fit questions about nasal pillows

[cheekywil]

Sorry - reposting this message AFTER logging in!!!

I am a new CPAP user (starting week 2). I have a trial machine (S8 Elite with humidifier) and was given a nasal mask to try. I had the Mirage Activa LT which sealed great but often left marks on my face and overall seemed too large as I would often wake up with the bottom of the mask covering both my upper and lower lips. I asked to try the Swift LT for Her nasal pillows and have found the headgear extremely comfortable and have had pretty good seal too. My main concern is that I find it more difficult to breathe with the nasal pillows (I have EPR on level 3, full time as with the first nasal mask). It seems like it is very hard to "catch my breath" when I first start CPAP for the night with the nasal pillows, and I seem to wake early in the morning feeling like I'm not getting enough air. I also have more noise with breathing than with the nasal mask - it seems to "whistle" at times and I can't get rid of this even if I move it to different angles.

I was fitted with both the small and extra small pillow sizes - both sealed well but I was given the extra small.

Does anyone have similar experience with nasal pillows vs nasal mask? Would moving up one size in pillows get rid of the whistling and the feeling of not enough air?

Also, would anyone out there mind sending me the clincial manual for the S8 Elite? I did not get this with my loaner machine and I would like to understand some of the settings better.

Many thanks and I really am grateful for this forum! It has helped me a lot already!

Wil

[Muse-Inc]

...Would moving up one size in pillows get rid of the whistling and the feeling of not enough air?

I moved from the OptiLife 'medium' pillows to the 'large' for that very reason and that move worked for me. After I lost a lot wt I moved back to the medium.

EDIT: Adjusting to exhaling against pressure take time.

[SleepyT]

Wil,
I have the same machine as you (Elite II)...and both of the masks you have (mirage activa nasal mask and activa LT for her nasal pillows). I had trouble adjusting to the pressure of the nasal pillows (exhaling against it) in the beginning.The Mirage Activa worked for me once I loosened it up some...so it wouldn't leave marks on my face...but it leaks when I sleep on my side. The Activa LT for Her nasal pillows is my favorite now...no leaks to speak of...and the readouts from my software say my therapy is going pretty well with the pillows.

I would give it some more time with the nasal pillows. I tried the small pillows...but it rubbed a small sore on my nose...so I went back to the extra small pillow...and it works just fine. Not sure if you should upgrade the size if it seems to fit pretty well now. I had the same experience of not getting enough air....and an almost panicked feeling when i first put it on. I learned to lie quietly on my back for a bit and settle my breathing...and then turn off the light and flip over to my side. Works like a charm!

Send me your private email and I will send you the clinician's manual.

SleepyT

[SleepyT]

wil,
use the PM button under your avatar to send a private message (for your email)...
thanks.

t.

[cheekywil]

Thank you all so much for the responses. It is so helpful to get this kind of feedback! Last night was my 5th night using the nasal pillows and it finally seemed a bit better. I didn't feel like there wasn't enough air last night and maybe I'm getting used to the noise. I tried lying quietly for about 5 minutes before putting the mask on and this seemed to help. I also adjusted my ramp settings to get a more gradual rise to full pressure (8) and I did not feel I wasn't getting enough air, so I guess it's a matter of lowering your heartrate and giving enough ramp time to solve that problem. I may still try the next larger size pillows at some point to see if that is quieter since I am still in the trial period and can try a few different masks without charge right now.

I found it was difficult to sleep on my side with the nasal mask since it would tend to shift and leak and my neck was really sore for that week from sleeping at a different head position. The nasal pillows are much less cumbersome and allow me to wear my glasses before falling asleep (TV or reading) and the headgear really feels much more comfortable for me than the nasal mask. Sleeping on my side is much easier now - leaks are rarely a problem or require only a minor adjustment of my bed pillow position to correct.

Next challenge is to get some hose management but there are lots of good ideas on this site!

Thanks again!
Wil

[SleepyT]

wil,
your next challenge is getting the software and card reader so you can really tell if your therapy is working! cpapaustralia.com sells the software (ResScan ver. 3.7). you can get the card reader there as well or go to cpap.com.

t.

[cheekywil]

Thanks - I will be looking into the software and card reader. That looks very useful. I have been checking my efficiency data each morning (thanks to finding a tip about how to access the clinical menu on this forum - press and hold Right and Down for 3-5 sec) and AHI is now 2.0 or less in general and leak rate is also very low (usually around 0.04L/s) so I think I'm getting a good seal. Would be interesting to see more detailed information though.

Wil

[ricochetv1]

Thanks - I will be looking into the software and card reader. That looks very useful. I have been checking my efficiency data each morning (thanks to finding a tip about how to access the clinical menu on this forum - press and hold Right and Down for 3-5 sec) and AHI is now 2.0 or less in general and leak rate is also very low (usually around 0.04L/s) so I think I'm getting a good seal. Would be interesting to see more detailed information though.

Wil

Actually, you can get results w/out using the Clinical Menu by holding down the right and left buttons for a few seconds.
May be a bit quicker to get to them.

Also, I've found, with the small pillow size on my mask, that the whistling is less when I pull the pillows more to the outside of my nostrils.

[DreamStalker]

The Swift LT comes with 3 sizes of pillows ... if your DME only gave you only one set, they likely stole your other two so they could sell them on eBay. Tell them to give you all three sizes of the pillows that come with your mask ... you (and perhaps the insurance) paid for them.

You can adjust the tilt that the pillows make with the frame ... that is an important adjustment for getting maximum airflow through the pillows. With the machine and mask on ... try adjusting that angle until you get the maximum flow. Also adjust the headgear straps for just enough tension to keep the mask in place and not over tighten those straps any more than is absolutely necessary.

As others mentioned, it is also important to stay on top of your efficacy data ... (especially with nasal interface masks) to make certain that you are not leaking your air pressure out your mouth. A dry mouth whenever you wake is often a sign of leaks from your mouth (although you can still have leaks without having the dry mouth) ... you will need to address mouth leaks if that should occur with your treatment.

[ricochetv1]

The Swift LT comes with 3 sizes of pillows ... if your DME only gave you only one set, they likely stole your other two so they could sell them on eBay. Tell them to give you all three sizes of the pillows that come with your mask ... you (and perhaps the insurance) paid for them.

You can adjust the tilt that the pillows make with the frame ... that is an important adjustment for getting maximum airflow through the pillows. With the machine and mask on ... try adjusting that angle until you get the maximum flow. Also adjust the headgear straps for just enough tension to keep the mask in place and not over tighten those straps any more than is absolutely necessary.

As others mentioned, it is also important to stay on top of your efficacy data ... (especially with nasal interface masks) to make certain that you are not leaking your air pressure out your mouth. A dry mouth whenever you wake is often a sign of leaks from your mouth (although you can still have leaks without having the dry mouth) ... you will need to address mouth leaks if that should occur with your treatment.

Or get a full-face or hybrid mask, the difference being that a full face covers your nose (Mirage Quattro), while a hybrid uses nasal pillows with a mouth cover (Mirage Liberty or http://www.hybridmask.com) to give you the best of both worlds, no taping required. I use these because I have allergies and mouth breathe a lot.

[cheekywil]

Thanks to SleepT for sending me the clinical manual for the S8 Elite II (and to others for offering!).

Good point about the mask coming with 3 different sizes of pillows - I will be asking for the other sizes of the nasal pillows at the end of my trial period (I have a one month trial for the machine and can try different masks at no charge during this time). My DME has not given me all of the materials (eg. the smart card for the machine, the extra mask pillows, etc...) until the end of the trial period and then they will bill my insurance, the equipment will be mine, and I'll get ALL of the accessories.

It sounds like a larger size of nasal pillows will promote a more "exterior" fit in the nostril and reduce some of the whistle so I will definitely try that. Things seemed to go better last night already - perhaps just getting used to it at last.

I don't struggle with mouth breathing at all since I have worn a mouth guard for bruxism for several years and this has me sleeping with mouth closed already. I don't have leak issues with my CPAP so I'm pretty sure I'm not opening my mouth and not being aware of it (also no dry mouth issues in the morning).

Wil

[hose head]

I switched DME providers in June. They last one didn't want to get me small pillows--because "they wouldn't fit right". She seemed to think I needed medium--maybe that's what they had in stock. The new one looked at my nares and gave me ex-small pillows. He seemed to think that the pillow should fit up into the nare. I wore extra small one night had horrible leak rate and switched back to small size. When I called order in for replacement pillows they were going to send ex-small, I said no, I use small and that's what they sent.
I fiddle with pillows before I settle down until they feel right and are blowing the air up into my nose, not into the side of the nose.
Good luck.

[JZ]

I also have more noise with breathing than with the nasal mask - it seems to "whistle" at times and I can't get rid of this even if I move it to different angles.

Wil

The Swift LT seems to come with a built-in whistle at times. When that happens to me, I have to adjust the pillows a little, or worst case scenario, turn off my cpap, pull the pillows away from my nares and re-seat them. Annoying. And some nasal pillows are a bit noisy in general, particularly on exhale. You can spend some money and get a fancy white noise machine, but what I did was put a table fan in my bedroom. I turn it on at night and the steady hum it makes helps cover up cpap noise.

Hang in there.

Janna

[ricochetv1]

I switched DME providers in June. They last one didn't want to get me small pillows--because "they wouldn't fit right". She seemed to think I needed medium--maybe that's what they had in stock. The new one looked at my nares and gave me ex-small pillows. He seemed to think that the pillow should fit up into the nare. I wore extra small one night had horrible leak rate and switched back to small size. When I called order in for replacement pillows they were going to send ex-small, I said no, I use small and that's what they sent.
I fiddle with pillows before I settle down until they feel right and are blowing the air up into my nose, not into the side of the nose.
Good luck.

The RT that delivered my eqp said you can, depending on the way the pillows work, cut them apart and use a different size in each nostril if that's what's most comfortable.
I know this works for the Liberty. I haven't seen the design on other masks.