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Why would cushion size affect how well I breathe?
#1
Why would cushion size affect how well I breathe?
Me: severe sleep apnea (35api), mostly hypopneas, overweight, big b**** (suspected hypoventilation), one week on Resmed Airsense 10, Dreamwear Full Face Cushion, recommended pressure 10-12 (from sleep study)

My question is: why would cushion size affect how well I breathe? 

This is week one on CPAP, and I'm not having a great time. So they had recommended a LARGE cushion for me at the sleep study, but I felt like when I licked my lips and moved my face it leaked a lot. When I picked up my machine (ResMed 10), they suggested I try a medium wide instead. So for a few days I tried that. It didnt feel like it leaked as much, but it also felt a little hard to breathe, and it sat on the bony protrusion above my right canine tooth in a way that was starting to hurt. Also I could never sleep through the night, would wake up after about 3 hours (this could just be CPAP acclimation, of course)
So I thought I'd try the large cushion for a night, and what a difference! felt like I could breathe MUCH easier, and I slept through the night. It did seem a little more prone to movement leaks (mask farts!) like in the sleep study. 
My AHI is below 1 with either mask. 
Any ideas? 
if I helps, I've attached two screenshots, one from last night (large cushion) and one from a previous night with MW cushion (July 16)


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#2
RE: Why would cushion size affect how well I breathe?
As pressure rises, the tendency of the mask/cushion to lift rises.  As you deform or just change the shape of your face, for whatever reason, licking lips, pursing lips, raising eyebrows even, the seal suffers a bit. It might hold, but it is weakened.  If your pressure rises substantially during inhalation, it might lift the seal.

So, we tend to improve the seal's efficacy over time, and that is usually done by tightening the mask/headgear straps.  As you are finding, between form and fit, and in wanting to enable a durable and reliable seal, you have pressure points.  

I can't answer the question about the resistance to drawing breath....I take it that is what you mean, not also in exhaling?  Except, as you probably already know, most machines have settings for the various types of masks.  And sizes?  Would you have made the appropriate adjustment in the machine's settings?  If the pressure checks out, and the various passages, orifices, and vents are clear, you should not have trouble breathing.  I think a great many of us tend to draw on the flow heavily for the first minute or so after donning the apparatus and commencing the treatment...I know I do.  I have just been moving around, maybe toweling off after my midnight dip in the hot tub, and I'm breathing heavier than I was just brushing my teeth ten minutes prior.

I think you will get more help, so be patient.
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#3
RE: Why would cushion size affect how well I breathe?
hi - I have seen the settings for masks in my Resmed 10, but it was just full face, not full face + [cushion size]. Unless there are deeper settings that I didn't dig into?
as to breathing, I'm not sure of the lingo to use, except that breathing with the LARGE cushion feels easier. (I think I have other issues with the length of the inhale/exhale but that is not mask-related.)
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#4
RE: Why would cushion size affect how well I breathe?
I have seen postings on this board expressing the opinion that larger masks/pillows are associated with easier breathing and lower flow limitations. Not sure if that is empirically true or merely individual opinions. The risk of larger cushions/pillows is that they may not seal well and thus produce leaks -- the same as using a cushion that's too small.

The mask you have may have come with a sizing template that you hold up to your face and determine what cushion size is best. If you don't have the original paperwork, or it wasn't included with the mask, I suggest going to the manufacturer website and searching for the sizing template.

A bit of lingo: "fitting" is how to put the mask on, whereas "sizing" is determining which size is best.
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#5
RE: Why would cushion size affect how well I breathe?
If you ever get a chance to try some nasal pillows like the Airfit P10, take it. Most people that think they are mouth breathers, just never had the nasal passages open enough to breathe before. Easy to wear, easy to seal and lightweight. I don't know what led to your decision to use a full-face, but you would not believe what you're missing.
Sleeprider
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#6
RE: Why would cushion size affect how well I breathe?
I desperately wanted to do a nasal cushion vs. full face, but I'm a mouth breather, and I tend to have nasal congestion frequently (I'm allergic to most trees and grasses out here on the west coast - I had allergy testing that figured that out), so I was advised to do full face. 
COme to think of it though - I did try out one of the nasal cushions in my sleep study, but there was hard plastic that felt like it was scraping on my upper lip.
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#7
RE: Why would cushion size affect how well I breathe?
Nasal pillows are far different from nasal masks. The air is applied directly to the nostrils, opening the nasal passages in a way you may never have experienced. In addition, ANY mask that rests on your face is laying right on the sinuses causing further obstruction. As I sit here typing and mouth breathing in the daytime, I enjoy that rush of air that opens my nose at night and allows normal nasal breathing. Also, Fluticasone Proprionate (Flonase) can do wonders on chronic allergies without any drawbacks or increased tolerance
.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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How To Deal With Equipment Supplier


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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#8
RE: Why would cushion size affect how well I breathe?
ha ha! SO I figured out the issue. And I feel like an idiot. I was comparing the cushions this morning, and happened to notice the air holes in the cushion were different shapes. The Large is nice and deep triangle to accommodate my giant nostrils, but the MW is wider but flatter. So I put them on my face and kind of looked up the mask to see how the holes fit on top of my nostrils. And guess what? the medium wide was covering part of my nostrils. NO WONDER I FELT LIKE I DIDN'T GET ENOUGH AIR. this is a big DUHHH for Charlene.


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#9
RE: Why would cushion size affect how well I breathe?
Well, that's progress!
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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
RE: Why would cushion size affect how well I breathe?
I would like to second Sleeprider's notion of trying a pillow mask. Sleeprider is the expert, I am not. But I do have an opinion. I happen to think that FFMs are suggested as a kind of knee-jerk reaction because it is easier the the sleep doc/tech. If you are not a mouth breather during the day, there is the possibility that the muscles relax when you sleep -- causing the mouth to open. In my case, the pillow mask helped a LOT. I hearyily recommend it.
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