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Some Mask Questions
#1
In case you have missed some of my other posts, I have an appointment to go to a sleep doc to get a study setup. The ones that were accessible to me are booked over a month out. At the rate I was going I felt like I needed to try to help myself while I wait. On my own I bought an S9, put it on auto with a full face mask. After a few uses I have the machine set to run between 10 and 20 and having an average pressure run between 13 and 14. AHI has been between 2 and 4 and I felt 100 times better than before I started.

Here's where the problem starts. The quattro full face mask doesn't give me any leak problems but is big and bulky and so many people use the airfit p10 that I decided to try it. I left the pressure settings alone and changed the settings on the machine to the pillow setting. Last night was the LONGEST most uncomfortable night ever! It seems like the pressure was way too high and I had to fight it the whole time I wore it. Not so much the mask but the pressure and breathing never got comfortable. The nose, sinuses and airway were pressured but I could not allow the pressure into my mouth. It was like having high pressure compressed air hose stuck down my throat! After about 4 hours I gave up and ditched it.

This morning I looked at the data. The pressure never got over 10 and I usually run 13-14 and 95% of 17. My AHI was 1.1 but I never really got into a relaxing sleep so I don't hold much stock in that low of a number.

Are the nose pillows so much more efficient at putting the pressure where it needs to be that they need to be on a lower pressure than the full face mask? What am I missing here?
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#2
Many of the people that have switched to a P10 mask from other types have reported lower pressure requirements and lower AHI. Try dropping your min pressure 1 or 2 cm and see what happens

Best Regards,

PaytonA
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#3
Nasal pillows are better at dealing with a common problem of nasal wall collapse, where each inspiration through the nose causes the outer walls of the nose to collapse inward, thus restricting the maximum airflow. People who have this problem are better advised to use pillows over nasal masks. Hybrid and full face masks are for people who either breath through their mouths or can't keep them shut. Pressure needs are a bit lower on nasal pillows because of the direct application of pressure via the nose rather than filling up a mask cavity with enough pressure to do the same job, but the pressure differences between nasal masks and nasal pillows is at best a few cms.

If you cannot adjust to keeping your mouth closed and the pressure from entering your mouth from your throat, then you would have to stay on a full face or hybrid mask. However, after a while, most people can make the switch, since, unless you are a mouth breather by day, which is rare (and unhealthy), your body will eventually automatically adjust to the new breathing requirements.
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#4
I agree with PaytonA. I think there is a period of adjustment, and one night is not going to tell you if this is a comfortable arrangement. If you did succeed in keeping air from entering your mouth, you did very well as a new user. Most people report a lower pressure requirement for nasal pillows vs FFM. If you do make the adjustment, you will find the P10 is lighter and quieter with fewer leaks.
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#5
Keeping the mouth closed isn't a problem. The pillows just seemed to put so much more pressure and air into the throat it was a fight to keep my breathing right. In comparison, the full mask was a little bit of a challenge to get used to the claustrophobic feeling and get used to breathing with the flow if you have never experienced it. It took me about fifteen minutes to get calmed and comfortable breathing with it on. Next thing I knew it was morning and I was feeling great. I know it takes time but it has to be at a level where it is bearable to be able to keep it on. I think maybe the best thing to do might be to back down the minimum and let my lungs and the machine work out where the levels are.




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#6
Try upping your pressure relief when using pillows. And use a lower starting pressure with a ramp feature. Usually that will do it.
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#7
(07-17-2015, 09:03 AM)rdonchann Wrote: Are the nose pillows so much more efficient at putting the pressure where it needs to be that they need to be on a lower pressure than the full face mask? What am I missing here?
I've not come across it, but I'm not that well read hosehead Smile

Nasal masks are sort of compromise between full face masks and nasal pillows masks
I've been using Activa LT nasal mask for a number of years with good results but seems to be out of fashion these days with younger folks
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#8
(07-17-2015, 09:03 AM)rdonchann Wrote: ...The pressure never got over 10 and I usually run 13-14 and 95% of 17. My AHI was 1.1...

Are the nose pillows so much more efficient at putting the pressure where it needs to be that they need to be on a lower pressure than the full face mask? What am I missing here?

...I could not allow the pressure into my mouth.

I don't know what you mean by that. If your mouth is closed, your tongue typically fills the cavity between the upper and lower jaw completely, meaning that there is no part of your mouth that is a part of the respiratory cavity, and so there is no pressure "in your mouth".

Your experience could not be more different from mine. When I put my NP on, and autostart starts the APAP, I have to actually pull the pillows away from my nose for a second to cause a leak so that I am sure the APAP is actually blowing. I find it so completely invisible that I can't feel anything other than the gentle pillows pressed up against my nose. And my pressure starts at 10.

But everyone is different.

As far as the pressure being somehow different, nuh-uh. Pressure is pressure, and the principle of hydraulics confirms that pressure in a system is equal at all points in the system. So if you have a mask and set the xPAP to that mask's configuration, and set a different mask to that mask's configuration, the pressure in each system, if set the same, will be identical in all points in the system.

So there is something else going on here that makes you have difficulty with one mask over the other, because pressure is not it. It may be turbulence; If your nasal cavity is built differently than someone else's, this can cause Venturi turbulence different than it might in another person, and for such a person, maybe a FFM makes better sense.

You can't actually "feel" pressure all that much, but you can indeed feel turbulence in the airflow; when the mask leaks, for instance, what you feel is not the pressure, it is the turbulence that the moving air causes. Of course a higher pressure will cause more air to move faster, meaning greater turbulence. But what you actually feel is not pressure, per se.

About all you can feel regarding pressure is when you try to exhale against it. There are settings that can mostly eliminate that, however, and maybe a bi-PAP might be needed just for the comfort of greater EPAP relief, alone. Talk to the sleep doc.

But you are on the same journey we all went on. It takes time to find what works best for you, and it takes time to adjust. You'll get there.
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#9
(07-17-2015, 05:29 PM)TyroneShoes Wrote:
(07-17-2015, 09:03 AM)rdonchann Wrote: ...The pressure never got over 10 and I usually run 13-14 and 95% of 17. My AHI was 1.1...

Are the nose pillows so much more efficient at putting the pressure where it needs to be that they need to be on a lower pressure than the full face mask? What am I missing here?

...I could not allow the pressure into my mouth.

I don't know what you mean by that. If your mouth is closed, your tongue typically fills the cavity between the upper and lower jaw completely, meaning that there is no part of your mouth that is a part of the respiratory cavity, and so there is no pressure "in your mouth".

Merely keeping my mouth closed does not fill the cavity with my tongue and my mouth becomes part of the respiratory cavity (kind of a backwater). With my mouth clamped closed and forcing my lips together as hard as I can, does not prevent chipmunk cheeks nor does it keep my mouth from leaking. Only actively using my tongue to seal will solve those problems.

(07-17-2015, 05:29 PM)TyroneShoes Wrote: As far as the pressure being somehow different, nuh-uh. Pressure is pressure, and the principle of hydraulics confirms that pressure in a system is equal at all points in the system. So if you have a mask and set the xPAP to that mask's configuration, and set a different mask to that mask's configuration, the pressure in each system, if set the same, will be identical in all points in the system.

What you describe is true for a system in equilibrium. The mask in operation is a dynamic system. The extra volume in the larger masks slows the response to pressure changes either from the patient or from the CPAP. I think this is the property that causes masks with smaller air volumes to act differently to pressure. What DocWils says about nasal wall collapse is another possible part of the difference even if it is not a full collapse.

(07-17-2015, 05:29 PM)TyroneShoes Wrote: So there is something else going on here that makes you have difficulty with one mask over the other, because pressure is not it. It may be turbulence; If your nasal cavity is built differently than someone else's, this can cause Venturi turbulence different than it might in another person, and for such a person, maybe a FFM makes better sense.


I agree that we do not feel pressure. We feel pressure differences. We do not feel the 14.7 lb/sq. in. atmospheric pressure because it acts upon us equally in all directions but if you put a compressed air hose against your skin you feel the difference between the atmospheric pressure on most of your body and the higher air pressure from the compressed air hose

(07-17-2015, 05:29 PM)TyroneShoes Wrote: You can't actually "feel" pressure all that much, but you can indeed feel turbulence in the airflow; when the mask leaks, for instance, what you feel is not the pressure, it is the turbulence that the moving air causes. Of course a higher pressure will cause more air to move faster, meaning greater turbulence. But what you actually feel is not pressure, per se.

About all you can feel regarding pressure is when you try to exhale against it. There are settings that can mostly eliminate that, however, and maybe a bi-PAP might be needed just for the comfort of greater EPAP relief, alone. Talk to the sleep doc.

But you are on the same journey we all went on. It takes time to find what works best for you, and it takes time to adjust. You'll get there.

Best Regards,

PaytonA
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#10
Nasal pillows are painful to me. No matter what brand or model. I simply cannot do them, long term. So I use a Respironics Wisp. And it is comfy for me. I'd LOVE to use a nasal pillow, and tried my best, but they are not for me.
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