Hybrid Mask -- The Good, The Bad, The Acceptable

In my two months of CPAP use, I have had relatively good fortune in adapting to this new way of sleeping. The transition has not been without its challenges, however. I suffer from chronic allergic rhinitis which has caused pressure rises (my pressure doubles when I’m congested), mouth breathing, eye leaks, and the last-ditch resort to spray decongestants to be able to be in compliance with my UltraMirage II Nasal Mask.

My prescribed pressure setting is 4-20cm, however, my average pressure prior to using the Hybrid was 7.8. The maximum pressure that I have noted is 9.8. I am learning to sleep on my back now that I am a hosehead, however I still spend 80 percent of my time on my side or stomach. Due to the chronic congestion, my ENT and I have been aggressively treating my nose to a daily treatment of pulsatile irrigation, steroid spray, and antibiotics. I had just begun this treatment when I started with the Hybrid. In spite of the treatment, they also allowed me to try an Ultra Mirage Full Face mask to see if that would help. Yuk. Need I say more? Ok, I will anyway… I had more leaks than Karl Rove’s office.

Thankfully, I was fortunate to be selected to test the new Hybrid mask. It was very hopeful that this would be a good solution to my issues.

The initial fitting took about 60 minutes with adequate time on the machine to check for leaks. I initially thought the small cushions would work, but decided that the medium cushions might provide a better fit. As instructed in the enclosed literature, I measured the distance between my lip and nose and chose the tall cushion setting. I went to my machine to give it a quick check. The most difficult part of this was removing the quick connect piece for my Ultra Mirage from the hose. There is a slight odor to the Hybrid mask and cushions, which is a bit of a concern for me. My migraines can be triggerd by chemical odors. I decided that I would keep my Imitrex handy just in case.

As a ResMed S8 Autovantage user, mask settings may be an issue. This mask has a high vent flow rate compared to the ResMed masks. I fiddled with the mask settings and found that with the machine set for a UMFF.

This review is the result of seven nights use of the Hybrid Universal Interface.

My Experience

One issue with the mask for some people may be the top clips and headgear straps. This mask is a very strong candidate for Pad-A-Cheeks. I have high cheekbones, but not a large face. The clips from the top straps on the headgear do dig in to my face. This may not be a problem for everyone, and it seems to be solved with the PACs. Using a larger mouth gasket is also helpful to keep the clips away from your face.

On the first night after laying in bed for a few minutes and turning over, I wasn’t satisfied with the mask fit. So, I swapped out cushion sizes two or three times. I ended up with the large mouth gasket and the medium nasal pillows. I fell asleep on my back (a rare occurrence) and woke up an hour later when I turned over and one nasal pillow started leaking. I went back to sleep and the next thing I knew, my phone was ringing. It was 5 am. The first test of the release buckles was not good. I was expecting the call, so I had the phone next to my bed. It took me about 30 seconds of fumbling to remove the mask, and what I actually ended up doing was releasing the Velcro instead of unbuckling the strap. After the phone call, I went back to sleep and woke up at 7:30.

My numbers were quite good. I had been very congested when I went to bed. In the past, that congestion would have made me turn to a nasal decongestant so that I could breathe through my nasal mask. I was very relieved that I didn’t have to do that. This was the first night that I’ve had an AHI below 1.0. Taking into account comments from the RT at the Sleep Lab, I would say that that is probably due to not having mouth leaks through the night. My leak rate was three times my normal, but the mask vent flow is significantly higher than the Swift setting that I was using. Still, the mask fit was in the very good range.

The only down side to the night is that my nares are quite sore. I didn’t expect this because of the softness of the pillows, but I think I just had the pillows too high and secured too tightly. I set the pillows to the low setting after the first night.

On subsequent nights, my tossing and turning caused problems with the nasal pillows coming unseated. I tried adjusting the headgear using ponytail holders to pinch the two straps together. This caused the mask to tilt back towards my nose a bit more, but it also made the mask tighter and less comfortable. A few nights later, I tried securing the nasal pillows by running dental floss lightly around the pillow and attaching it to the upper post on the opposite side of the mask. This fix was very helpful in keeping the pillows seated in my nares. Due to the ponytail holder, the mask was uncomfortably tight, but almost entirely leak-free. I decided to remove the ponytail holders and give it a try. My final setup: Large mouth cusion, medium pillows, dental floss pillow stabilizers, and pad a cheeks. The result is fairly comfortable and reasonably leak free.

For the most part, my AHI numbers remained quite low and leak rates were very good, especially as the mask fit more tightly. My AHI numbers did go up as I used the Large mouth cushion and released the poinytail holders. My thought is that the Hypo numbers are elevated due to leaks with this setup. My pressure numbers also decreased. Most nights on the Hybrid were spent between 5 and 6. My average pressure for the month after using the Hybrid for one week, has dropped to 7.0.

In trying different mask settings on my S8 Vantage, the Full Face setting provided the best leak numbers by far. The down side to this is that I am unable to use the Smart Start feature while using FF mask setting.

Conclusions--- The Good
This mask is very comfortable, but fitting is crucial to success. The design of the mask feels very different from the UM masks, and I think that many users will feel a tremendous sense of freedom while using this mask. I could watch TV and talk to my spouse (although the good-night kiss was a little tough ) with ease. I noticed that even on nights with multiple awakenings or the need to wake up very early for work, I still felt very refreshed. I think that the combination of nasal pillows and being able to breathe through my mouth when necessary are a big part of that.

Another very big plus for me is the ability to breathe freely with the mask on. The generous venting keeps respiration nearly effortless. I found that respirations using the hybrid were significantly slower while using this mask. Thumbs way, way, way up on this feature.

For comfort and ability to provide quality sleep, I give this mask an A-

The Bad
Unfortunately, the name Universal does not necessarily mean that there will be a universal fit out of the box for every face. I wish, I wish, I wish I could get the pillows to stay seated. I have a bit of an overbite, and the tip of my nose has a bit of an upturn making this mask a difficult fit. Even though the nasal pillows are soft and pliable, they leave a gap at the tip of my nose due to my anatomy. A pillow that has a bit of a molded S shape… to turn back up with the tip of my nose… I think would be the perfect fit. Hopefully as more users experience this mask, the TeleMed will be able to enhance the fit of the nasal pillows.

Another negative for me… perhaps the biggest one… is that there is no way to secure the elbow connection above my head. As a result, I woke up often to position the elbow connection so that it wasn’t pushing the mask off of my face while I’m on my side and stomach. The UMII comfort for me is derived from not having to position the hose in the middle of the night. Of course, the Hybrid design does not allow for this. I’m thinking though, that with a longer hose and a bit of a rig up over my bed, I could work around this.

The Acceptable

I dislike the headgear attachments on this mask. They absolutely do not lend themselves to easily removing the mask. In order to get the headgear off of the mask posts, you have to push firmly at the proper angle. That’s tough to do in the middle of the night, and it would be difficult for users with limited hand mobility. They may have to resort to removing the headgear by undoing the Velcro fastnern. All in all, it’s not a major issue for me, but it’s definitely an area that could use improvement in the future. The other item that I miss from my UMII is the quick connect for this mask. Having a quick connect for the hose, would be a terrific work around for the design shortcoming on the connector for the headgear. In fact, if some enterprising individual could come up with an interface between the Hybrid and the UMII quick connect, they would have a very nice market out there waiting!

Overall
I am glad to have this mask. Despite my issues with the nose pillows and the elbow connector, I will keep this mask on a steady rotation with my UMII. Is it worth paying $175? I’d say yes. Even out of the box, it was better on me than the UMFF. If you are willing to do a little experimenting, you can get a good fit with a full-face mask. While this mask is a big leap in the right direction, I have hopes that in coming years as the TeleMed engineers respond to users, the next version of this mask will be the answer to our prayers.

I can agree with birdiebaby about the general plus and minus factors of this new Hybrid. Though, I do not mind the down route of the hose, I would like to see the elbow modified (or removed) because of movement issues. (Seems to get in my way too and I find myself shifting it in the middle of the night.) And I hope that the first revision of this mask includes a better on/off system! Those "nubs" can be difficult to slide open!

I guess what has impressed me the most is the volume of air it delivers.
The two other masks I have are an old Adam Circuit, and a ComfortLite
2. I have used the CL2/Pillows for a few months now, and got along real well as long as I taped my mouth. However, if one nostril gets congested I cannot seem to get enough air through the CL2. With the Hybrid I can breathe easily with one nostril 'stopped up'.

I had the same problem with the hose swivel and placement. I found that when I move in the night, the hose would dislodge the mask and the seal.
I got around this partially by routing the hose up the left side of my head and fastening it loosely with a velcro strip to the upper part of the headgear.
Then I feed the hose through a scrunchy which is attached to a heavy lamp arm that I have whichis about a foot above head level (not as high on the wall as with other masks).
I have found that the hybrid doesn't get yanked off my face so easily if I do this.

Maryb

Rather than over the head I do my hose over my shoulder to a wall scruchy. With enough slack in the hose the elbow keeps pointing down and I can move side to side without any hose tugging..