Trying out a nasal pillow - what am I doing wrong?

[Elidh]

I have been on CPAP now for about a month. I breathe well with my full face mask, but am attracted to the minimalist characteristics of a nasal pillow. I went back to my DME and they fitted me with an Airfit P10 to try out. I have gone to bed with it a few times, but soon after (less than 10 minutes later) I remove it and switch back to the FFM. With the nasal pillow I seem to be unable to breathe out of my nose. The air comes in ok, but the flow is too strong to breathe out (I don't have this problem with a FFM). My flow rate is just 8 cm, btw. Is there a trick to this nasal pillow? I've adjusted the straps every which way and have tried different size pillows, to no avail. Perhaps I should try a nasal mask?

[palerider]

I have been on CPAP now for about a month. I breathe well with my full face mask, but am attracted to the minimalist characteristics of a nasal pillow. I went back to my DME and they fitted me with an Airfit P10 to try out. I have gone to bed with it a few times, but soon after (less than 10 minutes later) I remove it and switch back to the FFM. With the nasal pillow I seem to be unable to breathe out of my nose. The air comes in ok, but the flow is too strong to breathe out (I don't have this problem with a FFM). My flow rate is just 8 cm, btw. Is there a trick to this nasal pillow? I've adjusted the straps every which way and have tried different size pillows, to no avail. Perhaps I should try a nasal mask?

first there is no flow unless you're inhaling or exhaling.

the 8cm/h2o is pressure, not flow.

as far as not being able to breath, that's all in your head, because if you couldn't breath out for 10 minutes, you'd either explode, or be dead.

try a larger pillow.

[Pugsy]

Are you using the ramp feature?
What size nasal pillow are you using?

[Elidh]

Hi Pugsy

Are you using the ramp feature? No, turned that off the day I got the machine
What size nasal pillow are you using? They said I was between small and extra small. I have both sizes and have tried them both.

[Pugsy]

Unhook the mask hose from the long hose on the machine.
Put the mask on and see if you can move the air comfortably when it isn't attached to the machine.

Are you using EPR? If so, at what setting?
If not, let's try turning it on to see if it helps with the exhale.

[2kittymom]

I've been on cpap for over 4 years now, and I wasn't able to use the pillows for a long time. Recently I've finally had success with them, especially the Nuance Pro pillows. I know the feeling that you're having with feeling not being able to breathe out. Firstly, on my machine (Resmed S9), you have to change a setting if you're using pillows. (There's a separate setting for nasal, nasal pillows, and full face). I didn't know that right away. Then there's the setting to make it easier to breathe out. (EPR). I have mine set to the easiest one. If that doesn't help, I'd recommend you try the Dream Wear mask. It's a minimal design, and it just sits under your nose. It's very comfortable. I alternate with that one. I've tried the P10 pillows too, and find the Nuance Pro pillows more comfortable. They are thin gel, and I can hardly feel them when they're on. I'm always finding that the manufacturers are continually improving the products.

[Elidh]

Pugsy and kittymom - I'll bet the answer is in the EPR, and I'm going to check it as soon as I am able. I downloaded the clinician's manual for my machine in case I need to get into clinician's settings. I hope someday to be as helpful to a newbie as ya'll are to me!

[Pugsy]

The breathing test without the long hose attached is to eliminate the possibility of the inner cones on the nasal pillows being inverted or positioned in such a way as to block air flow.
If you can breathe easily that way (without the long hose and machine in the way) then most likely the trouble exhaling is because of the pressure. Your pressure isn't all that high (in the grand scheme of things) but I know that it can feel pretty high to start with.

While I doubt the problem is with the inner cones on the pillows...doesn't hurt to make sure and it also gives peace of mind knowing that you can breathe easily with the nasal pillows.

I also suspect that you just need either a little more EPR (if you are using it at an already low setting) or simply adding EPR if it isn't turned on right now.
Just play with the EPR settings and see what gives you the most natural comfortable breathing rhythm.
Sometimes adding EPR means that the pressure drop during EPR allows apnea events to happen if you happen to go below the threshold needed to prevent the airway collapse.
Doesn't happen to everyone though...so cross that bridge if you come to it. It's usually easily remedied by making the overall starting pressure just a little higher. Don't worry about it right now though. Might not happen in your case...watch your AHI to see if it goes up very much or not.