Nasal pillow leaks and noise

I've been successfully using a Full Face Mask for about 3 years. Now I must have some cancerous tissue removed from my cheek, right where the mask rests. So I went to my DME and the PT recommended an Opus 360 nasal pillow mask because it misses that part of my cheek.

Last night I tried it for the first time. After changing the Mask Type on the machine, I put it on. Really is comfortable, with two flared studs protruding into my nostrils and nothing else touching my face except the padded straps. I also ordered a chin strap and had in on last night. When I turned on the machine, I found I had two serious problems.

1) Really LOUD wind sound, changing in pitch between inhaling and exhaling. I wiggled the mask around, temporarily causing a loud and obvious leak, but it made no difference with the original sounds when I again had it comfortably seated. When I momentarily stopped breathing, the noise also stopped. My FFM is absolutely silent. The noise from this one would make sleeping difficult/impossible. I'm guessing the noise if from the tiny vent holes. The Nasal has about 30, the FFM has about 40 and they are a slightly different size and obviously shaped different.

2) As the pressure ramped up (5 minutes) to my 17/13 settings, I soon found air would leak out of my mouth unless I firmly pursed my lips. With the FFM the pressure was the same, both inside my mouth and outside it. With the nasal cushion, obviously the pressure inside my mouth is greater than outside it. As I began to go to sleep, my lips relaxed and a large gulp of air "belched" out of my mouth, waking me. Over the next 5 or 10 minutes, I went through this sleep/relax/belch cycle numerous times until I finally gave up. Start to finish, about 20 minutes

I took the nasal pillow mask off, reset the parameter on the machine, put on my regular FFM and had an uneventful sleep the rest of the night.

When I looked at the data this morning, it shows a ragged rising Leak line from about 16 to about 52 during the time I had the nasal pillow on. During the remainder of the night, when I had the FFM on, the Leak line was virtually flat along the bottom of the chart. No Events were recorded while I had the nasal pillow on.

I intend to try it on during the day today and play around with it, but it appears 2) is a show-stopper unless I tape my lips and, for other reasons, I don't want to do that. Also, I don't want to not use the CPAP while recovering from the facial surgery because my un-treated AHI is 68.

Comments? Suggestions?

Ward,

Thanks for bringing up this issue. I have similar issues. when inhaling I can hear a distinct noise though not always, but it is disturbing my sleep. I have the FX pillow system, using the resprionics system one.
Rupert Lux

See if your DME can get you the Resmed AirFit P10 nasal pillow mask...the vent noise with it is next to nothing.
Much, much quieter than the Opus.

Air leaking out the lips...that's because the air going up the nose and down the airway is trying to exit the airway prematurely via the oral cavity.. This is where we use the tongue to block that door so the air can't enter the mouth prematurely. When in proper position the tongue closes the door and air can't enter the mouth.
When air does enter the mouth and the lips are closed then the cheeks inflate (we call that chipmunk cheeks) and eventually will force the mouth open or the lips apart at least enough to let the air out.

The tongue needs to do a better job keeping the door closed. It's easy to do while awake but when we fall asleep the tongue gets lazy on the job and falls down and lets the air sneak into the mouth.
It really has nothing to do with whether the pressure is really high or not...it can happen and be just as annoying with pressures of 5 cm.

I'm not sure how the Airfit P10 will fit in your cheek area that you are concerned with but it has a very minimal headgear. I used a nasal mask, N10 and Swift Nano, both were noisy compared to the P10. I don't even hear it if I happen to wake up in the night.

It's been a while since I have used the Opus but the side cheek plastic stuff on it has more of a presence on the cheeks than the P10 so I would think that the P10 would maybe be a little more comfortable in the cheek area.
If the Opus side cheek things aren't are problem with the proposed surgery area then I doubt the P10 would be.

+1 for P10, soft straps must be better for surgery areas...

Another +1 for the P10. The P10 kept my CPAP from being thrown out the window.

Pugsy wrote:See if your DME can get you the Resmed AirFit P10 nasal pillow mask...the vent noise with it is next to nothing.
Much, much quieter than the Opus.

Air leaking out the lips...that's because the air going up the nose and down the airway is trying to exit the airway prematurely via the oral cavity.. This is where we use the tongue to block that door so the air can't enter the mouth prematurely. When in proper position the tongue closes the door and air can't enter the mouth.
When air does enter the mouth and the lips are closed then the cheeks inflate (we call that chipmunk cheeks) and eventually will force the mouth open or the lips apart at least enough to let the air out.

The tongue needs to do a better job keeping the door closed. It's easy to do while awake but when we fall asleep the tongue gets lazy on the job and falls down and lets the air sneak into the mouth.
It really has nothing to do with whether the pressure is really high or not...it can happen and be just as annoying with pressures of 5 cm.

Pugsy, the AirFit P10 looks like the right solution for me. It will stay away from the surgical area.

But what do I do about the lip leaks? It appears taping is the only solution. During the 20 minute trial, I could keep my lips closed until I started to doze off and the muscles relaxed, then the lips opened and a lot of air leaked out. This cycle occurred many times, until I finally gave up.

I apologize for taking so long to get back to you, but the snow storm cut our power and it took a while to get things sorted out.

wardmiller wrote: But what do I do about the lip leaks? It appears taping is the only solution. During the 20 minute trial, I could keep my lips closed until I started to doze off and the muscles relaxed, then the lips opened and a lot of air leaked out. This cycle occurred many times, until I finally gave up.

I have my hubby who will tap me on the shoulder when he hears it leaking out my mouth. LOL.

I was gradually able to train myself to keep my mouth closed and tongue on the roof of my mouth for the most part. I also use a hair band for a chin strap. It works better than the commercial chin strap I tried. I now will sleep through the small leakage and I never have a large leakage show up on my reports. Unfortunately I now tend to grit my teeth together to the point that I was biting my tongue the other night and it didn't even wake me up. I had a sore tongue all day yesterday. I hope that as time goes by, I'll eventually get it right. I also tried the taping bit but didn't like the feel of it on my face. It has mostly been trial and error for me. Choices: taping, chin strap, tongue on the roof of mouth are the ones I've seen posted. When I was using the Nuance Pro pillows, I had to create of strap that held the pillows on my nose because of my high pressure. My creation covered my mouth and I think that might have helped me learn to keep my mouth closed.

A soft cervical collar also seems to be the answer for some. I sleep on my side and this wasn't a problem that I encountered after a few days. Below is a link that has been posted here.
http://www.amazon.com/Carex-Health-Bran ... cal+collar

wardmiller wrote:But what do I do about the lip leaks? It appears taping is the only solution. During the 20 minute trial, I could keep my lips closed until I started to doze off and the muscles relaxed, then the lips opened and a lot of air leaked out. This cycle occurred many times, until I finally gave up.

I have nothing in my little bag of tricks to fix the lip leaks except tape. So sorry. With anything else the lips can part no matter what else we might do and even tape doesn't seal like cement.
I can clench my jaws shut..teeth clenched together right now and I can still open my lips easily if I want to.
Chin up strips....chin strap...cervical collar...none of those actually prevents my lips from opening enough to mouth breathe if the lips want to separate. They might help reduce jaw drop and mouth opening from jaw drop but for the lips themselves...if they want to separate they will separate unless I tape them.

I quit taping a long time ago because mouth opening or lips opening or jaw dropping issues weren't prolonged and weren't disturbing my sleep. I got lazy and simply didn't want to bother with taping.
In your case the lip fluttering is causing you to wake up...and that presents a problem.
If taping sounds too scary....wonder if you could maybe try vertical tape just over the part of the lip that is under the nose and leave the sides uncovered. Maybe just a little reminder to keep the lips closed would be enough???

I think your pressure is too high for nasal pillows of any sort. Chinstraps are a pain. I def suggest the ResMed F-10 FFM as the cheek straps don't touch you or its very minimal.

DreamDragonZzZ wrote:I think your pressure is too high for nasal pillows of any sort.

Not true. Lots of people successfully use nasal pillows at much higher pressures.
We have people here on this forum successfully using nasal pillows with pressures in the 20s.
If someone's lips want to open...it can just as easily happen with pressure as low as 5.

Pugsy wrote:

DreamDragonZzZ wrote:I think your pressure is too high for nasal pillows of any sort.

Not true....If someone's lips want to open...it can just as easily happen with pressure as low as 5.

Oh, pleasure as low as 5?
When I was younger, I often wanted to use my lips for a pleasant kiss. Now I'm 87, I guess my lips are just remembering. OH, WAIT! You said "pressure" not "pleasure". Chucks. <g>

wardmiller wrote:Oh, pleasure as low as 5?
When I was younger, I often wanted to use my lips for a pleasant kiss. Now I'm 87, I guess my lips are just remembering. OH, WAIT! You said "pressure" not "pleasure". Chucks. <g>

You are 87? Funny how we get ideas in our heads about people and for some reason I just didn't think you were 87 or anywhere close to that age.

If it wasn't for the lip thing waking you up I would just tell you to not worry about it for the short period of time you are going to need some sort of nasal mask while your surgery area is healing up and then just go back to your full face mask.
There's no guarantee that even if you could use a lower pressure that the lips wouldn't "flutter".
Some people just will have their lips want to open a bit no matter what pressure is used. The tongue trick to block the door takes some time to become a habit and you have had a lot of time already with the habit of being able to just let your mouth open or lips part and use the full face mask. I doubt we have time to break that habit now.

Maybe try the taping with a small vertical strip that I mentioned....maybe try taping horizontally with maybe a slit in the middle to alleviate any concerns about breathing "if you had to with the tape on"...maybe try some sort of chin up strips that are homemade to keep the lips together.
http://www.chinupstrip.com/
Not saying go buy these but maybe fix up something from home. I think ChunkyFrog has done this and used an old credit card as a pattern with wide tape.
You know Polident strips also can be used....and they don't set up like cement and the mouth can still be opened if a person just had to. A big yawn will break the seal.