New to this, tying different masks

Hello all,

I'm pretty new to my CPPAP device and I'm having some of the usual problems being described. The FAQs have been really helpful so far, but I'm still struggling. I've been using it the last 3 night after having had it sit unused on the night table for the last 5 months.

I got both an AirFit N10 (nasal mask) and an AirFit Nasal Pillow (P10) and I've been switching between them, but I can't get quite happy with either.

The N10 mask is far easier to breath out. I don't feel the extra pressure that I get with the pillow (P10). This is much better, but all the extra crap on my face... I just can't get the adjustment right and it's leaking plenty around the bridge (top) of my nose. One thing I've noticed with the N10 is that it has more holes to let air out around where the hose meets the actual mask. I was told that this is normal and helps with the breathing out.

I'd really like to be happy with the nasal pillows, but I just can't get used to the extra effort it takes to breath out. It is otherwise a lot more comfortable to wear. With this one, I've noticed there is almost no (or perhaps none at all) air coming out where the hose meets the mask. Is this normal?

With both I've tried wearing them for awhile to get used to it. Last night with the P10 pillows I read for about an hour with them on before trying to go to bed. Once I turn the lights out and try to go to sleep I can feel the extra effort it takes to breath out and it is making my heart rate go up as I lie there. That's just not conducive to falling asleep.

Any advice here on getting the pillows to work would be much appreciate.

Also, advice for adjusting the nasal mask, too.

On the bright side, last night I managed to sleep about 5:30 with the mask. It wasn't great, but it was OK. Moving the hose up and suspending it from the headboard really helped.

Thanks
=Sam->

Your machine has an exhale relief feature called EPR - makes it easier to breathe out - which you set the level of... be aware that as you set it higher, it's likely that your AHI will go up 1=2 cm, but that might not matter much to you if it's still relatively low and you feel better.

Struggled greatly with that until I found out about the exhale relief as well, don't think I could handle my P10 pillows without the relief. I also use essential oils directly behind the intake/vent thing, a mix of lavender and sweet orange which is restful and calming.

EPR is entirely unnecessary when you are sleeping. The auto-ramp/smart-ramp is available on most modern machines. This type of ramp ramps up automatically as you fall asleep. On the Resmed machine, it works incredibly well. I have only ever had it err on the side of ramping up to early. It has never ramped up too late. You can set EPR to ramp only, and use smart/auto ramp. This allows you to set any EPR level, and not worry about its affect on your therapy. My ramp pressure is only 1 cmH20 below my therapy pressure, but my ramp EPR is 3. With an 8/3 (pressure/ramp) combination, my breathing is just like I didn't have the mask on. When I wake up to 9 cmH2O with no EPR, I don't notice the exhalation pressure until I have been awake for at least 15 minutes. I use the Airfit P10.

As for switching between masks. Stop. Pick a mask and going with it. Fiddling with and switching between masks will only prolong your adjustment. The same goes for your machine. If your machine has an automatic cool down, you may want to switch it to warmup if you get out of bed or occasionally reset the ramp if it ramped up early, but other than that, don't mess with the machine when you are trying to get to sleep.

With the suspended hose, a soft knitted or crocheted hose cozy for the short hose goes a long way to increasing comfort. My wife made me one, and if the hose lays on my face, I barely notice it.

SamInWa wrote:I'd really like to be happy with the nasal pillows, but I just can't get used to the extra effort it takes to breath out. It is otherwise a lot more comfortable to wear. With this one, I've noticed there is almost no (or perhaps none at all) air coming out where the hose meets the mask. Is this normal?

Yes, the vent holes in the P10 are diffused but that is by design and allows for more diffused venting which is actually one of the reasons this mask is so popular. The air is coming out but it is much more diffused and it's normal for the P10.

If you used it comfortably for an hour while awake what changed when you turned the lights off?
You know if the lights being off is the only change....it shouldn't have felt different. Your mind focused on the breathing effort when you were doing fine with something to distract you.

What size nasal pillow are you using?
What pressure setting are you using?
And your machine has some Flex exhale relief....are you using exhale relief and at what setting?

Pugsy wrote:

SamInWa wrote:I'd really like to be happy with the nasal pillows, but I just can't get used to the extra effort it takes to breath out. It is otherwise a lot more comfortable to wear. With this one, I've noticed there is almost no (or perhaps none at all) air coming out where the hose meets the mask. Is this normal?

Yes, the vent holes in the P10 are diffused but that is by design and allows for more diffused venting which is actually one of the reasons this mask is so popular. The air is coming out but it is much more diffused and it's normal for the P10.

If you used it comfortably for an hour while awake what changed when you turned the lights off?
You know if the lights being off is the only change....it shouldn't have felt different. Your mind focused on the breathing effort when you were doing fine with something to distract you.

What pressure setting are you using?

>>>>>>>>I'm not sure... there is a setting on this called "SYSTEM ONE Resistance" This is cryptically labeled X1, X2, X3, etc. The manual says to refer to the manual of the mask to find the right settings. The mask's manual has no such reference. It says:

For S9: Select 'Pillows'
For other devices Select SWIFT (if available) otherwise seclect 'MIRAGE' as the mask option

And your machine has some Flex exhale relief....are you using exhale relief and at what setting?

>>>>>>>>I'm using the exhale relief (they seem to call the "A-FLEX") at "3" which the most of settings 1, 2, or 3)

What size nasal pillow are you using?

>>>>>>>>I'm using the large pillows, the medium was way to difficult to breath out.

In regards to actually going to sleep... as opposed to watching TV or reading... Clearly once I'm not distracted I notice the extra effort required to exhale and this is causing something.

WindCpap wrote:
As for switching between masks. Stop. Pick a mask and going with it. Fiddling with and switching between masks will only prolong your adjustment. The same goes for your machine. If your machine has an automatic cool down, you may want to switch it to warmup if you get out of bed or occasionally reset the ramp if it ramped up early, but other than that, don't mess with the machine when you are trying to get to sleep.

With the suspended hose, a soft knitted or crocheted hose cozy for the short hose goes a long way to increasing comfort. My wife made me one, and if the hose lays on my face, I barely notice it.

I kind of suspected I was screwing myself up here. I'll try to stick to the pillows and see if I can get used to it.

I have ordered a hose cover and hope that will help somewhat with the rain out and make it softer.

Just because someone posts something do not assume that others agree with it.

I tried 3 masks and did find one that I love. I personally am very glad that I DID try different masks.
I used EPR at 3 and it was still not enough for me to tolerate therapy. I now have a BiLevel machine and am sleeping like I remember doing as a kid. I would not be using CPAP if not for EPR.

I cannot tolerate exhaling into pressure, I tried the P10's and cannot use them. I talked to the tech at my DME (really good one) and she laughed and said that the P10 was exactly what I should NOT be using.

When people say that something is unnecessary they are really saying that it unnecessary FOR THEM. Much of these settings are personal preference to help you tolerate therapy. Use anything that you need to.

System One Resistance is a mask setting choice on your machine that pertains only to Respironics masks.
Long story but Respironics only gives a Resistance setting for their masks...it's not make it or break it setting though. For non Respironics masks we usually just set it to 0.

You need to figure out what pressure you are using when you are finding things uncomfortable.
Like the starting pressure or if you are using ramp or what.
Usually the pressure just shows up on the LCD screen...or you can go into the clinical menu and see what it is set at.
Are you using ramp at any time? Default ramp setting is 4 cm and a lot of people find that setting doesn't move enough air so they experience breathing issues.
Also try to figure out exactly what your problem is with the pressure...is it actually difficult to exhale or is it more of an air movement/air starved feeling.

Flex at 3 is the highest setting but Flex exhale relief is flow based meaning the more forcefully you breathe the greater the reduction but only up to a 2 cm reduction and it won't even do anything unless your pressure is at 6 cm. So if you are using less than 6 cm you are getting zero Flex relief.

Also Flex is more than just that up to 2 cm reduction...it's a timing thing with inhale and exhale so don't assume that 3 is best because it is the greatest...your timing might do better with setting of 2 or 1 or even off.
So play with all the setting choices to see what feels the best and use what feels good no matter what the setting.

Remember you don't get any Flex relief at all until 6 cm is used...it's turned off at pressures below 6 cm and if you are using ramp starting at 4 cm you don't get any Flex relief at all until pressures increase to 6 cm.

If you don't know about how to go into the clinical setup menu where Flex is explained (there's a demo available so you can easily switch between the settings to try each) but you may have to turn on the Flex access so you can get that demo.

Go here to see how to get to the clinical menu and you might as well request the provider/clinical manual while you are there. Just make sure to request the correct manual. It has a lot of useful information in it.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

SamInWa wrote: SamInWa

What are your pressure settings?

In April 2010, I started out with an EPR of 3.
I reduced it to 2 about 3 years ago; and see no reason to change.

PoolQ wrote:Just because someone posts something do not assume that others agree with it.
I tried 3 masks and did find one that I love. I personally am very glad that I DID try different masks.

If you were referring to my post, I should probably explain. I wasn't saying that the OP shouldn't try different masks. However, each and every mask on the market will cause some discomfort when you first start using it, particularly if you haven't worn a mask on that part of your face before. I love my P10, and if I based my opinion on the first few nights, and switched masks right away, I would never have known. People need to stick it out with a mask before making a final decision because minor irritations will often clear up.

WindCpap wrote:People need to stick it out with a mask before making a final decision because minor irritations will often clear up.

+1

"Willy-nilly mask switching can prolong the adjustment period."
- Abraham Lincoln

I was ready to give up the whole CPAP experience. Then someone mentioned the nasal pillow mask. The only nasal pillow mask that I could tolerate is the Swift FX. Love it!