HYBRID CPAP Mask Review

Our AWAKE Group is putting together our September Meeting. One of the
products we are highlighting is a full face mask that purports to work
(none of our members will report that about their FFM). As part of my
efforts to organize the meeting, I reviewed the HYBRID mask. FWIW, below is the review I sent to our members, using a format our group developed.

FEEDBACK REPORT

MANUFACTURER: RespCare, Inc. (Distributed by Hudson RCI)

PRODUCT: HYBRID Universal Interface (Hybrid Mask)

FIRST IMPRESSIONS: There are a few things one notices about this product
right away. It comes with all possible sizes in the box (a lot of
manufacturers are moving to this direction I like it). That way, you
can try different sizes without having to buy a different size. The
pillows can also be easily separated so one can use this mask even if
one has two different sized nares. I played with two different pillow
sizes for one nares to make sure I had the right one. (Later, I found
that I had better results with a different cushion size). They claim 9
different possible size configurations and they are not counting the
fact that you can put the pillows in two different height positions.

I fit my mask using a Fitting Guide that was mailed to me separately
from the Company. The suggested measurement information in this fitting
guide was very helpful and should be part of the materials for everyone
(it is only available from their web site which has tons of information
http://www.hybridmask.com). Between the video on their user CD (also
available on their website, http://www.hybridmask.com/video_index.htm)
and the supplemental fitting guide, it was easy to figure out what to
try initially (with the exception of hose routing see below). I found
the Hybrid a little noisy during fitting under pressure (more on this
later).

I slept through the night my first time. I have used pillows before
which I think helped. The pillows are great. Like ResMed�s Swift, they
have a raised surface which helps position the pillow in the nares and
seal the pillow. I used the pillows in the up position (someone with a
smaller face likely would use them in the lower position). The Hybrid's
system of pillow height adjustment is very simple and works.

The Hybrid has a much smaller profile on the face than any other full
faced mask (FFM) I have tried or seen. Perhaps this is why it leaks so
much less. And because it fits below the nose, there are no leaks around
the eyes at all. For my first few nights I had minor leaks around the
chin (especially when my facial muscles relaxed during sleep again more
on this below). Once I was awake, I was able to eliminate them by
tightening the straps and sleeping on my side (the pillow supporting the
lower part of the mask

I am an occasional mouth breather. I have to admit the Hybrid was much
more comfortable than using a pillow mask like the Swift AND a chin
strap. For a FFM, it is a very minimalist mask.

The only negative, was that during fitting, I found the mask noisy
relative to others I have used (again, please see explanation in next
section). We had the AC on my first night (it was not on during fitting)
so between the blower and the AC fan I didn�t notice any noise while
sleeping. I will pay attention to both leakage and noise for the next
few usages.

IMPRESSIONS OVER TIME: I spoke with the inventor who told me that the
Hybrid's design is quieter if the hose to be angled downwards. When the hose is up, the swivel creates a ricochet effect that causes the loud noise I experienced. When I tried using the Hybrid with the hose angled downwards, it was one of the quietest masks I have ever tried. I have told the manufacturer he should add a note to this instructions, that although the swivel allows the hose to be in any position, those who want the quietest experience will route it down along their body.

My sense about the pillows was correct. These are among the most
comfortable pillows I have ever tried (I also use Ayr Gel around my
nares to improve comfort and the seal). I like the fact one can separate
them and create the angle that fits best. They may look huge but they
work without leaks. Sometimes I have to make sure the top strap is tight
enough to keep the pillows in place (I am an active sleeper so I move
around putting pressure on the pillows to move out of position this
problem is not unique to this mask).

At first, I was frustrated with the chin leak issue. I slept most of the
night, but I always woke up once during the night and earlier than I
usually get up because of the chin leak. At first I suspected I just
needed to find the right strap pressure to make this go away. But, no
one likes to wake up and have to adjust a mask, no matter that one can
do it easily while lying down in bed.

Before accepting the leaks as part of the mask, however, I decided to
try a smaller cushion size than recommended by the fit guidelines. What
a difference! Although the sizing instructions indicated a Large cushion
would fit me better, the Medium worked like a charm the first time I
tried it. No leaks at all! And the mask has an even smaller footprint.
Repeated uses confirmed that this size produced zero leaks.
This clearly is a mask that works although it might require some
experimentation by the user including experimentation that differs from
the instructions.

The straps, for me, have to be tight enough to keep the mask tight to my
face to prevent leaks. Again, when I talked with the inventor, he
suggested that I should be able to loosen the mask now that I had the
right cushion size. I may be doing something wrong but loosening them
just brought back the leaks. Tight straps result in the tell-tale CPAP
mask strap marks in the morning. Anyone who hates morning mask marks
might be disappointed.
However, any person who needs a FFM and can deal with pillows will think
(s)he has found nirvana. The Hybrid Mask is a brilliant idea that is
well executed.

I ESPECIALLY LIKED: The overall design. This is a very comfortable,
quiet FFM that has no leakage around my eyes. I found it more
comfortable than my Swift when used in combination with a Topaz chin
strap (when I experienced mouth breathing).

I liked the fact that all sizes of cushions and pillows came with the
package. Everyone should be able to find some combination that more or
less works. I would not have been able to do the experimentation that
made the mask work for me had any of the parts not been included.
The mask is easy to clean. There are only three pieces, the shell, the
cushion, and two pillows (so you may think four). It is easy to put
together (although aligning the pillows might take a bit of getting used
to). It is relatively small to pack very small compared to most FFM.
As some may remember. I tend to like minimalist masks. This is a simple,
elegant design.

I DID NOT LIKE: 1) I wish I could use the mask with looser straps. 2) I
also think the directions could be better. I would have benefited from
knowing the hose should point down (as noted above). I think directions
should state that mask is intended to be leak free so if you experience
leaks, try a different pillow or cushion size. 3) The packaging should
be different. There is no reason to take the extra cushions, pillows,
fitting instructions or CD on a trip. I think the manufacturer should
supply a much smaller bag to just fit the mask (for travel) with the
extra components not in the travel bag but just shrink wrapped in the
box.

COMPARISON TO SIMILAR PRODUCTS: There is none. The Hybrid Mask is
unique. It is the smallest FFM on the market. It is the only one that
features a pillow system. It has a minimal footprint. One can read with
it since the entire unit fits below the nose.

The pillow system is as effective as ResMed's Swift and it has the
option of using two different size pillows. Being able to use looser straps
would make this fantastic mask even better.

FINAL COMMENTS ON NOISE, LEAKS, FIT, COMFORT: This is a very quiet mask with the hose routed down. It fits well. It is very comfortable around
the pillows. I wish the straps could be looser but there is so little
mask, it seems like a very reasonable trade-off to me.

WOULD YOU RECOMMEND THE SLEEP LAB RECOMMEND THIS MASK TO OTHERS?
Without making sure the patient can adapt to a pillow system, I am
undecided if I would recommend this mask during a titration. On the one
hand, it eliminates the need to experiment between nasal and FFM. It is
small, quiet, doesn�t leak and avoids the need for chinstraps. Between
the Hybrid and the combination of a nasal mask and a chinstrap for a new
user, the Hybrid is the way to go hands down. On the other hand, the
Hybrid is a pillow system that might be a challenge for a new user. I
remember how much I was wierded out the first time air rushed up my
nostrils. (NOTE: I have always thought that mask fittings should occur
the day before a titration to simplify the experience for the patient).

However, if someone is a mouth breather, I challenge them to propose a
better FFM alternative one that is smaller, more comfortable, leaks
less, and is quieter. This is the best FFM mask I have seen or tried so
far.

WHERE is your AWAKE Group from?

Your mask review is meaningless to us. The Hybrid is made by INNOMED, the same makers of the famous potato launcher the Nasalaire and the walrus mask, a company we have learned here over the years to be notorious for planting false testimonials on message boards like this one to drum up interest in a new gizmo they are pushing. There is cheap shoes, cheap insurance and cheap marketing.

It is like they get all 30 of their employees on the internet at the same time just to write how good it is, then after a few of us get suckered into it we start finding it was all hype and way overrated.

This is your very FIRST post and it is ALL a plug for a mask we already know about and members here have already commented about.

The Hybrid is getting at best mixed reviews here.

Normally I am not a proponent of conspiracy theories. But in this case I must have some sympathies with the skepticism expressed by snoredog in his post.

First, harl1828 appears to have registered on July 23 (i.e., today). Despite references to the "AWAKE group", there appear to have been no prior posts by representatives of this group, and there is no description of the nature of the group nor its members. Harl1828's profile is virtually empty.

Nonetheless, harl1828 refers to the "September Neeting" of the AWAKE group, implying that this is one of a series. Also, the implication is that a number of "FEEDBACK REPORTS" have previously been completed by this group, and that the group has even gone so far as to develop a standard report format. A little Googling effort turns up http://www.sleepapnea.org/awake/index.html, which seems to indicate that AWAKE groups are artifacts of the American Sleep Apnea Association. This "non-profit" organization APPEARS to be industry funded, and is located in Washington, D.C. Can we say "lobby"? Maybe not. I haven't spent a lot of time tracking down the details. But the LACK of readily available details is suggestive. There does seem to be a lot of funding behind this organization, but the only sources mentioned are industry ones. Nothing necessarily wrong with that. ASAA apparently "supports" a number of AWAKE groups, but details (aside from in laudatory press releases) are sketchy.

So this is great. Could we see those other reports? I'm sure there would would be tremendous interest in such reports.

Aside from that, it appears (could simply be coincidence) that some of the issues mentioned in the report seem to be a direct response to my generally negative evaluation of the Hybrid mask in my recent "Hybrid disappointment" thread. The recommendation that noise can be reduced by routing the hose in a downward direction is (in my experience) preposterous. That's how I orient my masks.

This "review" does seem to have a bit of a flavor of being an "apologetic" or "damage control". It seems to offer a number of excuses as to why someone would have trouble with the mask, but these really don't hold up under scrutiny. I'm not "disrecommending" the Hybrid, of course. I was merely pointing out what I regard as some rather fundamental flaws that make it unuseable for me. A number of others seem perfectly happy with it.

As to the final challenge of proposing a better FFM alternative, I have done so. For me at least, the better alternative is the UMFF. Again, a great deal of this depends on one's own preferences, needs, and goals. But it does seem as though this "review" is striving to "sell" the mask against alternatives. It's a little too "pitchy" and defensive for an objective review.

See other reviews by this AWAKE group, and seeing what the nature, constituency, and history of this group is would go a long way towards being able to regard this particular review as being offered in a truly objective spirit.

Ghmerrill and Snoredog,
Its wrong to quickly jump to conclusions but it seems like both of you have you have your interests aligned with companies whose products may be competing with this hybrid mask. If this mask didn't work for you, there are plenty of other masks that you can choose from. There is no need to waste a long post in telling everyone that somebody else's review is questionable. Remember than when you point a finger at someone, three fingers are pointing at you!

umm, for me the best ffm is the comfortfull2 but i'm trying to stay away from those style masks now since i found out my therapy wasn't as effective combatting daytime sleepiness until i went to the nasal type masks. and the argument about the hose being routed downward instead of up for less noise held true for me when i tried the hybrid for a week, or at least tried to, anyways, just my $.03, inflation adjusted of course.

outsideobserver (AKA "Guest")

Interesting. Yet another defensive post from an unidentifiable source that in this case is just an ad hominem response.

My interest in other such reviews by the AWAKE group -- and additional information on that particular group -- is genuine. The Hybrid isn't for me, but perhaps they have reviewed other products that I might be interested in.

That's not fingerpointing. That's a a request for the sort of information exchange that threads like this are intended to support.

outsideobserver wrote:Ghmerrill and Snoredog,
Its wrong to quickly jump to conclusions but it seems like both of you have you have your interests aligned with companies whose products may be competing with this hybrid mask. If this mask didn't work for you, there are plenty of other masks that you can choose from. There is no need to waste a long post in telling everyone that somebody else's review is questionable. Remember than when you point a finger at someone, three fingers are pointing at you!

my opinion
I stated my opinion, as for pointing fingers, I'll let you figure out which one I'm pointing. But I'm not trying to sell anything here and I don't know your newbie from man in the moon, as far as I know the newbie works for Innomed, so the review is pretty much worthless to me. Reading this review is like asking Bill Gates if Windows is any good. But I do know what has happened here in the past and I know people can waste a lot of money on hyped up masks. When the Hybrid became available a few weeks ago we were flooded with guest posts like this and it wasn't me questioning the validity of them either.

Didn't get mine for free
Now I'm not part of any AWAKE group associated with a sleep lab, if I was, I'd probably have gotten my Hybrid mask for FREE like I suspect the newbie did. Is that in the AWAKE mask review template? If not, it should be, because that can impact how one reviews a product. I know they gave a bunch away here and we got a few reviews back. Those reviews have some merit because we know those members as they post here regularly.

Price is expensive
But I paid $174 for my Hybrid. It came in a nice case, not the color I would have chosen but a nice case anyway. When I haul my cpap around I put it in its case it came with, if I can also stuff the mask inside that same bag that is what I'll do. Other FF masks cost in the $69-$159 range.

Easy to assemble
I found the Hybrid easy to assemble, in fact it was pretty much assembled right out of the box, only assembly is attaching the headgear. It came with the correct pillows and cushion size already installed. Connecting the headgear was easy and it was nearly adjusted properly right out of the box. I simply connected 3 of the 4 clips and it was ready to wear it. Wasn't excited with the clip design, not the easiest to disconnect in the middle of the night, but it did have clips. Clips make cleaning a mask much easier since you can remove the whole headgear and not lose your strap tension.

Pillows
Pillows are pillows to me, these seemed the same as the pillows found on the Swift, the Breeze and other pillow interfaces I tried in the past. Difference was these leaked, and it took some futzing to get them to stop. But I did finally accomplish that. As for comfort, maybe some people can get used to pillows, I'm not one.

Mouthpiece
The mouthpiece was small by comparison but it covered my whole mouth, it has a hard plastic frame with a skirted cushion. The cushion has a stiffer chin support that rests under your chin acting as a pseudo chin strap. The main cushion uses a inner thin membrane to help seal which is good , but I found the top of the skirt under the nares easily collapsed when tightening the straps up to stop a leak. This same skirt also holds the pillows on top so if it collapsed or moved up/down the pillows would move in or out with it which seemed to contribute to most leaks.

Air delivery
This interface brings the air into the lower mouthpiece where it is diffused a bit and then distributed up to the pillows finally the nares. I found this to be no benefit in reducing the direct cold air feeling into the nares. No difference in feeling compared to that of the Swift or Breeze or even the Nasalaire. The Hybrid seemed to have a higher built-in exhaust port leak rate for greater CO2 washout than other masks. Not as high as other Pillow mask such as the Swift, but still pretty high. This could be good or it could be bad if you are trying to retain CO2.

Summary
Overall, this wasn't my favorite mask, not even a close 2nd or 3rd choice. I found it to be just as prone to leaks as other type interfaces I've used and to stop them you cinch up on the straps which then makes it uncomfortable. I found the headgear to be of good quality, but the clips are picture frame slot-hole style, not the easiest to remove if you need to in a hurry.

If you are used to using a Pillow type interface and mouth breathe, this may be a solution for you, but if you haven't tolerated pillow masks in the past, I doubt you will with this one either.

P.S. I didn't find the straps cut into my cheeks at all, sorry to disapoint.

No matter how many reviews get posted, I'll bet we all have a different opinion than the person next to us.
It's just a mask.
I don't have to pay for it, so I will order one.
Would I order one if I did have to pay?
umm
Yes. And so will eveyone else. Because just looking at the stupid thing,it yells "try me".

harl1828 wrote:Our AWAKE Group is putting together our September Meeting.

Harl, where is your AWAKE meeting? Is the public invited? Do I need a referral? Does it cost anything? What else do you do at these meetings? Can you give me more information? Is there a website? Thanks. o.f.

The Hybrid is unforgiving if:
1) You arent't accustomed to nasal pillow interfaces.
2) The curvature of you face doesn't 'match up' with one of the included mouthpieces.
3) The distance between your nostrils and you mouth exceeds the length of the pillows.

I can use two of the Hybrid mouthpieces, the medium and the large. I have cut off both chin flaps and I use an extra strap with both of them. I have modified the curve of the large one with a couple of inserts. Why go to all this trouble when the CL2 works for me? With the Hybrid, inhaling is so pleasant, and if even one side is congested it works much better for me.
Unlike the CL2 with its very small supply tube, the Hybrid's manifold is huge

..and no mouth tape..

Sounds like there's a marketing opportunity for these Hybrid modifications -- kind of like custom van construction .

I beileve that this approach would avoid patent infringement issues, but of course the manufacturer might actually catch on and implement these improvements in a subsequent model -- if we're lucky.

OscarFraley wrote:

harl1828 wrote:Our AWAKE Group is putting together our September Meeting.

Harl, where is your AWAKE meeting? Is the public invited? Do I need a referral? Does it cost anything? What else do you do at these meetings? Can you give me more information? Is there a website? Thanks. o.f.

OscarFraley,

The AWAKE meeting is on Sept 13th in Chittenden County, Vermont.

Harlan

Thanks Harlan. I will be in Vermont in August, but not September. Otherwise it would be fun to see what an AWAKE group does exactly.

Cheerio.

o/f

No, I'm not connected with marketing this product.
Yes, I am a regular posting member here and I find the Hybrid to be a great product , for me!
I have worked with finding my best fit by using the video and simple trial and error! I've been using it now for over two weeks now and am sleeping through the night, recording lowest pressures and ahi's since being on cpap therapy for the last 20 months! No more chin straps! No more mouth tape! I am really thankful that this product solves my mouthleaks! Not to mention, what a great back-up FF mask to have during cold season!

Like many readers and posters here, we all seek comfortable interfaces that will enable us to comply with our prescribed therapy in order to attain better health! As new products come along and we read of its varying success and failures, each individual must decide for themselves if the product sounds like something to suit their needs. What may fail miserably for one may be a miracle for another!
So once again, I just want to say that the newHybrid is working out super for me.
I can only hope that more persons may find the same results if they are in real need of what this interface offers!

When I saw the first article on the Hybrid mask, I decided immediately to try and get one. Since it is not yet available in Holland, I ordered one in the US. This is the result of my first 4 nights with the Hybrid mask:
I have a Respironiocs Autopap with Cflex.
After having experimented with the various size options, I went to sleep. Absolutely no problem falling asleep, the mask was very comfortable, however, after one or two hours of sleep I woke up from the noise of heavy leakage. The leakage occurred on the mouthpiece only. The nasal pillows stayed leakfree. I experienced, that I could influence the amount of leakage by concsiously moving my mouth or lips as you do when you swallow. I have tried different strap settings and a different size, but the result is still the same. Too much leakage for comfort! Probably the leaks start when muscles around my mouth relax after falling asleep?
When I checked the feedback from my autopap with Encore pro, I found out, that my AHI varied between 4.5 and 7.5 when I had used the Hybrid, versus the usual 1 to 1.5 when using the Breeze nasal pillows. I would be very interested to know why. Any similar experiences?

Snoring Dutchman