I See So Many Mask Complaints And The Answer is So Simple-- Sleepdent

I have a similar post on another thread, but it is so important that it bears repeating.There is a basic reason that people have so many leakage and comfort problems with conventional CPAP masks. The word is SKIN. Your facial skin is soft, sensitive, and easily deformed. It is an ABSOLUTELY LOUSY surface on which to make a seal against the air pressure from CPAP. In order to get the seal, the straps have to be SO TIGHT that people can't stand it. And you expect people to be happy with it? The whole concept is a loser and the CPAP mask manufacturers have to face the music. The future is in tooth borne CPAP interfaces. The support comes from your bones, not from your skin. Now you have a solid immovable foundation. The mask doesn't squish all over the place when you move around and cause leaks. And now your nasal pillows seal very well with the LIGHTEST pressure against the skin. Really comfortable. End of problem. It is SO easy. In all fairness, the present tooth borne interfaces only work well for people with reasonable nasal patency(open nasal passages) or who can achieve reasonable nasal patency after treatment. However, I am already thinking about how to accomodate people who must mouth breathe. Give me some time. Arthur B. Luisi, Jr.,D.M.D., The Naples Center For Dental Sleep Medicine.

There is one oral only mask sold by Fisher & Paykel. Based on the odd forum post, people either love it or hate it. I would expect you would have to use nose plugs with it, and you would lose the benefit of breathing through your nose. Not sure if it is the one or not, but I have seen an oral mask mentioned that is kind of like using snorkel equipment, in that it goes inside your mouth and in front of your teeth. That one is a love it or hate it too.

The MyTapPap nasal pillow mask is good for people who breathe through their nose and tend not to get mouth leakage. You can order it directly through www.CPAP.com and install it yourself. It is easy to do and most people can manage it. Airway Management only sells directly to doctors. There are other online providers that I can tell you about. If you can breathe through your nose, but tend to get mouth leakage(use a full face mask), I have another modified version with a leak proof intraoral mouth shield. It is not yet in volume production, but I can provide you with one through my web site. If you must breathe only through the mouth, we don't have any tooth born device to address that yet, but are working on it. Arthur B. Luisi, Jr.,D.M.D.

I recently got some positive feedback on my concepts from the Mayo Clinic. Very encouraging. will keep you posted. Dr. Luisi

Some people have asked me whether or not they could do medical tourism and get a leak-proof CPAP interface that way. The answer is YES. I am in SW Florida and it is a pleasant place to visit. You need to call us and we will ask you some screening questions to see if you are a candidate. We will send you some life-size pictures to examine. If you are interested, we need a least 2-3 weeks lead time to assemble your device. It takes about 2 hours to deliver. You need to have your CPAP machine with you. We can deliver about 10 per week so order well in advance. And if we can't make it work to your satisfaction, there is no charge. See: www.naplescenterdentalsleepmedicine.com. Dr. Luisi

There has been a lot of discussion on the forum about mouth taping to eliminate the air leakage through the mouth caused by CPAP. I am not going to discuss the validity of the concept other than to say that: 1. The price is certainly right. 2. It does seem to be a bit of a hit or miss approach depending on the skill of the patient and how active his lips and facial muscles are during the night. 3. Even with the lightest and least allergenic tape you could find, I wouldn't think that the comfort would be superb, although you patients could correct me if I am wrong. Certainly having tape over your lips long term couldn't be that good for the health of your skin. What I am working on what seems to be a far better approach and it is proving to be so clinically. I have a very soft, comfortable, thin, hypoallergenic, silicone-like clear seal that goes right inside the lips. The air from the CPAP machine seals it tight inside the lips and there is no leakage even it your mouth and facial muscles move around. It is gentle to your skin, lasts about 3 months before replacement and costs between $12-$35 dollars to replace. I do believe that this could be the ultimate solution. The product is made by Airway Management, Dallas, Texas, but this is the first time that it has been used in this way. Only time will tell. Arthur B. Luisi, Jr., D.M.D. . The Naples Center For Dental Sleep Medicine.

Good news. I have been able to continue development of the no leak face mask from the prototype stage to a simplified production ready stage. To date, we have had to take between one half hour to an hour to assemble each one and therefore had to price it at $450 dollars installed on your CPAP machine. With the simplified assembly, we can now install one on your machine for $280. If we actually go into production, I would anticipate a price of somewhere near $150, which is competitive with a high-end conventional mask. Dr. Luisi

Yes folks, it is WORKING. One of our initial concerns was whether or not the soft, pliable intraoral mouth shield could stand up to the highest CPAP air pressures(in the 17-20 cm water) range without blowing out. As we have the opportunity to do more cases at the highest air pressures, we are finding that the seal is continuing to hold reliably. We also knew that skin-borne nasal pillows will often start to leak at the higher pressures, too. Again, we are finding that, when the pillows are stabilized by the teeth, they CAN take the highest pressures without leaking. It is hard even for me to believe, but it looks like this could be a historic break-through in CPAP interfaces. Stay tuned. Dr. Luisi

At this point, I am no longer concerned with how well the no-leak masks will perform because they have done well. The real question is how to integrate them into the present delivery system. The biggest problem is the typical CPAP DME company. The technicians are used to strapping on a large and varied inventory of masks, but have no experience with, and possibly, no particular interest in working with tooth-supported interfaces. There is even a question of whether or not they could legally do so. This leaves us with the possibility that licensed dentists would have to be included in the loop and, of course, the DMEs would be very reluctant to do that. This is a real problem. Any suggestions? Dr. Luisi

Let me review the present state of affairs. To date, when a person has chosen to use nasal pillow masks, and has developed a problem with mouth leakage, the conventional response is to go with a chin strap to keep the mouth closed. A very popular chin strap is made by ResMed. This leaves your head covered with TWO sets of straps. One set holds the nasal pillow mask in place and the other set is for the chin strap. Obviously, the comfort is less than ideal, and there can still be a fair amount of leakage from both the nasal pillows and the chin strap. Granted, in some applications, they don't leak, but oftentimes they still do. My device with tooth-supported nasal pillows and the intraoral mouth shield effectively replaces BOTH the nasal pillow mask AND the chin strap. Functionally, it does the same thing. The difference is that there are no straps and NO leakage, which is a big improvement in comfort. From a safety point of view, both arrangements are fine. The exhaust ports in the nasal pillow masks effectively gets rid of the exhaled CO2 unless the ports are blocked or the CPAP machine stops functioning. The addition of the chin strap or the mouth shield does not compromise safety because the exhaust ports avoid CO2 build-up even with the mouth sealed. I hope that this adds some clarity to the discussion. Dr. Luisi

Thanks for sharing it! You have some really good points, which are definitely worth considering.

Hey there, thanks for sharing this information about CPAP masks. As someone who has struggled with mask leakage and discomfort, I can definitely relate. Your suggestion about tooth-borne CPAP interfaces is really interesting and seems like it could be a game changer.

I have given the situation more thought. In a practical sense, using an oral appliance together with CPAP could be the best solution. I am talking about wearing an oral appliance together with your CPAP. The combination is MUCH MORE COMFORTABLE. CPAP operating pressure can typically be lowered about 50%. Mask leakage problems usually vanish with the lowered pressure. The combination is far more effective at reducing treatment AHI than either CPAP or oral appliances alone. And paired with CPAP, you can use a much more conservative level of protrusion with the oral appliance for much better comfort and much less strain on the TMJs.. I am now using the combination with people who are struggling with their CPAPS and most of them are THRILLED with the result. Arthur B. Luisi,Jr.,D.M.D.. The Naples Center For Dental Sleep Medicine.

Yes.