The Fisher-Paykel Oracle 2 mask is a oral mask designed for folks who, for whatever reason, cannot or will not use either a nasal mask or a full-face mask.
In my case, I have serious claustrophobia issues which prevent me from using any mask that clamps onto my face. The Oracle 2 mask works just fine for me.
What works best:
This mask has a strap that goes directly to the back of the head but it is entirely optional in use. I gave up using the strap after a couple of nights and haven't used it since. A note to the ladies, this mask will not mess up you hairdo.
It is light weight and very easy to get used to. Care, like for all masks, is required in the adjustment for leaks. In this case, the mask has two funtioning parts, one that fits into you mouth and the other outside. The distance between to two in adjustible to control leaks.
Contrary to adjustments on other masks, tighter is definitely not better. The adjustment is correct when it just barely but completely controls the leaks. Your lips fall between the inner flap and the outer flap assembly. Tightening too much will leave you with quite a bit of discomfort in the morning.
The mask has a filtered vent on the angle between the mask and the hose that connects to the CPAP hose. The location of this vent and the fact of the inner filter absolutely prevents any air from being blown anywhere on your face including your eyes - problem with some other style masks.
I use it with a hose support so the hose connection and hose go directly up and away. The result is I can toss and turn and not get the mask misadjusted nor feel any tugging when I do so.
This mask seals with the inner flap. The outer flap assembly keeps everything aligned and has little to do with leak control.
The cost for one of these is quite competitive. My most recent price was about $80 for one ordered today.
What doesn't work so well:
This mask is an oral mask and therefore blows air directly in you mouth and down your throat. That bypasses all the normal mechanisms you nasal passages have to adjust the humidity before the air reaches your lungs. Humidification is absolutely required for this mask.
I looked up the original FDA filings for this design and the FDA approval requires a humidifier.
The second issue with this mask is blocking your nasal passages. If they remain open, air blows out of you nose and is quite uncomfortable. Folks using a nasal mask have the reverse problem with air coming out of their mouths unless they can keep them closed while sleeping.
With this mask, F-P supplies nasal plugs that are supposed to address this issue. For me, they didn't. The plugs were uncomfortable and sometimes they blew out during the night - really bad scene. I did several experiments trying various approaches to overcome this problem. I tried swim plugs, etc. Nothing worked very well. I finally had the inspiration to try nose clips that my sleep doctor uses when measuring lung tidal volume. These clips gently press the nostrils closed and, when properly adjusted, don't often fall off, are almost unnoticeable, and do to job.
There does seem to be some limit on air pressure for this mask. For me, a pressure of 25 cm blows the mask off. My upper pressure of 18.5 cm works just fine. Remember, I'm using this mask with no strap so it's likely that with the strap in place somewhat higher presssures will work.
This is an oral mask. That means hygiene is essential. Wash it every day using mild soap as described by the manufacturer. With other masks, skipping a day now and then is relatively harmless. Not so here.
That's all of the bad news except to note that after a couple of months, I woke up one morning and my nose clip had fallen off in the night. The good part of that was, no nose leaks during the night. I haven't had to use them again. I guess I just learned how to not breathe out through my nose like many nasal mask wearers learn to keep their mouths closed while sleeping.
So, if you are a mouth breather, if you don't like strapping all that stuff around your head at night, if you are at all claustrophobic then this mask may just be the solution to your CPAP compliance. My personal experience with sleep center techs and DME's is that they will recommend almost anything else because they just don't know how to adjust one of these.
If you have one of these masks and need to see exactly what nose clip I'm talking about, let me know directly (private message) and I will likely just send you a sample to try - I have a big jar full of them I haven't needed for over 18 months.