nasal pillows vs. nasak masks vs. ffm

[lindam0521]

i began CPAP about eight months ago, mild to moderate, overwhelming more prevalent in REM sleep, prescribed a nasal mask and then changed to a FFM since mouth breathing was a problem. I have been on a stringent weight loss plan through a local hospital, have lost a significant amount of weight and have a significant amount more to go and as my weight went down the FFM was too large and i already have an XS so the pulmonary assistant suggested the nasal pillow. doc also thought that a pressure drop was needed due to weight loss, i know the symptoms are easing up as the weight comes down but it's not gone. Despite all of this CPAP has never kicked in to give me the restorative night's sleep i really need. some days are better than others but none are that good.

the nasal pillow was a little hard to get used to, adjusting the pillows, but seems as if will accommodate ongoing weight loss better than masks than conform to facial features.i just adusted my pressure back to 7 cfm, where it was originally titrated, from the 6 cfm it was on. Has anybody out there have any experience in having ffm/nasal mask/pillow and could give an opinion on what you thought about them in comparison? I had heard somewhere that nasal masks/pillows were more effective in treating sleep apnea but they weren't really helping either. Since using the nasal mask the second time i think i have gotten past the mouth breathing part and a lot of it was just habit, not congestion or other nasal problems. i know it takes a lot of people a long time to become acclimated but since i've been using it nearly every night i thought it would be better by now.

thanks.

[Janknitz]

As far as the nasal pillows, they are the best option for you because they will easily and effectively accommodate your facial structure changes. Just be aware that if you suddenly start to have leaking issues, it's probably pillow wear, not weight loss. The pillows can and should be replaced once or twice a month. Most insurers cover that. As your weight changes, you may need to adjust the headgear and possibly change pillow sizes, so make sure your DME gives you all THREE pillow sizes whenever you replace the entire mask.

Congratulations on the weight loss, that's AWESOME!

Now, for the bad news. Neither you NOR your doctor can tell what your pressure needs are as they change because you have brick for a machine that doesn't give ANY data except compliance data. Any recommendations your doctor makes or you try are guesswork at best. And you should be aware it's not safe to assume anything with respect to pressure changes and weight loss. We've seen people here who's pressure needs actually INCREASE as they lose weight.

You should really be on an APAP machine, because that would allow you to do some titration at home to see where your pressure needs really are. Without a data capable machine, the only way to really tell is to get another $leep $tudy

Unfortunately, after 8 months, there's very little chance your insurance will cover an APAP because it's the same billing code (E0601) as the dumb brick you were provided--as far as the insurance company is concerned you already have an E0601 machine and they won't pay for another (though it's always prudent to ask!)

If you have the financial resources, you might consider buying out of pocket an autopap that matches your machine model (so you don't also have to buy a new humidifier). You can get a good price at online vendors or look for a used one at cpapauction.com, secondwind.com, or craigslist. With an APAP, you can collect data to see where your pressure should be.

Shame on your DME for supplying you a dumb brick of a machine, and shame on your doctor for not insisting you have an APAP for just this reason!

[jimnsc]

I won't get into the technical issues about pressure but would like to give you my experience with the different interfaces. I started with the FFM (Quattro) as I was a mouth breather due to a deviated septum and periodic allergic congestion. I trained myself to breathe through my nose by placing my tongue just behind my upper teeth as recommended by some pros here. I first tried pillows and then the nasal masks (many because I'm impatient). I have settled on nasal pillows because I honestly believe I get more air directly to my airway than from a mask. The pillows clear up any congestion I may have very quickly but I don't know if that would be the case for everyone.

Not all pillows are equal in different nares nor do all pillows cause chaffing if the fit and angle are good. If you notice I'm currently using Swift II's. Its barrel can be turned after placing the pillows allowing changing the angle and you really can tell which position is best as you move it. As information, I really like to switch from my back to my left side. This is not done as swiftly as a child turns because I weigh over 200 pounds - it's a slow process and I have yet to dislodge these pillows in the process. I lose some air through my mouth during the night but as long as I stay from an AHI of 0.? up to 4.0 I don't plan to use a chinstrap or tape on my mouth. Should the time come when I can't be below a 5.0 I will promptly do so if necessary. I don't plan to chase 0.0 just because it's there (although once would be a thrill).

I'm rambling but wanted you to know what worked for me. I think the best thing I did was to train myself to breathe through my nose because I am convinced I get the best treatment with a nasal interface. Good luck to you.

Jim

[welki]

I lose some air through my mouth during the night but as long as I stay from an AHI of 0.? up to 4.0 I don't plan to use a chinstrap or tape on my mouth. Should the time come when I can't be below a 5.0 I will promptly do so if necessary. I don't plan to chase 0.0 just because it's there (although once would be a thrill).

Jim, I want to thank you. And Linda, maybe my new "AHA moment" will help you, too.

You've opened my eyes with your statement, Jim. I need to stop chasing that 0.0 and start sleeping. It's been about 6 weeks since I started APAP and I've been so preoccupied with AHI and leak numbers that I'm sure my sleep is suffering because I'm simply not relaxed enough to rest.

Mostly, I've been using nasal pillows (Swift FX for Her) with a chin strap because I mouth breathe. My nasal mask. the Mirage FX for Her, is comfortable, but leaks are high. The chin strap hurts (I've tried a couple); the clips either dig into the side of my face and my jaw hurts in the morning or the no-clip ones are either too tight or too loose to be comfortable and/or effective. The few times I've ripped them off in frustration, I've woken myself up only a few times breathing through my mouth and my stats, when reviewed later in the day, are always within "acceptable" range.

I just tried a Mirage Liberty (a hybrid), and it works for the most part, but the nasal pillows don't come in XS and the headgear seems like it's made for a man .. or maybe my skull is strange, so it needs to be cinched up very tight, probably too tight.

So it looks like what I need to do now is realize that while there's always room for improvement, I need to stop focusing on and striving for perfection and get some sleep.

welki

[jimnsc]

Amen Welki! Proficiency will come with use.

[gasp]

I lose some air through my mouth during the night but as long as I stay from an AHI of 0.? up to 4.0 I don't plan to use a chinstrap or tape on my mouth. Should the time come when I can't be below a 5.0 I will promptly do so if necessary. I don't plan to chase 0.0 just because it's there (although once would be a thrill).

Jim, I want to thank you. And Linda, maybe my new "AHA moment" will help you, too.

You've opened my eyes with your statement, Jim. I need to stop chasing that 0.0 and start sleeping. It's been about 6 weeks since I started APAP and I've been so preoccupied with AHI and leak numbers that I'm sure my sleep is suffering because I'm simply not relaxed enough to rest.

Mostly, I've been using nasal pillows (Swift FX for Her) with a chin strap because I mouth breathe. My nasal mask. the Mirage FX for Her, is comfortable, but leaks are high. The chin strap hurts (I've tried a couple); the clips either dig into the side of my face and my jaw hurts in the morning or the no-clip ones are either too tight or too loose to be comfortable and/or effective. The few times I've ripped them off in frustration, I've woken myself up only a few times breathing through my mouth and my stats, when reviewed later in the day, are always within "acceptable" range.

I just tried a Mirage Liberty (a hybrid), and it works for the most part, but the nasal pillows don't come in XS and the headgear seems like it's made for a man .. or maybe my skull is strange, so it needs to be cinched up very tight, probably too tight.

So it looks like what I need to do now is realize that while there's always room for improvement, I need to stop focusing on and striving for perfection and get some sleep.

welki

I so agree! I watched my number very closely which served me well in achieving the best numbers I could. Then relaxing and knowing my numbers are excellent put me into the next phase of therapy - just relaxing into sleep and knowing I'm doing well. I hope it works as well for you as it did for me. I do still look at my numbers, whenever I don't feel rested and if rested every two weeks or so.

[jimnsc]

Another good night....... AHI 2.4 with some leaking but not bad. Looking on the bright side, it could have been a 7.5 but I'm passing and that's what counts!

[Muse-Inc]

...I just tried a Mirage Liberty (a hybrid), and it works for the most part, but the nasal pillows don't come in XS and the headgear seems like it's made for a man .. or maybe my skull is strange, so it needs to be cinched up very tight, probably too tight...

If the Liberty doesn't fit your face well, it's likely the RespCare Hybrid Universal will...that's been consistently reported here: if one fits well, the other won't. Comfort of pillows, security of not losing air via flapping lips -- gotta love the hybrid-style masks!

PS Check how you feel each morning before you log/review your numbers! Most of us here are too geeky not to become addicted to numbers and tweaking!