(04-20-2013 09:29 PM)DaveL Wrote: I have recently felt tired, though I've been compliant for 15 years.
So...brought home a full face mask on trial. I found it hard to use. I've used nasal masks for my osa treatment.
ResMed Quattro FX
* found it hard to put on, comfortably
* shoots a very hard jet of air--my wife objects!
Any hints appreciated! I've used a nasal mask all 15 years; however, now I"ve become a mouth breather. I've used a cpap cap and I hate wearing all that gear.
What you experience is very common. Try the Hybrid mask with nasal pillows and a mouth cover to prevent mouth breathing.
These are my experiences, for what they are worth:
With tests on myself, I noticed that if I use a nasal pillow or nasal mask of whatever kind, I develop mouth breathing whenever the pressure goes above 6cm H₂O. This often causes a dry mouth which is a certain telltale. I was trying to establish why I did not feel as well as I expected, i.e. was not getting the full benefit of the CPAP when using a nasal pillow of some kind. I found that the natural resistance of my mouth tissues and lips having relaxed during sleep, can handle a delivery pressure of around 5cm H₂O before starting to leak, realizing that to exhale against a constant delivery pressure of 5cm H₂O coming into the lungs would require a return pressure of more than 7cm H₂O to push the delivery air back. Thus when these two anti-pressures totaling 12cm H₂O reach the back of my throat, it becomes natural to rather escape sideways through my mouth, if possible, than to continue along the inside of the nose to the outside of my nostrils. In my case, when I increase the delivery pressure to 6cm H₂O, the return pressure will probably have to increase to 8 or 9cm H₂O, totaling 14cm H₂O, and my natural resistance in my mouth is too low to resist and mouth breathing commences.
My guess is that most users may develop some kind of mouth breathing (leakage) depending on the pressure setting. ( Imagine if you had a delivery pressure of 10cm H₂O – with a return pressure of at least 12cm H₂O – a total of 22cm H₂O!). The CPAP machines, without exception, obviously only record a leakage (over and above the normal air escape through the mask vents) and it usually tends to be described as 'mask leakage'. This through-the-mouth escape of air into the surrounding atmosphere will cause a drop in the pressure in the airways, and all machines will respond with an increase in air volume delivery at a higher pressure to compensate – probably now exaggerating the air escape through the mouth! Not even mentioning that the higher air volume at a higher pressure is being forced through your nose – heaven forbid you have one nostril blocked! This differs markedly from a mask leakage, where the pressure in the airways remain relatively the same as the leakage is now still in the delivery system before it enters the body. To this mask leakage the machines will also respond the same, but the increased pressure and volume is not transferred to your airways but escapes through the mask leakage.
CPAP Auto, C-Flex technology and Bi-PAP machines address this high expiration pressure necessary to exhale by sensing the start of expiration and then dropping the delivery pressure by 20 – 30% so as to make exhaling (expiration) a little easier. They do succeed in making breathing easier, especially if you should need a high delivery pressure. But it becomes more difficult for these machines to predict the start of expiration when a major leak is present. No machine as yet has the capability to differentiate the position of an unintentional leak as opposed to the intentional leak provided by the vents in the mask. Therefore, even with these more expensive machines, the problem of mouth 'leaks' or mouth breathing is still present.
This drop in pressure and delivery during mouth breathing cancels most of the advantages of 'Continuous Positive Airway Pressure' (CPAP) and that appears to be the cause of my experience of not getting the expected benefits of the CPAP. The moment I switched to a full face mask or a Hybrid mask delivering positive air through my nose and covering my mouth, the problem disappeared and I have never felt better at waking in the morning. Mouth leakage now does not occur, as the pressure inside the airways, throat and mouth is the same as outside of the mouth inside the mask.
There is some discomfort and some skin side-effects as well as possible dangers ascribed to taping your mouth with paper tape or similar to prevent mouth breathing. Wearing a chin strap gives conflicting results, as most of them either slip off during sleep or may pull the lower jaw backwards, increasing the chances of apnee episodes. Various snoring devices to pull the lower jaw forward and/or seal the mouth and pull the tongue forward is not only uncomfortable, but has not been assessed as successful in preventing mouth breathing during CPAP usage.
I do realize and agree about the common reasons for not liking a full face mask, i.e. feeling hot, claustrophobic, condensation in the mask, pressure on the bridge of the nose, visible pressure marks the next morning, cannot speak to your partner, and the feeling of something big and heavy sealing you off from the outside world. But I imagine you have two choices if you want to make this CPAP experience really successful: get used to a full face mask (use a preferably bigger mask rather than smaller) – it takes easily a month, but the result is 1,000 times worth it, or try a hybrid mask where the mask does not cover the nose, no claustrophobia, and it uses nasal pillows combined with covering your mouth. It does feel a lot more comfortable with the same end result.
Therefore it appears that it is a fallacy to believe a technician or professional can really tell you how you actually feel in the morning when you wake – and he/she cannot give you a better idea of what works and what not than yourself. Trust your own feelings and intuition and take responsibility for improving your own wellbeing by responding and demanding from them the correct equipment needed as determined by your personal experience. You should also be able to adjust the delivery pressure of your machine yourself to control your own health care delivery if you so choose.