Starting to get discouraged - CPAP air noise

[jon.koelker]

Hi - after some very encouraging initial weeks with CPAP, my optimism about it is starting to fade. I overcame the initial panic/claustrophobic sensation within the first few nights of use and that's no longer an issue. I then started experimenting with different masks to reduce air leak and noise. That, also, brought some success with persistence and practice. However, now, just into the second full month of therapy, it seems that things are regressing.

I went looking for an alternative to the full face mask because I couldn't seem to control air leak with it. I read that using nasal pillows might work better because of the smaller area of facial contact to manage - that seemed to make sense, so I tried it, first the Dreamwear pillows, then the AirFit P10, which I'm currently using. I tried both the medium and large pillows and it seems that large is the one I should be using. Looked like I had found the right system for me and all was going well - until late last week. I began to have trouble getting a good mask seal. That has continued every night for about the last four nights. Along with that air leakage, it seems like the sound of the air coming in through the hose is also louder, to the point where my wife has had to leave the room the last two nights in order to get some sleep.

This is pretty discouraging. I went to the P10 because I read that, unlike some other products, it was virtually noiseless - and at first, that seemed to be the case. Why it's suddenly gone south on me, I don't understand (no offense to anyone from Dixie). It kind of looks like the only way to get it to fully seal and be quiet is to tighten the headgear straps a lot more than I have been - that was producing some discomfort on my septum and the lower part of the nostril, so I loosened it a bit - but I guess I'll have to go back to that.

I'm not ready yet to say that the cure is worse than the disease, but right now, the net effect of the disease and the cure is the same - my wife and I are sleeping in different rooms.....

Would welcome any suggestions on silencing air flow noise and consistently getting good mask seal.

Thanks.

[Pugsy]

If your wife is hearing air noise something is wrong somewhere.
Correctly sealed there should be no noise anywhere with the P10.

Is she hearing it at the beginning of the night or the middle of the night?
What noise is she hearing? Hose air noise? Leak noise? Darth Vadar breathing sounds?
What pressure are you using?

You might look at the F & P Brevida nasal pillow mask.
It also has the diffused venting so no vent noise but the headgear offers more adjustments in terms of tension than the P10 headgear.

[babydinosnoreless]

You didn't say how long it went well before having leaks again. Headgear stretched maybe? Or need to replace pillows ? I use the N-20 and when I start getting leaks I know its time to check out my headgear. For me I switched to the smaller "for her" headgear and that helps it to last longer without issues.

[jon.koelker]

If your wife is hearing air noise something is wrong somewhere.
Correctly sealed there should be no noise anywhere with the P10.

Is she hearing it at the beginning of the night or the middle of the night?
What noise is she hearing? Hose air noise? Leak noise? Darth Vadar breathing sounds?
What pressure are you using?

You might look at the F & P Brevida nasal pillow mask.
It also has the diffused venting so no vent noise but the headgear offers more adjustments in terms of tension than the P10 headgear.

The noise is being noticed at the beginning of the night; it can be hose air noise and/or leak noise or both at any given time. And I'm sure my breathing doesn't help, but not much can be done about that, I suppose. The pressure was set by the technician at 11 based on the doctor's Rx.

I should also mention that I'm using a chin strap to keep my jaw from opening and I also either tape my lips or use the Scunci head-band method to try to keep any air from escaping through my mouth.

What's most frustrating about this is that it seems like I had pretty much gotten it working correctly, i.e., quietly, for a period of a couple of weeks. I only started the therapy at the end of August - went to nasal pillows (Dreamwear) on the 9th of September - changed over to the P10 pillows on 9/21. Since that time, with a couple of adjustments, things had settled in and gone well. Then we went away for a couple of days last week - first road trip with CPAP - and I started to get air leak trouble last Friday, 10/4. It has gotten progressively harder to get anything like a decent, quiet mask seal since that date. Something has obviously changed, but I sure can't figure out what it is.....

[jon.koelker]

You didn't say how long it went well before having leaks again. Headgear stretched maybe? Or need to replace pillows ? I use the N-20 and when I start getting leaks I know its time to check out my headgear. For me I switched to the smaller "for her" headgear and that helps it to last longer without issues.

It was going pretty good from about the 21st of September until the 4th of October. I switched to the P10 pillows on 9/21 - had a couple nights of 'shakedown' to get used to it and tweak the fit - and then it seemed like things settled into a pattern of good mask seal and very minimal sound level for almost two full weeks. The the mask leak started to re-appear and has gotten progressively worse over the last week. It seems like no matter how I adjust it, I can't get it to seal. Have tried going back to the medium size pillows, but that didn't get it done, so I returned to the large one. I'm also using a chin strap and either tape or a Scunci headband over my mouth to keep the air from escaping there.

Despite my best efforts, the sound of the air coming through the hose and my breathing with and against it is loud enough to prevent my wife from getting to sleep. But it seems like for that period of almost two weeks in September, I had it almost completely silent - to just something like the sound of normal breathing. I don't know what has changed....

[ragtopcircus]

Have you tried loosening the strap instead of tightening it?

Pillows (at least the P10/P30i style need to have room to inflate to form a seal. I wear my P30i loose enough that it won’t quite seal on its own when I turn the air on. Then I give it a light nudge or jiggle, it seals/inflates, and I’m good to go.

[Pugsy]

Take the water chamber out and look inside and check the gasket and make sure it is sealed evenly and doesn't have a crimp in it.
Then insert the water chamber again and turn the machine on and check for air noise.
If that gasket isn't sealed well their will be a lot of air noise.
Check all the hoses and make sure no holes or tears.

[jon.koelker]

If your wife is hearing air noise something is wrong somewhere.
Correctly sealed there should be no noise anywhere with the P10.

Is she hearing it at the beginning of the night or the middle of the night?
What noise is she hearing? Hose air noise? Leak noise? Darth Vadar breathing sounds?
What pressure are you using?

You might look at the F & P Brevida nasal pillow mask.
It also has the diffused venting so no vent noise but the headgear offers more adjustments in terms of tension than the P10 headgear.

Thanks for the tip on the Brevida product. I'm looking into that - looks interesting.

jk

[jon.koelker]

I think I may have hit on a solution to the noise issue - part of it is just making sure I get the P10 nasal mask positioned right. I think I had started taking it for granted that I was getting it lined up correctly, and I must have begun to get careless. Now I'm putting on the mask in front of a mirror so I can really see how the pillows are fitting in the nostrils. Taking my time doing it, too. Also - I had been alternating between tape over my mouth and using a Scunci headband to control mouth leak (along with my chinstrap); turns out the system seems to work best if I use both the tape on my lips and the Scunci head band. The headband isn't there for additional mouth coverage - the tape takes care of that - but the headband, when I position it over my mouth, tends to exert just a little upward pressure on the nasal mask - enough so that, if I've gotten the mask positioned correctly, it holds it in place and significantly reduces (often eliminates) air leak around the nostrils.

The last thing I do before heading to bed, is to breath several times through the nasal pillows and hose and then I put my hand over the end of the hose, both on an inhale and an exhale. If I've gotten the nasal pillows positioned right, this will completely block any air flow - and, on the exhale, it also seems to 'inflate' the pillows slightly so they make a better seal.

This method seems to be getting it done for me. Yes, there's still the occasional night when I think I have it completely quiet but my wife is still hearing some sound - but that's now very infrequent. Also, over the last four nights or so, I'm seeing 0 air leak being reported by MyAir (I know, a lot of uses don't think much of that app, but I find it a useful benchmark without diving into tons of minute detail data from the more sophisticated software).

Anyway, things seem to be improving. I still plan to try the F & P Brevida mask later this month and see if it might be the all-in-one solution.....

Thanks for all the suggestions!

[zonker]

The headband isn't there for additional mouth coverage - the tape takes care of that - but the headband, when I position it over my mouth, tends to exert just a little upward pressure on the nasal mask - enough so that, if I've gotten the mask positioned correctly, it holds it in place and significantly reduces (often eliminates) air leak around the nostrils.

yes, i too have found this to be a benefit of using the scuncis. i remember one night, i masked up without the hairbands in place. heard the gawd awful results at once!