Pros and Cons of nasal pillows

I am considering getting my first nasal pillows. I am considering the Swift Lt. I have read that some people say they dry out their sinuses and produce pressure. What are your experiences? I would like to hear all of your pros and cons and which kind of pillow you use. I am a back and side sleeper, currently using a nasal mask. I have the narrow slotted type nostrils and had read the Swift Lt is best for that, anyone have other suggestions? Thank you everyone and Happy Holidays!

I'll be honest: I have no idea how I'd describe my nostrils as to shape or type. And I've never used a nasal mask or a FFM. On my first titration study, every time the tech tried to put the nasal mask on my nose, I started to sneeze uncontrollably. So it seems like I don't have much choice if I don't want to sneeze all night long.

Yes, the nasal pillows can dry out my sinuses. That can be a plus when my sinuses are congested in the first place. It's not so nice if they're nice and clear when I go to bed though.

And when the pillows are nicely placed and sealed and the exhaust vents from my FX are well placed, I have no air blowing around anywhere on my face causing chapping (which I'm very prone to---sleeping under a fan in the summer time has caused me to wake up with a chapped face for example).

Of course, its possible to scratch the top of my nose with pillows. But trying to scratch the area between my nose and lips is still hard, if not impossible without breaking the mask's seal.

As to whether the LT is better or worse than the FX for a particular person, I think that's a matter of how one's face and nose are shaped. For me, I"ve got hollow cheeks and very high cheek bones. The LT's L-shaped frames that are used to provide additional stability for the pillows dug into my cheeks in a most uncomfortable way and I could not tolerate having the mask on for more than a few minutes at the DME. But that was because of how my face is put together and should most definitely not be taken as a criticism of the design of the LT. Your mileage concerning the relative fit of the LT vs. FX may vary. Many folks here have commented (very favorably) that the LT has an adjustment that allows you to alter the angle the pillows fit into/onto your nostrils (and the FX does not, alas). And those L-shaped frames that don't fit my face do provide significant additional stability for the folks whose faces it does fit. You'll only know if the LT is an appropriate mask for you if you actually try it on.

I like the LT because you can pivot the pillows to an angle best suited to making a good seal. You can also attach the pillows so that the the openings are either in a / \ pattern or flip it to be in a \ / pattern. The FX, from what I gather, is unable to do that. I really like the LT... it is so lightweight and comfortable, and I have had very little problems with leaks except when the pillows start to wear out, but I use that as my signal to get new ones! I use Lansinoh lanolin on my nares, and have since the first night using the LT. I've never had an irritation at all.... When I put on the heat during a cold snap, it tends to dry out the air and I put the humidifier on to help keep my nasal passages moist. When the heat is off, I still keep water in the humidifier and use it in pass over mode. So far, no issues with drying out my nose.

I was fitted with the FX. I was told the secret is to have it almost to the point where it is falling off of your head. As you roll in your sleep, a quick shake of the head re-settles everything back into place. After a couple of nights this becomes "hard wired" into your sleep habits.

The pros... Hardly know it is there, good nights sleep.

The con... Since you hardly know it is there you have to make sure you remove your mask when you jump out of bed. You may find yourself dragging a xPAP machine down the hall in tow behind you...

I am a newbie and the Swift LT for her was my first mask. I used it for titration and every night since I started. I really like being able to see and not having a lot of stuff on my face. I get a good seal and use a little lanisoh on my nares each night. I don't experience any drying out at all. I do have S9 autoset with climateline hose if that makes any difference.

I have never had rainout or problems with humidity. I have not gotten so use to the pressure that some nights I have to pull the mask away to see if its really on or not.

I have fairly high pressures (up to 15 cm on auto) and I truthfully cannot perceive the airflow in my nose. I just spent two nights in a FF mask because of an upper respiratory infection, and I felt like I was in a cold wind all night. The nasal pillow mask airflow is so much more comfortable!

As for nasal passage drying, that's what the humidifier is for. Some people find a little bit of Ayr Gel, Lanisoh, or KY Jelly just inside the nose is helpful, and saline rinses or sprays can also help hydrate the nose.

Are you positive you have slotted nares? I have very nice, round nares, but when I tilt my head back and look in the mirror, the angle makes them look slotted! So I have a feeling some people may think they have slotted nares when they don't really (and some people definitely DO have slotted nares).

The LT is a good "beginner" nasal pillow mask because it is very stable and adjustable. With a proper fitting it works great. The FX is incredibly comfortable, but takes some tweaking to work well.

The key to success in using either of these masks is a proper fitting, and—unfortunately—a lot of DME’s don’t have a clue how to fit these masks. Remember that the cone-shaped nasal pillows rest AGAINST the nose, not IN it.

ResMed has fairly good video/slide presentations showing how to fit these masks, but—inexplicably—never addresses the fact that the nasal pillows should fit against the nose. If you search “handy, dandy fitting” on this site, you will see my suggestions for getting a proper fitting for these nasal pillows.

Nasal pillow masks are wonderfully light and comfortable. I have noticed a slight increase in drying vs. my nasal mask, but nothing really significant. The only real disadvantage to me is that regular use may lead to permanent widening of the nostrils. While this is only a cosmetic issue, it's a fairly serious con IMO. The process is similar to tissue expansion used in plastic surgery (breast reconstruction, for example):

"Keeping living tissues under tension causes new cells to form and the amount of tissue to increase. In some cases, this may be accomplished by the implantation of inflatable balloons under the skin. By far the most common method, the surgeon inserts the inflatable expander beneath the skin and periodically, over weeks or months, injects a saline solution to slowly stretch the overlaying skin. The growth of tissue is permanent, but will retract to some degree when the expander is removed."

http://en.wikipedia.org/wiki/Tissue_expansion

I have been limiting my use of my Swift FX to every other day (switching to a nasal mask on the other days) but I'm not sure that will prevent the problem. I may switch to the nasal mask full-time as I've been getting more comfortable with it over time. This link has more discussion and another link regarding this issue:

viewtopic.php?f=1&t=58377

robysue wrote:I'll be honest: I have no idea how I'd describe my nostrils as to shape or type. And I've never used a nasal mask or a FFM. On my first titration study, every time the tech tried to put the nasal mask on my nose, I started to sneeze uncontrollably. So it seems like I don't have much choice if I don't want to sneeze all night long.

Yes, the nasal pillows can dry out my sinuses. That can be a plus when my sinuses are congested in the first place. It's not so nice if they're nice and clear when I go to bed though.

And when the pillows are nicely placed and sealed and the exhaust vents from my FX are well placed, I have no air blowing around anywhere on my face causing chapping (which I'm very prone to---sleeping under a fan in the summer time has caused me to wake up with a chapped face for example).

Of course, its possible to scratch the top of my nose with pillows. But trying to scratch the area between my nose and lips is still hard, if not impossible without breaking the mask's seal.

As to whether the LT is better or worse than the FX for a particular person, I think that's a matter of how one's face and nose are shaped. For me, I"ve got hollow cheeks and very high cheek bones. The LT's L-shaped frames that are used to provide additional stability for the pillows dug into my cheeks in a most uncomfortable way and I could not tolerate having the mask on for more than a few minutes at the DME. But that was because of how my face is put together and should most definitely not be taken as a criticism of the design of the LT. Your mileage concerning the relative fit of the LT vs. FX may vary. Many folks here have commented (very favorably) that the LT has an adjustment that allows you to alter the angle the pillows fit into/onto your nostrils (and the FX does not, alas). And those L-shaped frames that don't fit my face do provide significant additional stability for the folks whose faces it does fit. You'll only know if the LT is an appropriate mask for you if you actually try it on.

Like you, I have high cheek bones and hollow cheeks, which has made finding a full face mask next to impossible. I didn't even think about that playing a factor in the nasal pillow straps. Thank you for pointing that out! It is amazing how informative everyone on this board is!

Emilia wrote:I like the LT because you can pivot the pillows to an angle best suited to making a good seal. You can also attach the pillows so that the the openings are either in a / \ pattern or flip it to be in a \ / pattern. The FX, from what I gather, is unable to do that. I really like the LT... it is so lightweight and comfortable, and I have had very little problems with leaks except when the pillows start to wear out, but I use that as my signal to get new ones! I use Lansinoh lanolin on my nares, and have since the first night using the LT. I've never had an irritation at all.... When I put on the heat during a cold snap, it tends to dry out the air and I put the humidifier on to help keep my nasal passages moist. When the heat is off, I still keep water in the humidifier and use it in pass over mode. So far, no issues with drying out my nose.

Thank you for responding. The ability to pivot the pillows does sound useful. I may have to try both LT and FX and see which fits best. I will definitely get the Lansinoh. Is it sold in stores?

HoseCrusher wrote:I was fitted with the FX. I was told the secret is to have it almost to the point where it is falling off of your head. As you roll in your sleep, a quick shake of the head re-settles everything back into place. After a couple of nights this becomes "hard wired" into your sleep habits.

The pros... Hardly know it is there, good nights sleep.

The con... Since you hardly know it is there you have to make sure you remove your mask when you jump out of bed. You may find yourself dragging a xPAP machine down the hall in tow behind you...

Do you mean have the straps so loose that they are almost falling off your head? I would love to have a mask that feels like it is hardly there. I am painfully aware of my mask all night long, unless I am on my back where it isn't getting smashed into my face.

Janknitz wrote:I have fairly high pressures (up to 15 cm on auto) and I truthfully cannot perceive the airflow in my nose. I just spent two nights in a FF mask because of an upper respiratory infection, and I felt like I was in a cold wind all night. The nasal pillow mask airflow is so much more comfortable!

As for nasal passage drying, that's what the humidifier is for. Some people find a little bit of Ayr Gel, Lanisoh, or KY Jelly just inside the nose is helpful, and saline rinses or sprays can also help hydrate the nose.

Are you positive you have slotted nares? I have very nice, round nares, but when I tilt my head back and look in the mirror, the angle makes them look slotted! So I have a feeling some people may think they have slotted nares when they don't really (and some people definitely DO have slotted nares).

The LT is a good "beginner" nasal pillow mask because it is very stable and adjustable. With a proper fitting it works great. The FX is incredibly comfortable, but takes some tweaking to work well.

The key to success in using either of these masks is a proper fitting, and—unfortunately—a lot of DME’s don’t have a clue how to fit these masks. Remember that the cone-shaped nasal pillows rest AGAINST the nose, not IN it.

ResMed has fairly good video/slide presentations showing how to fit these masks, but—inexplicably—never addresses the fact that the nasal pillows should fit against the nose. If you search “handy, dandy fitting” on this site, you will see my suggestions for getting a proper fitting for these nasal pillows.

Thanks, I will check out your fitting suggestions!

helpful1 wrote:Nasal pillow masks are wonderfully light and comfortable. I have noticed a slight increase in drying vs. my nasal mask, but nothing really significant. The only real disadvantage to me is that regular use may lead to permanent widening of the nostrils. While this is only a cosmetic issue, it's a fairly serious con IMO. The process is similar to tissue expansion used in plastic surgery (breast reconstruction, for example):

"Keeping living tissues under tension causes new cells to form and the amount of tissue to increase. In some cases, this may be accomplished by the implantation of inflatable balloons under the skin. By far the most common method, the surgeon inserts the inflatable expander beneath the skin and periodically, over weeks or months, injects a saline solution to slowly stretch the overlaying skin. The growth of tissue is permanent, but will retract to some degree when the expander is removed."

http://en.wikipedia.org/wiki/Tissue_expansion

I have been limiting my use of my Swift FX to every other day (switching to a nasal mask on the other days) but I'm not sure that will prevent the problem. I may switch to the nasal mask full-time as I've been getting more comfortable with it over time. This link has more discussion and another link regarding this issue:

viewtopic.php?f=1&t=58377

I have very narrow nasal passages, so the extra expansion might actually help me breathe better! I have to use nasal strips to hold my nose open at night. I have thought about nasal cones too.

KimberlyM wrote:Thank you for responding. The ability to pivot the pillows does sound useful. I may have to try both LT and FX and see which fits best. I will definitely get the Lansinoh. Is it sold in stores?

Yes you can usually find it in drug stores and I am sure walmart. Look in the section for nursing mothers or you may have to ask the pharmacist where its located.

CVS drugstore also carries a generic that is about $2 cheaper than the brand name Lanisoh.

Its basically purified lanolin of food grade quality....hence the use to prevent and heal cracked skin. It really takes a very smal amount on the nares. So tube I can see lasting for years!!! It also works wonders on dry scaly foot skin! lol

KimberlyM, That is the idea. The purpose of the straps is to just hold the pillows so they lightly touch your nose. The internal part of the pillow inflates with pressure to hold everything in place and create a seal against the outer part of the pillow and your nose.

Mine is so loose that it actually moves around when I turn and I have to snuggle my face back into it a little after a turn. This sounds like much more effort than it really is. With the loose fit I don't have issues with the back strap moving up on my head.

Of course, there is the hose to deal with, but that is a separate issue. I just lay on them and crush and destroy them...

The way I was fitted was to first be sized up to see what size pillows would work best. Then I held the pillows softly up to my nose while it was hooked up to a xPAP machine blowing air. Then the straps were adjusted to simply snuggle things in place so I could let go. I was told to go home and disconnect the hose from the mask and wear it for awhile to get use to how it feels. Then to attach the short hose and make any final adjustments. I then settled down for a restful nights sleep...

Please note that as with all things in life your mileage may differ, but the goal is to let the mask seal and use the straps just to hold it in position. Tightening the straps to create a seal is not productive with the FX. When it works, it is excellent, but if your face or head prevents it from working, look elsewhere.

HoseCrusher wrote:KimberlyM, That is the idea. The purpose of the straps is to just hold the pillows so they lightly touch your nose. The internal part of the pillow inflates with pressure to hold everything in place and create a seal against the outer part of the pillow and your nose.

Mine is so loose that it actually moves around when I turn and I have to snuggle my face back into it a little after a turn. This sounds like much more effort than it really is. With the loose fit I don't have issues with the back strap moving up on my head.

Of course, there is the hose to deal with, but that is a separate issue. I just lay on them and crush and destroy them...

Your experience sounds a whole lot like mine. There have been times that I've sat up in bed only to have the mask literally fall off in my lap---with no leaks until it fell of my nose! And I sleep on my side with the hose cuddled between my body and my upper arm most of the time. I"m sure if I weighed more than 106lbs, I'd be crushing and destroying them too.