiratory air flow with the Pilaro (even with the Diffuser System completely removed) causes me to ponder which therapeutic PAP objectives might be best achieved with the fabric filter and filter cover removed, especially if the Diffuser System's stated function is primarily sound/noise reduction.

I'd appreciate comments and recommendations on situations which dictate that the diffuser system should removed vice leaving it in place.

It is also struck me that the x-sectional area of the "vent passages" in the pillows mask is much smaller in the Pilairo Q pillows mask. What is the advantage of that?
(This post was last modified: 04-14-2014 06:44 PM by critterdoc.)
04-14-2014 06:41 PM
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PaytonA Online
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Post: #2
RE: Conflicted about using the F&P Pilairo Q Diffuser System
First, I think that the smaller vent area for the Pilairo may be for several reasons. One would be the fact that there is less room available on a nasal pillow mask. Another might be that there is less dead space in the nasal pillows that needs to be cleared of residual higher CO2 content.

If the vent air coming out of your Simplus mask does not bother you or anyone else - either sound level or air jet - then there is no need for the diffuser.

The purpose of the vent is to reduce the CO2 level from your exhaled breath so it does not build up too much in the air that you breathe in.

I had 2 different versions of the F&P Zest mask. One was the Q version which had the vent holes in a different place and had a diffuser. In doing some qualitative testing, I found that the diffuser reduced flow from the vent a lot (my "opinion" was that it was much more of a reduction than F&P claimed. I did som volumetric calculations and it seemed like it might be OK but I did not trust it. I had better results with the non Q version which had more vent holes to begin with and no diffuser.

I like it better when I have plenty of air flushing out my mask but that is just personal preference and doesn't have a lot of basis in fact.

Why did you start out with the Simplus ffm. Are you a mouth breather?

Best Regards,

PaytonA
04-14-2014 07:55 PM
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robysue Online
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Post: #3
RE: Conflicted about using the F&P Pilairo Q Diffuser System
(04-14-2014 06:41 PM)critterdoc Wrote:  I'd appreciate comments and recommendations on situations which dictate that the diffuser system should removed vice leaving it in place.
Comfort.

I really think that's the be all and end all of when the diffuser system should or should not be used.

Some people (like me) are excessively sensitive to the noise and airflow coming out of the exhaust vents of the mask and find it very disruptive of their sleep. Some people (like you) find the change in how the mask feels when a diffuser is in place disruptive of their sleep. So the decision on whether to use the diffuser or not all boils down to: Which way creates the fewest sleep problems for the PAPer (and bedpartner if that's relevant)



Quote:A significantly larger degree of expiratory resistance was immediately perceived when comparing an F&P Pilairo Q Pillow Mask to my current F&P Simplus Full Face Mask even with the entire Diffuser System (fabric filter & cover) of the Pilario dismounted.
I think the issue here is not the diffuser on the Pilario. It's that you're comparing a FFM with a nasal pillows mask. And the "feel" of the two masks is very, very different. My guess is that you'd have the same kind of sensation if you were to try other nasal pillows masks that don't have a diffuser, such as the Swift FX nasal pillows masks.

Again for some people the degree of expiratory resistance is less of an issue than overall comfort; for others the degree of expiratory resistance is more of an issue than overall comfort. There's not a right/wrong answer here.

Quote:The Pilaro Q feels more comfortable when fitted to my face but the increased resistance to expiratory air flow with the Pilaro (even with the Diffuser System completely removed) causes me to ponder which therapeutic PAP objectives might be best achieved with the fabric filter and filter cover removed, especially if the Diffuser System's stated function is primarily sound/noise reduction.
By reducing sound and concentrated airflow, the diffuser eliminates one or two physical stimuli that potentially irritating and that can make a mask very difficult for some of us to use. If the manufacturer has done their job correctly, enough CO2 is still washed out of the mask even with the diffuser in place to ensure that there is no serious rebreathing of CO2 going on when the mask is used with the diffuser in place. And hence, for some PAPers, the addition of the diffuser may increase compliance.

But it's also perfectly reasonable to expect that there are other people who are sensitive enough to changes in how the exhalations feel with the diffuser on to make the diffuser optional.

Quote:It is also struck me that the x-sectional area of the "vent passages" in the pillows mask is much smaller in the Pilairo Q pillows mask. What is the advantage of that?
The whole nasal pillows mask is much smaller than in your Simplus FFM. The dead space inside the mask is much, much smaller. Hence there is less air that needs to be vented out to prevent rebreathing.

Look at it from a design point of view: The vent holes in any mask need to be large enough to provide for the venting that needs to be done in order to prevent rebreathing, but they also need to be small enough to allow the machine to easily maintain the desired pressure inside the "system." The balance point between the two requirements will be largely based on the dead-space in the mask---the amount of air volume that must be vented in order to prevent rebreathing. The larger the mask, the more air is trapped inside the mask and there is more air that must be vented to the outside. And this requires additional (total) cross-sectional area of the vent holes, which can be accomplished by increasing the size of the individual vent holes, increasing the number of vent holes, or both.
04-15-2014 11:51 AM
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critterdoc Offline

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Post: #4
RE: Conflicted about using the F&P Pilairo Q Diffuser System
(04-14-2014 07:55 PM)PaytonA Wrote:  First, I think that the smaller vent area for the Pilairo may be for several reasons. One would be the fact that there is less room available on a nasal pillow mask. Another might be that there is less dead space in the nasal pillows that needs to be cleared of residual higher CO2 content.

If the vent air coming out of your Simplus mask does not bother you or anyone else - either sound level or air jet - then there is no need for the diffuser.

I would think that increasing the area and efficiency of venting in the Pilairo Q would not present a problem from the engineering standpoint, but...

The Simplus mask does not provide a Diffuser System and the volume of expired air from the Simplus appears to be enormous compared to the Pilairo Q with the diffuser system fully invoked. With the fabric filter and the diffuser cover installed, expiratory venting seems to be palpably reduced to a relative trickle.

Most of my comparative experience in this context is with unidirectional closed circle or semi-closed circle gas anesthesia systems with in-circle CO2 absorber soda lime canisters onboard, where less variation seems to exist when compared to PAP machines and particularly mask designs that are intended to improve the quality of sleep. I'm a virtual noob to this but I have difficulty with some of the compromises I sense in balancing the need to support quality of sleep and appropriate exchange of "air" with variations in equipment design and performance.

(04-14-2014 07:55 PM)PaytonA Wrote:  The purpose of the vent is to reduce the CO2 level from your exhaled breath so it does not build up too much in the air that you breathe in.

I like it better when I have plenty of air flushing out my mask but that is just personal preference and doesn't have a lot of basis in fact.

Concur with all of the above, sir, but that leads me to another perplexing reference that I note with some frequency here - the dreaded mask leak. I have no way of assessing or comparing venting and mask leakage other than the "large leak" record that my machine offers. I have no clue how the machine derives that number, it's practical meaning, or how it differs from purposeful but variable venting that is built into various masks.

(04-14-2014 07:55 PM)PaytonA Wrote:  I had 2 different versions of the F&P Zest mask. One was the Q version which had the vent holes in a different place and had a diffuser. In doing some qualitative testing, I found that the diffuser reduced flow from the vent a lot (my "opinion" was that it was much more of a reduction than F&P claimed. I did som volumetric calculations and it seemed like it might be OK but I did not trust it. I had better results with the non Q version which had more vent holes to begin with and no diffuser.

Why did you start out with the Simplus ffm. Are you a mouth breather?

Best Regards,

PaytonA
At this early stage of the game, I'd have to err on the side of tending toward venting and control of respiratory effort as being a ruling factor. Balancing that with maintaining increased pressure in the upper airway seems to be the trick but restriction of one's ability to blow off CO2 is of great concern to me. In that context, and in my view as a rank beginner with little noise sensitivity, the more aggressively vented Simplus FFM seems superior to the Pilairo Q Nasal Pillows for anyone other the most airway impaired.

I did not start out with the Simplus. The selection of Swift FX pillows was made by the DMA, perhaps related to some brand of pillows having been used in my split sleep study. After several miserable evenings of rocking and rolling and my honey beating the crap out of me I headed back to the DME who suggested I give the Simplus a test drive. After two weeks of "test driving", the Simplus appears to be top dog for now. The only reason I opted for the Pilairo trial is to more easily mount and remove bedtime reading glasses, and I expect to be returning it soon.

And lastly, yes I think I do qualify as a mouth breather especially when I am snoring and sleeping on my back - or at least so claims Blondie! It's a strange feeling when I relax my lips or even slightly open them and a blast of high pressure air is emitted. I'm not sure why but that problem seems more intense with the Pilairo than it was with the Swift Fx - perhaps because of reduced venting capacity. I am not aware of that problem when I am wearing the Simplus FFM.
04-15-2014 01:50 PM
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robysue Online
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Post: #5
RE: Conflicted about using the F&P Pilairo Q Diffuser System
(04-15-2014 01:50 PM)critterdoc Wrote:  The Simplus mask does not provide a Diffuser System and the volume of expired air from the Simplus appears to be enormous compared to the Pilairo Q with the diffuser system fully invoked. With the fabric filter and the diffuser cover installed, expiratory venting seems to be palpably reduced to a relative trickle.
The venting is not really reduced to a trickle; rather the venting is no longer concented in one stream of air---the air is now venting in multiple directions instead of one main direction. The exhaust flow is effectively scattered and the scattering makes is less noticeable than the concentrated jet flow of an exhaust vent found in the Swift FX for example.


Quote:but that leads me to another perplexing reference that I note with some frequency here - the dreaded mask leak. I have no way of assessing or comparing venting and mask leakage other than the "large leak" record that my machine offers. I have no clue how the machine derives that number, it's practical meaning, or how it differs from purposeful but variable venting that is built into various masks.
You are using a PR System One according to your signature. The LCD information on leaks is virtually useless: All the LCD tells you is how much time you spent in "Large Leak territory" as a percentage of the night. It is quite possible to have some real leak issues that simply don't register as Large Leaks for a long enough period of time for the LCD to show anything other than 0.0%

To really understand the leaks on the System One, you need to look at the data in Sleepy Head or in Encore. And you need to look at the leak graph as opposed to just the numbers.

The System One simply records total leak: How much air is being leaked out of the system each minute? Loosely thinking that's the same as "How much air has to be added to the system each minute in order to maintain the desired pressure level?"

Total leak includes both the intentional leaks built into the mask to prevent rebreathing of CO2 AND all other (unintentional) leaks regardless of where they come from.

This is why the total leak data on a PR machine is NEVER, EVER going to be 0.0 L/min----there's always the intentional leak present.

To figure out how to interpret the leak numbers requires you to look in the owner's manual of your MASK. There will be a chart or a graph somewhere that lists or shows the intentional leak rate for your mask at various pressures. Once you know the intentional leak rate, you can compare the total leak rate to the intentional leak rate. If they're roughly the same (say within about +/- 5 L/min of each other) then you know that you don't have much unintentional leaking going on.

As for the dreaded official "Large Leak" on the PR System One. PR has not published exactly what constitutes an official Large Leak, although Encore will flag them and the screen's LCD will tell you how much time you're spending in Large Leak territory. By looking at a lot of data posted here and on other forums, it appears that the "Large Leak" line is somewhat dependent on the pressure you're using and also depends on whether you're using a Series 60 System One or a Series 50 System One. On the Series 60 machines at medium pressures (say 8-15cm), the Large Leak line seems to be about 70 L/min or so. That's roughly 20-30 L/min above the intentional leak rate for most masks being used in that pressure range.

As a general rule, the machine won't have any real problems compensating for an unintentional leak rate that is in the 10-15 L/min range and it should do an OK job for compensating for unintentional leaks in the 15-25 L/min range. So as a rule of thumb you want your total leaks to stay below Intentional Leak Rate + 20 L/min if possible if the leaks are NOT waking you up.

But if the leaks are waking you up, it doesn't really matter how big or small they are: Anything that wakes you up is worth trying to fix.

Quote:At this early stage of the game, I'd have to err on the side of tending toward venting and control of respiratory effort as being a ruling factor. Balancing that with maintaining increased pressure in the upper airway seems to be the trick but restriction of one's ability to blow off CO2 is of great concern to me. In that context, and in my view as a rank beginner with little noise sensitivity, the more aggressively vented Simplus FFM seems superior to the Pilairo Q Nasal Pillows for anyone other the most airway impaired.
Makes sense since you are NOT particularly sensitive to either the noise or airflow generated by the exhaust vents.

But as someone who is on the opposite end of the sensitivity spectrum, all I can say is that I wish there HAD been some nasal pillows masks with diffusers when I started back in 2010. The exhaust venting from the Swift FX was a huge issue for me; it bounced off the covers and back into my eyes or my mouth drying them out. Or it flowed directly onto my chest and arms making me shiver all night long. Which problem I had to deal with depended on which way I had the elbow on the small hose pointed. But I could never find a direction where that exhaust flow was NOT noisy and windy. And I had to go through great lengths to protect my eyes, my lips and mouth, my chest, and my arms from the damn mask's exhaust vents each night.

I eventually started using a homemade diffuser cut from an air filter for a lawn mower. The leak rates with and without my homemade diffuser were essentially the same so I decided that I was not putting myself at serious risk of rebreathing, and diffusing the jet stream exhaust flow allowed me to (finally) get to sleep without arming myself with a handkerchief to protect the eyes, another hanky to protect the mouth, and two layers of long sleeves to protect my chest and arms from where ever that jet stream of exhaust was reflected to.

Quote:And lastly, yes I think I do qualify as a mouth breather especially when I am snoring and sleeping on my back - or at least so claims Blondie! It's a strange feeling when I relax my lips or even slightly open them and a blast of high pressure air is emitted. I'm not sure why but that problem seems more intense with the Pilairo than it was with the Swift Fx - perhaps because of reduced venting capacity. I am not aware of that problem when I am wearing the Simplus FFM.
You're not aware of the problem in the FFM because opening the lips does NOT cause a leak in the semi-closed pressurized system: Your lips are under the pressurized mask.

As to why it was more noticeable on the Pilairo than the Swift FX, that may have had more to do with the fact that the Pilario's cushion is larger and hence it's an easier target for the high pressure stream of air coming out of the open lips to hit. And once the air hits that cushion it bounces right back in your face so you've got two sources of irritation to notice rather than one.
04-15-2014 02:47 PM
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PaytonA Online
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Post: #6
RE: Conflicted about using the F&P Pilairo Q Diffuser System
Wow Robysue. I don't think that you left much question that you prefer the diffused vent.

Critterdoc. The diffuser on the Zest mask is made up of a non-woven fabric like the old furnace filters used to be and held in place by a little plastic snap-on grille. One of the things that I tried with the diffuser on my Zest mask was to reduce the cross section in half and use it that way. I still was not happy with it but that is just me. I am very happy with the vent on the ResMed Mirage Quattro full face mask that I am now using. It lets out a lot of air but they have managed to design the vent holes so that it is very quiet unless something like a hand interrupts the high velocity air coming out of the vent before it has a chance to diffuse into the atmosphere and slow down.

Well I think that what all of this discussion boils down to is what Robysue and I have said and that is that the whole venting thing, like mask selection, is very dependent on how it works for the individual.

Best Regards,

PaytonA
04-15-2014 03:32 PM
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critterdoc Offline

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Post: #7
RE: Conflicted about using the F&P Pilairo Q Diffuser System
Many thanks to both of you for your detailed and cogent replies.

~Doc
04-15-2014 03:58 PM
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snowboardjoe Offline

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Post: #8
RE: Conflicted about using the F&P Pilairo Q Diffuser System
Have you been adjusting your machine to match your mask (full mask vs. nasal vs. nasal pillows)? That might make a significant difference in the therapy delivered. I'm guessing it adjusts the exhalation pressure if it know there is a smaller exhalation vent on the other end?

I'm also in the middle of converting from Simplus to Pilarios Q. I made sure to adjust my S9 for each switch.
04-17-2014 10:47 AM
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critterdoc Offline

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Post: #9
RE: Conflicted about using the F&P Pilairo Q Diffuser System
(04-17-2014 10:47 AM)snowboardjoe Wrote:  Have you been adjusting your machine to match your mask (full mask vs. nasal vs. nasal pillows)? That might make a significant difference in the therapy delivered. I'm guessing it adjusts the exhalation pressure if it know there is a smaller exhalation vent on the other end?

I'm also in the middle of converting from Simplus to Pilarios Q. I made sure to adjust my S9 for each switch.
I see no adjustment for mask type in the PRS1 REMstar DS460TS clinician's setup module. I've gradually come to the conclusion that I'm a mouth breather after I've entered the early stages of entering the drift. As I relax, my lips begin to flutter and a startling blast of chilly air exists my mouth which is a strange feeling and which tends to push my Spartiate honey into combat mode. Bug-eyed
04-17-2014 12:45 PM
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Post: #10
RE: Conflicted about using the F&P Pilairo Q Diffuser System
It is my understanding that there is no setting for mask type on the Philips machines. That is a ResMed thing. It would not affect therapy anyway. The CPAP will continue to increase air volume to reach the set pressure until it maxs out. The main thing the mask type is used for on the ResMed machines is to calculate the unintentional leak rates.

Best Regards,

PaytonA
04-17-2014 01:26 PM
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