Questions about Opus 360 Nasal Pillow CPAP Mask

[John_Jason]

Last night was my seventh night with my CPAP machine and Opus 360 mask. I tried other masks but I discovered that I have a phobia about something on my face. I can tolerate the Opus 360, but all the others make me so anxious that I would never be able to get to sleep with them.

I have been having a lot of problems with pain in my nose from the air pressure. Yesterday I visited the place where I obtained the machine and mask to talk with the nice gentleman about this. I had been using the large size pillows, so he switched me to the medium pillows. As you can see from my pic my nose is pretty ordinary, so probably medium is a better fit. After using the medium pillows last night my nose is not as painful this morning as it has been, so it looks as if the smaller pillows are an improvement.

However, looking at my data from last night (the first night with the medium pillows) I note a dramatic change for the worse. According to SleepyHead for the first six nights my best AHI was .93 and my worst 2.89. Last night it was 6.74. Lots of the other figures were really bad as well.

Of course it's only one night's data. Not enough for an indictment, but more than enough to arouse suspicion. I don't know enough yet about how this stuff works, so I'd appreciate comments.

[Pugsy]

Can you get the breakdown on the AHI from last night?
How much was the Clear Airway Index?
Did you have some awakenings last night.
What was your average leak rate?

Get some Lansinoh ointment (found in baby section of Walmart because breast feeding mom's use it on nipples)....use a little ointment and it will help with the tenderness at the nostril area. If you have pain that is significant...something is not fitted properly. Usually means too tight or wrong size of pillow. So it may just be the pillow size but the ointment also helps while the nostrils get used to having something on them where as before they never had anything touch them.

[RocketGirl]

I use the Opus and really like it, but it does take some fiddling to get it to sit right. Do try the Lansinoh - it is pure lanolin and won't degrade the pillows, and it really helps both in soothing the skin and in helping to maintain a comfortable seal.

Keep your large pillows though - sometimes one size can start to chafe after a while, and just switching to the other for a while helps. I switch out medium and small every so often - most of the time I use medium, but if I do start to get a sore nose, I switch for a few nights.

Also, sometimes it can feel like the pillows are the right size, but are maybe spaced a little too wide or a little too narrow for your particular nose, giving rise to too much pressure on one side of your nostrils or the other. If that is the case, you can use small O-rings and/or a piece of dental floss to lasso them and change the spacing.

The other thing I'd suggest is to spend some time playing with the headgear straps. I was having pain in my nose because it felt like the pillows were pushing up too hard, and found that I needed to adjust the top strap so the mask didn't sit up quite so high. It is important to do this while lying down, in basically the same position you'll sleep in, to get the right fit.

[Slartybartfast]

Ditto here. Ayr Gel, K-Y and Astroglide all work well, too. Just a very thin layer will keep the pillows from irritating your skin and help seal the pillows to your nostrils.

Straps need to be played with. You don't need much strap tension with this mask. The tendency is always to have them too tight. When things aren't right, I always loosen the straps and then tighten them a little at a time until it feels right. If you haven't already, you might also try unhooking the hose from the velcro on the top strap and let the hose flop around whichever way it wants to. And get a Resmed Slimline hose or the equivalent if you don't already have something like it. Some hoses are awfully stiff.

I have the Opus 360 and a Swift FX. I muchly prefer the Opus.

[Maxie]

I started with the Opus 360 and tried a full face and a hybrid mask. After trying them going back to the Opus was great. It has to be just right on my face and not very much nose wiggle room but if you fiddle with yours a bit, I think you will really like it.

[John_Jason]

Can you get the breakdown on the AHI from last night?
How much was the Clear Airway Index?
Did you have some awakenings last night.
What was your average leak rate?

Get some Lansinoh ointment (found in baby section of Walmart because breast feeding mom's use it on nipples)....use a little ointment and it will help with the tenderness at the nostril area. If you have pain that is significant...something is not fitted properly. Usually means too tight or wrong size of pillow. So it may just be the pillow size but the ointment also helps while the nostrils get used to having something on them where as before they never had anything touch them.

Here is a screenshot:



Or if that didn't display: http://www.picpaste.com/Screenshot_-_04 ... NUnNBm.png

The screenshot above does not display the graphs because I haven't got that problem fixed yet.

Re the Lansinoh, I guess I didn't make something clear. The pain in my nose is inside my nose from the air pressure. It is not on the outside of the nose from contact with the mask. It is also not from lack of humidity, as I have tried up to the maximum humidity settings with no relief, and also the Ayr gel. The fellow at the DME (is that what you call the place that supplied the device to me?) said that it might be from the direction that the air is blowing into the nose. Since I have less pain this morning after using the medium pillows his theory may be correct.

At the moment I am just wondering why or how different size pillows in this mask could make a difference in the benefit.

[Pugsy]

Clear Airway Index...2.67 so that leaves roughly 4 to be obstructive.
Just watch things...if you happen to have a couple of awakenings for a few minutes during the night and you leave the mask and machine on sometimes events get flagged that are "awake" events because the machine can't tell if you are asleep or not.

The Clear Airway index....we don't treat the clear airway events with an increase in cpap pressure.
It is normal to have a few at sleep onset or turning over in bed. So when evaluating your therapy...keep in mind that the Clear Airway index is looked at differently than the obstructive events.

Could have just been a fluke night. I still get them from time to time myself. Just keep one eye on them and see if your AHI stays elevated (as compared to your other nights with lower AHI). It isn't common to have a dramatic increase in events with a change in nasal pillow size. Not impossible though if there was a significant leak. When you get the graph thing sorted out you will be able to evaluate the leak graph and have a better handle on when the events occurred.

I have never used Linux so I have no clue how to help you get SleepyHead to show what you need. So sorry. Onkor online analyzer that I sent you the link for..you can get graphs with it. They look visually a little different but you can get the idea and at least evaluate the higher AHI night to see if those events were clustered around something.

[robysue]

Re the Lansinoh, I guess I didn't make something clear. The pain in my nose is inside my nose from the air pressure. It is not on the outside of the nose from contact with the mask.

If you can reach the sore spot with your finger, the Lansinoh will help ease the pain and protect the delicate, sensitized tissue from the onslaught of the CPAP wind. Think of the Lansinoh as "chapstick for the inside of your nose".

The fellow at the DME (is that what you call the place that supplied the device to me?) said that it might be from the direction that the air is blowing into the nose. Since I have less pain this morning after using the medium pillows his theory may be correct.

The guy at the DME is correct: If the pillows are at the wrong angle, the airflow can hit the side of your nose. For many people it's not a major problem. But for some of us, the spot where the air flow is concentrated gets "chapped" or "wind burned" because of the constant flow of air on it. When the pillows are at the proper angle, the airflow should go straight up the nose and NOT hit the sides of the nose at all.

At the moment I am just wondering why or how different size pillows in this mask could make a difference in the benefit.

It could be that the medium pillows just manage to seal at the right angle more easily for you. Pillows that are too small or too large can "rock" back and forth---i.e. they are less stable when they are fully inflated and sealed against your nostrils. And as they rock, the concentrated airflow can move around inside your nostrils.

[Papit]

The fellow at the DME (is that what you call the place that supplied the device to me?) said that it might be from the direction that the air is blowing into the nose. Since I have less pain this morning after using the medium pillows his theory may be correct.

The guy at the DME is correct: If the pillows are at the wrong angle, the airflow can hit the side of your nose. For many people it's not a major problem. But for some of us, the spot where the air flow is concentrated gets "chapped" or "wind burned" because of the constant flow of air on it. When the pillows are at the proper angle, the airflow should go straight up the nose and NOT hit the sides of the nose at all.

Right on. That's is exactly right in my experience: wind flow directed against a spot on the side of your nose can be awful. The air flow should go as straight up your nose channel as possible, not to either side. If the flow at the moment is to the outer side of one or both nostrils, tying (i.e., pulling) the pillows together just a bit as suggested earlier might work out to better "aim" the air flow. You may have to experiment with how much to tie them.

If the flow at the moment is to the inner side of each nostril, you might want to try my 'compression clip' : ), but instead of "setting" the spring action to compress (or squeeze the pillows together), you would set it to SPREAD the pillows apart just a bit to redirect the air flow. You can check out the idea at viewtopic.php?f=1&t=76155&p=696357&hili ... ss#p696357 or do a search at this site for the thread, ' A 3" length of dental floss... ' I use that clip every night with my Swift FX pillow mask. Very good seal and very comfortable. Keep the straps "barely snug, almost loose" for an optimal fit and seal.

And don't be afraid to ask for another mask. At this early stage, the equipment supplier should be working with you to give you a good start. Mine gave me about 6 masks (not all at the same time) until I settled on the FX. For me, with clip in place it's a sweet mask.

Keep at it.

[John_Jason]

Right on. That's is exactly right in my experience: wind flow directed against a spot on the side of your nose can be awful. The air flow should go as straight up your nose channel as possible, not to either side. If the flow at the moment is to the outer side of one or both nostrils, tying (i.e., pulling) the pillows together just a bit as suggested earlier might work out to better "aim" the air flow. You may have to experiment with how much to tie them.

If the flow at the moment is to the inner side of each nostril, you might want to try my 'compression clip' : ), but instead of "setting" the spring action to compress (or squeeze the pillows together), you would set it to SPREAD the pillows apart just a bit to redirect the air flow. You can check out the idea at viewtopic.php?f=1&t=76155&p=696357&hili ... ss#p696357 or do a search at this site for the thread, ' A 3" length of dental floss... ' I use that clip every night with my Swift FX pillow mask. Very good seal and very comfortable. Keep the straps "barely snug, almost loose" for an optimal fit and seal.

And don't be afraid to ask for another mask. At this early stage, the equipment supplier should be working with you to give you a good start. Mine gave me about 6 masks (not all at the same time) until I settled on the FX. For me, with clip in place it's a sweet mask.

Keep at it.

Thanks for your input. Your clip idea sounds great, although I can't see how it would work with the Opus. The pillows are too far from hard plastic. But I may end up getting another mask. Bear in mind that I am claustrophic and cannot tolerate things on my face. I need something that I can't see. I can see the Opus, but not very much so it is barely tolerable. Already I have had a couple of panics when I woke up in the middle of the night and found the mask on my face. Try getting back to sleep when your heart is racing from a panic attack. My choices in masks are probably pretty limited.

I plan to give the medium size pillows a couple more nights and see what kind of data I get. If it continues as bad as last night I'll go back to the DME again. Here's hoping last night was a fluke.

I'm starting to feel like I don't want to go to bed. This is really hard for me.

[Papit]

John, I recently traded an extra Swift FX for an Opus 360 to give it a try. I slept in it for a few hours on one night. No more. That was enough for me. The Swift FX pillows mask has it beat by a country mile, at least for me and I would venture most of us who have tried both would vote the same way.

Why? (1) Because the silicone pillows (and the silicone barrel beneath it) on the FX are for me noticeably softer and more comfortable to wear. Also, (2) the much narrower, soft silicone FX straps that cross my cheeks are hardly "there", especially compared to the wider hard plastic straps on the Opus. They seem way too stiff to me. What I did like about the Opus was the way the air tube fastens overhead to the crown head strap.

I wouldn't wait another day, John, before getting a Swift FX from your supplier. I think you've put up with enough. If you're getting turned off by the mask, I would even take a "siesta" break from CPAP for a couple days until the FX (or something else) is in hand. The FX is the least invasive and lightest mask I know of.

If you like the overhead tube routing (I prefer it to keep the tube out of my way) and you're handy, you can connect the FX mask tube to the crown strap buckle. I used a piece of wire slipped cross-wise through the little buckle and wrapped it to hold the tube perpendicular to the strap. It works fine.

Hang in there, brother.

[John_Jason]

First, the overhead tubing is something I do not want. I am claustrophobic and I have panic attacks with something on my face. The advantage of the Opus is that it is the least visible of all the masks I tried at the DME. When I first went to the DME and the fellow put a mask on me me hand flew up instinctively to rip it off my face.
We tried other masks and settled on the Opus as the one I was most likely able to tolerate.

I already posted my results from night before last - AHI 6.74, where I was previously around 3 or less. Well, last night was better, down to 3.60, but otherwise things were worse. When I put the mask on it was harder than usual to overcome the claustrophobia. I laid in bed for over an hour before I could finally get to sleep. And when I got up this morning I discovered that my nose was bleeding. I've been trying to tell the DME guy and people here that the thing makes my nose hurt, but everyone pooh-poohs it and says I will adjust or assumes I mean the pressure of the mask on my skin. No, it's the air pressure inside the nose that makes it hurt.

I've called the DME guy three times this morning but he has always been in a meeting or otherwise unavailable. I want to ask him if they have the Swift FX before I drive 40 miles through to their office. I'll keep trying, but if I can't get hold of him today, then I won't be able to do anything about it until Tuesday because I have lectures tomorrow and Monday.

Sigh.

[Slartybartfast]

It's time to call your doctor. DMEs live and die by being responsive to doctors. If the DME is OTL all the time, your doctor needs to know that. And if you're getting nosebleeds, then something is really wrong. It sounds like you might be a candidate for a nasal mask if you can't tolerate air blowing in your nostrils. The Swift FX won't be any different in that regard. The only difference between the masks that might affect your particular condition is the way the pillows rest against your nostrils.

Keep after them. Be persistent and vote with your feet, if you have to.

[SleepyToo2]

John, I used the Opus 360, and thought they were quite good. Then I had the opportunity to try the Swift FX. For some reason I was more comfortable with the FX. However, just recently I decided to check out the DeVilbiss Aloha because of the good reviews it was getting. It is the most comfortable of the 3. I wear glasses for reading (actually, all of the time except sleeping!), but I don't find it a problem to have the mask on at the same time. The frame is fairly stout, but on my face I don't find it a problem because of the soft covers on it. The pillow "box" stays up off my upper lip enough that I don't feel it - the only thing I feel is the pillows pressing on my nostrils. It does require briefly pulling the pillow box away from the nostrils after starting the air flowing to make sure that the pillows are seated properly. Then for me, most nights, it is lights out until the morning. The Aloha is a bit cheaper than some of the others, which is another positive aspect! Please note that I am not employed by DeVilbiss in any capacity, and purchased the mask I am using and recommending out of my own money!

If you can ask the DME for a couple of masks to test while you are there - take your machine and a pillow along with you, and if you can lie down on the floor to try each mask properly, do so! Don't let them pull the straps really tight - loose is better for most people. You only need to pull the straps just tight enough to keep the leaks to a minimum. You should not be distorting your nose, or causing sores where the mask touches. One other thing - I have found the large size pillows work best for me. Seems they cover the nare best. Your mileage may vary.

[RocketGirl]

John_Jason, a couple of other thoughts - I know you mentioned that you have the humidity turned all the way up, but waking up with a nosebleed really sounds like dry nasal passages - have you checked to see if the water level in the humidifier is significantly lower in the morning than when you went to bed? I find myself wondering if your humidifier is working properly.

The other thought is, since you have to drive 40 miles to get to the DME (and that doesn't work on days you have lectures) - if you can swing it, perhaps consider whether it's worth your while to just buy a different mask outright from our hosts - they offer mask insurance in case you can't adjust to the mask you purchase, and their delivery is quick. I just bought an Aloha here since my DME doesn't stock them, and I got the insurance just in case.

I haven't tried the Aloha yet, but a lot of people here seem to like them a lot, and I think it meets your needs for minimal face coverage. (And it appears that the pillow angle is a little more adjustable than the Opus is, which is why I decided to try it.)

Good luck! It is no fun lecturing when painfully sleepy. Been there, done that...