Help with moving to nasal mask from F40

[charlie*M]

Hi folks,

I've been on CPAP for less than a year, using an F40 mask with large cushion from the outset.  Generally I've made good progress, with a 30 day average AHI around 0.8, compared to 3-5 at start of therapy.  (Sleep study at the lab showed AHI of 77).  Using guidance from this board, I've reduced aerophagia and (some) mask leakage by reducing the upper pressure setting from 12 to 10 cm, increased the minimum pressure from 5 to 7 cm to benefit from EPR of 3, and taken measures to reduce my positional OSA due to jaw drop or chin tucking.

But for the last few months I've been running into some problems with the F40, and I'm looking to make a change.  Initially I was certain I needed a full face mask, as without CPAP I often was aroused with a very dry mouth.  Xylimelts helped a little.  Since I'm looking for F40 alternatives, I thought I'd try moving to a nasal mask.  Hopefully I've trained myself to keep my mouth shut.

There are two main issues with me using the F40: first I'm noticing some movement of my teeth, affecting the bite.  Not severely, but enough to notice on waking.  Usually reverts somewhat during the day, but there may be some longer term changes that change so slowly I don't notice them.  (AFAIK I am not clenching or grinding my teeth during sleep)

Second issue I have with the F40 is related to the straps.  First going to bed straps are good, no leaks.  But during the night the skin on my scalp / head / cheeks compresses, creating ridges on the scalp and deep facial marks.  The problem with that is that the straps are not elastic, and thus the mask seal is compromised.  Even a slight movement of my jaw (chin tuck without mouth opening) is enough to open the seal around the cushion and cause an arousal.  I'm reluctant to tighten the straps further, either starting out or during the night due to the dental issue.  

Sorry for the long backstory, but here are my questions:

* What's the anecdotal success rate going from a FFM to a nasal mask, in general?


* Any feedback on elastic straps, say like on the P10?  Seems like the P10 is the go-to nasal mask, and the elastic seems that it would maintain a better seal for me than rigid straps without any give.  I'm a little worried about hypercapnia with the P10 but it seems manageable with proper maintenance.

* Are there other nasal masks with elastic somewhere in the strap system?  F&P Solo and Micro look quite good but have no elastic that I can see from reviews.  Although maybe a nasal mask would not be as sensitive to straps loosening during the night.

Thanks for any guidance!

[Deborah K.]

I have used the F&P Nova Micro.  The straps in front do not stretch, but the two on the top and back do.  This and the P10 are both nasal pillows masks.  The F&P worked well, but I am back to my beloved Bleep.  If you try the Nova, make sure your DME can provide a fit pack.  That will make it a lot easier to end up with the right size.

[super7pilot]

Sounds strange with a ff mask. But have you tried a chin strap. Anytime you cinch a ff mask down, the lower part of the mask can push on your chin.

That was the case for me with my F40. So when i started wearing my knightsbrige. It kept my jaw closed and so teeth didn’t have a chance to move. An added benefit is that the knightsbridge is a full cap type of chin strap. So it holds mask straps in place.

But as i have grown a beard. The F40 is a no go now. So i use the P10. And the same chin strap cap keeps those straps in place.

[LaurenceShaw]

Thanks for the recommendation, super7pilot!

And sorry to keep having to posting this, but please note that the official site of Knightsbridge Sleep Solutions is Supplier #37. (If you do a keyword search, you will still likely end up with a counterfeit.)

[martyedb]

I started out with a FFM. My therapy improved greatly when I changed to a nasal mask. I still have to tape my mouth at night. I breathe through my nose just fine but the pressures seem to just push my lips open.

[martyedb]

The F&P Solo has  stretchy  (elastic ?)  straps.   The website probably would demonstrate how it works.   I've been using mine for two weeks and I think I will continue with it.   I do tape my mouth, and I'm wearing a loose sleep mask, which is surprisingly comfortable.   My DME has a 30-day policy for exchanges.

[ejbpesca]

I have to stay with a FF mask (currently the F40 hybrid) due to nothing suggested (chin strap, tape, collar) will keep my mouth closed and enable me to use a nasal mask.  I tried the Evora FF (also hybrid) and it worked okay, then the F40 which was an improvement.  The Evora FF may have straps with better elasticity.

Unfortunately, to keep leaks down I have to tighten the straps by the second week of use of a cushion and the discomfort rises.  This has been the case with all seven of the FF masks I've tried.

[charlie*M]

Thanks for the feedback folks!  I will try the P10 and see how the transition to nasal goes.

How does one go about getting a mask trial from a DME or other supplier?  Most suppliers need a prescription, do I need to get the doc involved for a mask change?  I know about the DME / Medicare timeline for getting new masks, but I'd rather A) not wait that long and B) not make a change at the DME until I'm sure it works.  I'm willing to pay out of pocket for the first one and a 30 day trial of a P10 fit-pack sounds great.  I searched about getting trial masks, but perhaps not well enough.

[ejbpesca]

Once you pick a DME that accepts your insurance there will be contact with your doctor to establish your prescription.  If a local DME you can go in for fitting of various masks.  If online you will depend on shipments (usually free of charge) and returning them one mask at a time to try them out.

There is a list of CPAP suppliers at the top of this forum's page.  Many of them do not accept insurance and will sell masks without the need of a prescription.  Many have a return policy for exchange within a period of time.

A search of "cpap supplies," will produce many suppliers.  Some file insuance claims some do not.

[charlie*M]

Thanks!  I've ordered a P10 mask, headgear and two sizes of pillow from Supplier #38, w/o a prescription.  Oddly, a fit-pack requires a prescription, but individual parts to make up the same mask, do not (!?)

I will follow here up in a month or so with how the P10 works for me.