nasal pillows vs nasal mask

[oaklandcpap]

Hello,

I am a newbie in about my second month with APAP. Most nights I am able to get 5-6 hours before I get too irritated. I have met with the sleep therapists twice and both times they have *strongly* urged me to use the nasal pillows as the least irritating of the mask choices.

However...I am finding that I wake up every hour-and-a-half, almost without fail, and each time I am at risk of tearing off my mask in irritation.

Looking at my data after the first few weeks, the sleep therapist said it is the higher pressure which is waking me (at about 12), especially because "the machine can't lower the pressure fast enough" once the obstruction is opened. (I didn't totally understand this part). I raised the issue of a mask to avoid irritation of the skin around my nostrils and she again assured me I don't want a mask.

However...I just read that nasal masks can be better for those bothered by raised pressure, because the air is not as focused.

So, long-winded question: SHOULD I PRESS TO GET A TRIAL OF A MASK? Or even just buy one...

And if so, how do I start picking a mask???

[palerider]

However...I just read that nasal masks can be better for those bothered by raised pressure, because the air is not as focused.

that's garbage, 12cm of pressure is 12cm of pressure. it doesn't get "focused".

[yaconsult]

Ideally, your DME would work with you to be able to try out some different masks. If this is not the case, our sponsor cpap.com, offers some of the most popular masks at very good prices with free return insurance for 30 days which lets you return a mask if it doesn't work for you. For the masks without free return insurance, it can usually be added to the order for a reasonable price.

The most popular nasal pillow mask by far both here and at cpap.com is the AirFit P10 nasal pillow system.

[RRL]

Hello and welcome! I suggest you fill in your profile information to provide details about your equipment and pressure, etc. People here can better assist you if they have that information up front.

About the sleep therapist's comment that "the machine can't lower the pressure fast enough", and pressure of 12 waking you - they probably mean that the pressure was increased UP to 12 from a significantly lower minimum pressure, (say 8 for example) and once the pressure of 12 cleared the windpipe the machine may have decided to go back down to 8....but during the time it took the machine to go back DOWN from 12 to 8, you were woken up by the higher pressure, be it 11.5, 11, 10, 10.5 or whatever pressure on its way back down to 8. That's what I think they meant. Machine doesn't/can't/isn't designed to drop back down to the minimum pressure (that doesn't wake you) instantly.

I take "focused" to mean more direct pressure. Nasal pillows, as you know from the irritation, seal around the nostril openings. Nasal mask, as you know, seals in a triangular shape along the sides, bottom and bridge area of the nose. As such, there is 'dead space' (albeit not much) within the sealed area of a nasal mask. With the pillows there isn't that 'dead space' so the air pressure is "focused" directly into your nose. With the nasal mask the pressure is "focused" 'toward/at' your nose, but could swirl around some on the inside of the seal before/while entering the nose, based on my experience. So I can personally see where pillows could be seen as more "focused" by sending pressure directly into the nose vs 'toward/at' the nose. Whether nasal masks are better for those bothered by raised pressure, I don't know since I don't seem to be bothered so it's hard to compare. I think considerations may be is it the actual pressure opening windpipe that is waking you? or are Mask leaks? Mouth leaks? Sounds? other? waking you when pressure is higher?

Yes, you should press for a trial of a mask(s) if it is feasible for you to do so. It sounds like you want to try a different mask(s), but the "professionals" are steering you in the direction they think is right. Finding the "right" mask can often be the most difficult part of all this and it can take a long time and much trial and error. Of course, if it applies to you, consider things such as "mask trial period" policies of insurance (if it applies) and the equipment supplier, potential copays, expenses, etc. This forum's host cpap dot com offers a wide range of masks and many can be purchased with return insurance (often free) which allows a person to try a mask and return it if they don't like it. These things also may factor into whether you "should press to get a trial of a mask...or even just buy one."

If you decide to try masks, I started by looking at them online at this forum's host site and thoroughly read mask descriptions and reviews and compared different masks of interest. I searched this forum for topics and discussions about mask types and brands and read member posts. Another option that might be useful to "start picking a mask" is "chatting live" with a representative of and/or calling a reputable site that sells masks. These are some ways to start. It's all about the right mask for YOU, not what someone says you should use. It's important to find a mask that is comfortable and effective and doesn't leak or wake you up at certain pressures or have other problems. Finding that mask typically involves actually trying them. I tried 3. Some try 1 mask and they are set. Some try 10 or more before they find the "right" mask for them. Best wishes on your mask and CPAP journey!

[Pugsy]

SHOULD I PRESS TO GET A TRIAL OF A MASK? Or even just buy one...

Yes...you should try another mask but not because of the "focused" pressure thing but because you are wondering and wanting to. If you don't try it you will be dong a lot of "what iffing"....what if you liked a nasal cushion mask better and I think that people should scratch the "what if" itch whenever possible.

12 cm of pressure is the same no matter how it is delivered. Now will it "feel" different...I don't know.
I use a nasal pillow mask primarily and have for over 7 years now. I have tried some nasal cushion masks and the pressure felt the same to me.

If it is the pressure waking you....it's very likely going to wake you with a nasal cushion type of mask but you never know til you try.

I would be more interested in why this is going on every 90 minutes...why is the pressure changing so much.
Are you using available software to see what is for sure going on?
90 minutes corresponds to first REM cycle. I wonder if you are needing a lot more pressure during REM (which is very common and I know first hand about that) and it's the big increases that are the problem and maybe if the increases weren't so big they wouldn't wake you up so much.
Or maybe the machine is increasing the pressure and trying its darndest to open the airway but it can't get it done and you are having apnea events that are causing you to wake up.
So get the software so you can see exactly what is going on.
https://sleep.tnet.com/equipment

If you want to post an image of what you are seeing so we can see
https://sleep.tnet.com/reference/tips/imgur
how to organize...there's 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize
and some examples of the format we like to see
viewtopic/t103468/Need-help-with-screen-shots.html

If you are having irritation around the nostrils from the nasal pillows...make sure that things aren't too tight and you are using the correct size nasal pillow....consider going up in size..I know it sounds weird but often going up one size will allow the nasal pillow to be more stable and not move around and its the moving around that can irritate the skin on the nostrils.
The nostrils are pretty much virgin territory...not used to having anything rub up against them.
Even something as soft as a silicone nasal pillow.
We normally suggest that newbies go to the store and get some Lansinoh lanolin ointment/cream and use it sparingly at night and a lot during the day to help prevent the soreness and help heal any minor boo boos. It's the stuff breast feeding mom's use on their nipples...works wonders while your nostrils are getting used to having something on them.

Nasal pillow masks shouldn't ever cause anything more than very minor tenderness and if they do cause more than just tenderness...something is wrong.
Either with the size of the nasal pillow or the fitting. The most common error that people make with a nasal pillow mask is they make things too tight. These things don't have to be tight at all to seal.

And if so, how do I start picking a mask???

Mask preferences are going to vary among users so what I like you might not like and I have no way to know what you might like...and heck, since you are new there's no way for you to know what you might like either.
But I will share with you what I found that I had success with in terms of a nasal cushion type of mask and why I recommend them to newbies.

Look at these 2 nasal cushion masks. Your DME may or may not have them in stock but you can ask or just buy them yourself but you will need a RX...which is easy to get.

First the DreamWear from Respironics. It's the latest in nasal cushion masks and it's a very nice little mask and doesn't rub on the nostrils. I tried it not long ago and had good success with it. Call for final price...I think it is $89 if you call and it comes with free return insurance so you have 30 days to return it and get your money back. A prepaid shipping label is sent via email if you need to return it.
https://www.cpap.com/productpage/pr-dre ... -pack.html

Second the Swift FX Nano...which is a more traditional nasal cushion in the triangle shape.
https://www.cpap.com/productpage/resmed ... dgear.html
Minimal headgear and lightweight and a very nice little mask. It's the only one of the traditional triangular nasal cushions that I can use successfully.
It your current nasal pillow mask happens to be the Swift FX...you can get just the cushion and use it with your existing headgear.
It also has free return insurance.

I usually try the new nasal masks just for fun...so that I can learn about them. Not because I am unhappy with my nasal pillow mask.
Both the DreamWear and the Nano I kept and didn't return them...which is saying a lot because I won't keep what I won't ever use. I kept them just in case I ever had a situation where I couldn't use my nasal pillows...like a big pimple or something.

Do get the software and learn how to evaluate what is going on yourself. If your pressure is sub optimal and varies widely...changing the mask type may not fix your problem.

[chunkyfrog]

Different designs of the same class of mask have different proportions and angles.
I tried a bunch before I found any that did not "fight" with my face.
Like with shoes, I look for a fit that feels like NOTHING, or as close as I can get.
This is essential, as all faces are different.
DME'S may think all faces are the same; no logic there at all--just ignore them..

[oaklandcpap]

SHOULD I PRESS TO GET A TRIAL OF A MASK? Or even just buy one...

Nasal pillow masks shouldn't ever cause anything more than very minor tenderness and if they do cause more than just tenderness...something is wrong.
Either with the size of the nasal pillow or the fitting. The most common error that people make with a nasal pillow mask is they make things too tight. These things don't have to be tight at all to seal.

And if so, how do I start picking a mask???

Thanks so much to Pugsy and others for your extensive help and suggestions.

Currently, I am using borrowed equipment (from Kaiser) and don't have a way to read the memory card yet. I am a bit of a geek though, and will figure out how soon enough.

In the meantime, I will get the lanolin for the nose. I have already tried the different sizes and settled on the large.

However, I am most intrigued by the issue of tightness you mentioned. Sometimes the skin is irritated, but I also often feel the pressure from the pillows and the straps themselves is TIGHT. I must admit I am an oversensitive type, to begin with. When I complained about the tightness of the band, the sleep therapist said it was the largest (or only?) size of band. When I get home today, I will look and see the brand of the nasal pillows and see if larger straps are offered

Now, on the 90 minute wake-ups: The sleep therapist said that I was "panicking" at the raised pressure and that if I just breathed through the wake-ups and fell back asleep (without turning off the machine or pulling off the strap) that eventually I will get used to it.

However, right now I am really frustrated -- the past two nights I only got 2.5 hours a night on the hose.