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Switching from full mask to nasal pillows?
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Purdue writer Offline

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Post: #1
Switching from full mask to nasal pillows?
I have been on CPAP for about a month and am doing well. My AHIs are well below 5 and I use the machine every night all night. I recently switched from a Quattro FX to a Swift FX for her because the full mask was causing skin irritation and it drove me crazy that I couldn't scratch my nose. My question: I had trouble sleeping last night, awoke numerous times and awakened this morning with a dry mouth. Is it possible that I was mouth breathing, even tho my AHIs were 3.7 and my leaks were 8L/min? If so, does that mean my therapy was not effective? Should I try a chin strap (which I have, but haven't used)? I'd really rather not if I don't need to. BTW: I really prefer the Swift over the full mask! Thanks for your help!
04-23-2013 09:36 PM
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Tez62 Offline

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Post: #2
RE: Switching from full mask to nasal pillows?
Purdue writer, Full face masks are for mouth breathers or people with colds or blocked noses. Your treatment wouldn't have be in effective it sounds like it was good from your figures. If you are a mouth breather it is very hard to train yourself not to be one. Try the chinstrap for a while then experiment without it. Your mouth is probably dry because you are breathing through it and that way your treatment will be less effective. A couple of ways you can work out whether you are a mouth breather or not are during the day we normally breathe the same way we do at night so if your watching the TV with your mouth open you will more than likely do so when your asleep, it's not a conscious thing that we do. Also if your opening your mouth with the nasal mask you should hear an awful sound which is the air going in your nose and straight out your mouth.
04-23-2013 10:25 PM
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matthew1943 Offline

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Post: #3
RE: Switching from full mask to nasal pillows?
(04-23-2013 09:36 PM)Purdue writer Wrote:  I have been on CPAP for about a month and am doing well. My AHIs are well below 5 and I use the machine every night all night. I recently switched from a Quattro FX to a Swift FX for her because the full mask was causing skin irritation and it drove me crazy that I couldn't scratch my nose. My question: I had trouble sleeping last night, awoke numerous times and awakened this morning with a dry mouth. Is it possible that I was mouth breathing, even tho my AHIs were 3.7 and my leaks were 8L/min? If so, does that mean my therapy was not effective? Should I try a chin strap (which I have, but haven't used)? I'd really rather not if I don't need to. BTW: I really prefer the Swift over the full mask! Thanks for your help!

Please don't switch!!
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.
04-23-2013 10:49 PM
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archangle Offline
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Post: #4
RE: Switching from full mask to nasal pillows?
(04-23-2013 09:36 PM)Purdue writer Wrote:  I have been on CPAP for about a month and am doing well. My AHIs are well below 5 and I use the machine every night all night. I recently switched from a Quattro FX to a Swift FX for her because the full mask was causing skin irritation and it drove me crazy that I couldn't scratch my nose. My question: I had trouble sleeping last night, awoke numerous times and awakened this morning with a dry mouth. Is it possible that I was mouth breathing, even tho my AHIs were 3.7 and my leaks were 8L/min? If so, does that mean my therapy was not effective? Should I try a chin strap (which I have, but haven't used)? I'd really rather not if I don't need to. BTW: I really prefer the Swift over the full mask! Thanks for your help!

If you can avoid the mouth leaks, and breathe through your nose, a nasal mask is much better than a full face mask (FFM) for several reasons. FFMs should be a last resort, but they are necessary sometimes.

Try a chin strap. I use a 3 inch non-adhesive ACE bandage to make my own.

(04-23-2013 10:49 PM)matthew1943 Wrote:  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.

Your explanation of the physics makes no sense unless your nose is really badly clogged. The pressure in your mouth with a nasal mask will not be more than the pressure in the mask.

Also, the "proper" way to seal your mouth off is with your tongue at the back of the mouth. You shouldn't have air in your cheeks or pushing against your lips. If your jaw drops down, this tends to lose the seal your tongue makes at the back of your mouth.

Get the free SleepyHead software here.
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04-23-2013 11:02 PM
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big_dave Online

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Post: #5
RE: Switching from full mask to nasal pillows?
(04-23-2013 09:36 PM)Purdue writer Wrote:  I have been on CPAP for about a month and am doing well. My AHIs are well below 5 and I use the machine every night all night. I recently switched from a Quattro FX to a Swift FX for her because the full mask was causing skin irritation and it drove me crazy that I couldn't scratch my nose. My question: I had trouble sleeping last night, awoke numerous times and awakened this morning with a dry mouth. Is it possible that I was mouth breathing, even tho my AHIs were 3.7 and my leaks were 8L/min? If so, does that mean my therapy was not effective? Should I try a chin strap (which I have, but haven't used)? I'd really rather not if I don't need to. BTW: I really prefer the Swift over the full mask! Thanks for your help!

A chinstrap works as a training aid to remind you to keep your mouth closed while sleeping. You may be able to stop using it once your mouth leak is under control. I was able to quit wearing mine for a while, but the mouth leaks returned and I'm wearing it again to retrain myself.
04-23-2013 11:36 PM
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zonk Offline

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Post: #6
RE: Switching from full mask to nasal pillows?
Full face masks didn't worked for me, leaked like sieve but many folks have no such problem ... Everyone is different

I use chinstrap each night, chinstrap helps minimize mouth leaks and keep mask in place (worn over mask)
Occasionally mouth breathe but not significant enough to impact on the therapy
When congested, one tend breathe thru the mouth and mouth breathing causes dry mouth .. its a cycle ... one thing leads to another Cold
04-24-2013 01:20 AM
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trish6hundred Offline

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Post: #7
RE: Switching from full mask to nasal pillows?
Hi Purdue writer,
I would suggest that you try a chinstrap for a while to see how you do with it.

trish6hundred
04-24-2013 08:09 AM
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imfletch Offline

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Post: #8
RE: Switching from full mask to nasal pillows?
(04-23-2013 09:36 PM)Purdue writer Wrote:  I have been on CPAP for about a month and am doing well. My AHIs are well below 5 and I use the machine every night all night. I recently switched from a Quattro FX to a Swift FX for her because the full mask was causing skin irritation and it drove me crazy that I couldn't scratch my nose. My question: I had trouble sleeping last night, awoke numerous times and awakened this morning with a dry mouth. Is it possible that I was mouth breathing, even tho my AHIs were 3.7 and my leaks were 8L/min? If so, does that mean my therapy was not effective? Should I try a chin strap (which I have, but haven't used)? I'd really rather not if I don't need to. BTW: I really prefer the Swift over the full mask! Thanks for your help!

If you AHI was 3.7, your therapy was effective. A leak rate of 8L is not much BUT the dry mouth does say something. When using nasal pillows you must not only keep your mouth shut, you must also keep your LIPS sealed. I bet you were allowing your lips to slightly separate with each exhalation. This would allow the humidified air (the moisture in the air includes, among water from your humidifier, moisture from your body) to escape into the room instead of being recirculated. This could result in dry mouth even though your therapy was effective. Your unit is MORE than capable of compensating for an 8 liter leak rate.
Now, what to do about the lips? That can be difficult because even a chin strap (while it will keep your mouth closed) will not keep your lips sealed. Some people place about a 2" piece of regular Scotch-brand tape, vertically, across the middle of their lips. This will easily pull apart if you NEED to mouth breathe, but might provide just the subtle reminder your subconscious needs to keep the lips sealed.

...just a thought from one who once used Painter's Tape all the way across his lips. (Yes, I hear the crowd gasping.)
04-24-2013 12:31 PM
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Purdue writer Offline

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Post: #9
RE: Switching from full mask to nasal pillows?
(04-24-2013 12:31 PM)imfletch Wrote:  
(04-23-2013 09:36 PM)Purdue writer Wrote:  I have been on CPAP for about a month and am doing well. My AHIs are well below 5 and I use the machine every night all night. I recently switched from a Quattro FX to a Swift FX for her because the full mask was causing skin irritation and it drove me crazy that I couldn't scratch my nose. My question: I had trouble sleeping last night, awoke numerous times and awakened this morning with a dry mouth. Is it possible that I was mouth breathing, even tho my AHIs were 3.7 and my leaks were 8L/min? If so, does that mean my therapy was not effective? Should I try a chin strap (which I have, but haven't used)? I'd really rather not if I don't need to. BTW: I really prefer the Swift over the full mask! Thanks for your help!

If you AHI was 3.7, your therapy was effective. A leak rate of 8L is not much BUT the dry mouth does say something. When using nasal pillows you must not only keep your mouth shut, you must also keep your LIPS sealed. I bet you were allowing your lips to slightly separate with each exhalation. This would allow the humidified air (the moisture in the air includes, among water from your humidifier, moisture from your body) to escape into the room instead of being recirculated. This could result in dry mouth even though your therapy was effective. Your unit is MORE than capable of compensating for an 8 liter leak rate.
Now, what to do about the lips? That can be difficult because even a chin strap (while it will keep your mouth closed) will not keep your lips sealed. Some people place about a 2" piece of regular Scotch-brand tape, vertically, across the middle of their lips. This will easily pull apart if you NEED to mouth breathe, but might provide just the subtle reminder your subconscious needs to keep the lips sealed.

...just a thought from one who once used Painter's Tape all the way across his lips. (Yes, I hear the crowd gasping.)

Thank you so much. I am new to this and don't really understand the leak rate, but thought it was okay. I've been having trouble staying asleep since I started the nasal pillows, tho. I'm thinking I might try my old mask tonight to see if it's any better.
04-24-2013 01:45 PM
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zonk Offline

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Post: #10
RE: Switching from full mask to nasal pillows?
(04-24-2013 12:31 PM)imfletch Wrote:  ...just a thought from one who once used Painter's Tape all the way across his lips. (Yes, I hear the crowd gasping.)
[/b]
You can use whatever you like as long as you.re aware of the risk associated with taping and have some back-up plan in case of power failure or machine stopping for some other reason during the night

For that reason, full face masks have anti-asphyxia valve so you can breathe fresh air otherwise will be in dire straits situation
04-24-2013 03:19 PM
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