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Switching from full face mask to nasal mask
#1
According to my insurance company I’m due a new mask next month.  I’m currently using an F10 ffm and was considering an F20 as the replacement.
 
This would be the ideal time to consider switching to a nasal mask (such as the N20) and lowering my required pressure settings.  

Has anyone had success in REDUCING your required pressures by switching from a full face mask to a nasal mask?
 
My pressure setting is in the 17-19.5 range with average AHI’s in the 2’s and 3’s.  Was hoping I could reduce that pressure range downward.   

Thanks
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#2
It seems generally accepted that a full face mask requires slightly higher pressures than a nasal mask, and a nasal pillows requires slightly lower than a nasal mask. However the differences are only minor. Still, if you're running a consistently very high pressure even half a cm difference might add to your comfort. One thing to be aware of - when using a nasal or pillows mask, you need to be able to seal your mouth so that air doesn't leak out that way, which would obviously undo any benefits you gain.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
pressure drop is not that much between masks.
my pressure differs every night. Last 5 nights my IPAP went from 18.28 to 21.48 (Brevida mask)
depends on how much time I spent sleeping on my back.
Noticed more of a pressure drop by side sleeping than mask types.

is there a reason why you want to see a pressure drop?
it is what it is to keep you breathing.
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#4
Thanks for the responses, guys. 

My purpose for attempting to gain lower pressures with a nasal mask is mostly based on comfort and having less mask on my face.   This goal may not be achievable if the pressure relief benefit is measured in small units.... like a point 5 or 1.  (Was hoping with a nasal I could get down to about a pressure of 12 or 13.  At these pressures I could use a chin strap and possibly tape or cervical collar to help keep leaks to a minimum).  

My present nightly routine is using the F10 ffm with liner, a chin strap and a soft cervical collar to help prevent leaks.  By the time I get all that gear on I feel like a mummy.  I really do like to sleep on my back best but know this is the worse position to be in; invariably I have to move to a side position because leaks begin developing.  After being on CPAP for a year I thought I'd have this process down pat by now.

I think I'll have to give the F20 ffm a try and hope that it works better. 

Hate-cpap
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#5
We have seen individual with high pressure like yours reduce pressure by up to 3 cm on nasal pillows masks like the Resmed Airfit P10. Three cm seems to be at the high end. I think it is worth mentioning that at your high pressure requirement, BiPAP (bilevel) could potentially be justified if you are "intolerant" of the higher pressures of CPAP, and even the Airsense 10 Autoset with a 3 cm exhale pressure relief would be much more comfortable.

Mouth leaks in some people are not that dependent on pressure, and you can have severe leaks using a nasal interface at much lower pressures if you cannot exclude air from the mouth. A chinstrap is a band-aide approach, and the people who do best with nasal therapy are those who use the tongue to exclude air pressure from the mouth. A chinstrap can keep the jaw in a more favorable position for this, but if the tongue drops, almost nothing will stop the pressure from exiting.
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#6
The 3 cm pressure reduction statistic is interesting.
 
I had a disaster on the titration study with the nasal pillows, though.  The attendant had to switch me over to a ffm after a few hours due to pillows seriously irritating nostrils and stuffing me up.  The rest of the study was a disaster too, but that is another story.
 
I think I will try switching to a nasal mask.  If I could keep my pressure down to 14 or so, I would be happy.  Having said that, I don’t have a problem tolerating the higher pressures.  The main problem with the higher pressures is that I have to have the mask so tight to prevent leaks from occurring.
 
I do need my chin strap as a crutch, though.  As long as I’m awake I can keep the tongue in the correct position to eliminate mouth breathing.  Once I’ve fallen asleep, everything relaxes and you know the rest of that story!    Smile 
 
If the nasal mask and/or some combination of chin strap, tape or cervical collar fails, I’ll move toward purchasing the F20 ffm.
 
Thanks
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#7
In mask selection strategy, I strongly believe in going from the smallest, least intrusive to the largest most intrusive. For most people this means from pillow masks to FFM. There is no reason a pillow mask shouldn't be tried if you are going to try a nasal mask.

from the Mask Primer
First, even a mouth breather may be able to use ANY style of mask, even the simplest, most unobtrusive, Nasal Pillow. See the Mouth Breathing section to see what to do.

Try masks from the most unobtrusive to the biggest bulkiest of masks. This would typically be starting with Nasal Pillows, Nasal Mask, Hybrid Masks, then finally the Full Face Mask. The smaller masks that you start with leave you with less mask on your face and more visibility.

Finally, as I have said before, you have to try masks on, under pressure, and preferably lying down in sleeping position.
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#8
Have any of you noticed an inflection point above which nasal masks & nasal pillows don't seem to work as well? My PA said that if I ended up needing a high pressure then a FFM would probably be required. Tonight will be my first night with a PAP machine (treatment before titration), but even trying the FFM on today I was thinking that something that allowed me to put my glasses back on would be nice.
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#9
Insist on the ResMed P10 Nasal Pillow Mask.
At least give it a try. If it doesn't work out for you, move up to a nasal mask, then to full face.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#10
Seems like the pros are recommending nasal pillows to start on the path of “lease to most” mask intrusion.  That’s good enough for me. 
 
I’ll begin there in a few weeks when I meet with the DME.  Thanks to all who have contributed.
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