NZ758180B2

NZ758180B2 - Unobtrusive Nasal Mask

Info

Publication number: NZ758180B2
Application number: NZ758180A
Authority: NZ
Inventors: Peter Ross Anderson; Adam Francis Barlow; Matthew Eves; Phoebe Katherine Hill; Kai Stuebiger; Moger Lochlan Von
Original assignee: ResMed Pty Ltd
Priority date: 2009-06-02
Filing date: 2010-06-02
Publication date: 2021-08-03

Abstract

patient interface 200 for delivering pressurized breathable gas to a patient comprising a flexible sealing portion 210 that is configured to sealingly engage with an exterior of the patient’s nose, and a pair of nozzles 320 protruding from the flexible sealing portion and configured to be inserted into the patient’s nostrils in use. The sealing portion 210 comprises a pair of resiliently flexible lateral sides and a central part between the lateral sides, with the central part comprising a septum locator 326 configured to engage with the patient’s septum, and the pair of lateral sides configured to be outwardly flexed by the patient’s nose. Each nozzle 320 has a central longitudinal axis, a base end at the flexible sealing portion and a discharge end 322 opposite to the base end, and tapers from the base end toward the discharge end. The septum locator 326 is positioned between the pair of nozzles 320, and the pair of lateral sides of the sealing portion are configured to pivot at the septum locator 326 when outwardly flexed by the patient’s nose. The pair of nozzles 320 are configured so that the discharge ends 322 of the nozzles 320 move away from each other when the lateral sides of the flexible sealing portion are outwardly flexed by the patient’s nose. into the patient’s nostrils in use. The sealing portion 210 comprises a pair of resiliently flexible lateral sides and a central part between the lateral sides, with the central part comprising a septum locator 326 configured to engage with the patient’s septum, and the pair of lateral sides configured to be outwardly flexed by the patient’s nose. Each nozzle 320 has a central longitudinal axis, a base end at the flexible sealing portion and a discharge end 322 opposite to the base end, and tapers from the base end toward the discharge end. The septum locator 326 is positioned between the pair of nozzles 320, and the pair of lateral sides of the sealing portion are configured to pivot at the septum locator 326 when outwardly flexed by the patient’s nose. The pair of nozzles 320 are configured so that the discharge ends 322 of the nozzles 320 move away from each other when the lateral sides of the flexible sealing portion are outwardly flexed by the patient’s nose.

Description

UNOBTRUSIVE NASAL MASK CROSS-REFERENCE TO APPLICATIONS This application claims the beneﬁt of Australian Provisional Application No. 2009902524, ﬁled June" 2, 2009; Australian Provisional Application No. 2009906101, ﬁled December 15, 2009; lian Provisional Application (not yet allocated — attorney reference C10110P), ﬁled 28 May 2010; US Provisional Application 61/222711, ﬁled 2 July 2009; US Provisional Application 61/272162, ﬁled 25 August 2009; US Provisional Application 61/272250, ﬁled 4 September 2009; US Provisional ation 61/263175, ﬁled November 2009; US Provisional Application 61/282693, ﬁled 18 March 2010; and PCT Application No. , ﬁled 28 May 2010, each of which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION The technology relates to a nasal respiratory mask for use with an air delivery system for treatment, e.g., of Sleep Disordered Breathing (SDB) with Continuous Positive Airway Pressure (CPAP) or Non-Invasive Positive Pressure Ventilation (NIPPV). In particular, the technology relates to a respiratory mask that is unobtrusive.

BACKGROUND OF THE INVENTION Apparatus to deliver breathable gas to a patient typically includes a ve airway re (PAP) device, an air delivery conduit or tube, and a patient interface, wherein the patient interface contacts the t’s face in use to r pressurized breathable gas to the patient from the PAP device.

In use, the patient interface can appear bulky and as such may discourage patients from using treatment as it is too obtrusive. This in turn may lead to lower y compliance and thus failed treatment.

Patients using nasal pillows or puffs may dislike the ent of the pillows in the nares and/or the ion of pressurized air being directed up the nares (also known as the ‘air jetting’ affect). 2010/000684 Therefore, a need has developed in the art to provide alternative t interfaces that are less obtrusive, may not include placement of pillows up the nares and/or may reduce the sensation ofpressurized air being directed up the nares.

SUMMARY OF THE INVENTION One aspect of the present technology relates to a patient interface for delivering breathable gas to a patient. Another aspect of the present technology is a patient interface that forms a seal on an underside of a patient’s nose. Another aspect of the present technology is a patient interface that avoids contact with a nasal bridge region of a patient’s nose. Another aspect of the present technology is a patient interface that forms a seal on an underside of a patient’s nose in a region surrounding both nares. Another aspect of the present technology is a patient ace that avoids contacting the nasal septum. Another aspect of the present technology is a patient ace deﬁning a single breathing chamber that provides a supply of air at ve pressure for both nostrils.

One form of patient interface in accordance with the present logy includes a sealing portion including a nose tip engagement portion adapted to form a seal with the patient’s nose tip, an upper lip engagement portion adapted to form a seal with the patient’s upper lip and/or base of the patient’s nares, and nostril ment ﬂaps adapted to form a seal with the t’s nares. In one form, the nose tip engagement portion, the upper lip ment portion, and the nostril engagement ﬂaps are all structured to extend or curve outwardly from a supporting wall deﬁning an air path.

In accordance with one form of the present technology, a patient interface is provided that makes use of different orming mechanisms in different regions of the patient interface. Preferably, in a region adapted to form a seal with a nasal crease region of a face, a n of the seal acts in compression. Preferably, in a region adapted to form a seal with a tip of the nose region of a face, a portion of the seal acts in tension in use. Preferably in an alar sidewall region intermediate of the crease region of the face and a tip of the nose region of a face, a seal portion of the patient interface is arranged to form a cantilever. ably in a region intermediate of a left crease region and a right crease region of a face, a seal portion of the patient interface is constructed and arranged to be in tension in use.

In ance with one form of the present technology, a patient interface is provided that includes a nose tip seal forming portion in the form of a membrane. Preferably the membrane is constructed and ed to be held relatively ﬁxed at its ends and in tension against a tip of a nose in use.

In ance with one form of the present technology, a patient interface is provided that comprises a seal forming portion constructed and arranged to have regions of different stiffnesses. In one form, the seal forming portion has a region of vely high stiffness arranged in use adjacent a nasal crease region of the face, or adjacent the base of the nose near the junction between the top lip and a side of the nose. In one form, the seal forming portion may include respective left and right regions of relatively high stiffness. In one form, the seal forming portion es a region of relatively low stiffness adapted to form a seal on an underside of a tip of the nose region of a face. In one form, the seal forming portion has a region of intermediate stiffness arranged in use adjacent a side portion of a nose.

In one form, a seal forming portion of a patient interface in accordance with the present technology deﬁnes front and rear lateral portions on both a left side and a right side. In one form, a seal g portion of a patient interface in accordance with the present technology deﬁnes front and rear medial ns. ably, the respective left and right lateral ns are constructed and arranged to hinge about the front and rear medial portions in use. With reference to Figures 19 to 21 of International Patent Application published as WO 73778, a seal forming portion in accordance with an aspect of the present logy is adapted to hinge about a medial portion to accommodate an alar angle of a patient. In one form the sealing portion is adapted to hinge outwardly to accommodate a wider nose. In one form the sealing portion is adapted to hinge inwardly to accommodate a narrower nose.

In one form of the present technology, a patient ace is provided that includes ar and a seal forming portion. The seal forming portion is adapted to ﬂex about a medial portion thereof to deﬁne an angle therebetween. The patient interface is constructed and ed so that the angle may be adjusted by altering a headgear tension. In one form, the t interface includes lateral headgear connectors arranged at an angle with respect to an oriﬁce through which a supply of breathable gas is delivered to the patient. The patient interface is constructed and arranged in one form so that the angle of the headgear connector is adjustable. In a preferred form, adjustment of the angle of the headgear connector may be used to adjust an angle of the seal-forming portion. In one form, adjustment of headgear may be used to increase or decrease a lateral or pinch force of a seal-forming portion. In one form, headgear is connected close to an underside of a seal—forming portion.

Preferably the patient interface is arranged so that ﬂexure of a seal-forming portion about a medial n thereof may be achieved by altering a headgear tension. In one form, a top surface of a headgear connector is conﬁgured to push against an underside of a seal-forming n, preferably a rear-lateral n thereof, to increase a lateral or pinch force.

In one form, a t interface is provided that includes a seal-forming portion d to form a seal on an underside of a nose of a patient, the patient interface includes a ﬂexible body that deﬁnes a breathing chamber. ar is connected to sides of the ﬂexible body. The body is constructed and arranged to ﬂex in response to a changed headgear n to alter a l or pinch force on a side of a nose to effect a seal. In one form the ﬂexible body is formed from a rubber, preferably silicone. In one form the ﬂexible body is formed from a rubber having a Type A durometer of about 35 to about 45, preferably about 40.

In one form of the present technology, a patient interface is provided that ses a seal forming portion, headgear, an air ry conduit and a ling arrangement. The headgear is connected to a region of the patient interface close to the seal forming portion. The air delivery conduit is connected to the decoupling portion. The decoupling portion is located between a point of connection of the headgear and a point of connection of the air delivery conduit.

Another aspect of the present technology relates to a patient ace for delivering breathable gas to a patient, the patient interface including a sealing portion structured to extend or curve outwardly from a supporting wall deﬁning an air path. In one form of the present technology, a seal—forming portion is arranged in a t or horn shape in cross-section. In one form, a seal-forming portion has a bell-shape in cross-section. In one form, a seal-forming portion lies on an inside surface of a cushion. In one form, certain regions of the seal forming portion have a trumpet, horn or bell shape, while other regions have a different shape. For example, a region of the seal forming portion adapted to form a seal with an ide of a tip of the nose may have a trumpet, horn or bell shape.

In one form of the present technology, a seal forming portion is formed from a low durometer rubber, preferably a silicone having a Type A ter in the range of 1 to In one form of the present technology, a patient interface is provided that comprises a mask body formed from a rubber having a Type A durometer in the range of abOut 35 to about 45, and a seal-forming portion formed from a rubber having a Type A durometer in the range of 1 to 15. In one form, the patient interface further comprises headgear connectors formed from a ﬂexible material, preferably a rubber having a Type A durometer in the range of about 35 to about 45. Preferably the rubber is silicone rubber.

Another aspect of the present technology relates to a patient interface for delivering breathable gas to a patient, the t ace including a sealing portion structured to curve outwardly and form at least one g membrane.

Another aspect of the present technology relates to a patient ace for delivering breathable gas to a t. The patient interface includes a sealing portion including a nose tip engagement portion adapted to form a seal with the patient’s nose tip, an upper lip engagement portion adapted to form a seal with the patient’s upper lip and/or base of the patient’s nares, and nostril engagement ﬂaps adapted to form a seal with the patient’s nares, and a supporting portion supporting one or more portions of the sealing portion, wherein the supporting portion supports different ns of the sealing portion with varying s of support. The supporting portion may include one or more ned portions, have cored out portion or recesses, or portions having variable hardness to provide the varying degrees of support.

Another aspect of the t technology relates to a patient interface for delivering breathable gas to a patient, a supporting portion supporting one or more portions of the sealing portion, wherein the supporting portion supports different portions of the sealing portion with varying degrees of support.

Another aspect of the present logy relates to a t interface for delivering breathable gas to a patient. The patient interface includes a sealing portion including a nose tip ment portion adapted to form a seal with the patient’s nose tip, an upper lip ment portion d to form a seal with the t’s upper lip and/or base of the patient’s nares, and nostril engagement ﬂaps adapted to form a seal with the patient’s WO 39014 nares, and a supporting portion supporting the sealing portion, the sealing portion being ted to the supporting portion on side ns of the sealing portion, and the g portion being spaced apart from the supporting portion on front and rear portions of the sealing portion.

Another aspect of the present technology relates to a patient interface for delivering breathable gas to a patient. The patient interface includes a sealing portion including a nose tip ment portion adapted to form a seal with the patient’s nose tip, an upper lip engagement portion adapted to form a seal with the patient’s upper lip and/or base of the patient’s nares, and nostril engagement ﬂaps adapted to form a seal with the patient’s nares, and a supporting portion supporting the sealing portion, the sealing portion being connected to the supporting portion, and the sealing portion being attached to the supporting portion, wherein the supporting n is compliant.

Another aspect of the present technology relates to a patient interface for delivering able gas to a patient. The patient ace includes a sealing portion and a supporting portion ting the sealing portion, the sealing n being connected to the supporting portion in some s, and being spaced apart from the supporting portion in other regions.

Another aspect ofthe present technology s to a t interface for delivering breathable gas to a patient. The patient interface includes a sealing portion including a nose tip engagement portion adapted to engage with the patient’s nose tip, and a supporting portion supporting the sealing portion, the supporting portion being connected to the sealing n on two side portions of the sealing portion, and the supporting portion being spaced apart by a gap from the sealing portion at the nose tip engagement portion, the nose tip engagement portion being d to stretch to ﬁt and seal with the patient’s nose tip.

Another aspect of the present technology relates to a patient interface for delivering breathable gas to a patient. The patient interface includes a sealing portion adapted to form a seal with a patient’s face in use, the sealing portion including a front stretch portion adapted to form a seal with the patient’s nose tip, a rear stretch portion d to for a seal with the patient’s upper lip, side push portions adapted to anchor the sealing portion at regions of the patient’s nose adjacent the nasal labial creases by applying a force normal to a plane of the patient’s face, and side wrap portions adapted to form a seal with the patient’s nares by applying a pinching force normal to the patients nares. The side wrap portions and side push portions may have a greater thickness than the front stretch portion or the rear stretch portion. The front stretch portion may stretch to seal with the patient’s nose tip in use and the rear stretch portion may stretch to seal with the patient’s upper lip in use.

Another aspect of the present logy relates to a patient interface for delivering pressurized breathable gas to a patient. The patient interface includes a g portion adapted to form a seal with the patient’s face, the sealing portion having an opening d to receive the rized breathable gas, an outer sealing margin to seal with the patient’s face, and a transition region between the opening and the outer sealing margin that gradually increases in size from the opening to the outer sealing margin.

Another aspect of the present logy relates to a patient interface for delivering able gas to a patient. The patient interface includes a sealing portion adapted to form a seal with the patient’s face, a supporting portion supporting one or more portions of the sealing portion, headgear connectors extending from the supporting portion, the ar tors adapted to t to headgear to secure the patient interface to the t, wherein the headgear causes the headgear connectors to bend s the supporting portion in use, and a bending force from the headgear connectors is transferred to the sealing portion as a sealing force. The bending force may be applied as a pinch force to sides of the patient’s nose, and/or as an anchor force to regions of the patient’s nose nt the nasal labial creases Another aspect of the present technology relates to a patient interface for delivering breathable gas to a patient. The patient interface includes a g portion, and a multi—axis elbow assembly operatively coupled between the sealing portion and a ﬂexible tube, wherein the multi-axis elbow ly allows movement of the ﬂexible tube in two separate planes while substantially isolating drag forces from the ﬂexible tube from being erred to the sealing portion.

Another aspect of the present technology relates to a multi-axis elbow assembly that allows movement of a connected tube in two separate planes while substantially isolating drag forces from the tube.

Other aspects, features, and advantages of the present technology will become apparent from the following detailed description when taken in conjunction with the accompanying drawings, which are a part of this disclosure and which illustrate, by way of e, principles of this technology.

BRIEF DESCRIPTION OF THE DRAWINGS The accompanying drawings facilitate an understanding of the various embodiments of this technology. In such drawings: Fig. 1 shows a PAP system with a prior art patient interface; Fig. 1-1 shows a patient interface according to an ment of the technology in use; Fig. 1-2 is an isometric view of a sealing portion and suspension system of the patient interface of Fig. 1-1; ' Fig. 1-3 is another isometric view of the sealing portion and suspension system of Fig. 1-2; Fig. 1—4 is a top View of the sealing n and sion system of Fig. 1—2; Fig. 1—5 is a bottom View of the sealing n and suspension system of Fig. 1 -2; Fig. 1-6 is a front view of the sealing portion and suspension system of Fig. 1- Fig. 1-7 is a rear View of the sealing portion and suspension system of Fig. 1-2; Fig. 1-8 is a side view of the sealing portion and suspension system of Fig. l- Fig. 1-9 is an isometric view of a suspension system and frame of the t interface of Fig. 1-1; Fig. 1-10 is a bottom view of the suspension system and frame of Fig. 1-9; Fig. 1-11 is a top view of the suspension system and frame of Fig. 1-9; Fig. 1-12 is a front view of the suspension system and frame of Fig. 1-9; Fig. 1-13 is a rear view of the suspension system and frame of Fig. 1-9; Fig. 1-14 is a side view of the suspension system and frame of Fig. 1-9; Fig. 1-15 is an isometric view of a sealing portion, suspension system, and frame of the patient interface of Fig. 1-1; Fig. 1-16 is a rear view of the sealing portion, suspension system, and frame of Fig. 1-15; Fig. 1-1 7 is a front view of the sealing n, sion system, and frame of Fig. 1-15; Fig. 1-18 is a side view of the sealing n, sion system, and frame of Fig. 1-15; Fig. 2-1 is a rear View of a sealing portion and frame according to an embodiment of the present technology; Fig. 2-2 is a front View of the sealing portion and frame of Fig. 2-1; Fig. 2-3 is a side View of the sealing portion and frame of Fig. 2-1; Fig. 2-4 is a top view of the sealing portion and frame of Fig. 2—1; Fig. 2-5 is a bottom View of the g portion and frame of Fig. 2-1; Fig. 2-6 is an isometric view of the sealing portion and frame of Fig. 2-1; Figs. 2-7A and 2-7B are top views illustrating alternative shapes of the sealing portion according to embodiments of the present technology; Figs. 2-8A and 2-8B are side views illustrating alternative shapes of the sealing portion according to embodiments of the present logy; Figs. 2-9A and 2-9B are rear Views illustrating alternative shapes of the sealing n according to embodiments of the present technology; Fig. 2-10 is an isometric View of a sealing portion and frame in use according to an embodiment of the present technology; Fig. 2-11 is a rear View illustrating an alternative shape of the sealing portion according to an embodiment of the present technology; Fig. 3-1 shows a patient ace according to another embodiment of the technology in use; Fig. 3-2 is an isometric view of a g portion and suspension system of the patient interface of Fig. 3-1; Fig. 3-3 is a rear View of the sealing portion and suspension system of Fig. 3—2; Fig. 3-4 is a top view of the sealing portion and suspension system of Fig. 3-2; Fig. 3-5 is a bottom view of the sealing portion and suspension system of Fig. 3-2; Fig. 3-6 is a side view of the sealing portion and sion system of Fig. 3- Fig. 4-1 shows a patient interface according to another embodiment of the technology in use; Fig. 4-2 is an isometric View of a sealing portion of the patient interface of Fig. 4-1; Fig. 4-3 is another isometric View of the sealing portion of Fig. 4-2; Fig. 4-4 is a rear view of the sealing portion of Fig. 4-2; Fig. 4—5 is a front view of the g portion of Fig. 4-2; Fig. 4-6 is a side View of the sealing portion of Fig. 4-2; Fig. 4-7 is a top view of the sealing portion of Fig. 4-2; Figs. 4-8 and 4-9 show alternative self-adjusted shapes of the sealing portion of Fig. 4—2; Figs. 5-1 and 5-2 are cross-sectional views illustrating sealing portions with gel beading according to embodiments ofthe present technology; Figs. 6-1 and 6-2 are schematic views illustrating nostril engagement ﬂaps for sealing ns according to embodiments of the present technology; Figs. 7-1, 7-2, and 7-3 show sealing portions with ﬁngers or ridges according to embodiments of the t technology; Fig. 8-1 illustrates a mask with a gel sion system according to an embodiment of the present technology; Figs. 8-2 and 8-3 show a mask with a gel sion system according to another embodiment of the present technology; Figs. 9-1 and 9-2 show sealing portions with stiffening ribs according to embodiments of the present technology; Fig. 10 shows a g portion with headgear connectors according to an ment of the t technology; Fig. 11 shows a suspension system with headgear connectors according to an embodiment of the present technology; Fig. 12 shows headgear for a mask according to an embodiment of the present technology; Figs. l3-l, 13-2, 13-3, 13-4, and 13-5 shows headgear according to an embodiment of the present technology; Figs. 14-1, 14-2, 14-3, and 14-4 show elbows for a mask according to embodiments of the present technology; Fig. 15 shows a sealing portion with adhesive strips according to an embodiment of the present technology; Figs. 16-1 and 16-2 show sealing portions with ﬂexible tubing according to embodiments of the t technology; Fig. 17-1 and 17-2 illustrate g ns with a gusset-type suspension system ing to embodiments of the present technology; Figs. 18-1 and 18-2 illustrate a g portion provided to an exoskeleton according to an embodiment of the present technology; Fig. 19 illustrates a gel sealing portion ing to an embodiment of the present technology; Figs. 20-1 to 20-7 show cross sections of a sealing portion according to an embodiment of the present technology; Fig. 21-1 is a side View of a lower portion of an embodiment of the present technology; Fig. 21-2 is a rear View of a lower n of an embodiment of the present technology; Fig. 21-3 is a front view of a lower portion of an embodiment of the present technology; - Fig. 21-4 is a top view of a lower portion of an embodiment of the present technology; Fig. 21-5 is another top view of a lower portion of an embodiment of the present technology; Fig. 21-6 is a bottom View of a lower portion of an embodiment of the present logy; Fig. 22-1 is a side view of an upper portion of an embodiment of the present technology; Fig. 22-2 is a rear View of an upper portion of an embodiment of the present technology; Fig. 22-3 is a front View of an upper portion of an embodiment of the present technology; Fig. 22-4 is a top View of an upper portion of an embodiment of the present technology; Fig. 23—1 is a side View of an embodiment of the present technology; Fig. 23—2 is a rear view of an embodiment of the present technology; Fig. 23-3 is a front view of an embodiment of the t technology; ] Fig. 23-4 is a top View of an embodiment of the present technology; Fig. 23-5 is a bottom View of an embodiment of the present technology; ] Fig. 23-6 is a cross section through a side view of an embodiment of the present technology; Fig. 23-7 is a cross section through a front View of an embodiment of the present technology; Fig. 24-1 is a top View of a sealing portion according to an embodiment of the t technology; Figs. 24-2 and 24-3 are front views of the g portion of Figs. 24—1; Fig. 24-4 is bottom View of the sealing portion of Figs. 24-1; Figs. 25-1, 25-2 and 25-3 are cross sections of sealing portions according to alternative embodiments of the present technology; ] Fig. 25-4 is a top View of a sealing portion according to an embodiment of the present technology; Fig. 26 is a side view of a decoupling ement according to an embodiment of the present logy; Fig. 27-1 and 27-2 are isometric views of an embodiment of the present logy; Fig. 28 is an isometric View of a sealing portion with sizing s according to an embodiment of the present technology; . [00119] Fig. 29 is a cross section of a prior art sealing portion; Fig 30 is a cross section of a prior art sealing portion; Fig. 31 is a cross section of a sealing portion according to an embodiment of the present technology; Fig. 32-1 is a rear view showing headgear attachment to a sealing portion according to an embodiment of the present technology; Fig. 32-2 is a front view showing headgear attachment to a sealing portion according to another embodiment of the present technology; Figs. 33-1 and 33-2 are top views of supporting members for sealing portions ing to ative embodiment of the present technology; ] Fig. 34—1 and 34-2 show membrane support for a sealing portion according to an embodiment of the present technology; Fig. 35-1 is a top view of a sealing portion with ﬂexible portions according to an embodiment of the present technology; Figs. 35-2 and 35-3 are cross-sectional views of the sealing portion of Fig. 35- Fig. 36 is a side View of a membrane support according to an embodiment of the present technology; Figs. 37-1 and 37-2 illustrate a vent according to an ment of the present technology; Fig. 38 is a side view of an elbow according to an embodiment of the present technology; Fig. 39 is an ric views of support mechanism for a stem of the sealing portion according to an ment of the present technology; Fig. 40 is a cross section of a sealing portion according to an embodiment of the present logy; Fig. 41 is a side View of a tube decoupling mechanism according to an ment of the present technology; Fig. 42-1 is a top View of a swivel ring with vents according to an embodiment of the present technology; Fig. 42-2 is an isometric view of the swivel ring of Fig. 42-1; Fig. 42-3 is a side View of a swivel ring according to an embodiment of the present technology; Fig. 42-4, 42-5, 42-6 and 42-7 are top views of swivel rings including vents according to alternative embodiments of the present technology; Fig. 42-8 is a cross section of the swivel ring of Fig. 42-7; Fig. 43 is a side View of a system including a plenum according to an embodiment of the present technology; Figs. 44-46 show sealing of a sealing portion with a patient’s nose according to an embodiment of the present technology; Figs. 47-1, 47-2 and 47-3 are isometric views of a patient interface according to the t technology including a sealing portion and a supporting portion; Fig. 48-1 is a top view of the sealing portion and supporting portion of Fig. 47— Fig. 48-2 is a schematic top View of the sealing portion of Fig. 47-1; Fig. 49 is a front view of the g n and supporting portion of Fig. 47- Fig. 50 is a rear view of the sealing portion and supporting portion of Fig. 47- Fig. 51-1 is a cross-sectional side View of the sealing portion and supporting portion of Fig. 49; Fig. 51-2 is a cross-sectional side View of the sealing portion and supporting n of Fig. 49, with a second membrane; Fig. 52-1 is a side View of the supporting n of Fig. 47-1; Fig. 52-2 is a cross-sectional front View of the sealing portion and supporting portion of Fig. 49; Fig. 52-3 is a partial cross-sectional front view of the sealing portion and supporting portion of Fig. 49; Fig. 52-4 is a cross-sectional side View of the g portion and supportng portion of Fig. 49 on the t in use; Fig. 52-5 is a side view of the sealing n and supporting portion of Fig. 49 on the patient in use; Fig. 52-6 is a cross-sectional side view of the sealing n and supporting portion of Fig. 49 on the patient in use; Fig. 52-7 is a front perspective View of the sealing n and supporting portion of Fig. 49 on the t in use; ] Fig. 53 is a front View of the supporting portion of Fig. 47-1; Fig. 54 is a front view of the supporting portion of Fig. 47-1 and headgear connectors; Fig. 55 is a top view of the supporting portion and ar connectors of Fig.

Fig. 56-1 is a side view of the supporting portion and headgear connectors of Fig. 54; Fig. 56-2 is a cross-sectional view of the supporting portion of Fig. 54; Fig. 56-3 is a cross-sectional view of the supporting n of Fig. 54; ] Fig. 57 is a front perspective view of a patient interface according to an embodiment of the present technology; Fig. 58 is a front perspective View of a patient interface in a bent position according to an embodiment of the present technology; Fig. 59 is a perspective view of a multi-axis elbow assembly according to an ment of the present technology; Fig. 60 is a'right side perspective view of a patient interface on the patient in use according to an embodiment of the present technology; Fig. 61 is a left side ctive view of a patient interface on the patient in use according to an embodiment of the present technology; Fig. 62 is a front perspective view of a patient ace on the patient in use according to an embodiment of the present technology; Fig. 63 is a left side perspective View of a patient interface on the patient in use according to an embodiment of the present technology; Fig. 64 is a front perspective View of a patient interface on the patient in use according to an embodiment ofthe present technology; Fig. 65 is a perspective view of,a patient interface with a bellows according to an ment of the present technology; Fig. 66 is a perspective view of a patient interface with a bellows according to an embodiment of the present technology; ] Fig. 67 is a left side perspective view of a patient interface with headgear on the patient in use according to an embodiment of the present technology; Fig. 68 is a perspective View of a bellows according to an embodiment of the present technology; Fig. 69 is a graph illustrating various dimensions of the s of Fig. 68; Fig. 70 is a ctive view of a patient interface with a ball joint and socket connector according to an embodiment of the present technology; Fig. 71 is a perspective View of a ball joint and connector according to an embodiment of the present logy; ] Fig. 72 is a perspective view of a socket conneCtor according to an embodiment of the present technology; Fig. 73 is a perspective view of a ball joint and elbow with a vent according to an embodiment of the present technology; Fig. 74 is a cross-sectional view of a ball joint and elbow with vent according to an ment of the present technology; Fig. 75 is a perspective View of a ball joint and elbow with removable vent insert ing to an ment of the t technology; Fig. 76 is a perspective View of a mesh vent according to an embodiment of the present technology; Fig. 77 is a view of a ball joint and elbow with vents according to an embodiment of the present technology; Fig. 78 is a perspective view of a socket connector with vent grooves according to an embodiment ofthe present technology; Fig. 79 is a left side perspective View of a patient interface with headgear on the patient in use according to an embodiment of the present technology; Fig. 80 is a perspective view of a hybrid elbow and ball joint according to an embodiment of the t technology; Fig. 81 is a cross-sectional view of the hybrid elbow and ball joint of Fig. 80 according to an embodiment of the present technology; Fig. 82 is a perspective side view of a patient interface with the hybrid elbow and ball joint of Fig. 80 on the patient in use according to an embodiment of the present technology; Fig. 83 is a perspective side view of a t interface with the hybrid elbow and ball joint of Fig. 80 on the patient in use according to an embodiment of the t technology; Fig. 84 is a perspective side view of a patient interface with a thin membrane and elbow assembly on the patient in use according to an embodiment of the present technology; Fig. 85 is a perspective view of an angled elbow ball joint assembly according to an ment of the present technology; Fig. 86 is a left side perspective view of a patient ace with headgear on the patient in use according to an embodiment of the present technology; ] Fig. 87 is a perspective view of a patient interface with headgear on the patient in use according to an embodiment of the present technology; Fig. 88 is a left side perspective view of a patient interface with headgear on the patient in use according to an embodiment of the present technology; Fig. 89 is a rear perspective view of headgear on the patient in use according to an embodiment of the present logy; Fig. 90 is a perspective view of a patient interface with ar on the t in use according to an embodiment of the present technology; Fig. 91 is a perspective view of a patient interface with headgear on the patient in use according to an embodiment of the present technology; ] Fig. 92 is a rear ctive View of a patient interface with headgear according to an embodiment of the present technology; Fig. 92-1 is a front perspective View of a patient interface with headgear according to an embodiment of the present technology; Fig. 93 is a left side perspective View of a patient interface with ar on the patient in use according to an ment of the present technology; ] Fig. 94 is a perspective view of a patient interface with headgear on the patient in use according to an embodiment of the present technology; Fig. 95 is a perspective view of a ball and socket assembly incorporated with a ball joint portion, vent and swivel ring according to an embodiment of the present technology; Fig. 96 is a perspective view of a swivel ring and ball joint according to an embodiment of the present technology; Fig. 97 is a front perspective view of a ball and socket assembly incorporated with a ball joint portion, vent and swivel ring ing to an embodiment of the present technology; Fig. 98 is a perspective View of a ball and socket assembly incorporated with a ball joint portion, vent and swivel ring according to an embodiment of the present technology; Fig. 99 is a side perspective view of a ball and socket assembly incorporated with a ball joint portion and swivel ring according to an ment of the present technology; ] Fig. 100 is a side perspective view of a ball and socket ly incorporated with a ball joint portion and swivel ring according to an embodiment of the present technology; Fig. 101 is a sectional side view of a ball and socket assembly incorporated with a ball joint portion, vent and swivel ring joint according to an embodiment of the present technology; Fig 102 is a perspective view of a t interface with a side connected tube on the patient in use according to an ment of the present technology; ] Fig. 103 is a front perspective view of a patient interface with a side connected tube on the patient in use according to an embodiment of the present technology; Fig. 104 is a front perspective view of a patient interface with a side connected tube on the patient in use according to an embodiment of the t technology; Fig. 105 is a front perspective view of a patient interface with a two side ted tubes according to an ment of the present technology; Fig 106 is a front perspective View of a patient interface with a frame and ar according to an embodiment of the present technology; Fig 107 is a front perspective view of a patient interface with a frame and headgear on the patient in use according to an embodiment of the present technology; Fig 108 is a perspective view of a patient interface with a headgear cradle according to an ment of the present logy; Fig 109 is a perspective View of a patient interface with a headgear cradle according to an embodiment of the present technology; Fig 110 is a perspective view of headgear with hook and loop material and a ﬁnger loop according to an embodiment of the present logy; ] Fig 111 is a perspective View of a ﬂexible tube and ball having curved vent grooves according to an embodiment of the present technology; Fig 112 is a perspective view of a ﬂexible tube and ball having vent holes according to an embodiment of the present technology; Fig 113 is a perspective View of an elbow and ball having vent grooves and a removable barrier according to an embodiment of the present technology; ] Fig 114 is a ctive View of a patient interface with a headgear connecting cradle and connecting elbow ing to an embodiment of the present technology; Fig 115 is a perspective View of an elbow with vent grooves and a swivel connector according to an embodiment of the present technology; Fig 116 is a perspective View of an elbow with vent grooves and a swivel connector according to an embodiment ofthe present technology; Fig. 117 is a front ctive View of a sealing portion of a patient interface according to an embodiment of the present technology; Figs. 118-1, 118-2 and 118-3 are perspective views of a sealing portion of a patient interface according to an embodiment of the present technology; Fig. 119 is a top View of a sealing portion of a patient interface according to an embodiment of the present technology; Fig. 120 is a perspective view of a g portion of a patient interface according to an embodiment of the present technology; Fig. 121 is a front view of a g n of a patient interface according to an embodiment of the t technology; Figs. 122-1, 122—2 and 122-3 are cross-sectional views of a sealing portion of a patient interface according to an embodiment of the t technology; Fig. 123 is a cross-sectional View of a sealing portion of a t interface according to an ment of the present technology; Fig. 124 is a top view of a sealing n of a patient interface according to an embodiment of the present technology; and ] Fig. 125 is a top View of a sealing portion of a patient interface according to an embodiment of the present technology.

DETAILED DESCRIPTION OF RATED EMBODIMENTS The following description is provided in relation to several ments which may share common teristics and features. It is to be understood that one or more features of any one embodiment may be combinable with one or more features of the other embodiments. In addition, any single e or combination of features in any of the embodiments may constitute additional embodiments.

In this specification, the word “comprising” is to be understood in its “open” sense, that is, in the sense of “including”, and thus not limited to its “closed” sense, that is the sense of “consisting only of’. A corresponding meaning is to be attributed to the corresponding words ise", "comprised" and "comprises" where they appear.

The term "air" will be taken to include breathable gases, for example air with supplemental oxygen. It is also acknowledged that the PAP devices or blowers described herein may be designed to pump ﬂuids other than air. 1. PAP System As shown in Fig. 1, a PAP system 10 generally includes a PAP device 15, an air delivery conduit 20 (also referred to as an air ry tube or tubing), and a t interface 100. In use, the PAP device 15 generates a supply of pressurized air that is delivered to the patient via the air delivery conduit 20 that includes one end coupled to the outlet of the PAP device 15 and an opposite end coupled to the patient interface 100. The patient interface 100 comfortably engages the patient's face and provides a seal. 2. Patient Interface t interface 100 may include a mask 200 and a headgear 300 structured to maintain the mask in on on the patient’s face in use, as shown in Fig. 1. As illustrated, mask 200 may include a sealing n 210, a frame 220, an elbow 230 (e.g., with swivel) adapted to be connected to the air delivery tube 20, headgear attachments 240 (e.g., slots or clips on the frame and/or forehead support adapted to engage headgear straps), forehead support 250 and forehead ment 260.

In prior art patient interfaces such as ’s Mirage QuattroTM (as shown in Fig. 1), the mask is bulky and obtrusive on the face of the patient. The substantially rigid frame 220 combined with the headgear 300 encompasses a large portion of the t’s face.

Such a ration can psychologically discourage patients from treatment and thus vely impact their compliance.

Another prior art patient interface is ResMed’s Mirage SwiftTM, a nasal pillows or puff mask that seals in or around the nares of the patient. Such a conﬁguration can cause fort due to the contact of the nasal pillows in or around the nares. Additionally, the “air jetting” affect can cause discomfort — this is due to laminar ﬂow being directed up into the nares at higher velocities, thereby causing more pressure on small areas within the nasal passage and drying out the mucosal membrane.

A patient interface disclosed in one or more embodiments of the following description overcomes this by being less obtrusive and more comfortable. The proposed patient ace does not seal in the nares so overcomes this fort. Also, the proposed patient interface has a single opening or aperture that directs breathable gas into the patient airways, unlike a nasal pillows patient interface; The single opening can cause more turbulence in the airﬂow, thereby reducing the “air jetting” affect. 3. Mask Figs. 1-1 to 1-18 illustrate a mask 200 including a sealing portion 210, a suspension system 215, and frame 220 according to an embodiment of the present technology.

The mask 200 may be either a full face mask or a nasal only mask. The mask 200 may also be a mouth only mask. Whilst a preferred mask is in an under the nose conﬁguration, aspects of the present technology may be incorporated into other forms of mask, such as one surrounding a nose, or both a nose and a mouth. _ Sealing Portion g portion 210 aces with the patient in use, allowing delivery of breathable gas to the patient. In the illustrated ment, sealing portion 210 may form a seal with the nares of the t in use. For example, sealing portion 210 may interface and thus seal with the external portion of each of the alar or nostril ﬂares, the upper lip and/or base of the nares, and the tip of the nose. Sealing n 210 may be made from materials including but not limited to: silicone, thermoplastic elastomer, gel, foam, or any other suitably conformable material. The material may have a durometer of about 1 to 15 Shore A.

Preferably, the material may have a durometer of about 3 to 10 Shore A. Preferably, the material may have a durometer of about 5 to 12 Shore A. Most preferably, the material may have a durometer of about 5 Shore A. Thus, the preferred sealing portion es a non- invasive arrangement that does not extend into the t’s nostrils in use. The preferred sealing portion 210 does not inﬂate, and thus does not require inﬂation pressure to form a seal. Preferably, the seal is not pressure assisted, although it could be modiﬁed for such. In one form, the g portion could use a gusset (e.g., having a projected area greater than the area of the sealing portion) to help provide a seal as disclosed in US. Patent 7,523,754 or WO 01/97893 Al, which are incorporated herein by reference in their entirety.

In an embodiment, the sealing portion may include a wall thickness of about 01-15 mm. Preferably, the sealing portion may have a wall thickness of about 2 to 10mm. ably, the sealing portion may have a wall thickness of about 7 to 12mm. Preferably, the sealing n may have a wall thickness of about 1-5mm. Most preferably, the sealing portion may have a wall thickness of about 1-3mm. Most preferably, the sealing portion may have a wall thickness of about 1.5mm. . The wall thickness may vary in different regions of the sealing portion, e.g., thickness of about 0.5 mm in thinner regions and ranging up to about 2-10 mm in thicker regions. Alternatively, the sealing portion may include a constant wall thickness, e.g., about 1.2 mm. The walls may be constructed ous layers of al, each layer of material having a ent hardness and/or thickness (e.g., two layers each being 1.2 mm thick but having different durometer silicones). 3.1.1 Shape In the illustrated embodiment, sealing portion 210 (also ed to as a nasal cradle) may have a generally cradle, cup or U shape such that when positioned under the nose of the t, it is conformed or lly shaped to the alar angle of the patient (e.g., see Fig. 1-1; see also s 19 to 21 of ational Patent Application published as and the related description).

The generally smooth curvature or undulating shape of sealing portion 210 may be comfortable as it can ﬂex to accommodate a variety of nose shapes and sizes. The general shape of sealing portion 210 may also infer comfort and unobtrusiveness to the patient, thereby increasing compliance.

Alternatively, sealing portion 210 may be generally ﬂat yet be able to ﬂex into the desired alar angle of the patient. This may be achieved by providing sealing portion 210 with portions of reduced thickness to encourage bending and/or constructing sealing n 210 from a ﬂexible material or incorporating portions of ﬂexible material. 3.1.2 Aperture As best shown in Figs. 1-2 to 1-7, sealing n 210 may have an aperture 211 that allows the passage of breathable gas from the air delivery conduit 20 to the patient.

Aperture 211 may be generally circular, rectangular, or any other desired shape (e.g., oidal or oval shaped as shown in Figs. 1-4, 1-5 and 48). In an ment, aperture 211 may be shaped so as to indicate the alignment or orientation of the sealing portion 210 with the patient’s nose in use, e.g., trapezoidal or triangular shapes.

The aperture 211 of the sealing portion may be larger when compared to that of a nasal pillows or prongs mask. This means that the velocity of the air may be lower when exiting aperture 211 compared to a nasal prongs or pillows mask. The lower velocity of air exiting the aperture 211 makes it easier for the patient to exhale against the incoming air and also s irritation due to high velocity air ﬂow in and around the nose.

As shown in the embodiment of Fig. 48-1, the aperture 455 may have dimensions d1 (width) to accommodate the width of the nares on a range of patients with g anthropometry and d2 (height) to accommodate nose tip height or ce from the top lip on a range of patients with varying anthropometry. Preferably, dimension d1 may be about 10-60mm. Preferably, dimension d1 may be about 15-40mm. Most preferably, dimension d1 may be about 21m. Most ably, dimension d1 may be about 38m. Most preferably, dimension d1 may be about 58m. Preferably, dimension d2 may be about 1- 20mm. Most preferably ion d2 may be about 5-15mm. Most preferably, dimension d2 may be about 11m. Any other values of d1 and d2 may be used to provide a sufﬁcient ﬂow of gas Without unduly high impedance and to ﬁt noses of ent sizes. The radius of curvature at comer portion 457 may be 5 mm, although different radius of curvature may be used. 3.1 .3 Engagement Portions In the illustrated embodiment, sealing portion 210 may include a nose tip engagement portion 212 and an upper lip engagement n 213. As shown in Figs. 1-2 to 1-4 and 1-8, nose tip engagement portion 212 is generally ﬂat or planar along its length so as to provide a sufﬁciently long sealing surface to accommodate various sized noses. The upper lip engagement n 213 is generally curved along its length so as to minimize contact with the t’s upper lip in use. Fig. 20-1 shows a top view of another embodiment and indicates sections shown in Figs. 20-2 to 20-7. In an ment and as shown in Fig. 20-5, the radius of curvature R4 of the external or non-patient contacting side of the nose tip engagement portion 212 is larger than the radius of curvature R2 of the external or non- patient contacting side of the upper lip engagement portion 213. In an embodiment, the radius of curvature R3 of the internal or patient contacting side of the nose tip engagement portion 212 is larger than the radius of curvature R1 of the internal or patient contacting side of the upper lip engagement n 213. The radius of curvature of the non-patient contacting side (e.g., R2, R4) may be different (e.g., larger or smaller) than the radius of curvature ofthe t contacting side (e.g., R1, R3). The radius of curvature of R1, R2, R3 and R4 may be 1-5mm, e.g. 2mm, 3mm, 4mm. In an example, R1 may be about 3-3.75mm, R2 may be about 2 mm, R3 may be about 3.25-4.5 mm, and R4 may be about 3.25-4.25mm.

As shown on Fig. 20-2, the radius of curvature R10 and R11 may be about 8-13mm, e.g. 9mm, 11.5 mm. In an example, R10 may be about 95-115 mm and R11 may be about 9- .5 mm. 3.1.4 Nostril Engagement Flaps In the illustrated embodiment, sealing portion 210 may include nostril engagement ﬂaps 214 structured to align next to or t the nostrils of the patient. In use, ﬂaps 214 seal with the nares (e.g., either directly at the entrance to the nares or along the nostrils of the t) and ﬂex or bias inwards towards the nose of the patient to stabilize or anchor the seal and enable the sealing portion 210 to ﬁt a variety of nose sizes and shapes.

As demonstrated in Fig. 1-6, nostril engagement ﬂaps 214 may be angled in a generally V-shaped ation, indicated by angle 0L (measured from the center of aperture 211 and plotting the general linear path along each nostril engagement ﬂap 214).

In an embodiment, angle 0t is in the range of about 0-180°, e.g., about 90-180°, about 90-120°, about 120-180°, about 0-90°, about 0-45°, about 45-90°, about 90°, about 75°- 95°. Angle (1 trates the angle of the engagement ﬂaps when not in use or in a relaxed form. Angle a may increase when in use, that is, when the patient places the mask on their nose and their nose exerts a force on the mask, and may thus cause the engagement ﬂaps to ﬂex outwards to an in use position. This may include angles of about 75° - 200°. The radius of curvature as ted by the general area bound by (X may be approximately 5-8mm.

] The nostril engagement ﬂaps may include alternative conﬁgurations to e the seal. For example, as shown in Fig. 6-1, the l engagement ﬂaps 214 may be more narrow (e.g., decrease the angle 0t) so that the ﬂaps “pinch” the nose, i.e., nose ﬂexes ﬂaps outwardly in use. As shown in Fig. 6-2, the ﬂaps 214 may include hook-shaped end portions 214(1) structured to “hook” onto and seal over the patient’s nares in use. 3.1.5 Flared Sealing Portion ] As shown in Figs. 1-2 to 1-8, the nose tip ment portion 212, the upper lip engagement portion 213, and the nostril engagement ﬂaps 214 are all structured to curve or extend outwardly from an annular supporting wall or base 219. That is, the nose tip engagement portion 212, the upper lip engagement portion 213, and the nostril engagement ﬂaps 214 are hung or cantilevered from the supporting wall such that they extend or curve outwardly from the supporting wall deﬁning the air path to outer edges of the sealing portion 210 in a continuous, uninterrupted and smooth manner. 3.1.6 Sealing Portion with Malleable Wire Figs. 4-1 to 4-7 show a sealing portion 210 provided with a malleable wire 270. As illustrated, the malleable wire 270 is provided to the underside or non-face- contacting portion of the sealing portion and extends about the perimeter of the sealing portion (e.g., spaced inwardly from the edge of the sealing portion to avoid any contact with the patient’s face in use). However, the malleable wire may be provided to one or more selected ns of the sealing portion (e.g., only along the ﬂaps). The malleable wire allows the patient to deform the sealing portion 210 to their speciﬁc nose shape (i.e., self-adjust the geometry of the sealing portion) and in such deformed sealing portion shape during use. For example, Fig. 4-8 shows the sealing n 210 deformed into a general V-shape, and Fig. 4-9 shows the sealing portion 210 deformed into a general ﬂat or planar shape.

In this embodiment, the sealing portion 210 with malleable wire 270 is ed to a base 271 adapted to attach to a frame. However, such sealing portion may be provided to a suspension system or directly to the frame as described below.

The ble wire may be ed or otherwise provided to the sealing portion in any suitable manner, e.g., co-molded with sealing portion, retroﬁt, etc.

The g portion may be deformable in other le manners, e.g., similar effect may be achieved by constructing the sealing portion of a thermo-forrnable plastic material. 3.1.7 Gel Beading As shown in Figs. 5-1 and 5-2, gel beading 272 (e.g., tear-drop shaped) may be provided around the perimeter of the sealing portion 210 or one or more portions of the sealing portion (e.g., along the nostril engagement ﬂaps) to support the sealing n, e compliance, and/or provide ity in use. The gel g 272 may be positioned along the edge of the sealing portion (Fig. 5-1), along a portion of the edge, and/or within the edge (Fig. 5-2). 3.1.8 Fingers or Ridges In an embodiment, ﬁngers or ridges may be provided along the face-contacting surface of the sealing portion to enhance the seal and prevent leak in use. Fig. 7-2 illustrates an embodiment of ﬁngers 273 and Fig. 7-3 illustrates an embodiment of ridges 274. As shown in Fig. 7-1, the ﬁngers 273/ridges 274 may be provided in concentric rings around the sealing portion 210. However, the ﬁngers/ridges may be arranged in other suitable manners, e.g., provided in one or more selected regions of the sealing portion. In each embodiment, the ﬁngers/ridges extend outwardly (e.g., height of about 0.5 mm) from the face-contacting surface of the sealing portion, and are structured to deform and m to the various contours of the patient’s face and nose in use. Such /ridges may especially improve sealing in awkward positions, e.g., along the joint of the nose to the upper lip. Such ﬁngers/ridges may also improve tactility or maintaining location as the ﬁngers/ridges may create a friction/stabilizing interface with the patient’s skin in use. 3.1.9 Stiffening Ribs In an embodiment, stiffening ribs 275 (e.g., thickened portions ally formed with the sealing portion) may be provided to one or more portions of the sealing portion 210 (e.g., nostril engagement ﬂaps 214) to support the g portion in use. For example, as shown in Fig. 9-1, the stiffening ribs 275 may be provided in one or more concentric rings around the sealing portion to add th around the entire perimeter and support the outer edges of the sealing n 210 from collapsing away from the patient’s nose in use. As shown in Fig. 9-2, stiffening ribs 275 may extend radially from the aperture 211 (e.g., with one or more hes” of ribs) to add support and reduce ﬂexing in selected regions of the sealing portion, e.g., regions most susceptible to leak or deformation. In another embodiment, the stiffening ribs or thickened portions may be provided at te points of the g portion, e.g., points most susceptible to leak or deformation. Stiffening ribs 275 may be thicker than the sealing portion 210. Alternatively, stiffening ribs may be made from a different hardness material than the sealing portion 210, e.g., a durometer of silicone higher than that of the sealing portion 210. 3.1.10 Gel Sealing Portion Fig. 19 illustrates an ment of a sealing n 210 constructed of gel, i.e., gel-filled bladder or membrane (e.g., wall thickness of about 0.3-5 mm, e.g., 0.7 mm).

As illustrated, the ne or bladder 276 is ﬁlled with one or more layers of gel, and a cap 277 (e.g., constructed of polycarbonate, silicone, polypropylene, nylon) is provided to close WO 39014 and seal the opening into the bladder. In addition, the cap 277 helps to locate and maintain the gel-ﬁlled r to the frame 220. The gel sealing portion enhances comfort and compliance in use. 3.1.11 Color Changing Material In an embodiment, the sealing portion may be constructed of a material adapted to change color, e.g., heat sensitive. For example, the sealing portion may be constructed of a color changing silicone that is heat sensitive, e.g., starts off blue (or any ﬁrst color) at room temperature and turns white/clear (or any second color different from the ﬁrst color) with added heat, e.g.,‘body temperature.

This color changing material may be used by the patient to size their sealing portion. For example, the patient may be provided with a sealing portion for the largest size nose, and when the patient ﬁts the sealing portion to their nose they will be able to see exactly how much excess material is on the sealing portion, e.g., contact with t’s face will heat al and change from ﬁrst to second color. The patient could then trim off the excess material to customize the mask to their nose.

Also, the color changing material may be used for leak indication, e.g., leaking air will be colder than body temperature so the color ng material will maintain its ﬁrst or original color where any leak path exists.

The color changing material may have other applications, e.g., for the sealing portion and/or other portions of the patient interface or PAP system.

For e, the color changing al may be used for sterilization. If the cleaning substance to be used (e.g., water) is most effective at ng the mask at a certain temperature, the silicone could change color at this certain temperature to indicate the required sterilization ions have been met, e.g., the mask could turn from colored to clear at 100 degrees Celsius if the best method of sterilizing the mask is to boil it in hot water. Alternatively, if cleaning the mask with alcohol is preferable, the reaction of latent heat with the applied alcohol could‘cause the silicone to change color.

The color ng material may be used as an end of life indicator. If the color changing silicone will only change colour a certain number of times before breaking down, this could be used to indicate that it’s time for a new mask.

The color changing material may be used for enhanced invisibility. For example, the silicone changing color to a clear silicone makes the mask s less obtrusive.

The color ng material may be used as a r. For example, the color ofthe silicone may be useful to locate parts that have been dropped or lost.

The color changing material may be used for mask asymmetry. For example, if the patient has an asymmetric nose, this could be a useful indicator of alignment. It could suggest that the patient needs to position the mask off-center to accommodate their tric nose. The ne will change color where their nose is currently contacting the mask, and they could adjust the position of the mask in use to ensure both nostrils are able to receive the ﬂow of breathable gas from the mask.

The color changing material may be used on the PAP device, humidiﬁer, and/or tubing (e.g., heated tube) to indicate that the temperature of the PAP device, humidiﬁer, and/or tubing is at its limit or desired temperature.

] In another ment, the sealing portion may be ucted of a color changing material that is pressure sensitive. In such embodiment, the patient would be able to identify pressure points and then update the mask accordingly.

An exemplary material may be Chromazone® Free Flowing Powder available from Thermographic Measurements Ltd, Devon, UK.

Another exemplary material may be Thermochromatic and Liquid l products available from B&H Colour Change Ltd, London, UK.

Another exemplary material may be Thermochromatic Inks available from Siltech Ltd, Nottingham, UK. 3.1.12 Sizing Indicator Figs. 27-1 and 27-2 illustrate the sealing portion 210 with thermo-chromic sizing tors. Fig. 27-1 shows the sealing portion 210 before use with the sealing portion 210 all being color region 358. Fig 27-2 shows an exemplary sealing portion 210 after use, where the region touched by the patient has changed color, as shown by color region 360.

The color change indicates the portions of the sealing portion 210 that have been contacted by the patient, and may enable the patient to remove excess material after use (i.e., color region 360 in Fig. 27-2). The color changing portions could also be used by people ﬁtting the sealing n to the patient, whereby the change in color would indicate the ideal selection from among de sealing ns of various sizes. 3.1.13 Sizing Options The sealing portion 210 may be arranged such that a single size cradle may be produced that is able to be trimmed down or cut back into smaller sizes. For example, as shown in Fig. 28, sizing of the sealing portion for different sized patients may relate to the size of the oriﬁce, such that oriﬁce opening 362, oriﬁce opening 364 or oriﬁce opening 366 may be used depending on the nose size of the patient, i.e., oriﬁce g 366 for larger noses and oriﬁce opening 362 for smaller noses. The extra membrane material of membrane 348 may also be trimmed off by the patient or a ian. Perforations or g lines may be incorporated into the sealing portion 210 to indicate sizing ranges. 3.1.14 sions Figs. 24-1 through 24-4 show a sealing portion 210 (also referred to as a nasal cradle) provided with nozzles or protrusions 320. The nozzles 320 are positioned on the g portion 210 so as to be d in or near the patient’s nares and position the sealing portion under the patient’s nose 324 when in use. The nozzles 320 position the sealing portion 320 to enable an effective seal and provide adequate therapy to the,patient.

] The nozzles 320 are provided with oriﬁces 322 which are used to expel gas into the patient’s nose 324. The nozzles 320 may not necessarily seal with the t’s nares, instead the sealing portion 210 may seal with the underside of the patient’s nose, e.g., in a manner as described above. In the illustrated embodiment, the sealing portion 210 is provided with a septum locator 326, where the patient’s septum can be located n the nozzles 320. The septum locator 326 may include a cushioning material to provide comfort to the patient at this sensitive region of the nose. Alternative alignment protrusions or isms may be used to position the sealing portion in relation to the patient.

The nozzles 320 are conﬁgured to have a curved or concave outer surface 321 that gradually increases in width from a top of the nozzles 320 to a bottom of the nozzles 320 to provide a comfortable ﬁt to different sized noses and nares. As illustrated in Fig. 24-2, a patient with a relatively-small nose 324 and nares may utilize the curved surface of the nozzles 320 in a way that the patient’s nose extends part of the way down the curved outer surface 321 to provide a comfortable seal. As illustrated in Fig. 24-3, a t with a relatively larger nose 324 and nares may utilize the curved surface of the s 320 in a way that the patient’s nose extends further down the curved outer surface 321 to also e a comfortable seal. At the same time, the sealing portion 210 may ively ﬂex to accommodate noses of different size, e.g., width. 3.1.12 Sealing n Comfort Figs. 25-1 h 25-4 show a sealing portion 210 including elements structure to provide comfort to the patient. For example, the g portion 210 may be provided with a soft, conforming cushion to enhance comfort and thus compliance with therapy. The cushion may be constructed of a low durometer material, such as a material having a hardness of less than 40 Shore A (or Type A). For example, the material may have a hardness of about 5—60 Shore A. Preferably, the material may have a hardness of less than 20 Shore A. Most preferably, the al may have a hardness of less than 10 Shore A.

] In Fig. 25-1, a cushion 330 or pocket of soft material is positioned under a sealing membrane 328. The membrane 328 may be constructed of silicone or other suitable material. The cushion 330 may be a molded thermoplastic elastomer (TPE), a gel ﬁlled bladder, foam, or another mable material or a combination of these. As rated, the membrane 328 includes an end portion that hooks or wraps over an outer edge of the cushion 330, such that the membrane 328 positions and retains the cushion 330 underneath the membrane 328. Locking bumps 332 on a stem 334 of the sealing portion 210 may also be provided to maintain the cushion 330 in position by ting it from slipping downward, i.e., locking bumps 332 provide interference to prevent nt of the cushion in the downwards direction.

The sealing portion 210 includes an oriﬁce 336 through which breathable gas may be delivered to the patient. The membrane 328 interfaces with the patient, and preferably prevents the cushion 330 from interfacing with the patient, so that there are fewer constraints in material choice of the cushion 330 due to patient safety.

Fig. 25-2 shows a similar arrangement to Fig. 25-1, but further includes a lower ne 340 to support the cushion, i.e., an upper membrane 338 and a lower membrane 340 are provided to support the cushion 330 in position. As the patient positions the sealing n 210 in use, the patient will impart a patient force (as indicated by the arrow) on the sealing portion 210 and the cushion 330. In order for the n 330 to provide ent reaction force (as indicated by the arrow) at an appropriate displacement, the lower membrane 340 supports the cushion 330 in position to enable a seal with the patient and to provide comfort to the patient.

In Fig. 25-3, the sealing portion includes an upper cushion 342 provided over a lower cushion 344. In this ment, the sealing n may or may not include a sealing membrane as described above. The upper cushion 342 may have one hardness and the lower cushion 344 may have another hardness, e.g., the upper cushion 342 may have a lower hardness than the lower cushion 344. In one example, the upper cushion 342 may have a hardness of about 5-20 Shore A (for example, about 7-1 5 Shore A, preferably about 7 Shore A) and the lower cushion 344 may have a hardness of about 20—80 Shore A (for example about 40-70 Shore A, preferably about 40 Shore A). However, other le sses are possible. The upper cushion 342 and the lower cushion 344 may be made from silicone, TPE, gel, foam, nylon, or a combination thereof, for example. The lower cushion 344 may support the sealing portion 210 in a position to be comfortable and able to seal with the patient in use.

An oriﬁce 336 is provided through the upper and lower cushions to allow the delivery of gas to the patient.

In Fig. 25-4, the sealing portion 210 may have a horseshoe shape 346 (when viewed from the top) to n the nose tip portion 352 and nostril engagement ﬂaps. This arrangement allows for molding of a bladder as the n, since the line of draw of the molding tool (as indicated by the arrows) is straight and therefore easier to mold. The bladder may be ﬁlled with gel, foam, TPE or any other suitable material. A membrane 348 may be provided to the cushion 346 and positioned to contact the patient’s upper lip in use. The ne 348 may be stretchable and/or ﬂexible to accommodate various upper lip conﬁgurations. The membrane may also seal with less force on the patient’s face, and therefore be more table at the upper lip position. > In the embodiment illustrated in Figs. 47-1 to 50, the g portion 450 may be formed from a material and with a softness to provide patient comfort, and to readily conform to the patient’s face. For example, the sealing portion 450 may be a liquid silicone rubber material or another elastomeric al, e.g. TPE. The sealing portion may have a durometer of about 5-40 Shore A (preferably about 5-15 Shore A, most preferably about 5 Shore A) to provide comfort to the patient. 3.1.15 ne Flexing In prior art s such as shown in Figs. 29 and 30 in cross section, the membrane 368 is rolled in or curves inwards from the support wall 370. Such an arrangement permits the patient’s nose to travel into the cushion, and the membrane rolls or moves downwards to create a seal. The supporting walls 370 ensure that the membrane 368 is supported and has enough room to roll or bend inwards. Such rolling may cause occlusion of the patient’s nares, as the excess material may cover the patient’s .

In contrast, in embodiments of the present technology such as illustrated in Fig. 31, the membrane 348 is structured to ﬂex outwards or away from a center of the patient’s nose in use. Alternatively this conﬁguration may be described as a trumpet or bell shape. The supporting wall 372 maintains the membrane 348 in its non-use position and prevents the membrane 348 from ﬂexing outwards beyond its intended limit. Since the excess material of the membrane 348 is ﬂexing outwards, it reduces the chance of material occluding the patient’s ls. The excess material of the membrane 348 s the chances of ion by ng or reducing pinch forces created by a collapsible outer wall. 3.1.16 Membrane Support The headgear may be attached to the membrane so as to support the outer walls of the membrane in an upwards position, i.e., to prevent the membrane from ﬂexing outwards into a ﬂat position which may e the patient’s nares or break the seal of the mask with the patient. As illustrated in the rear View of Fig. 32-1, headgear straps 378 may attach to the sealing portion at headgear ment points 376. As illustrated, the headgear attachment points 376 are at a on close to oriﬁce 374, so that the straps 378 may support the length of the sealing portion 210 and support the membrane 348 in an upwards position in use. The membrane 348 therefore cannot excessively ﬂex outwards, preventing ion of a t’s nares or breaking the seal of the mask with the patient. The headgear straps 378 may ﬂex and move underneath the sealing portion 210 at portions where the headgear straps 378 are not attached via the headgear attachment, to enable greater ﬁt range due to the headgear being able to rest in multiple positions under the membrane.

As illustrated in Fig. 32-2, the headgear 378 may alternatively be attached via headgear attachment points 376 at a portion farther away from oriﬁce 374, and closer to an edge of a ne. This allows r ﬂexibility of the membrane to accommodate various shapes of noses (e.g., pointy noses versus ﬂat noses).

Fig. 33-1 illustrates a supporting member 381 (e.g., a substantially rigid member) positioned under, within or as a part of the sealing portion 210 (the supporting member 381 is shown by the dotted line). The supporting member 381 is structured to force the membrane of the sealing portion 210 into contact with regions of the patient’s face that are difﬁcult to seal in. For example, the corner of the nose and the nostril ﬂare may be difﬁcult to seal in as patient’s have widely varying geometries in these regions. The supporting member 381 may be more rigid or stiff than the membrane, thereby anchoring the sealing portion at the top lip , corner of the nose regions 382 and the l ﬂare regions 384, also ensuring that the ne is held in sealing engagement with the patient in these regions. As the tip of the nose is quite sensitive, there may be no supporting member positioned at the nose tip region 352. The supporting member 381 may at least lly extend into the top lip region 350.

The ting member 381 may be co-molded with the sealing portion 210, and may include a malleable wire or other rigid element. The supporting member 381 may include ally molded thickened regions to provide support.

Fig. 33-2 illustrates an alternative supporting member 381 that does not include the nostril ﬂare regions so as to allow the membrane 348 to ﬂex in these regions. The support member 381 further extends to the nose tip region 352 to anchor the sealing n in position with the t’s nares. The supporting member 381 may also at least partially extend into the top lip region 350 and the comer of the nose regions 382.

The supporting member may be co-molded or separately attached to the membrane. The support member may be made from a material with greater hardness than the membrane 384. For example, the membrane may be about 10 Shore A and the support member may be about 40 Shore A. However, other suitable hardnesses are possible As rated in Figs. 34-1 and 34-2, s of the sealing portion may include material that is able to support the membrane 348 as well as provide comfort to sensitive regions of the face. For example, stabilizing portions 386 may be providing at the corners of the nose and tip of the nose. The stabilizing portions should be stiff enough to maintain the shape of the sealing portion and support the membrane 348 attached or adjacent to it, while providing ent ﬂexibility to be comfortable when in use. The stabilizing regions 386 may be constructed of gel, foam, TPE, silicone or any other suitable material. 3.1.17 Flexible ne Portions Fig. 35-1 illustrates an alternative arrangement to Figs. 34-1 and 34-2 where the ﬂexible or cushioning region is in the upper lip region 350. As shown in Figs. 35-2 and —3, this ﬂexible or ning region has a lower durometer or lower hardness than other regions of the sealing portion, such as the nose tip region 352. In addition, the rest of the g portion has two layers ~— a lower ter or hardness top layer L1 (i.e. layer contacting the patient’s face) and a higher durometer or ss bottom layer L2. The lower durometer al may have a higher tack or stickiness than the bottom, harder layer and' may therefore provide a on ﬁt with the patient’s face. 3.1.18 Membrane Support The membrane 348 may be supported by struts or tabs 390 (Fig. 36) positioned underneath the outer ﬂaps (nostril engagement ﬂaps) 388 ofthe sealing portion 210. The struts 390 may be attached to or positioned with headgear connectors 376. The struts 390 prevent the outer ﬂaps 388 of the sealing portion 210 from collapsing away from the patient’s face, enabling a more effective seal by maintaining the sealed position of the sealing portion 210 on the patient’s face. 3.1.20 Diffuse Venting ] As illustrated in Figs. 37-1 and 37-2, the sealing portion 210 may be d in position on the patient’s head with one or more headgear straps 390. The sealing portion 210 may also be connected to a tube 20 for the delivery of breathable gas to the t. The tube may connect to the sealing portion 210 by a vent ring 392. As shown in Fig. 37-2, the vent ring 392 includes a tube connector 398 d to attach the tube 20 at one end, with a step or ﬂange 396 to prevent the tube 20 from being positioned on one or more gas washout vents 394. The vent ring 392 includes a sealing portion connector 395 adapted to attach to the sealing portion at its other end. The tor 395 provides the one or more gas washout vents 394, which align with vent holes or tracks along the end of the sealing portion, allowing d gases to pass from the sealing portion 210, through the gas washout vents and out to atmosphere. The gas washout vents or pathways ageously direct air away from the patient’s face. The gas washout vents or ys also disperse air around the perimeter of the vent ring 392, thereby diffusing the exhaled gases and thus preventing jetting. 3.1.21 Support of Stem Figure 39 illustrates a sealing portion 210 having a stem 404 for allowing breathable gas to ﬂow through the mask to the patient. The stem 404, which is attached to tube connection 406, may include one or more ribs 402 or other supporting mechanisms to support the stem 404 and prevent it from possibly collapsing and occluding the ﬂow of gas in use. The ribs may be thickened regions or separately attachable or embedded struts to maintain the stem 404 in an open position. Ribs 402 may also support the sealing n 210 such that it may in an open position thereby preventing occlusion of the oriﬁce delivering breathable gas to the patient. 3.1.22 Supported Sealing Portion The sealing portion 210 may be supported by a supporting portion. The sealing portion may be totally separated from the supporting portion by a gap, or one or more portions of the sealing portion may be in contact with the supporting portion, while other portions of the sealing portion may be separated from the supporting portion by one or more gaps. When such gaps are utilized, the corresponding portions of the sealing portion 210 may be able to h to ﬁt the patient’s face. .1 Separated Sealing Portion Figure 40 illustrates a sealing portion 210 that is separated from supporting portion 409 by a space or gap 408(1), , allowing the sealing portion 210 to ﬂex downwards until it reaches the supporting portion 409. The supporting portion 409 prevents the sealing portion 210 from losing its shape or collapsing and thus assist in maintaining a seal to the patient. The patient contacting portion 407 preferably has a lower hardness than the supporting n 409, and may be thinner than the supporting portion 409. The patient contact portion 407 and the supporting portion 409 may be formed by multiple shot molding, gluing, or any other suitable .

The top lip portion 350 of the sealing portion 210 may have a gap 408(1) between the patient contacting portion 407 and the supporting portion 409 to allow for varying anthropometrics ofpatient upper lips. This also allows ﬂexibility of the patient contacting portion 407 near the septum of a patient, which is a highly sensitive region. The nose tip region 352 of the sealing portion 210 may also have a gap 408(2) between the t contacting portion 407 and the ting portion 409 to allow for varying anthropometrics of patient nose tips. The ﬂexibility also enables the patient contacting layer 407 to ﬂex around the nose tip and y enhance the scalability of the sealing portion 210. .2 Partially Separated g Portion ] Fig. 47-1 shows a View of a sealing portion 450 that is supported or positioned by supporting portion 453. The sealing portion 450 is separated from the supporting portion 453 by a front gap in an area of a nose tip engagement n 452 n front anchor points 469, and the sealing portion 450 is connected to the supporting portion on sides of the sealing portion 450 outside the front anchor points 469.

] The nose tip engagement portion 452 is ﬂexible and can extend downward when contacted by a patient’s nose, but will be limited in how far it can extend if it reaches the supporting portion 453. The nose tip engagement portion is extended in length from the aperture 455 to ﬁt nose tips of different size, so that the nose tip of different patients may engage the nose tip engagement portion at different locations. Stem 454 supports the supporting n 453 and the sealing portion 450. Stem 454 is also adapted to receive the air delivery tube to supply pressurized breathable gas to the patient.

The sealing n 450, the stem 454, and the supporting portion 453 may be a liquid silicone rubber al or r material, e.g., TPE, gel or foam. The sealing portion 450 may be formed from a material having different properties than the material forming the supporting portion 453 and the stem 454. The stem 454 and the supporting portion 453 may be formed together such as in a mold, and the sealing portion 450 may be formed separately and then joined together with the supporting n 453, e.g. such as by gluing. Alternatively, the stem 454 and the supporting n 453 may be formed together such as in a mold, and then the sealing portion 450 may be bonded to the supporting portion 453 and the stem 454 in the mold.

The g portion 450 may have different ties than the supporting portion 453 and the stem 454. For example, the g portion 450 may be formed from different (or the same) materials, have a different geometry, have a different hardness, than the supporting portion 453 and the stem 454.

The supporting portion 453 and the stem 454 have a hardness that is greater than the hardness of the sealing portion 450 (which as described above may have a hardness of about ter 5 Shore A), because the supporting portion 453 and the stem 454 both support the sealing portion 450, and provide a reactive force to stabilize the sealing portion 450 in position on the patient’s face. For example, the supporting portion 453 and the stem 454 have a hardness of about durometer 20-80 Shore A. Preferably, the supporting portion 453 and the stem 454 have a hardness of about durometer 30-65 'Shore A. Most ably, the supporting portion 453 and the stem 454 have a hardness of about 40 Shore A.

The hardness of the sealing portion 450, the supporting portion 453, and the stem 454 may vary from the hardness levels described, but if so then a ess of material may need to change to ensure a seal is provided with the patient. For e, the nose tip engagement portion 452 of the sealing portion 450 may have a thickness of 1.2mm with a hardness of about durometer 5-20 Shore A (preferably about 5-10 Shore A, most ably about 5 Shore A), but if a harder material is used for the sealing portion 450, then the nose tip engagement portion 452 should have a thickness reduced to, for example, 0.3mm, so that the same stiffness or reactive force is applied to the patient’s face to provide an effective seal.

Fig. 47-2 illustrates another View of the sealing portion 450. The sealing portion 450 is separated from the supporting portion 453 by a rear gap in an area of an upper lip engagement portion 462 between rear anchor points 475, and the sealing portion 450 is connected to the supporting portion 453 on sides of the sealing portion 450 outside the rear anchor points 475. The upper lip engagement portion 462 is ﬂexible and can extend downward when contacted by a patient’s upper lip, but will be limited in how far it can extend if it reaches the supporting portion 453.

] Fig. 49 (and 48-2) illustrates a front view of the sealing portion 450. The nose tip engagement portion 452 is formed as a hanging, ﬂexible membrane. The sides of the sealing portion 450 are ted to or bonded to the supporting portion 453, while there is a front gap between a central portion of the sealing portion 450 and the ting portion 453 between front anchor points 469. By utilizing this hanging, ﬂexible membrane, the nose tip engagement portion 452 provides a ﬂexible surface that remains in tensile contact with the nose during patient interface movement, and better accommodates varying nose geometries.

Different sized noses are provided with a comfortable and effective seal by utilizing a wide nose tip engagement portion 452, which allows the nose tip to be oned at various locations between the aperture 455 and a front edge of the nose tip engagement portion 452.

The nose tip engagement n 452 may stretch rds towards the supporting portion depending on the size of the patient’s nose.

The sealing portion 450 includes two thickened comer regions 467 oned on each side of the upper lip engagement portion 462. The thickened corner regions 467 are adapted to seal with the patients face in use at regions of the patient’s nose adjacent the nasal labial creases. The two thickened comer regions 467 protrude d to e an effective seal in this area. The two thickened corner s 467 may each have a radius of curvature of between about 2.4mm and about 6mm. A radius of ure of the upper lip engagement portion may be about 5mm.

A width d5 ofthe g n 450 may be about 48m to ﬁt noses up to about 45m in width. A larger width d5 such as 60mm could be used to ﬁt noses up to 60mm in width. A distance d6 n the nose tip engagement portion 452 and the supporting portion 453 may be about 5-20mm, preferably about 5-15mm and most preferably about 10mm. This distance d6 has provided effective sealing of the patient interface 451 with ts having nasal alar angles of up to about 135°, but may also ﬁt ts have nasal alar angles of up to about 200°. Distance d7, a width of the nose tip engagement portion (and a distance (width) of the portion of the sealing portion 450 not bonded to the supporting n 453) may be about 38m, but for larger noses could be another value such as about 48mm, or up to about 60mm.

A radius of curvature of the nose tip ment portion 452 may be about 30- 45mm, preferably about 30-40mm and most preferably about 35mm, but to ﬁt ﬂatter noses, could be about 35 to 50mm, preferably about 40-50mm, and most preferably about 40m. At protruding edge 476 in Fig. 48, an at least 1 mm bond t radius may be used to aid tooling, where the ding edge 476 may be clamped in a tool while the g portion is molded. A distance (height) d3 of the nose tip engagement portion is about 10 to 30mm, preferably about 12-18mm and most preferably about 17m. A distance d4 of the nose length region is about 20- 40mm, preferably about 25—35mm and most preferably about 27m, which covers nose lengths of about 12m to about 25m. The distance d4 could be reduced to about 17mm for wide/shallow noses (over 40mm wide and less than 15mm long).

Fig. 48-2 illustrates a schematic top View of the sealing portion 450. The sealing portion 450 es an aperture 455, a front stretch portion 564, a rear stretch portion 562, side push or compression portions 566 and side wrap or cantilever portions 568. The front stretch portion 564 and the rear stretch portion 562 are ﬂexible portions of the sealing n that can stretch or ﬂex, when they come into contact with the nose tip and upper lip of a patient. In these regions, sealing portion 450 is a thin membrane that is in tension and thus hugs or closely follows the geometry of the nose tip and top lip of the t. Preferably the respective front and rear stretch portions are held at their ends, and unsupported in their middle. The ﬂexibility zes the force for a given displacement on the top lip and nose tip as these areas can be sensitive.

] The side wrap or cantilever portions 568 are adapted to provide a substantially horizontal or lateral force that is substantially normal to the plane of the ﬂares of the patient’s nose. As the ﬂares of the patient’s nose ﬁll with pressurized air, the ﬂares are urged outwards due to the air pressure. The side wrap or cantilever portions 458 provide a reactive force to this outwards force of the ﬂares, ensuring a good seal in this region. Reinforcement or greater stiffness of the side wrap or cantilever portions 568 (when compared to the stretch portions 562, 564) may be required to ensure the reactive force is sufﬁcient to maintain the seal and avoid blow out or broken seal. Reinforcement may be provided by additional thickness of the sealing portion 450 in these side wrap portions, such as by utilizing a higher stiffness material, or additional structure such as a headgear attachment or ribs underlying the side wrap or cantilever portions 568.

] The side push or compression portions 566 are adapted to anchor or support the sealing portion 450 in position. In use, the ns 566 may be largely in compression.

The force provided from the side push ns 566 may be normal to the plane of the patient’s face, in a ntially horizontal direction. Since this region of the sealing interface of the patient’s face is the least sensitive, tension from ar is substantially transmitted to the side push portions 566. Preferably, this is the stiffest region of the g portion 450.

The side push ns 566 may have a greater thickness than the front stretch portion 562 or the rear stretch portion 564.

The sealing portion 450 has varying ess in different portions, i.e. front stretch portion versus rear stretch portion versus side push portions versus side wrap ns.

A stiffness of these portions is varied by varying the materials, the hardness of the materials, the thickness of the materials, or by using supporting portions.

Fig. 50 illustrates a rear view of the patient interface 451. The sealing portion 450 is connected to the supporting portion 453 on both sides of the patient interface 451, and includes an upper lip engagement portion 462 that engages with a patient’s upper lip in use.

The upper lip engagement portion 462 is formed as a hanging, ﬂexible membrane, with a rear gap between the upper lip ment portion 462 of the sealing portion 450 and the supporting portion 453. The rear gap is positioned between rear anchor points 475 that anchor the sealing portion 450 to the supporting portion 453. The ﬂexible, g membrane provides a ﬂexible surface that remains in tensile t with the upper lip of the patient during patient ace movement, and can stretch to accommodate varying facial geometries by allowing movement of the upper lip engagement portion 462.

A thickness d8 of the thickened comer regions 467 of the sealing portion 450 could be about 1 to 5mm, preferably about 2 to 4mm, most preferably about 3.5mm with a relatively low durometer Shore A hardness for comfort. The thickness d8 could be increased up to about 5 to 10mm, ably about 5 to 8mm, most ably about 5mm depending on the thickness of the ying supporting n 453, and could be decreased to a same thickness as the upper lip engagement portion 462, about 0.25 to 3 mm, preferably less than 2mm, most preferably about 1.2mm.

The distance d9 between the unbonded region of the sealing portion 450 at the upper lip engagement portion 462 and the supporting layer 453 may be about 1 to 15 mm, preferably about 5 to 10 mm, most preferably about 7 mm when not in use, and may vary . between 0mm and 15mm, preferably up to 7mm in use based on contact seal force to the philtrum of the patient. The distance d10 between the top edge of the g portion 450 and the supporting portion 453 may be about 10 to 30 mm, preferably about 15 to 20mm, most preferably about 18m. The width ofthe upper lip engagement portion 462 (and a distance (width) (ill of the unbonded portion of the sealing portion 450) may be about 10 to 30mm, preferably about 15 to 25mm, most preferably about 20m, but this could be varied between about 14m and about 22m depending on nose width. A radius of curvature at the center of the upper lip engagement n 462 may be about 5 to 20mm, preferably about 10 to 15mm, most preferably about 12.5mm when not in use, but will lessen when in use and with inwards ﬂex ofthe patient interface 451.

The sealing portion 450 is thus connected to the supporting portion 453 on both sides, but is separated by gaps from the ting portion 453 between the front and rear anchor points 469, 475. These gaps allow the g portion 450 to ﬂex in use at the nose tip and upper lip regions of the patient to provide a good fit and comfort to the patient.

Fig. 51-1 illustrates a cross-sectional side View of the patient interface 451. A front unbonded region 460 of the sealing n 450 may have a radius of curvature of about 8 to 15mm, preferably about 10 to 13mm, most preferably about . A rear corner portion 464 of the sealing n 450 may have a radius of curvature of about 1 to 7mm, preferably about 3 to 6mm, most preferably about 4mm.A rear unbonded region 463 of the sealing portion 450 may have a radius of curvature of about 2 to 8mm, preferably about 3 to 6mm, most preferably about 5mm, but this value can vary to almost ﬂat at the outer edge.

The sealing portion 450 may include an outer sealing margin 534 above the dotted line to seal with the patient’s face, and a transition region 536 between the opening 455 and the outer sealing margin that gradually increases in size from the opening to the outer sealing margin 534. The opening 455 deﬁnes an or surface in communication with the 2010/000684 breathable gas, and the outer sealing margin 534 is formed as a continuous extension of the interior surface. Outer edges of the sealing portion 450 are oriented away from the opening 455 and/or a direction of ﬂow of the breathable gas. The outer sealing margin 534 is substantially convex as seen from its top View.

Fig. 51-2 illustrates a cross-sectional side View of the patient interface 451.

This embodiment includes an intermediate n 450.1 disposed between the sealing portion 450 and the supporting portion 450. The intermediate portion 450.1 may be formed as a hanging membrane. The intermediate portion 450.1 may be molded together with the sealing portion 450, may be molded together with the supporting portion 453, or may be molded tely from the sealing portion 450 and the supporting portion 453. The intermediate portion 450.1 may e support to the sealing portion 450. The entire intermediate n 450.1 may be separated from the sealing portion 450 by a gap, such as shown in Fig. 51-2, or portions of the intermediate portion 450.1 may be in contact with the sealing portion 450 while other portions of the intermediate portion 450.1 may be separated from the sealing n 450 by a gap.

Fig. 52-1 illustrates a support membrane 465, which may include the supporting n 453 and the stem 454. The supporting portion 453 and the stem 454 may be formed as a single unitary element. The support membrane 465 may have a general wall section 466, a front thickened portion 468, and a rear thickened portion 470. A front thickened portion 468 and a rear thickened portion 470 are formed on each side of the supporting portion 453. The front thickened n 468 and the rear thickened portion 470 provide varying degrees of support to the sealing portion 450 when assembled. Support membrane 465 may be constructed of a ne with a ss of about 20 to 90 Shore A, preferably about 20 to 60 Shore A, and most preferably about 40 Shore A. The support membrane 465 could also be made from polycarbonate, polypropylene, nylon, thermoplastic elastomer (TPE), HytrelTM, etc.

The front thickened portion 468 is positioned adjacent to an area of the sealing portion that contacts with sides of the patient’s nose in use as seen in Fig. 47-2, and transfers headgear load into a pinch force on the sides of a patient’s nose to provide an effective seal.

The front ned n 468 may have a ess that increases from a top to a bottom, and have a height dl2 of about 5 to 20mm, ably about 7 to 14mm, most preferably about 11 mm.

The rear thickened portion 470 may include a lower portion 471 having a ﬁrst thickness and an upper portion 473 having a second ess greater than the ﬁrst thickness.

A height d13 of the upper portion 473 may be about 7 to 20mm, preferably about 8 to 12mm, most preferably about 9.5mm, although it could be reduced to about 4m to reduce loading.

The rear thickened portion 470 may have a curved portion 472, which may have a radius of curvature of about 0.5 to 3mm, preferably about 2mm, although it could be increased to about 4mm to increase stiffness against the upper lip of the t. The rear thickened portion 470 may include a cored out portion 477 to reduce a bulk of the ne and to reduce a curing time.

The rear thickened portions 470 are positioned ly below the thickened comer regions 467 of the sealing portion 450, as may be seen in Fig. 47-3. The rear thickened portions 470 transfer a load from the headgear connectors to the thickened comer regions 467 and to the lower comers of the patient’s nose to aid in providing an effective seal, and when the headgear is tensioned, the transfer of load to the lower comers of the patient’s nose is increased. The bending force from the headgear connectors 456 is transferred in use by the rear thickened portions 470 to the thickened comer regions 467 of the sealing n 450 to apply a sealing force as an anchor force to regions of the patient’s nose adjacent the nasal labial creases. The transfer of force from the headgear connectors 456 to the rear thickened portions 470 may occur by due to the stiffened headgear tor arms, which when bent, cause the bending force, and/or by actual contact of the headgear connectors 456 with the rear ned portions 470.

A side upper lip n 474 may also be thickened as compared to general wall section 466, and have a width dl4 that varies from about 3.5mm to 1.2mm, to vary the amount of resistance force against the upper lip of the patient.

Fig. 52-2 illustrates a cross—sectional View of the support ne 465 and the sealing portion 450. The cross-section illustrates how the supporting portion 453 supports and is in contact with the sealing n 450 on the sides of the sealing portion.

Fig. 52-3 illustrates another cross-sectional View of the of the support membrane 465 and the sealing portion 450. The cross-section illustrates the difference in 2010/000684 thickness between the lower portion 471 and upper portion 473 of the rear thickened portion 470, and illustrates the cored out portion 477.

Fig. 52-4 rates a cross-sectional view of the support membrane 465 and the g portion 450 as it interfaces with and seals with a patient. The nose tip engagement n 452 engages with and seals with the patient’s nose tip. When the nose tip engagement portion 452 and upper lip engagement portion 462 are ﬁtted to the patient’s nose tip and upper lip, the nose tip engagement n 452 and the upper lip engagement portion 462 are stretched towards the supporting portion 453.

Fig. 52-5 illustrates a side view of the support membrane 465 and the sealing portion 450 as it interfaces with and seals with a patient. The sides of the sealing portion 450 and the supporting portion 453 pinch with and seal with the sides of the t’s nose. The thickened comer regions 467 seal with the patient at regions of the patient’s nose adjacent the nasal labial creases. The rear thickened n 470 is positioned adjacent to and below the thickened comer region 467 to provide onal sealing force.

] Fig. 52-6 illustrates another cross-sectional view of the support membrane 465 and the sealing portion 450 as it interfaces with and seals with a patient. The sides of the sealing n 450 seal with the sides of the patient’s nose, and are supported in this area by the supporting portion 453, the front thickened portion 468 and the rear thickened portion 470.

Fig. 52-7 illustrates a front View of the support membrane 465 and sealing portion 450 as it interfaces with the patient’s face. The nose tip engagement portion 452 engages with and seals with the patient’s nose, and stretches towards the supporting portion 453. The front anchor points anchor the sealing portion 450 to the supporting portion 453 on both sides of the nose tip engagement portion 452. The sides of the sealing‘portion 450 engage with and seal with the sides of the patient’s nose.

] Fig. 53 illustrates a front view of the support membrane 465. The distance d15 between the front thickened portions 468 may be about 25 to 45mm, ably about 35 to 42mm, and most preferably may be about 40m. The ce d15 may be varied to change stiffness of contact between the headgear and side walls of the membrane to increase a pinch load on sides of the patient’s nose. Distance d16 between the rear thickened portions 470 may be about 35 to 55mm, preferably about 40 to 50mm, most preferably about 46m.

Varying dl6 varies the point at which the headgear contacts the rear thickened portion 470 to increase or reduce load.

] Fig. 54 illustrates a front view of the t membrane 465 with headgear connectors 456. The headgear connectors 456 may be formed as a single y element molded with the support membrane 465, or could be formed separately and attached to the support membrane 465. The headgear connectors 456 may include headgear tabs 458 for connecting the headgear. The distance d21 from a bottom of the headgear connectors 456 to a top of the support membrane may be about 10 to 25mm, preferably about 12 to 20mm, most preferably about 17m. The distance d20 between the outer ends of the headgear connectors may be about 60 to 100mm, preferably about 70 to 90mm, most ably about 80m. The ar connectors 456 may be angled upwards at an angle (11, which may be about 2 to 15°, preferably about 5° to 8°, most preferably about 6.5°.The higher the angle (11, the lower the moment of pinch force applied by the patient interface.

As shown in Fig. 55, the headgear connectors 456 are placed towards the base of the g portion 450 in order to create a moment force on the side walls. As the headgear force is applied by tightening the headgear straps, a load is placed on the headgear connectors 456 and the tabs 45 8, which promotes an inward force on the sides of the sealing portion 450, to provide a seal force to the sides of the patient’s nose. When the ar straps are tightened, the pinch load moment force applied to the sealing portion 450 may cause the inward displacement of the sealing portion 450 to reduce a width of the g portion by almost one half from an initial width without the headgear straps in place. The bending force from the headgear connectors 456 is transferred in use by the supporting portion 453 to the sealing portion 450 as a pinch force to sides of the patient’s nose.

The stiffness of the side walls of the support membrane 465, the stiffness of the headgear tors 456, and the connection point of the ar connectors 456 all affect the amount of pinch force transferred to the sealing portion 450. The headgear connectors 456 may have a thickness of about 2.5mm to 4.0m, with the side walls of the support membrane 465 having a thickness of about 1.2mm to 5.0m, with both using silicone having a hardness of about durometer 40 Shore A to durometer 65 Shore A. The ar connectors 456 and the side walls of the support membrane 465 do not have to be a constant thickness, but the thickness can vary along their length and width or they may have localized thickened regions to control stiffness in speciﬁc regions. Also, there may be additional silicone at the point where the headgear connectors 456 connect to the support membrane 465. Headgear connectors may alternatively be constructed of r material than silicone such as nylon, polycarbonate, polypropylene or other suitable material. This may aid connection of the headgear to the headgear connectors.

Fig. 55 illustrates a top view of the support membrane 465 with headgear tors 456. The supporting portion 453 may include recessed regions 478 formed in an upper surface of the supporting portion 453, to allow the stiffness of the supporting portion 453 to be reduced by ﬁlling the recess with a low hardness ﬁlling al, having a lower hardness than the ting portion. The recess may be about 8mm by 9mm inwards from the upper most surface of supporting n 453, although other size recesses could be used.

A reduced stiffness of the supporting n 453 allows a lesser pinching force to be applied to the patient’s nose (when compared to a supporting portion with a higher stiffness), which can provide a more comfortable seal. Distance d17 between a center point of the oriﬁce 479 and a center of the headgear connectors 456 may be adjusted to bias the load on the patient interface from front to back, and dl'7 may be about 2.7mm, although values between 0mm and 4.0mm may be used. The headgear sweep angle (12 may be varied, and increasing a2 biases a load towards the back (upper lip area) of the patient interface. The headgear sweep angle (12 may be about 6.6°, although values between 0° and 10° may be used.

Fig. 56-1 illustrates a side view of the support membrane 465 with headgear tors 456. ce d18 between the top of the headgear tab 458 and the rear comer load points formed by rear thickened portion 470 may be about l-Smm, preferably about 1- 3mm, most preferably about 2m, to allow the headgear tabs 458 a n amount of movement before they touch the patient interface. This helps to stop the sealing portion from closing while it is ﬁrst being ﬁtted by the patient. The angle (13 may be 90°, which could be varied by +/- 5° If the ar connectors 456 are not molded to the t membrane 465, this angle may vary by +/— 10°, and varying a3 biases the angle that the t interface sits under the patient’s nose (naso-labial angle).

Fig. 56-2 and 56-3 illustrate cross-sectional side views of the support membranes 465 illustrated in Fig. 56—1 and Fig. 52, respectively. The stem 454 may be adapted to connect to a ring for connection to an air tube. The ring could have a socket type ﬁtting for a ball joint and/or e venting. The diameter at the base of the stem 454 has to be sufﬁcient to allow an air path with ﬂow limitations for ﬂow generator compatibility, and could have a diameter of 8 to 25mm, preferably less than 20mm and preferably about 15mm.

However, different diameters could be used, e.g., 12mm.

The stem 454 may include a thin walled portion 481, which may have a height d19 of 5.5mm, gh d19 may be varied between, e.g., 2m to 10mm. . The thin walled portion 481 allows ﬂex of the decouple region of the stem 454 with drag of a tube connecting thereto. The thin walled portion may have a wall thickness of about 0.3mm to 1.0mm depending on ﬂex and strength requirements. The stem 454 may contain stiffening ribs in a radial or circumferential manner, either internal or external, or other stiffening elements. 3.1.23 Seal with Patient The sealing portion 210 provides an effective seal with a t’s nose 324, as illustrated in Figs. 44-46. The nostril ﬂare portions 384 of the sealing portion 210 provide a seal with a patient’s nostril ﬂares 385. The nose tip portion 352 provides a seal with the patient’s nose tip 353. The upper lip portion 350 provides a seal with the patient’s upper lip 351. The nostril ﬂare portions 384, nose tip portion 352 and upper lip portion 350 all help provide an effective and comfortable seal with the t, and help position the oriﬁce 336 adjacent to the patient’s nares. 3.2 Suspension System In Figs. 1-1 to 1-18 for example, the sealing portion 210 is ed or otherwise provided to a suspension system 215. ment may be ent (e.g., including but not limited to: single component mold (e.g. see Figs. 1-2 to 1-8), co-molding, insert molding, gluing, or any other le means). Alternatively, attachment may be with removable means (e.g., including but not limited to: clips, Velcro TM, tongue and groove, or any other suitable means). In an embodiment, ment of the sealing portion 210 to the suspension system 215 may occur along the perimeter of aperture 211 on sealing n 210 and aperture 216 on suspension system 215.

Suspension system 215 may be provided to mask 200 to decouple or absorb forces from the sealing portion 210 and the remaining components of patient interface 100 (e.g., air delivery tube 20). Suspension system 215 may be formed from a generally ﬂexible al such as silicone, foam, gel or any other suitable material. 3.2.1 Shape Suspension system 215 may have a generally wedge or triangular shaped cross section as shown in Fig. 1-8 and 1-14. Such shape may help to orient the sealing portion with respect to the t’s nose in use.

The surface adjacent aperture 216 of suspension system 215 may be generally U or V shaped as shown in Figs. 1-12 and 1-l3. Such surface may deﬁne an angle0 between about 90-180°, e.g., about 0°. Alternatively, suspension system 215 may be relatively ﬂat.

In an embodiment, suspension system 215 may be similar to the gusset disclosed in US. Patent Application Publication No. 2009/0044808 published 19 February 2009, which is incorporated herein by reference in its entirety. In an embodiment, suspension system 215 may be r to the ling element disclosed in PCT ation No. , ﬁled 27 February 2009, which is incorporated herein by reference in its ty. 3.2.2 Connection to Frame In the illustrated embodiment of Figs. 1—1 to 1-18, suspension system 215 includes a ting ring 217 to sealingly attach suspension system 215 to a frame 220.

Connecting ring 217 may interface with a channel 227 provided along the frame perimeter to form an interference ﬁt. The interference ﬁt may be achieved by a tongue and groove, snap ﬁt or any other suitable means. In another embodiment, the connecting ring 217 may be adapted to attach to an elbow 230 and/or an air delivery conduit 20. For example, elbow 230 may interference ﬁt within, around or against connecting ring 217 so as to seal the connection of the elbow 230 or air delivery conduit 20 with the suspension system 215.

The connecting ring 217 deﬁnes aperture 218 to allow the e of breathable gas from frame 220 into suspension system 215. The re 216 allows the passage of breathable gas from the suspension system 215to the sealing portion 210. 3.2.3 Foam or Gel Suspension System sion system 215 may constructed of an alternative material to silicone that may provide greater compliance, ence, lity, comfort, and/or consumer appeal.

For e, the suspension system may be constructed of foam. Foam acts as a spring to support the sealing portion 210 and urge it towards the nares of the patient in use. The compliance of the foam also enables adjustment of the seal position. Figs. 3—1 to 3- 6 show various views of a foam suspension system 215 for use between the sealing portion 210 and the frame 220. The foam may be an open or closed cell foam or a foam with a combination of open and closed cells. The foam may be skinned or un-skinned. The foam may be 1-50mm thick, e.g., 30mm thick.

In an alternative embodiment, the suspension system may be constructed of gel. Gel may be conformable, compliant and comfortable. In an embodiment, multiple durometer gels may be used. Fig. 8-1 illustrates a gel suspension system 215 according to an embodiment of the present logy. As illustrated, the gel suspension system 215 is in the form of an encapsulated gel jacket 278 provided between the g portion 210 (e.g., silicone) and a base 279 (e.g., plastic). In an embodiment, the gel suspension system may alter the geometry of the sealing portion, e.g., ﬂex thinner regions of the sealing portion (e.g., nose tip engagement portion). The gel may be a silicone gel, polyurethane gel or any other le gel. The gel may a gel as disclosed in PCT application No. , ﬁled 17 November 2008, which is incorporated herein by reference in its entirety.

In an embodiment, the sealing portion 210 may overhang the foam or gel suspension system to reduce weight and enhance compliance along the edges of the g portion 210 to ﬁt a wider range of t’s facial geometries. For example, Figs. 8-2 and 8-3 illustrate the sealing n 210 (e.g., silicone) nging a gel suspension system 215.

Such overhang allows the edges of the sealing portion to “give” or “pinch” depending on ation to enhance the seal. As illustrated, edges of the sealing portion 210 may include a tear-drop shape gel pocket to facilitate sealing in gaps and comers of the patient’s face in use.

In a further embodiment, the suspension system could be constructed from a thermoplastic elastomer (TPE). 3.2.4 Sealing Portion with Flexible Tube In an alternative embodiment, the suspension system may be in the form of a ﬂexible tube that is provided (e.g., co-molded) or otherwise attached to the base of the sealing portion.

As shown in Fig. 16-1, the ﬂexible tube 280 may be corrugated to allow the tube to move relative to the sealing portion 210 in any direction, e.g., compress, expand, bend, etc., e.g., like a drinking straw As shown in Fig. 16-2, the ﬂexible tube 280 is provided with ﬂexible spiral ribbing which allows the tube to resiliently bend relative to the sealing portion 210.

In each embodiment, the end of the tube may be d directly to the air ry tube in use.

In each embodiment, the ﬂexible tube 280 may have a nt wall section.

Alternatively, the ﬂexible tube 280 may have a g wall thickness to, for example, alter the h, elongation or ﬂexibility characteristics of the tube in speciﬁc regions.

In an embodiment, one or more vents may be provided to the tube (e.g., molded into tube, insert molded, attached to tube as separate insert) and/or one or more vents may be provided to a swivel on the end of the tube.

] As shown in Fig. 26, a concertina portion 354 and a hinge portion 356 may be provided between the sealing potion 210 and the tube 20. The concertina portion 354 absorbs movement of the tube 20 when the tube 20 rotates away from the patient’s face in use. That is, when the sealing n 210 is oned, the tube 20 cannot ﬂex into the patient’s face as the patient’s chin or other parts of the patient’s face will prevent such movement. When the tube 20 ﬂexes away from the patient’s face in use, the hinge n 356 will transmit the movement of the tube 20 into the concertina portion 354 and thus prevent movement of the sealing portion 210, ving the seal with the patient. The hinge portion 356 may also prevent the concertina portion 354 from stretching out, preventing the concertina section 354 from losing structural integrity and allowing the concertina section to continue absorbing movement of the tube 20. Fig. 26 also shows the position of the nose tip portion 352 and the upper lip portion 351 of the sealing portion. 3.2.5 Gusset WO 39014 In an embodiment, as shown in Fig. 17-1, the suspension system may be in the form of a gusset or decoupling chamber 281 that is provided (e.g., co-molded) or otherwise attached to the base of the sealing portion 210. In use, the gusset 281 may expand/compress/tilt to enhance the range of adjustability.

The thickness of the gusset side walls may be constant, for example about 0.2 to 3mm thick, preferably 0.2 to 1mm thick, most preferably 0.3mm thick. Alternatively, the gusset side walls may be varied throughout, for example some regions may be thicker than others to aid coupling of the air delivery tube to the gusset, or some regions of lesser thickness than others to promote ﬂexibility in that region.

In this embodiment, the base of the gusset may be coupled directly to the air delivery tube 20 in use.

In another embodiment, as shown in Fig. 17-2, headgear connectors 240 may be provided to the sealing portion 210 for attaching headgear. As illustrated, the headgear connectors may extend from a line-type base 282 which allows the sealing portion to ﬂex, stretch, and/or bounce relative to the ar connectors and hence the headgear to ate pressure in use. Such arrangement enhances adjustability along with the gusset.

Preferably, ar connectors 240 may be between the sealing portion 210 and the e base 282 to permit decoupling of tube forces from the sealing portion 210.

Furthermore, an additional trampoline—type arrangement 283 may be provided to the base of the gusset 281 to allow additional adjustability of the air ry tube to relative to the gusset. 3.2.6 Tube ling Mechanism The sealing portion 210 may be ed with a spring portion 413 (Fig. 41) to absorb or take up tube drag forces. The spring portion 413 may have a width 416 that is less than the width 418 of the sealing n (cradle) connection portion 399 and the swivel connection portion 414. The swivel connection portion 414 may connect to a swivel ring 415 such as the embodiment described above. Fig. 41 also shows headgear straps 390 attached to the sealing portion 210 to support the mask in position on the patient’s head. 3.2.7 Swivel Ring e Venting The swivel ring 415 may include one or more gas washout vents 422. The gas washout vents 422 may take ed as one or more aperture, hole, slot or scallop. Fig. 42-1 and 42-2 illustrate a swivel ring 415 with one or more gas washout vents 422 cut out of the inner wall that interfaces with an elbow wall 426 (shown in dashed lines), to form one or more vent slots or gas washout vents 422 that enable expired gases to pass through and exit from the mask to atmosphere. There may be one or more vent slots or gas washout vents 422 (3 shown), which are formed n the support walls 424. The elbow wall 426 interfaces with the inner wall 423 of the swivel ring 415 and also the support walls 424. The support walls 424 prevent the elbow from accidental disassembly.

Fig. 42-3 illustrates where the swivel ring 415 connects to the sealing portion 210 at cradle ﬂange 430 and to the elbow at elbow ﬂange 432. The swivel ring 415 is inserted into an aperture in the sealing portion 210 and is retained by an interference ﬁt with the ﬂanges on either side of the sealing portion interference web 434. The sealing portion interference web 434 may be U-shaped, although other shapes may be used. In an example, the swivel ring 415 may be structured similar to that shown in ﬁled October 22, 2008, which is incorporated herein by reference in its entirety.

Fig. 42-4 illustrates ative gas washout vents 422 where there is an array of small holes provided as the gas washout vents 422 within the swivel ring 415. The gas washout vents 422 (e.g., from 5-50, or about 15) may be about 0 mm, e.g., 0.7mm, in diameter.

Fig. 42-5 rates alternative gas washout vents 422 where there is a single vent slot provided as the gas washout vent 422 in the swivel ring 415. Fig. 42-6 illustrates another alternative gas washout vents 422 where there are multiple vent slots provided as gas washout vents 422 in the swivel ring 415 (e.g., more than 2, or about 5-20).

Fig. 42-7 illustrates an array of vent holes provided as gas washout vents 422 arranged about the swivel ring 415. As rated, two rows of vent holes are provided as the gas washout vents 422, with the vent holes from each row being offset or staggered from one another. The vent holes may be positioned or arranged in other rations.

] Fig. 42-8 illustrates an exemplary cross section of the vent holes provided as gas washout vents 422 shown in Fig. 42-7. The diameter] of the vent holes varies from the entrance to the exit in this ment, e.g., the vent holes tapers along their length. The diameter D1 of the vent holes on the side of the swivel ring 415 facing the sealing portion 210 is greater than the diameter D2 on the other side of the swivel ring 415. The diameters D1 and D2 could also be the same, or the er D2 could be greater than the diameter D1. The diameter of the vent holes may be about 0.5-1.0mm. Preferably, the er of the vent holes may be about 0.7mm.

In all of the above venting examples, the venting is directed downwards and therefore away from the patient’s face, and along the elbow or air delivery tube. The vent holes 422 are also arranged on only half or a portion of the swivel ring 415 so that air may avoid being directed towards the patient’s chest in use. 3.2.8 Vent ion ] As illustrated in Fig. 43, the direction of air expelled from the vent 395 may be d by positioning the attachment of the elbow 397 to the sealing portion 210 using a plenum 438. The plenum 438 may attach the sealing portion 210 in an upwards position so as to engage with a patient’s nose in use. The plenum 438 may attach via swivel ring 415 to elbow 397 in a location where it will avoid contacting the patient and direct air away from the t when in use. The plenum 397 may further absorb tube drag forces by buckling or ssing when the tube drag force is applied, rather than dislodging or moving the sealing portion 210 from its sealed position. 3.3 Frame Figs. 1-9 to 1-14 show the suspension system 215 connected to the frame 220 (without sealing n 210 provided to the suspension system 215), and Figs. 1-15 to 1-18 show the suspension system 215 connected to the frame 220 (with sealing portion 210 provided to the suspension system 215). In the illustrated embodiment, the suspension system 215 includes connection ring 217 adapted to be push ﬁt into channel 227 on frame 220. Alternatively, suspension system 215 may be connected to frame 220 by other removable means, e.g., such as clips, hooks, zip locks or any other suitable means. Also, suspension system 215 may be ed to frame 220 by permanent means, e.g., including but not limited to insert molding, co-molding, gluing, etc.

Frame 220 may be generally more rigid than suspension system 215 and g portion 210 to support and stabilize sealing portion 210 and/or suspension system 215. Frame 220 may be made from, including but not limited to, silicone, TPE, polycarbonate, polypropylene, foam, gel, nylon etc.

As best shown in Fig. 1-10, frame 220 may include an aperture 226 adapted to connect to an elbow 230 or to an air delivery tube 20. Frame 220 may connect to elbow 230 or air delivery conduit 20 by a snap ﬁt, tongue and groove mechanism or any other removable or non-removable connection. Exemplary connections are disclosed in US. Patent Publication No. US 2009-0044808, which is incorporated herein by reference in its entirety. 3.3.1 Headgear Attachments In the illustrated ments, frame 220 includes headgear attachments or connectors 240 to removably attach headgear 150 and/or headgear rigidizers 160 to the mask 200, as shown in Figs. 1-1 and 1-9 to 1—18. Headgear ments 240 may be made from, e.g., including but not limited to: silicone, TPE, polycarbonate or any other suitable material.

Headgear attachments may be molded with frame 220. Alternatively, headgear ments may be provided to the suspension system 215 and/or sealing portion 210 as described below.

Alternatively, headgear attachments may be attached to any part of the mask 200 by, e.g., including but not limited to: gluing, push clip, snap ﬁt, etc.

] As illustrated in Figs. 61 to 64-2 and 67, the patient interface 459 may be secured to the t with ar 484. The headgear 484 may extend in use from the headgear connectors 456 n the patients eyes and ears on each side of the patients head and t at the top n of the patient’s head. An adjustable connector 500 may allow the adjustment of the headgear to ﬁt the patient. The headgear 484 may include a back of head n 485 that wraps around the back of the patient’s head.

In an embodiment, headgear attachments may include those disclosed in US.

Patent Application Publication No. 2009/0044808 published 19 February 2009, which is incorporated herein by reference in its entirety. 3.3.1.1 Orientation In the illustrated embodiment, the headgear connectors 240 extend generally perpendicular to the longitudinal axis of frame 220 as shown in Fig. 1-12, e.g., indicated with B. As shown in Fig. 1-1, the rigidizers 160 are rotatably coupled to tive headgear connectors (as described in U.S. Patent Application Publication No. 044808 incorporated herein by reference) to allow ment to suit the nasolabial angle for a large range of patients. In addition, such arrangement allows adjustment of the suspension system to move the suspension system away from the patient’s top lip. 3.3.1 .2 Alternative Positioning In an ative embodiment, headgear connectors may be provided closer to the sealing pOrtion to improve stability of the seal as it eliminates or reduces the length of the moment arm. For example, Fig. 10 illustrates headgear connectors 240 provided to the sealing portion 210 directly.

In another embodiment, the headgear connectors may be positioned so that the ar straps/rigidizers extend under the l engagement ﬂaps 214 in use. For example, as shown in Fig. 11, the headgear connectors 240 may be provided to the suspension system 215. In use, the headgear straps 190/rigidizers 160 are positioned under the nostril engagement ﬂaps 214, which straps/rigidizers act as stops to prevent further deformation of the ﬂaps and/or urge the ﬂaps upwards in use. The /rigidizers are positioned to engage speciﬁc regions of the ﬂap and allow remaining portions of the sealing portion to bend or conform in use. As illustrated, a strut 284 may be placed under the ﬂaps for engaging the straps/rigidizers.

In another ment illustrated in Fig. 47-3, a t interface 459 includes headgear connectors 456. The headgear connectors 456 may include tabs 458. The tabs 458 may provide connection points for connecting headgear. The headgear tors 456 may be molded together with the stem 454. Alternatively, ar connectors 456 may be removably attachable to stem 454 and/or the supporting portion 453. For example, headgear connectors 456 may be clipped, wrapped or ise connected to the stem 454. connectors 456 may have a hardness of about durometer 20 to 80 , Headgear Shore A, preferably about 20 to 60 Shores A, and most preferably about 40 Shore A. The geometry of the supporting portion 453 may be adjusted to be molded with the headgear connectors 456.

The position of the headgear tabs 458 relative to the g portion 450 is important. If the headgear tabs 458 are too low, i.e. further away from the sealing portion 450, they may not provide enough stability. The greater the distance from the sealing portion 450 to the headgear tabs 458, the longer the lever arm and hence a greater tendency for movement of the sealing portion 450. If the headgear tabs 458 are too close to the top of the sealing portion 450, the g portion 450 may hinge inwards beyond what is required for seal, and increase the force on the patient’s nose. There could also cause a possibility of occlusion of the t nares. Accordingly, the headgear tabs 458 should be 1 to 10mm_ from the sealing n. Preferably, the headgear tabs 458 should be about 2 to 5 mm from the sealing portion.

Further details of such headgear connectors and tabs are disclosed in 2008/001557, ﬁled October 22, 2008, which is incorporated by reference herein in its entirety. 3.3.2 Sealing Portion Support In an embodiment, as shown in Figs. 18-1 and 18-2, the frame 220 may include an exoskeleton or support arrangement 290 structured to urge the nostril engagement ﬂaps 214 towards the nostrils in use. As illustrated, the ﬁngers 291 provided by the exoskeleton 290 will support and shape the sealing portion when engaged therewith. That is, the exoskeleton is constructed of a more rigid material than the sealing portion, so that the ﬁngers may ﬂex/deform, but to a less extent than the sealing portion so that the ﬁngers will urge or pinch the g portion on the t’s nose.

In an embodiment, the base of the g portion may include a rolling ne 292 adapted to ﬁt into the exoskeleton so as to provide some adjustability of the sealing portion to relative to the exoskeleton (e.g., compress or expand).

In an embodiment, the sealing portion and exoskeleton may be provided as a one-piece molding or may be formed separately and ed to one r. 4. Headgear As best shown in Fig. 1—1, headgear 150 may include side straps 190, top strap 170, back strap 180 and rigidizers 160 provided to respective side straps 190 (e.g., stitched onto respective side straps).

In the illustrated embodiment, the rigidizers provide end ns adapted to engage respective ar connectors 240 on the frame, e.g., with a snap ﬁt, as shown in Fig. 1-1. However, the rigidizers may be coupled to respective headgear connectors in Other suitable manners, e.g., rigidizers include openings adapted to receive respective lug-like headgear connectors.

' In an embOdiment, headgear 150 may include headgear disclosed in U.S.

Patent Application Publication No. 2009/0044808 hed 19 February 2009, which is incorporated herein by reference in its entirety.

The rigidizers may be conﬁgured to add support to selected areas of the mask.

For example, the zers may provide cheek supports (like those disclosed in US. Patent Application Publication No. 2009/0044808) and/or the rigidizers may be conﬁgured to engage lower cheek or chin portions for supporting/locating the mask in use (see Fig. 12).

In an alternative embodiment, headgear straps may be constructed of silicone and rigidizers may be co-molded into tive silicone straps.

In the illustrated embodiment, the headgear provides a int connection to the mask. However, other arrangements are le, e.g., three-point, or more. 4.1 One-Piece Headgear Figs. 13-1 and 13-2 illustrate headgear 150 ucted in one piece, e.g., cut from material as a one-piece structure. As illustrated, the headgear 150 includes a central portion 185 and side straps 190 adapted to engage one another, e.g., via a buckle ement.

The central portion 185 includes an opening 186 for ing and supporting a sealing portion 210. As shown in Fig. 13-3, the headgear may include a contoured portion 187 surrounding the g 186 which is adapted to support the sealing portion in use.

In an embodiment, as shown in Fig. 13-4, the region 188 nding the g 186 may be conﬁgured to provide a trampoline-type arrangement to the sealing portion 210 which allows the g portion to ﬂex, stretch, and/or bounce relative to the headgear 150 to alleviate pressure in use. For example, the region surrounding the opening may be thinner than the remaining portions of the headgear.

In another embodiment, as shown in Fig. 13-5, the headgear 150 may be formed in one piece with the sealing portion 210.

In each of the above arrangements, the air delivery tube 20 may be connected directly to the base of the sealing n 210. 4.2 Adhesive Headgear As shown in Fig. 15, instead of ar, adhesive strips 285 may be ed to respective nostril ment ﬂaps 214 to adhere the sealing portion 210 directly onto the patient’s face.

However, the strips may be provided to a lower portion of the sealing portion, e.g., as indicated in dashed lines in Fig. 15. Examples are disclosed in US. Patent Application No. 12/478,537, ﬁled June 4, 2009, which is incorporated herein by nce in its entirety. 4.3 Other Headgear Fig. 86 illustrates headgear 484 that includes a strap 527 and a back strap 529.

The strap 527 includes slots 531 for attaching to headgear connectors 456 (Fig. 47-2), and an adjustable connector 500. The strap 527 could connect to the headgear connectors 456 by other connecting structure, e.g., utilizing hook and loop type connectors.

The strap 527 is conﬁgured to extend in use between the patient’s eyes and ears and connect at the top of the patient’s head with the adjustable connector 500. The ﬂexible tube 486 may be attached to the strap 527 in the area of the adjustable connector 500 of strap 527 by a tube clip or other retention means, to hold the ﬂexible tube 486 in place at the top of the patients head.

Back strap 529 is conﬁgured to extend in use around the back of the patient’s head to assist in maintaining the strap 527 in on. The back straps may include a tor 500 for ting at the back of the patient’s head, or alternatively may be a single piece strap. The strap 527 and the back strap 529 may be silicone or other suitable material, such as elastic or TPE.

Figs. 87-89 illustrate headgear 533 that includes two side portions 535 and a rear portion 524 connected to each of the side ns 535. The side portions 535 each n a ﬁrst slot for connecting to the headgear connectors 456 (Fig. 47-2), and a second slot 537 for connecting to the rear portion 524. The rear n 524 may have an end portion 526 that threads through the second slot 537. The end portion 526 may be formed with a hook-type material, for connecting to a loop-type material 528.

The side ns 535 may be formed from a silicone material, which may be . The silicone material may reduce the visual bulk of the side portions 535 by giving them a more streamlined appearance. The rear portion 524 may be formed from a softer material to provide comfort to the patient, such as a soft polymeric material, e.g., TPE or thermoplastic urethane (TPU).

] The rear portion 524 may include one or more rigidizer or stiffener to help maintain the shape of the headgear and also secure and position the headgear in relation to the patient’s crown and/or occiput. The one or more rigidizer may be constructed of a rigid or semi-rigid material structured to add rigidity or stiffness to the headgear and anchor the headgear in position in use. The rigidizer may be able to bend or deform along its length but resist or prevent stretching of the headgear in the lengthwise direction of the rigidizer. The rigidizers may be substantially inextensible. The rear portion 524 may wrap around a crown of the patients head. The rigidizer may be resilient. The rear portion may be thermoformed and/or ultrasonically die cut, such as disclosed in , ﬁled December 10, 2009. The headgear disclosed in may be ed with the present technology disclosed in this application, and is hereby incorporated by reference in its entirety.

Figs. 90 to 93 illustrate ar 539 that is formed in one piece. The ar 539 covers over the front of the patient interface in area 541 and covers the headgear connectors 456 to give a more streamlined appearance. Rigidizers may be included in or on the headgear 539 for added stability.

Fig. 94 illustrates headgear 543, which is similar to headgear 539 in that it covers over the front of the patient interface in area 541. However, headgear 543 es cutout portions 545 that allow the headgear tabs 532 to be e on the outside of the headgear 543. This arrangement may assist in alignment of the headgear with the patient ace.

Fig. 110 illustrates headgear 484 that may be used with any of the ments herein, and includes a hook and loop attachment. A loop material 560 may be positioned on a ﬁrst portion of the headgear 484, and a hook al 562 may be positioned on a second portion of the headgear 484. The hook material 562 and the loop material 560 fasten when pressed together, but allow a user to pull them apart when a n amount of force is exerted.

A ﬁnger loop 558 may be included on the hook material 562 to aid the user in gripping and ﬁnding the end portion of the hook material 562. A buckle 590 may be attached to an end of the portion of the headgear 484 having the loop material 560 to aid in alignment and guide the hook material 562 portion of ar 484 into position on the loop material 560. The buckle 590 and ﬁnger loop 558 may be interchanged, i.e., the buckle 590 at the end of the hook material 562 and the ﬁnger loop on the loop material 560 portion of the ar 584.

. Elbow In Fig. 1-1, the elbow 230 (e.g., with swivel) is generally L-shaped and is adapted to t the mask to the air delivery tube 20.

] In an alternative embodiment, the elbow may be bendable or ﬂexible to prevent or reduce tube drag in use. For example, as shown in Figs. 14-1 and 14-2, an intermediate portion of the elbow 230 may include a series of corrugations 286 and a living hinge 287 to allow end portions of the elbow to pivot relative to one another in use. Such corrugated elbow may be molded in one piece (e.g., 2-shot mold, co-mold, insert mold) or may be an assembly (e.g., -2 or 3 part assembly).

In another embodiment, as shown in Fig. 14-3, a ﬂexible region 288 may be incorporated into the elbow 230 to allow end portions of the elbow to move relative to one another in use. The ﬂexible region may be constructed of resilient material (e.g., TPE, soft rubber) to allow the ﬂexible region to compress and expand. Such elbow may be formed by molding, e.g., 2-shot mold, d, insert mold.

In r embodiment, a corrugated region 289 may be provided between end portions of the elbow 230 to allow the end portions to move relative to one another in any ion, e.g., compress, expand, bend, etc. Such elbow may be formed by molding, e.g., 2- shot mold, co-mold, insert mold.

WO 39014 In another embodiment, as illustrated in Fig. 38, a generally L-shaped elbow 397 ts to a sealing portion or mask system at one end and to a tube at the other end, e.g., sealing portion connector 399 to a sealing portion or mask system, and tube connector 398 to a tube.

A vent 395 may be positioned between the connectors. The elbow 397 is conﬁgured such that when the patient is wearing a mask, the elbow 397 moves the tube connector 398 away from the patients face and upwards of the mask, so that the tube may be positioned over the patients head in use. The vent 395 advantageously directs expired air away from the patients face in use. Connector 398 may attach the an air delivery tube and connector 399 may attach to a mask, such that the vent 395 is parallel to the t and facing directly away from the patient’s airways. 6. Sealing Portion without Suspension System ] In an alternative embodiment, the mask 200 may be provided without a suspension system between the sealing portion 210 and the frame 220, i.e., sealing portion attached directly to frame as shown in Figs. 2-1 to 2-6.

In such embodiment, sealing portion 210 may be removably connected to frame 220 by, e.g., including but not limited to: snap ﬁt, tongue and groove, clips, etc.

Alternatively, sealing portion 210 may be permanently connected to frame 220 by, e.g., including but not limited to: co-molding, insert molding, gluing, etc. In an alternative form, sealing portion 210 may be constructed in one piece with the frame 220. 6.1 Shape Sealing portion 210 may be generally gular or ical when viewed from the top, as shown in Fig. 2-7B. In an alternative embodiment, sealing portion 210 may be generally triangular or trapezoidal when viewed from the top, as shown in Fig. 2-7A. The embodiment of Fig. 2-7A is structured to reduce the amount of excess material in the sealing portion 210 that may cause fort or be less obtrusive. This may also be to indicate alignment to the patient, i.e., the patient may be more likely to tly align a triangular shaped sealing portion 210 as the nose is naturally shaped more like a le and thus the nose tip engagement n 212 and upper lip ment portion 213 are more likely to be oriented in their desired locations.

As shown in Figs. 2-8B and 2-9B, the upper lip engagement portion 213 of the rectangular-shaped sealing portion is sufﬁciently long such that its free end overhangs at least a portion of the frame, e.g., to prevent engagement of the t’s upper lip with the frame in use. In on, the upper lip engagement portion may be ently long so as to accommodate a variety of nose and upper lip shapes (e.g., the embodiment shown in Fig. 2- 8B may have a larger ﬁt range of patient’s than the embodiment shown in Fig. 2-8A). In the triangular-shaped sealing portion embodiment, as shown in Figs. 2-8A and 2-9A, the length of the upper lip engagement portion 213 is shortened or abbreviated, e.g., to reduce the amount of excess material. Fig. 2-10 illustrates the triangular-shaped sealing portion embodiment engaged with t’s face in use.

Fig. 2-11 is a rear view of a sealing portion showing a portion of the upper lip engagement portion 213 to be removed (shaded section), e.g., with respect to the sealing portions of Figs. 2-8B and 2-9B. The reduction of al in the upper lip engagement portion may improve comfort and appeal of the mask (i.e., more unobtrusive look) and may improve leak performance. 7. Alternative Mask to Tube Connections Figs. 57 to 85 and 95 to 101 illustrate various ative mask to tube * connections that may be utilized with the present technology. 7.1 Thin Membrane As illustrated in Fig. 57, thin membrane 482 may be disposed between the supporting membrane 465 and ﬂexible tube 486. In this embodiment, headgear connectors 456 allow connection of headgear 484. As illustrated in Fig. 58, a degree of freedom of movement is provided between the support membrane 465 and the ﬂexible tube 486 by thin membrane 482, which may join the ﬂexible tube 486 to the patient interface 459 via swivel ring 480. Thin membrane 482 may stretch, ﬂex or ise elastically deform to permit movement n the supporting membrane 465 and e tube 486. Thin membrane 482 may have a wall thickness that is less than the supporting membrane 465. Thin membrane 482 may have a wall thickness of about 0.2 to 5mm. Preferably, thin membrane 482 may have a wall ess of about 0.5 to 2mm. Most preferably, thin membrane 482 may have a wall thickness of about 0.5 to 1mm. Movement between the tube 486 and the sealing portion 450 may be limited by the length of the membrane 482, which may be adjusted based on a desired amount of movement. Any additional movement becomes a function of the e tubing. 7.2 Multi-Axis Elbow Assembly ] Figs. 59 to 64illustrate a multi-axis elbow assembly 495 that creates additional degrees of freedom by allowing rotation in two separate planes, as shown by the arrows in Fig. 59, for example. The multi-axis elbow assembly 495 includes frame 491 which may be connected to thin membrane 482 or to support membrane 465, elbow 488 connected to frame 491, swivel assembly 494, swivel ring 492, and elbow 490.

The onal degrees of freedom provided by the multi-axis elbow assembly 495 have a marked impact on the functionality of the patient ace 459. For example, the multi-axis elbow assembly 495 allows the ﬂexible tube 486 to easily be placed on either side of the patient’s head, as illustrated in Figs. 60 and 61, to be positioned along the nose and between the eyes of the patient as illustrated in Fig. 62, while being streamlined (not bow outward), while applying a moment to the patient interface that is almost zero. Additionally, as shown in Figs. 63 and 64, the ﬂexible tube 486 may also be positioned in a downward conﬁguration or in an outward conﬁguration, respectively. The multi-axis elbow ly 495 allows the tube 486 to be placed in many different positions that may be utilized by a patient while not ng signiﬁcant moment to the patient interface created by tube drag to provide an effective and table seal with the patient. 7.3 Bellows Short Tube Decouple A bellows or concertina tube le is illustrated in Figs. 65-69. A series of bellows 502 connects to patient ace 459 at one end, and connects to a tube 506 at the other end. The tube 506 may have a swivel tor 504, which may be used to connect to a gas supply tube, for example. The bellows 502 es a bore with a plurality of supportive rings that helps prevent air path occlusion under tight bending conditions, i.e. the bellows may have a thicker wall section than the portions of the bore without the bellows portions.

Alternatively, the bellows and the bore may have a constant wall section. The length of the bellows may be selected to e a decoupling on, to retain the seal of the patient interface 459 e bending of the bellows 502. The bellows 502 thus es a degree of freedom of movement between the patient interface 459 and the tube 506.

The bellows 506 may be molded as a unitary structure with the support membrane 465, or may be a separately, removably attachable element. The bellows 502 may be formed from a material with a hardness of about durometer 20 to 80 Shore A, preferably to 60 Shore A and most preferably about 40 Shore A to match the support membrane 465 so that both parts may be molded together, and where the bellows 502 is a separate element, it may have a different hardness, such as about ter 20 -40 Shore A, preferably about 20 Shore A. ably, when a durometer of Shore A 40, a preferred thickness is about 0.3mm.

The bellows 502 may have an al bore of 8 to 20mm, preferably 10 to 15mm, most preferably 12mm or 15m. A thin ne may be used between the bellows 502 and the support membrane 465 ofthe patient interface 459.

The added ﬂexibility ofthe bellows 502 allows the tubing 506 to be easily positioned overhead as illustrated in Fig. 67, to the side of the head, outward or downward with minimal force on the patient interface 459. The bellows 502 has a wide separation between rings to ensure adequate g with the tube. The bellows 502 prevents ion of the air path when the tube bends sharply.

Fig. 69 illustrates various dimensions of the bellows rings and sidewall shown in Fig. 68. Each bellows ring has a height of e.g., 2 to 6mm, preferably 3 to 5mm, most preferably 5mm, including the sidewall, and a width of, e.g.,about 2 to 8mm, preferably about 3 to 6mm, most preferably about 4mm. The radius R1 of the curved n between each bellows ring may be about 1 to 4mm, preferably about 2 to 3 mm, most preferably about 2.5mm, the separation between the rings of the bellows is, e.g., about 2 to 8mm, preferably about 4 to 6mm, most preferably about 5mm, and the thickness of the side wall of the bellows ring is, e.g., 0.2 to 2mm, preferably about 0.5 to 1.5mm, most ably about 0.3mm. The radius of the bellows 502 measured from an inner side of the bottom of each curved portion between the bellows ring is, e.g., about 4 to 12mm, preferably about 6 to 10mm, most preferably about 7.5mm. These values may be varied but have been found to provide improved impedance and overall tube/patient interface compatibility while providing a very e bellows at about durometer 20 to 60 Shore A, preferably about 40 Shore A.

WO 39014 7.4 Ball and Socket Fig. 70 illustrates a patient interface 459 that connects to a ﬂexible tube 486 via a ball and socket connection. The ball and socket connection es a ball 508 and a socket connector 510. The ball 508, also rated in Fig. 71, may be connected to the ﬂexible tube 486 by connector 507, also illustrated in Fig. 72. The socket connector 510 may be connected to the patient interface 459. The socket tor 510 may be a conventional elbow ring sized to accept the ball 508. The socket connector 510 may also include a diffuse vent allowing exhaled air from the patient to be vented.

The ball and socket connection provides decoupling of movement of the ﬂexible tube 486 to relieve moment created on the patient interface 459 d by tube drag.

As the ﬂexible tube 486 is moved about, the ball 508 may move about in socket connector 510.

Fig. 73 and 74 illustrate the ball 508 connected to an elbow 509. The elbow 508 may connect to a ﬂexible tube. The elbow 509 includes a bend, which may be, e.g., about 90° to 150°, preferably about 100° to 130°, most preferably about 110°, although other angles may be used. The elbow 509 may include a vent 511, which may include one or more vent holes 513 for venting exhaled air. The vent holes 513 may be an array of spaced apart vent holes. Preferably, the internal diameter of the bend is about 7 to 15mm. Preferably, bend may have an internal diameter of less than 12mm. Most preferably, bend may have an internal er of about 8mm.

Ball 508 may preferably have outside diameter in the range of about 15 to 19mm. Most preferably, ball 508 may have an outside diameter of about 17mm.

Ball 508 may preferably have an internal diameter of about 7 to 15mm.

Preferably, ball 508 may have an internal diameter of less than 12mm. Most preferably, ball 508 may have an internal diameter of about 8mm.

As rated in Fig. 75, the vent may be in the form of a ble insert ’ 517. The removable insert 517 may be attached to the elbow 509 by structure to lock it in place, such as lugs, tongue and groove, etc. The insert may be a mesh vent 515, as shown in Fig. 76. ‘ ] Fig. 77 illustrates an embodiment in which the ball 508 includes a series of vent grooves 501. The vent grooves 501 may have a length to extend to both sides of the socket connector 510 in use, so that d air may exit through the vent grooves 501. Vent s may have a length of about 2 to 50mm. Preferably, vent s 519 may extend along the outer surface of the ball 508 to create a long vent ﬂow path. A long vent ﬂow path may reduce the noise of the exiting gases as the velocity of the air may decrease. Preferably, vent grooves 519 are distributed around ball 508 to diffuse the exiting air ﬂow paths.

Preferably, vent grooves 519 are molded on ball 508. Preferably, grooves 519 have a width of about 0.2 to 3mm. Preferably, grooves 519 have a width of less than 1mm. The thinner the groove, the slower the air ﬂow and hence the quieter the vent. The grooves 519 may be generally linear or may have various other conﬁgurations. A curved or tortuous y is preferred as this may increase the length of the vent ﬂow path and hence reduce the noise of the vent.The walls of ball 508 adjacent the s 519 may interface with the connector 510.

Connector 510 may lie over the top of groove 519 and hence form a cover over grooves 519.

Fig. 111 illustrates an embodiment in which the ball 508 includes a series of curved vent grooves 564. The curved vent s 564 may also have a width of about 0.2 to 3mm. Preferably, vent grooves 564 have a width of less than 1mm. The ball 508 may be connected to a tube 486 or to an elbow 509 or other element.

Fig. 112 illustrates an embodiment in which the ball is a perforated ball 568, which includes a series of vent holes 570. The perforated ball 568 may allow the air to ﬂow between a connector (such as connector 510) and the ball 568. The ball 508 may be connected to a tube 486 or to an elbow 509 or other element.

Figs. 113-1 and 113-2 illustrate an embodiment with a ball 508 having vent grooves 570, in which a ﬂow path barrier 592 may be removably attachable to the ball 508.

The ﬂow path barrier 592 may ace with a connector 510 to create a ﬂow path between the barrier 592 and the connector 510.

Fig. 78 illustrates an alternative socket connector 521. The socket connector 521 includes vent grooves 523. The vent grooves 523 allow exhaled air to exit the patient interface. The vent grooves 523 may extend ly ds (as shown). Alternatively, vent grooves 523 may extend axially. Alternatively, vent grooves 523 may extend along the inner surface of the inner wall of socket connector 521.

Fig. 79 illustrates the patient interface 459 utilizing the ball 508 and socket connector. The ball 508 may be freely moved in the socket connector ing a degree of freedom of movement, ng the tub 486 to be placed in various positions. 7.5 Hybrid Elbow and Ball Joint Figs. 80 to 83 illustrate a hybrid elbow and ball joint. Elbow assembly 514 includes a swivel connector 512 and a socket connector 518. Ball assembly 516 includes a ball '522 and a swivel connector 520. The ball 522 mates with the socket connector 518.

The elbow assembly 514 may utilize an angle of, e.g., 90° to 150°, preferably about 100° to 130°, most preferably about 110°. The combination of the elbow assembly 516 with the ball joint provides multiple degrees of freedom of movement. For example, utilization of an elbow without the ball joint would either force the connected tubing to close to the patient’s chin in the tube down on, or too far out in the tube up position. Utilizing the elbow assembly with the ball joint allows the tube to be place in more desirable positions.

Fig. 82 illustrates the elbow assembly 514 utilizing the ball assembly 516, with the e tubing 486 in the downward on. The ball 516 allows positioning of the ﬂexible tube 486 away from and not in contact with the patient’s face.

] Fig. 83 illustrates the elbow assembly 514 utilizing the ball assembly 516, with the ﬂexible tubing 486 in the upward position. The ball 516 allows positioning of the ﬂexible tube 486 closer to the patient’s face, to help prevent obstruction of vision. 7.6 Thin Membrane with Elbow Fig. 84 illustrates the thin ne 482 utilized with elbow assembly 514 and a swivel connector 512. The sealing n 450 includes an aperture that exits at an angle downward from the horizontal, making it difﬁcult to be able to achieve both the tube-up and tube-down positions. The thin membrane 482 is e to be able to adjust the exit angle to a more horizontal position. The thin membrane 482 thus allows the ﬂexible tube 486 to hang downward without applying excess moment to the sealing portion 450, and also allows the ﬂexible tube 486 to be properly positioned in the upward position. 7.7 Angled Elbow Ball Joint Fig. 85 illustrates an angled elbow and ball joint assembly 525. The angled elbow ball joint assembly 525 includes an elbow 514, a ball 516, and a swivel connector 520 for connecting to the ﬂexible tube 486. The angled elbow ball joint assembly 525 may include an angle of, e.g., 100° to 160°, ably about 100° to 130°, most preferably about 110°. The ball 516 may be ted to a socket tor such as illustrated in Fig. 70. The ball 516 es the freedom of movement that will allow the ﬂexible tube 486 to be properly positioned in the upward or downward positions. 7.8 Ball and Socket Assembly Figs. 95 to 101 illustrate a ball and socket assembly 561 orated with a ball joint portion and swivel ring. Swivel ring 550 may interface with the mask or support membrane 465. Ball 552 is placed within the swivel (see Fig. 101) to allow 360° rotation of the ball joint portion 548 axial to the swivel ring 550, and to move in planes other than axial to the swivel ring 550. atively, the swivel ring 550 may be omitted and the ball 552 may interface with the mask.

Connector 556 is adapted to connect to a ﬂexible gas supply tube, so that gas may be supplied in the air passageway 560 in the ion of arrow 558. The air passageway may have an internal er of 11-15mm, and the connector 556 may have the same internal diameter. A vent 554 may be incorporated into ball joint portion 548, to vent exhaled gas from a patient.

The swivel ring 550 may be manufactured in a mold and set. The swivel ring 550 may then be placed in a tool, where the ball joint portion 548 is molded about or within the swivel ring 550. As the material of the ball joint portion 548 cools down, it will shrink off of the swivel ring 550. The vent 554 may be molded into the ball joint portion 548. 7.9 Side Connected Tube Figs. 102 to 104 illustrate a patient interface 459 with a side connected ﬂexible tube 486. In all of the embodiments, the patient interface 459 may include the sealing portion 450 and the support membrane 465, even if not speciﬁcally illustrated. Two apertures 538are located on each side of the patient interface 459, and allow connection of the ﬂexible tube 486 on either side of the patient interface 456, extending towards the side (laterally). A plurality of vent holes 544 may also be included, for venting gas exhaled by the patient.

An elbow 542 may be connected to the end of the ﬂexible tube 486, and be adapted for tion to the aperture 538. The elbow may include a swivel connector allowing the ﬂexible tube 486 to be swiveled to ent positions, such as an upward position along a side of the patient’s face, as illustrated in Fig. 103, or a downward position, such as illustrated in Figs. 102 and 104. A plug 540 may be utilized on an re 538 to which the e tube 486 is not connected, to seal the aperture 538.

The side connected tube presents a streamlined appearance and moves the tube 486 away from the face of the patient. The side connected tube also decouples tube drag forces from the sealing portion 450. Further details of the side connecting interface are disclosed in US. Application Serial No. 12/377,801 ﬁled ry 29, 2008, which is incorporated herein by reference in its entirety. 7.10 Two Side Connected Tubes Fig. 105 illustrates a patient interface 459 which utilizes two side connected ﬂexible tubes 548. A frame 546 may be utilized to t the patient interface 459. The ﬂexible tubes 548 may have a r diameter than when one ﬂexible tube is utilized. For e, the ﬂexible tubes 548 may have half the diameter as when one tube is utilized. This may provide more t to the t, particularly if the patient rolls over onto one of the tubes 548. 7.11 Rigid Frame Over Patient Interface Figs. 105 to 107 illustrate a rigid frame 546, which may be adapted to ﬁt over and support the patient interface 459. For example, the rigid frame may be shaped to ﬁt over the patient interface 459. The rigid frame 546 may include headgear connectors 456for connecting to headgear 484.

The frame 546 may be formed from a rigid material to provide rigid support.

Further details of the frame 546 are also disclosed in US. Application Serial No. 12/377,801, which is orated herein by reference in its entirety. 7.12 Headgear Cradle Figs. 108 and 109 rate a ar cradle portion 552 adapted to connect to patient interface 459. The headgear cradle portion 552 may include an aperture 554 for connecting the headgear cradle portion 552 to the t interface 459. The headgear cradle portion 552 may have apertures at its ends to receiver the ar 484.

The headgear cradle portion 552 may also tactile ends 550 to enhance a patient’s grip to ease in connecting and disconnecting of the headgear 484. The headgear 484 may use hook and loop material to connect. The headgear cradle portion 552 may also include a conformable pad 556 internal to the headgear cradle portion 552. The conformable pad 556 supports the patient interface 459 and provides decoupling between the patient interface 459 and the headgear cradle portion 552. The conformable pad 556 also es a softened feel to the patient when using the patient ace 459. 7.13 Elbow With Lugs Fig. 114 illustrates an embodiment in which a patient interface 459 connects to headgear 484 and an elbow 582. The patient interface includes a connector 578 having apertures 580. The headgear 484 has a headgear connector 557 shaped to interface with connector 578, by ﬁtting over the e of connector 578. The lugs 586 of the elbow 582 ﬁt within the res 580. The elbow 582 is adapted to form an ht connection with the connector 578. The ar 484 may have apertures if needed near the headgear connector 557 to receive portions of the elbow 582 near the lugs 586. 7.14 Vented Elbow Assembly Figs 115 and 116 illustrate a vented elbow assembly. The vented elbow assembly includes an elbow 509, a swivel ring 550 and a tor 556. The swivel ring 550 may be connected to a patient interface 459 or a support membrane 465, and the connector 556 may be connected to a ﬂexible tube supplying gas.

The elbow 509 may include a series of vented grooves 558 for venting gas exhaled by the patient. The vented grooves 558 may be of different lengths, and may be arranged parallel or perpendicular to the direction of gas ﬂow through the elbow 509. 8. Additional Embodiments Figs. 23-1 to 23-7 show an additional embodiment of the present technology.

Fig. 23-1 shows a patient interface 3000 with an interfacing portion (also known as sealing portion) 2000 positioned above or on top of a supporting portion 1000. ting portion 1000 is shown in Figs. 21-1 to 21-6. Supporting portion 1000 may have a nose tip portion 212B, nostril portions 214B, and an optional upper lip portion 213B. Regions underneath or on the non-patient contacting side may have ridges or thickened sections to provide additional support to acing n 2000 when assembled, and to provide varying degrees of support to the sealing portion 210. Supporting portion 1000 may be constructed of a ne with a hardness of about 20 to 90 Shore A, preferably about 40 Shore A. The supporting portion 1000 could also be made from rbonate, polypropylene, nylon, thermoplastic elastomer (TPE), TM, etc. The supporting portion 1000 may be about 1-15mm thick, preferably 1.2mm. As best shown in Fig. 21-4, upper lip portion 213B may be cut out or removed.

Figs. 22-1 to 22-4 show interfacing portion 2000. Interfacing portion 2000 may have a nose engagement portion 212A, l engagement portions 214A, and an upper lip engagement portion 213A. Interfacing portion 2000 may engage with the patient in use. acing portion 2000 may be made from a silicone, with a ss of about 7 durometer on the Shore A scale. Alternatively, the hardness of the interfacing portion 2000 may be about 12 durometer on the Shore A scale. The thickness of interfacing portion 2000 may be about 1.2mm. The interfacing portion 2000 may be made from other suitable materials such as nylon, a textile, TPE, etc. The interfacing portion may have a polished surface ﬁnish for tactility and to ‘stick’ or tack on to the patient’s skin in use.

Figs. 23-1 to 23-7 show interfacing portion 2000 attached to or positioned on top of support n 1000. Interfacing portion 2000 may be co-molded, insert molded, glued or otherwise attached to support portion 1000. Interfacing portion 2000 may be permanently attached or removably ed.

As best show in Figs. 23-3 and 23-6, nose engagement portion 212A may be raised or supported above nose portion 212B. This arrangement may be beneﬁcial for allowing patient’s noses to ﬂex into nose engagement n 212A, thereby allowing a r ﬁt range. Nose portion 212B supports the side walls of the interfacing portion 2000.

As best shown in Fig. 23-5, upper lip engagement portion 213A is suspended over the gap at upper lip portion 213B. This allows ﬂexibility of the patient ace 3000 at the patient’s upper lip region, y allowing a greater range of ﬁt.

Fig. 117 illustrates a patient ace 600. The patient interface 600 includes a sealing portion 600 for sealing with the patient’s face, a supporting portion 608, and a connecting portion 610 for connecting to a supply of gas, such as a e tube. An optional gusset 604 may also be included.

Headgear may be ed to the patient interface 600 creating headgear vectors in an area such as position 606. This may be accomplished by disposing headgear connectors under the sealing portion 602 on the supporting portion 608, for example. An optional gusset 604 may be ed between the sealing portion 602 and the supporting portion 608.

Figs. 118-1, 118-2 and 118-3 illustrate a patient interface 612. The patient interface 612 includes a sealing portion 602, a supporting portion 616, a gusset 614 between the sealing portion 602 and the supporting portion 616, and a connecting portion 618 to a supply of gas, such as a ﬂexible tube, and an aperture 620.

The sealing portion 602 interfaces and s a seal with the face of the patient, typically with the upper lip and nose of the patient. The sealing portion 602 may include stiffened portions, such as portions of the sealing portion 602 that interface with the patient at regions of the patient’s nose adjacent the nasal labial creases. The stiffened portions of the sealing portion 602 may be formed from a non-compressible material such as a gel or a material such as a high durometer silicone as compared to other portions of the sealing portion 602. Alternatively or in addition, structural support may be added such as ribs or thickened portions on sides of the sealing portion or on the supporting portion, such as in the ment of Fig. 52-5, and/or the gusset 614 may be ﬁlled with a stiff material to e additional support.

Fig. 118-3 illustrates a cross-sectional view that includes a gel ﬁlled pocket 622 in the corner region of the sealing portion 602, and such a gel ﬁlled pocket may be located in each corner . The gel ﬁlled pocket 622 may be utilized to provide the stiffened ns and e a more effective seal with the patient in use. A gel ﬁlling on 623 may be included allowing a user or patient to add or remove gel as needed.

Fig. 119 illustrates a top view of a sealing portion 602 of a patient interface.

The sealing portion 602 may include an oriﬁce 602 for delivering gas to the patient in use.

The oriﬁce 602 may have a ntially trapezoidal shape as illustrated, or may be a substantially triangular shape. These shapes are closer to the shape of a patient’s nose, which allows a patient to more easily put the patient interface on in the correct orientation.

] Fig. 120 illustrates a patient interface 630, which includes a sealing portion 632, a supporting portion 636, an optional gusset 638, and a connecting portion 640. The sealing portion 632 may be a single wall sealing portion, and in this embodiment may e a second sealing wall 634 underneath the g n (forming a ﬁrst sealing wall) to provide additional support.

Fig. 121 illustrates a patient interface 642, which includes a sealing portion 644, a supporting portion 652, and an optional gusset 650. In this embodiment, the front portion 648 (nose engaging portion) of the sealing portion 644 is curved downward making the sealing interface deeper and more curved. This shape allows the side walls of the sealing n to ﬂex outwards more with ﬂatter noses, and allows more pointy noses to rest in the curvature provided by this shape.

Figs. 122-1 and 122-3 illustrate cross-sectional views of the patient interface 600 or 642, with the addition of a soft, conformable t structure. A support structure 604 is provided below the sealing portion 602. The support structure 604 may be foam or r soft, conformable al, while the sealing portion 602 and support portion 606 are silicone or other similar material as described herein. The support structure 604 may ﬁt into an indent formed in the side wall of the sealing portion 602 or in the supporting portion 606.

The support structure 604 may have a varying width as illustrated, or may have a constant width. Thee support structure 604 may be in the shape of a ring.

] As illustrated in Fig. 122-3, the t structure 604 may provide an additional contact on the t’s upper lip in use, and because the material of the support structure 604 is soft and conformable, it may provide additional comfort to the patient in use.

Additionally, the support structure 604 may assist in providing a seal with the patient’s upper lip. Fig. 122-2 illustrates the support structure 604 with a sealing n that curves outward at its outer edges.

The cross-section of the foam ring may vary in different regions. For example in a tip of nose region, the foam ring may have a small cross-section and be readily able to ﬂex to ﬁt different sizes of nose. In a side of nose , e.g. adapted to be located adjacent a crease region of a face, the foam ring may be thicker.

The foam ring may incorporate different densities of foam and vary the level of support in different regions.

Fig. 123 illustrates a sectional view of an inwardly curving g portion 620. The ends of the sealing portion 620 have been lengthened so as to seal against the sides (ﬂares) of the patient’s nose and e side t 622, rather than sealing just on the underside of the nose. This provides a more effective seal.

Figs. 124 and 125 illustrate a top view of a patient ace 630 having a sealing portion 636 that includes nasal prongs 634 disposed on an upper surface 640 of the sealing n 636. The nasal prongs 634 are adapted to form a seal with the patient’s nares in use. A ting portion 638 may be optionally included under the sealing portion.

As illustrated in Fig. 125, the sealing portion 636 may include support portions 642 disposed adjacent to the nasal prongs 634. The support portions may be foam or another suitable material, and are disposed in an area of the sealing portion 636 that interfaces with an upper lip and corners of the nose of the patient in use, to provide support and secure the sealing portion 636 and the nasal prongs 634 in place.

It is believed that a patient interface in accordance with the present technology is more able to accommodate different sizes and shapes of faces and noses than prior designs.

It is believed that a patient interface in accordance with the present technology may reduce the need for ory in different sizes. It is ed that a patient interface in accordance with the present technology can provide improved comfort for patents, and ed compliance with their therapy.

While the technology has been described in connection with what are presently considered to be the most practical and red embodiments, it is to be understood that the technology is not to be limited to the disclosed embodiments, but on the contrary, is intended to cover various modiﬁcations and equivalent arrangements ed within the spirit and scope of the technology. Also, the various ments described above may be implemented in conjunction with other embodiments, e.g., aspects of one embodiment may be combined with aspects of another embodiment to realize yet other embodiments. Further, each independent feature or ent of any given assembly may constitute an additional embodiment. In addition, while the technology has particular ation to patients who suffer from OSA, it is to be appreciated that ts who suffer from other illnesses (e.g., congestive heart failure, es, morbid obesity, stroke, bariatric surgery, etc.) can derive beneﬁt from the above teachings. Moreover, the above teachings have applicability with patients and non-patients alike in non-medical applications.

JAWS Ref: 505304DIV5

Claims

WHAT WE CLAIM IS:

1. A patient interface for delivering pressurized breathable gas to a patient, the patient interface comprising: a le sealing portion that is configured to sealingly engage with an exterior of the patient’s nose, the flexible sealing portion comprising a pair of resiliently le lateral sides and a central part between the lateral sides, the central part of the flexible sealing n comprising a septum locator configured to engage with the patient’s septum and the pair of lateral sides of the flexible sealing portion being configured to be outwardly flexed by the patient’s nose; and a pair of nozzles protruding from the flexible sealing portion and configured to be inserted into the patient’s nostrils in use, each nozzle having a central longitudinal axis, a base end at the flexible sealing portion and a discharge end opposite to the base end, wherein each nozzle tapers from the base end toward the discharge end, wherein the septum r is positioned n the pair of nozzles, wherein the pair of lateral sides of the flexible sealing n are configured to pivot at the septum locator when outwardly flexed by the t’s nose, and wherein the pair of nozzles are configured so that the discharge ends of the nozzles move away from each other when the lateral sides of the flexible sealing portion are dly flexed by the patient’s nose.

2. The patient interface of claim 1, wherein the pair of nozzles are configured to not seal with the interior of the patient’s nostrils.

3. The patient interface of any one of claims 1 to 2, wherein the outer surface of each nozzle is concave.

4. The patient interface of any one of claims 1 to 3, wherein the pair of nozzles are oriented so that the central udinal axes of the nozzles intersect each other. JAWS Ref: 505304DIV5

5. The patient interface of any one of claims 1 to 4, wherein each nozzle is ured so that the corresponding central longitudinal axis pivots when the lateral sides of the flexible sealing portion are outwardly flexed by the patient’s nose.

6. The t interface of any one of claims 1 to 5, wherein each nozzle comprises an opening at the discharge end configured to deliver pressurized gas directly into a respective one of the patient’s nostrils.

7. The patient interface of any one of claims 1 to 6, wherein the pair of nozzles are ured to align the le sealing portion with the patient’s nose to enable an effective seal.

8. The patient interface of any one of claims 1 to 7, further comprising a stem configured to be connected to an air delivery tube.

9. The patient interface of claim 8, n the stem is connected to the central part of the flexible sealing portion.

10. The patient ace of any one of claims 8 to 9, wherein the lateral sides of the flexible sealing portion overhang the stem.