Nasal Cushions- need some help

[letchworth]

Hi All;
I have enjoyed reading these forums for the past 6 weeks and have learned a lot-- thank you to everyone.

I have been on CPAP for more than a year. First 7 months with Respironics Comfort Gel mask. Generally worked fine except I have dry eyes and many times I would awaken with the mask migrated to my eye socket & then leaking air directly to my closed eyes (Nothing critical, but at the time I was going through tests for glaucoma and wasn't willing to take a chance).

A friend told me about these wonderful nose pillows/cushions- and I liked the idea of a smaller footprint on the mask and keeping air out of my eyes- so, since it was time to change masks/headgear I asked my provider about pillows- they brought me a Respironics OptiLife mask with various sizes of pillows and a couple cushions to try out.

I think the representative knew less than I did- he showed me how the pillows/cushions snapped into place, but was no real help in fitting the headgear to me. I played with it and decided to use it that night. Standing up the mask worked great, not bad while lying on my back, but the headgear kept popping off my head while lying on my side. I later tied the cushions and the same or worse- but I was able to get a descent sleep as long as I didn't move too much.

After a couple weeks I began wondering what was wrong with the OptiLife design and noticed a second slot in the cushion holder (thing that looks like a horse's bit). I figured it was designed for different face contours, but I wondered that if I put an elastic strap through there, it might hold the mask in place better (going around neck & connected to existing headgear via a short strap to keep the pressure upward as well as against face). Long story short- it works great and my friend suggested a plastic parachute clip for quick release.

Next thing was the pillows- they now sealed well to my nose, however it often seemed like I was getting less air in one nostril than the other (not always the same one)--- but, when I tried the cushions the airflow seemed much more uniform & at a comfortable flow rate. Great night's sleep as long as I didn't move too much (or leaks would result- even with new strap in place).

That's kind of where I am- at one point I thought of enlarging the hole in the pillows for more airflow, and I am beginning to wonder if the 6 month old cushion is just getting worn out & needs replacing (again, provider not going out of their way to help- never have check up on me- Unfortunately the place where I had sleep study represents a couple of providers, but not one that works with my insurance).

Anyway, as I told someone recently, "I spent two nights getting set up for CPAP-- and joined the league of those who spend an entire lifetime seeking the perfect mask".

Sorry my post is so long (not that I am ever brief) but a lot of history as to where I have come from. I was diagnosed with 67% Oxygen at night and 99% in daytime; 40+ episodes an hour with the longest being 45 seconds. Not only unbearable snoring for my wife, but neurologist suspected that my migraines (almost 20 years) might be directly attributable to Apnea. Since beginning CPAP I have had no migraine episodes and have been able to use only my sustenance medication- and no episode medication during that entire time. I feel like I am not only alive because of CPAP- but able to live my life.

Having said that, I am sure you realize I am committed to continuing- but sometimes frustrated with the search for the "perfect mask". Your insights, suggestions, comments will be much appreciated. (& thank you for your patience with my volume 1. (My machine is Respironics RemStarPro M Series with Resironics Humidifier).

letchworth

[Pugsy]

Try some new cushions. I use the nasal pillows and while my insurance will replace the pillows or cushions (if I used them) every 2 weeks, I find that I can get about 6 weeks of use then it gets harder to get a good consistent seal. Check with your insurance company to see exactly what their replacement schedule is. If it mimics Medicare it will be every 2 weeks for cushions or pillows.

I used the Optilife nasal pillows during the titration study. Came home with it and used it for a week or so till I got the Swift LT for Her. I had trouble getting the sizing down small enough for my head and the little chin strap ended up not doing what it was supposed to do. So I am zero help with any tricks but I never had the head gear problems you describe and I toss and turned all night long.

[Muse-Inc]

...the headgear kept popping off my head

Are you sure you have it properly adjusted? Watch the online videos to verify how to adjust. I loved the OptiLife and wore it for 20 months (still would be but I lost a lot of wt and started leaking air, so wear the RespCare Hybrid which covers my mouth and has nasal pillows).

...often seemed like I was getting less air in one nostril than the other (not always the same one)

This sounds like a congestion issue. But, if it's not, are you sure you're using the right pillow size? They put me in a medium pillow but I felt like I wasn't getting enought air and switched to the large which was perfect. Too, the pillows must be clean to ensure you get a good seal. I am a pretty much a clean freak re nose from chronic allergy-sinus issues so I wash in an all-natural soap, leave soapy while I shower, rinse well, spray with vinegar, let sit 2-3 mins, rinse well, then air dry. If the OptiLife pillows became filmy, I soaked them 20 mins or so in dissolved bromelian powder (from pineapple, it dissolves proteins) -- it always restored their transparency.

EDIT: I replaced the first pillow in 3 months (got filmy and I couldn't get it clear again...hadn't tried bromelian yet). Next one lasted 9 months. The last one is still good to go.

[letchworth]

First, my apologies for not responding sooner- I hadn't realized I had a second response (apparently something not set correctly in my profile-- how do I change it?)

Thanks to Pugsy, I contacted my provider and had some conversation with them- which resulted in ordering some new pillows & cushions as he old ones were getting old. The fact that sealing is getting worse on the 5 month old cushion made me conclude that might be the problem. I ordered two pillows to follow up on that as well, but ordered four cushions as I seem more comfortable there.

Fit is a good question-- I did go to Respironic's website and found .pdf but not video for OptiLife. Fit is a real question for me, and the original "salesman" who delivered the OptiLife didn't seem to know too much. After being "fitted"- I felt as though I was wearing a skull cap that kept slipping off. Eventually in my frustration I pulled it down further and it now feels more like a child's Thanksgiving head-dress (from just above brow and around like a headband). And I re-adjusted the other straps to make the appropriate fit (or so I think).

The ComfortGel I started with came with a DVD showing proper fit & care of the mask- all I got with this one was a packing slip.

As for the question about congestion and the pillows--- I switched to the cushions after trying the pillows for a few weeks (switched in a night of frustration-- and got immediate relief).

As for cleansing-- I wash the pillows or cushions thoroughly within an hour of putting them on- and they still look basically clear (but I ordered new ones assuming they might be breaking down a bit). Hopefully the new ones will arrive in Monday's mail (I switched from my providers local office 55 miles away to their phone warehouse-- I wasn't getting the service anyway, so this gives me faster service and a seemingly more sympathetic ear (and the answers seem to make more sense this way- we'll see).

Again, my apologies for not responding sooner (& thank you very much for your interest and time)
letchworth

[Muse-Inc]

Try here for OptiLife fitting instructions here http://optilife.respironics.com/fittingGuide.aspx and here http://optilife.respironics.com/fitting.aspx

Here's FAQ on the OptiLife http://optilife.respironics.com/faqs.aspx

It really sounds like it's not fitted properly. You have seen these images, right? https://www.cpap.com/viewImage.php?PNum ... k-side.jpg

[letchworth]

Try here for OptiLife fitting instructions here http://optilife.respironics.com/fittingGuide.aspx and here http://optilife.respironics.com/fitting.aspx

Here's FAQ on the OptiLife http://optilife.respironics.com/faqs.aspx

It really sounds like it's not fitted properly. You have seen these images, right? https://www.cpap.com/viewImage.php?PNum ... k-side.jpg

I don't know where i found what I found-- but the links you gave me were very helpful

Indeed, I had been working against the design of the Opti-Life out of ignorance (you have both been so much more helpful than my provider- and so much more knowledgeable- Thank you both).

I read your post about 11:30 last evening & took the time to read and/or listen to each link- very revealing, I then took time to readjust everything. That shortened my night a bit- but was well worth the "price of admission". I still developed a few small leaks throughout the night, but a definite improvement.

I was not constantly re-seating the mask as sometimes happens, & even had less marks on my face after taking off the headgear.

I still have some of the various sizes of pillows and cushions- so will try to put some pillow-time into trying to verify size- but I do think this cushion is getting old and needs replacement (on its way).

Thank you for the links and the advice
(I have a question or two on cleaning- but will post that separately below, this afternoon)
letchworth

[drubin007]

I started off with the same headgear and nasal pillows, but have since switched.

As Pugsy suggested, the Swift is a much better design, and more comfortable for side sleepers. Granted, everyone will have their own opinions, but I think the Opus setup is even better then the Swift. (I have since given the swift to my neighbor who has been on a nasal mask for 2 years, unbeknownst to me until recently!)

In any event, you clean the pillows daily? Again, this can be a different topic altogethger and already is, but I soak mine in baby shampoo and water for 15 minutes once a week, then to a pot of water and white vinegar... soak it and let air dry for the day... I am in a routine, and that is my Sunday ritual. Once during the week I take it all apart and let everything air out... I am still a noob to the cpap world (about 4 months or so?) but it has been working for me, and no apparent breakdown in my equipment.

One thing that has not been mentioned that I will throw in here as well... with the headgear the back strap (the bottom one if you will) is to support it, adjust the top one... that chin strap thing built on there is worthless in my opinion as well.

[OneCatBelleSundance]

Hey Pugsy, did you say that the nasal pillow needs to be replaced every 6 weeks to two months? I just started CPAP in mid-July and am still using the same pillow as when I started. Everything seems to be okay. How can you tell when you need a new pillow? Do you automatically change every two months? Can I order new pillows and filters from CPAP.com without a prescription? I'm thinking my DME will charge a lot more and while I have good insurance I'll still have to pay 15% and think CPAP.com will be cheaper. Plus I want the pink hose cover they have. Honestly, I don't know what I'd do without everyone's advice/information. Thank you!

[Pugsy]

Hey Pugsy, did you say that the nasal pillow needs to be replaced every 6 weeks to two months? I just started CPAP in mid-July and am still using the same pillow as when I started. Everything seems to be okay. How can you tell when you need a new pillow? Do you automatically change every two months? Can I order new pillows and filters from CPAP.com without a prescription? I'm thinking my DME will charge a lot more and while I have good insurance I'll still have to pay 15% and think CPAP.com will be cheaper. Plus I want the pink hose cover they have. Honestly, I don't know what I'd do without everyone's advice/information. Thank you!

First you can order just about anything from cpap.com without a prescription EXCEPT the actual mask package, humidifier and cpap/apap machine. Anything else is not governed by the RX requirement. So any replacement parts to the mask (like pillows or cushions, headgear, etc) do NOT require a prescription to be on file. Makes zero sense because you can essentially construct a new mask with replacement parts but that is not very cost effective.

Medicare guideline for replacement parts will allow 2 nasal pillows or cushions per month. Most insurance companies tend to follow Medicare replacement guidelines. I think 2 per month is quite generous and I don't see the need to change mine that often. In fact I can still use the original nasal pillow that came with my mask the last of May. To be honest, I cannot tell a huge difference between the old one and the new one. The old one may be a bit more "soft" overall. But then I got some extras early on and have rotated use. The best way to tell if new would make any difference is to get one and try it. If you don't see a big difference, then continue using the old until it seems to act up.

Watch cpapauction because sometimes you can get some really good deals on supplies. So far I don't see that they are requiring a Rx on file for even masks themselves. This is a good place to get a mask for an experiment.

Do the math when it comes to your insurance and your co-pay vs online prices. My co-pay for nasal pillows with my insurance is $5.14. Obviously I can't buy them anywhere for that but it all depends on your insurance and your deductible. I can get 1 mask every 6 months through insurance through DME. My co-pay for my Swift LT for Her was $38. Great deal twice a year but leaves me out in the cold if I want to experiment. So I bought online at the auction for my experiments for just about what my co-pay for the Swift LT was.

[Pugsy]

To OneCatDance
I see you are using an Opus 360. What size pillow do you use?? If it is a size I have that I don't use, I will let you have it or maybe swap for pillow of my size that you don't use????

The Opus pillow does seem a little sturdier than the Swift LT so they may not need to be changed very often.

Increased leaks and poor sealing ability (having to keep fiddling with them) seem to signal that nasal pillows or cushions are getting tired.

[Robespierre]

letchworth

When I first started using the OptiLife, I also had trouble keeping the back strap from slipping out of place. I did some searching and found this tip viewtopic.php?t=5965&highlight=#p54055. Though it was originally for another mask, it works very well for keeping the back strap of the OptiLife in place.

Jim

[Muse-Inc]

I'm glad the links helped. I adore this mask, so minimal, so comfortable!

OptiLife pillow life: replaced first on in 3 months (I had problems figuring out how to clean it without aggravating my allergies-sinuses-inside nose and was too rought and tore it). Second one lasted 9 months. Third one was still good when leaking air thru pursed lips forced me to move to the Hybrid mask...that pillow was in nightly use for 8 months and is still in good shape. I just washed everything and bagged it as my backup mask.

I washed the pillows after every sleep (night or nap) in 7th Generation soap, let sit soapy while I showered (or min of 20 mins), rinsed well, sprayed with vinegar, let sit for 2-3 minutes, rinse well, check for cloudiness, if cloudy (meaning protein deposits in my case), soak for 15-30 minues in bromelian (pineapple extract) dissolved in warm water, rinse well, let air dry.

[OneCatBelleSundance]

To Pugsy: Thanks for all the information. My insurance will probably pay for new pillows so I think I'll call my DME. I wear a small but will pass on your kind offer to trade.

[Pugsy]

To Pugsy: Thanks for all the information. My insurance will probably pay for new pillows so I think I'll call my DME. I wear a small but will pass on your kind offer to trade.

I wouldn't have been able to help much. I wear the small also..

[letchworth]

I'm glad the links helped. I adore this mask, so minimal, so comfortable!

I washed the pillows after every sleep (night or nap) in 7th Generation soap, let sit soapy while I showered (or min of 20 mins), rinsed well, sprayed with vinegar, let sit for 2-3 minutes, rinse well, check for cloudiness, if cloudy (meaning protein deposits in my case), soak for 15-30 minues in bromelian (pineapple extract) dissolved in warm water, rinse well, let air dry.

When you say you wash the pillows after every sleep...." I am assuming you literally mean JUST the pillows?? Another of my frustrations with OptiLife is that I haven't figured out to wash the short tube (non-detachable, at least I haven't figured out how to detach it). So, not sure how to wash short tube and part that holds pillow-- without detaching ALL the straps.

Any thoughts would be appreciated
letchworth