Best mask to address RERA

[reinvigorated]

Hi all,

In your experience/opinion, what mask is the best to deal with RERAs?

The sleep studies I did showed no apnea (AHI close to 0) but I had a ton of arousals and respiratory events that lead to me having zero deep sleep (when not using CPAP). I tried full face one during the follow-up sleep study and it was quite effective. I'm now trialing a CPAP at home (just got it yesterday), but this time with a pillow nose mask (the doc. insisted that it should be sufficient for RERA given that I don't have a full-blown sleep apnea). So far the pillow nose mask feels a bit weird, to be honest: I'm never sure if it's tight enough.

I need to decide which CPAP machine and mask to purchase and I'm gravitating towards Airsense Autoset. I'm not sure about the mask though. I care most about the effectiveness and consistency, not about the way it looks or how comfortable it is. I found some conflicting information on full face vs noise vs pillow, so I would appreciate it if you could share your experience! Did any of you look at the data your machine generates and tried to correlate RERA with the type of mask you used?

Thank you very much!

[Julie]

I'm not sure that your mask type has anything to do with whether or not you have RERA, or OSA, UARS or any other form of apnea. The mask is made to deliver air in whatever way is most comfortable for you and prevents as much leakage as possible. There may be certain masks that are dialed into certain machines for optimal effect, but in general it's the machine that does the job, the mask that works best for you to sleep well with it on.

[reinvigorated]

what is causing the RERAs ?

I don't really know what's causing RERAs, but most likely it's the resistance in my upper respiratory airway (my nose gets somewhat blocked at night; I was also diagnosed with non-allergic/vasomotor rhinitis a while ago).

are they caused by your mask ??

or are they caused by your machine andor its settings ?

No, the first diagnostic study (the one done WITHOUT a mask) showed that I have them. I am now trying to address them with a CPAP machine. I'm just trying to pick the one that would be the most effective for this particular situation/purpose.

[reinvigorated]

I'm not sure that your mask type has anything to do with whether or not you have RERA, or OSA, UARS or any other form of apnea. The mask is made to deliver air in whatever way is most comfortable for you and prevents as much leakage as possible. There may be certain masks that are dialed into certain machines for optimal effect, but in general it's the machine that does the job, the mask that works best for you to sleep well with it on.

Thanks, I see. I realize that the machine plays a bigger role, but I thought that the type of mask used also played a role (even though a smaller one).

[Pugsy]

Use the mask (whichever one) that you feel the most comfortable with and can feel like you sleep the best with.
There's really no difference in effectiveness in terms of holding the airway open between nasal vs full face.
People with high RERAs typically are a bit more sensitive to just about everything. That's why they get an arousal from a small flow reduction that others would sleep right through.

You may have some UARS (Upper Airway Resistance Syndrome) going on and I haven't seen any documentation as to where a certain mask might be most suited for that type of problem. Mainly the documentation just mentions cpap/apap use as being the usual way to go to try to fix things and there's been no mention of any type of mask being "better" than another that I have ever seen.

Getting to sleep and staying asleep is the number one goal and if you try to use a mask that isn't comfortable or you don't like then you may stand a greater chance of not sleeping so great. This stuff is hard enough without adding mask discomfort into the mix.

The only caveat I might mention is that some people ...please note I said some and not all people...who have OSA will sometimes need a bit more pressure to attain the same results when they use a full face mask over a nasal mask. In theory it should not make a difference. If someone needs X amount of pressure to hold the airway open then it shouldn't matter how the pressure is delivered but I have seen too many reports from people who have used both a full face mask and a nasal mask and they note a 2 or 3 cm difference in pressure needs (full face mask needing more) for me to say it doesn't happen. Now I might be all wet in my thinking but I think that the use of a full face mask can sometimes alter the airway position a bit because of the lower strap needed to secure the bottom of a full face mask. If I put on a full face mask and look at my neck position and compare it to what my neck looks like with a nasal pillow mask there is a slight difference in the angle. Does this affect my pressure needs???? I don't really know for sure but it might.
Since I prefer a nasal pillow mask I never experimented to see if I was one of those people who have different pressure needs or not.

Either type will get the job done...just use the one that let's you sleep the best with least amount of difficulties which could potentially cause you to wake up.

[robysue]

I need to decide which CPAP machine and mask to purchase and I'm gravitating towards Airsense Autoset.

Just make sure that the AirSense AutoSet will record RERAs since that's your problem.

Since you had a successful titration study, it is worth considering whether you want to get an APAP from the same manufacturer as the machine you were titrated on. Also pay attention to whether exhalation relief was turned on or off during the CPAP study. Resmed and PR have different exhalation relief systems and some folks can tell the difference in how they feel.

I'm not sure about the mask though. I care most about the effectiveness and consistency, not about the way it looks or how comfortable it is.

Comfort is critical: If the mask is not comfortable, you will not be able to get to sleep in a timely fashion and you will probably wind up with a substantial number of comfort-related arousals. Both of which are NOT good for the overall quality of your sleep.

If the pressure is set correctly and the leaks are under control, then the mask style should not affect the efficacy of your therapy in the sense of minimizing the number of RERAs you experience while sleeping.

[reinvigorated]

Thank you for such a comprehensive response, I appreciate it!

Will definitely look into exhalation relief settings. I guess "comfortable" was not the right word, I realize that comfort during sleep is important. Don't pillow masks have a higher probability of leaking, relative to nose or face masks? Unfortunately, I cannot check this on the machine that I'm trialing at home (it's Philips Auto CPAP, but I'm not sure if it provides such detailed statistics).

[reinvigorated]

I'm thinking of getting the AirSense Autoset 10 machine and one of these masks:
1. Swift™ FX Nasal Pillow CPAP Mask with Headgear
2. Mirage Swift™ II Nasal Pillow CPAP Mask with Headgear
3. AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
4. AirFit™ N20 Nasal CPAP Mask with Headgear

Are there any significant non-obvious differences that I should keep in mind when making the choice? Thank you all!

[Pugsy]

Actually from my personal experience with masks the less area that needs to come in contact with the skin to stay sealed is better for me. The more places any mask touches my skin the more places there are potential for leaks to happen.
For this reason I prefer nasal pillow masks and they don't leak anymore than any other mask when properly sized and fitted.
I toss and turn all night (bad back) and they will rarely move no matter which position I end up in. I can even sleep on my stomach without issues.

Of the list you presented of nasal pillow masks...I have tried all of them at one time or another.
My personal preference is the P10...mainly because one of my own personal preferences is to have as little on my face and head as possible and the headgear on the P10 is about as next to nothing as you can get.
The Swift FX nasal pillow is very similar to the P10 pillow but the headgear is maybe a little more "there" in terms of it being on my head. It was my primary mask until the P10 was released. The down side to the P10 is that the headgear isn't maybe quite as versatile or stable as the Swift FX but the P10 is so "nothing" that I am willing to accept that minor "con".

The Mirage Swift II nasal pillow...very old model...been around since well before I started therapy 8 years ago. Next would be the Swift FX which was released in 2010 and the P10 is the latest of the 3 nasal pillows and it's been out in use 3 or 4 years maybe. Time flies with this stuff.

Of the 3 nasal pillow masks you listed...since you are new to therapy and the Swift FX is maybe a little more easily adjusted I would suggest that you look at it closely and maybe try it first...or the P10.
I would cross the Mirage Swift off the list...the other 2 are so much more comfortable and easier to fit and use.

I have no experience at all with any of the nasal cushion masks like the N20. So can't help you there. I don't like having anything pushing on the bridge of my nose area so I just don't try those type of masks. I know I won't be comfortable so no sense in wasting time and money. Now you might like that type of mask better than the pillow type..and that's fine.

There's a well known little saying about masks here...one man's trash is another man's treasure. What I might hate you might love and what I might love you might hate. You just have to try something yourself to figure out which it is for you. We can give you our own personal opinions based on our own personal experience but there's no guarantee that your preferences and needs will mimic mine.

Oh...make sure if you get the AirSense 10 AutoSet that it records/flags RERAs. The for Her model for sure does but used to be that was the only one but now some of the regular AutoSet models do and it seems to depend on what part of the world you live in.
And I don't know which ones or where the difference is.
I mention this because you are particularly concerned about RERAs and it would be a bummer to get a machine that didn't flag them.

[Julie]

No (tho' others may have more to say) but I haven't heard that pillows are any less effective.

[robysue]

Unfortunately, I cannot check this on the machine that I'm trialing at home (it's Philips Auto CPAP, but I'm not sure if it provides such detailed statistics).

Most likely you CAN check our your leak rate. If the Philips Auto CPAP is either the DreamStation or the either of the System One models, it has a SD card slot, and it should have an SD card in that slot, but if it doesn't, it's easy to just buy a cheap SD card and put it in the machine. The machine you are trialing should be compatible with SleepyHead.

Don't pillow masks have a higher probability of leaking, relative to nose or face masks?

It really depends on the person, the geometry of their face, and whether they do a significant amount of mouth breathing.

Some people do have trouble figuring out what angle the nasal pillows should be. Or they put too much of the pillows inside their nostrils. Both problems can lead to more problems with leaks. But other people (including me) find that the much smaller seal makes the mask easier to seal. The bigger the area that makes up the seal of the mask, the more places the seal can spring a leak. Many people find that the larger masks are more difficult to seal than nasal pillows masks are.

Full face masks that cover both your nose and mouth can be very prone to leaking. Their advantage is that you can mouth breath without losing pressure, but their large seals are prone to springing leaks when people's lower face completely relaxes in deep sleep and if the pressure increases significantly. There are known ways to deal with these problems, but the fact remains that many people find it harder to get a good seal on a FFM than on nasal pillows. If you are not a big mouth breather, there's really no particular need for using a FFM.

In my case I wear my Swift FX nasal pillows mask ridiculously loose, but I have almost no unintentional leaks most nights.

[robysue]

I'm thinking of getting the AirSense Autoset 10 machine and one of these masks:
1. Swift™ FX Nasal Pillow CPAP Mask with Headgear
2. Mirage Swift™ II Nasal Pillow CPAP Mask with Headgear
3. AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
4. AirFit™ N20 Nasal CPAP Mask with Headgear

Are there any significant non-obvious differences that I should keep in mind when making the choice? Thank you all!

I agree with Pugsy: Cross the Mirage Swift II off the list. It is not as comfortable as the Swift FX or the AirFit P10.

I've never tried the AirFit N20 since I don't like things covering the tip of my nose---it's psychological, but every time I've tried a nasal mask, the tip of my nose starts to itch just because I can't reach it. And I seem to sneeze repeatedly when trying to fit them.

I've used both the Swift FX and the P10. They're both nice masks. They both have their pluses and minuses.

Like Pugsy, I think the Swift FX may be a bit more "newbie" friendly because its headgear is obviously adjustable. The P10's can be adjusted, but it requires some additional effort until you learn how to do it.

Here's my list of +/- for both masks. Please note that my +/- are my personal preferences. Others might rate some of my +'s as big -'s or vice versa.


Swift FX
Pluses:

• Fully adjustable headgear that is easier to understand than the P10
• Softer, more comfortable pillows
• Easy to tug the pillows just a smidge and let them resettle when you need to scratch your nose or when there's a small leak
• Can wear the mask ridiculously loose
• Gives me less problems with piggy nose.

Minuses:

• Silicone part of headgear gets tangled in my hair and doesn't feel great on my cheeks, but I fixed that problem completely with a custom made mask pad from Padacheek. She made me two pads that cover the entire silicone part of the mask over 6 years ago. Both pads are still going strong ...
• Exhaust venting has a jet plane like feel. The exhaust flow is very concentrated and designed to NOT hit the bed partner. In my case, that means it can blow directly on my arms or chest, which I do NOT like at all. (I'm more comfortable with the FX if it is cool enough for me to wear long sleeves to bed; the long sleeves prevent the exhaust flow from hitting my arms.)
• Exhaust venting can be noisy if it hits the bed covers or your pillow. If the exhaust flow doesn't hit anything, it's pretty quiet.
• Heavy short hose which can pull the mask around. I have much fewer problems with this than most.

AirFit P10
Pluses:

• Exhaust venting is very nicely diffused. Almost no noise and it doesn't blow on my arms or chest the same way the FX does.
• Smaller, cloth headgear. I don't need a mask pad with the P10 the same way I do with the Swift FX.
• Easy to tug the pillows just a smidge and let them resettle when you need to scratch your nose or when there's a small leak
• Lighter hose is less prone to pulling the mask around.

Minuses:

• Headgear is harder to adjust. And unlike many people, I find the headgear too small and I have a pretty small head. (And yes, I use the regular P10 rather than the "For Her" for this reason.)
• The pillows are not as comfortable to me. The P10 pillows rest on a rigid "platform" that contains the mesh exhaust vents, whereas the FX pillows are totally soft. (The FX vent is at the elbow joint between the pillows and the hose.)
• The mesh exhaust vents can be a pain to clean and dry. They can also get a bit clogged with moisture at night.
• It's more difficult to control the angle the pillows rest against your nose. And that's a critical part of fitting a nasal mask.

The only reason the P10 has not replaced the FX as my main mask is the fact that the pillows are not quite as comfortable because of the rigid "platform". With the FX, I can pretty much squish the nasal pillows anywhere I want my nose to go and it will still vent normally and it won't push into my face. With the P10, there are certain positions that the rigid platform winds up digging into my face OR the venting winds up being blocked. Still I like the P10 and when it's super hot and I can't wear long sleeves to bed, I prefer the P10 because it doesn't blow on my arms.

[Pugsy]

The P10 diffuse venting is one of my main reasons for preferring it over the Swift FX...not that the Swift FX is horribly horrible (I have used worse believe it or not) but with the P10 I have to put my hand about an inch away from the vent holes to feel the venting.
With the Swift FX your bed partner will feel it if you end up facing your partner. The venting will extend several feet into the room...never really measured how far but 2 or 3 feet depending on pressures used.

While I was using my Swift FX my husband never ever complained about the air blowing on him (and even though the air is heated by the time it hits someone else or a part of your body that air will feel cold). Never once did he say anything but when I changed to the P10 he did say something and it was "how come I don't get a cold blast of air anymore...not that I am complaining about not getting it but it sure is nice to not get woke up with cold air blowing on my face or back" .

The rigid shell that RobySue talks about being annoying for her...yeah but it doesn't seem to annoy me as much so I don't really think about it. This is where the personal preferences thing comes into play. Things that might bug one person won't necessarily bug another person. For me the nothing headgear and the diffused venting outweighs whatever minor annoyance I might have with another aspect of the P10. No mask is ever 100% perfect. I haven't found one yet and I have tried many, many masks and pretty much all the nasal pillow masks out there at some time or other. I try them not so much because I am unhappy with what I am using but because I like to try new things because I usually learn something. Now with some of the experiments I have done the only thing I learned was what a stupid idea that was...but I learned something.

I tried the Wisp once...a nasal cushion mask. It lasted 90 minutes before it was removed and replaced by the usual nasal pillow mask.
Longest 90 minutes of my life. I thought for sure I made it almost all night but when I look at the software reports the change was made after only 90 minutes. I never wanted to try it again and I returned it to my DME and got another package of my usual mask as a replacement.
Right now I am trialing the new Respironics DreamWear Gel nasal pillow mask. Been using it for a couple of months now I guess and while it isn't perfect either...it's worth investing some time in. Nice little mask. Unsure yet as to whether it will replace the P10 as my primary mask...the jury is still out on that one.

[reinvigorated]

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This is super helpful, thank you so much for your response! I live in the US, so Airsense Autoset should be fine if my understanding is correct.

[reinvigorated]

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I've just installed the app. You're right, it worked. Thank you!