Trouble exhaling with Swift LT

[allinknots]

I have a Swift II as well as a Swift LT. I can exhale just fine when I use the Swift II, but I struggle with leaks. (I've tried various things: with and without wearing a pap-cap, using some plumbers teflon tape, using rubber o-rings, etc. My leak rate hovers around .16.) I thought that a Swift LT might work better for me, but I have difficulty exhaling with it. It seems like I have to forcibly exhale to clear the air.

My pressure is currently set to cpap only, and at 9.6. After reading on the forum that several members' AHI's were helped by turning down or off their exhalation relief, I did the same. I turned mine down from 3 to 1 (ResMed Auto S8), and my AHI numbers improved. I can exhale just fine with the Swift II, but I have leaks; I have trouble exhaling out of the Swift LT, but the leak rate seems less. (I don't have an actual number to report since I tend to rip the mask off because I feel like I'm suffocating.) I tried upping the EPR again to 3, but I still had trouble exhaling with this mask.

Does anyone else feel that it is difficult to exhale with the Swift LT? I like the feel of this mask so far, and it seems to not leak--to the point of not even letting my exhaled air out properly .

Suggestions?

Thanks,
All in Knots

[Raj]

Try going to the next cushion size up for the LT. I suspect the double walls of the LT reduce air-flow a bit compared to the Swift II.

[allinknots]

Woops, Raj, forgot to mention that. Yes, I did try to go up to a medium from the small, but it just felt uncomfortably too large. I did seem to get air up into my nostrils more easily with the medium, but the exhalation was still an issue. It seems like the exhalation holes on the mask--not the pillows/nares--are too tiny. I've thought of tinkering with the exhalation holes screening by trying to enlarge the tiny holes a bit with a needle, but whenever I tinker with a mask I seem to make it worse.

Thanks for your response,
All in Knots

(edited for clarity)

[boston]

It seems to me sometimes that exhaling is a bit difficult with the swift lt, but i am usually stuffy or allergies are bugging me some. I did find that when i lay down, instead of grabbing my mask and putting it on immediately, I lay still for about 5-10 minutes and focus on being relaxed, and I can tell my breathing slows down, then I put my mask on and I dont seem to have the exhaling issue.

[jnk]

It is a risky business to do, but you may want to think about the silver123 trim fix:

viewtopic.php?f=1&t=36044&p=311137&hili ... rs#p311137

[birdshell]

Here is the solution that jnk suggested:

You might try the next pillow size up. I get less leaks with the small pillow but feel like I am working really hard to move air. The medium tends to not seal as well and leaks. My remedy was to trim more plastic from the opening in the small pillow for more airflow and that worked fine. You have to trim both walls since it is double walled. I used very fine micro-surgical scissors and only trimmed a 1 -2 mm or so. But try moving up a size and see if that helps first.

silver

I second the trimming solution; I did something similar with my ComfortLite 2 Direct Seal as the edges seemed bit of fluttery and tickled. Go LESS than 1 mm if you can; it doesn't take much to really enlarge those openings. You can always trim off a touch more. I used some cuticle scissors that I dunked in alcohol after washing with warm/hot water and dish detergent.

Further, I have found with several different nasal pillows systems that it can seem difficult to breathe at times until I've played with the adjustment of the pillows in my nares. So, maybe that would work for you? I hope so!

Let us know if you solve it, as this could happen to someone else. Besides, if you DO solve it you will definitely need to brag about and/or celebrate your victory!

Karen,
Celebrate good times, come on!

[elader]

Its my biggest complaint with the swift (besides the horrific pimple in my nostril) - breathing in is not the problem, but breathing out into two little holes. I am gonna try the nailclipper thing.

[lmmo]

Maybe, since the lt leak rate is so low with the swift lt, your pressure is not comprimised as when you have leaks with the swift 2?

[plr66]

Just another FWIW response from a true-believer in the Swift LT. This may sound ridiculous, but I have often been surprised at the great amount of difference I find in ease of exhalation (straight cpap, no flex) by just re-seating the nasal pillows by pulling out each nostril pillow and re-setting separately. But I find on some nights that the trick is even more effective with just tilting the whole pillow assembly slightly back and forth once the nasal pillows are seated, while I'm comfortably lying down. I'm talking about what seems to be infinitesimal adjustments when tilting this back and forth. There should be no leaks happening with the nasal pillows when you do this. And then I suddenly seem to light on the "AHH" factor. Really. Try it, and do it patiently with pauses for a few normal breaths to adequately see how it feels. For some reason, once I then go to sleep, the adjustment seems fine for the rest of the night, despite my usual changing of sides every couple of hours. Occasionally I do need to do this tilting adjustment during the night as well.

I'd at least suggest you try this for a couple of nights before clipping off slivers of the silicone.

[sleepyangler]

Not sure why but I've had the exact opposite experience when exhaling with the LT. After maybe a half doz breaths when the machine 1st starts up and the pressure builds, I suddenly find it very easy to exhale. My apap is set at 12 to 15 and often ramps up to above 13. Once I get settled in after those first few breaths the only way I know the machine is still blowing air is by feeling the breeze from the exhaust vents. At first it sort of freaked me out as I thought maybe my apap was malfunctioning since the breathing is so easy. But based on the data, including an acceptable AHI and perfectly flat leak line, I am now happy knowing that I may have finally reached cpap nirvna!

I'll 2nd plr66 advise as it is very similar to what I do when I turn the apap on each night.

[plr66]

Not sure why but I've had the exact opposite experience when exhaling with the LT. After maybe a half doz breaths when the machine 1st starts up and the pressure builds, I suddenly find it very easy to exhale. My apap is set at 12 to 15 and often ramps up to above 13

Well I have to apologize and must have been preoccupied when I wrote my response above. I do not have my machine set to straight cpap. It is apap with a range of 10/20 with no aflex. Sorry. Same recommendations I made apply.

[allinknots]

OK, thanks for all the responses! I'll try it again tonight, by trying to separately seat each nare, and then lay back down and tilt it back and forth as needed. I'm glad that so many suggestions have been offered! Had you not offered these, I was going to try and tinker with the pinhole exhalation ports. I keep wondering if it would be easier to exhale out of these if they were larger? But I'm also wondering if enlarging them would also cause the leak rate to go up since more air would be escaping? Hopefully I won't need to find out--if some of these other fixes work.

Thanks, and I'll let you know how the nare-tilt works.
All in Knots

[jnk]

OK, thanks for all the responses! I'll try it again tonight, by trying to separately seat each nare, and then lay back down and tilt it back and forth as needed. I'm glad that so many suggestions have been offered! Had you not offered these, I was going to try and tinker with the pinhole exhalation ports. I keep wondering if it would be easier to exhale out of these if they were larger? But I'm also wondering if enlarging them would also cause the leak rate to go up since more air would be escaping? Hopefully I won't need to find out--if some of these other fixes work.

Thanks, and I'll let you know how the nare-tilt works.
All in Knots

Messing with the exhaust ports is rarely, if ever, a good idea in my opinion. They are fine-tuned for smooth, quiet operation. Messing them up would affect your leak rate, as you say, and your machine would try to compensate, if it could, so it wouldn't really help it feel easier to exhale anyway.

[plr66]

I was going to try and tinker with the pinhole exhalation ports. I keep wondering if it would be easier to exhale out of these if they were larger? All in Knots

Wait, wait! Before going any further, I've got to at least ask the question. You've referred to the pillow holes as "tiny" and "pinhole" sized. They are not. They are each about 1/4" across on the Medium size. Is it possibe that yours missed a step in the manufacturing process?

[lktnky]

I think the pinholes he's talking about are the ones on the tubing that attaches to the mask. It then attaches to the hose.
The ones you're referring to must be the nasal inserts?