First 30 days - Averaged 3 hours a night. Suggestions?

[karmamatic]

Newbie here, a month in. The most common complaint about CPAP- I can't get comfortable with the mask. Is it common to be having this much trouble after 4-5 weeks? I average 3 hours a night of mask use. My record is about 5 and a half hours with Z-Quil. I have the FP 431 mask, size medium. The heat and pressure of the straps and cushion feels like I am wearing plastic bondage gear to bed, and I'm not into that. I never take the mask off in my sleep. I always wake up and have to get it off my face because it's so uncomfortable.

So far I have tried:

- adjusting the straps and air pressure until I was as comfortable as possible
- Pad a Cheek - was still hot and uncomfortable, caused major leaks, and the velcro closure sits in front of the vent, causing a loud hissing. Not a fan.
- Switched to a size L cushion from a size M. Leaked like crazy.
- Tried an AirFit P-10 nasal pillows mask last night. I love how lightweight it is, and not having the triangle of pressure around my mouth and nose. Unfortunately, my nasal passages are too damn narrow or congested to breathe through them effectively all night.

With the nasal pillows mask, I dropped the initial pressure to 4 (4-20 range) because it seemed much stronger coming through the nose only. Before I slept, I did a saline sinus rinse (Netti pot type of thing) to try and open myself up as much as possible. It seemed to work for a few minutes, then closed up even more, especially when I laid down. Every breath was a struggle, but I stuck with it for about 30 minutes. Also, exhalation is very difficult with the amount of pressure it takes to breathe through the vent mesh. No way was I going to sleep like that. Switched to the FP mask and managed to keep that on for 2 hours. Still woke up with clogged sinuses and a headache, which is not normal for me.

I'll try again tonight. Any suggestions or questions?

[Pugsy]

What size P10 nasal pillow did you try last night?
If at all possible go up in size and try it again and also change the minimum pressure from 4 to 6 and see if it helps or not. Use it while awake and sitting up watching TV or reading for about 30 minutes and then lay down and try it.

And what setting is the humidifier on?

Does your nose clog up and become congested when you lay down and don't have the mask or machine on?

[karmamatic]

What size P10 nasal pillow did you try last night?
If at all possible go up in size and try it again and also change the minimum pressure from 4 to 6 and see if it helps or not. Use it while awake and sitting up watching TV or reading for about 30 minutes and then lay down and try it.

And what setting is the humidifier on?

Does your nose clog up and become congested when you lay down and don't have the mask or machine on?

I started testing it when I was awake and upright, with the size M nasal pillow. It seemed to make exhalation very difficult. I switched to the size L pillow for sleeping, and exhaling was easier but far from ideal.

The humidifier is maxed at 5 (System One).

I started testing at minimum pressure 6 and it seemed to contribute to exhaling being very difficult. With that much pressure going in, it was hard to breathe out, in addition to the resistance from the vent itself. I did my initial test sitting up, for about 20 minutes. Laying down does make my nose close up more, but it is frequently open enough to sleep with my mouth closed. With the nasal pillows mask on, and air being constantly forced in under pressure, it is very difficult to keep my mouth closed while trying to sleep. It takes conscious effort.

[yaconsult]

Have you experimented with Exhalation Pressure Relief yet to see if it helps you? Your machine has EPR settings of off, 1, 2, or 3.

Please fill in the equipment section of your profile to display your equipment in all your posts.

[Pugsy]

Are you using AFlex or CFLex exhale relief?
If not...try it...but remember AFlex needs to be set to at least 6 cm for it to engage at all.
Starting out at 4 cm and trying to get the benefit of the Flex exhale relief doesn't work.

Nasal congestion issues do present a problem.
If congestion is worse when masked up...maybe the humidity is contributing to the congestion.
You are using a high setting...might try lower setting to see if that helps or not.
It's funny about how the nasal mucosa react...for some people they get congestion if not enough humidity and for some people they get congestion if there is too much humidity and there is no right or wrong in this situation because it's just normal to have that variable among cpap users.

If you have nasal congestion issues without even being masked up then that presents a real problem when trying to use nasal pillow masks. Gotta be able to breathe in and out of the nose without opening the mouth for the therapy to work. So if you can't resolve congestion issues then you are pretty much going to have to use a full face mask.

Now I use the P10 mask so I am familiar with it and I have used a lot of the other nasal pillow masks over the years. The P10 is a nice little mask but at lower pressures it does sometimes present a problem for some people. Simply not enough air movement.

I am sorry but I can't help at all with full face mask hints. I have never really used one beyond a quick trial.
About all I can offer is that if this one doesn't work....try a different one.
Same thing with the nasal pillows....if you can get the congestion issues resolved you might like the air movement in the Swift FX nasal pillow mask a little better. It's similar to the P10 but the venting isn't as diffused and the pillows are tiny bit larger and I think air movement is a little bit easier with them.

You are going to find that finding the right mask is probably the most difficult part of this therapy and you are just going to have to try them out yourself to see if you can make them work or not.
In the mask market...one man's trash is another man's treasure.

First thing is to isolate, if you can, the potential culprit for the congestion and try to get it resolved.
If you get the congestion when laying down even without cpap...then we can't blame it on humidity and there's something else going on.

[Pugsy]

Have you experimented with Exhalation Pressure Relief yet to see if it helps you? Your machine has EPR settings of off, 1, 2, or 3.

OP mentions System One humidifier setting of 5 so we assume Respironics machine and the Flex form of exhale relief.

EPR is for ResMed machines and he may get confused looking for EPR on his machine.

[karmamatic]

Have you experimented with Exhalation Pressure Relief yet to see if it helps you? Your machine has EPR settings of off, 1, 2, or 3.

Please fill in the equipment section of your profile to display your equipment in all your posts.

It has C-Flex and A-Flex settings in the software. I guess from pugsy's reply that is EPR. Sounds good!

I've now filled in my profile to the best of my understanding, thanks for your suggestion.

[karmamatic]

Are you using AFlex or CFLex exhale relief?
If not...try it...but remember AFlex needs to be set to at least 6 cm for it to engage at all.
Starting out at 4 cm and trying to get the benefit of the Flex exhale relief doesn't work.

I went to the provider menu and set Aflex to be on. It is default at level 2. Does this detect exhalation and lower pressure for breathing out? I will set the lower end to 6 cm, thank you.

First thing is to isolate, if you can, the potential culprit for the congestion and try to get it resolved.
If you get the congestion when laying down even without cpap...then we can't blame it on humidity and there's something else going on.

I've always had problems breathing through my nose, in addition to athsma and allergies. It was surprising to me that the saline rinse just seemed to irritate my sinuses and make things worse. After my typical 3 hours of mask time, my nose sometimes opens up enough that I can sleep with my mouth closed, and therefore don't snore. Not always though.

[karmamatic]

Wow! Just tried the A-Flex. This is huge. Makes everything MUCH easier. Used the nasal pillows mask. I think this might work!

Pugsy- are you sure that with 3.06 software, it still needs 6cm to engage A-Flex? It really seemed like it was working at 4cm to me. I did switch it to 6cm min also. Big improvement either way.

[Pugsy]

Yes, AFlex or CFlex is Respironics form of exhale relief. On the ResMed machines it is called EPR for Exhale Pressure Relief.
AFlex being what is offered in auto mode and CFlex when in CPAP mode. They essentially are the same things called something slightly different depending on mode of operation.
I had a link to explanations but for some reason that link is broken right now.

To have exhale relief work you have to be using a pressure that gives the machine room to offer the relief.
Since 4 cm is as low as the machine will go anyway then when you are using 4 cm there is no room for any exhale relief.
With exhale relief there is a slight drop in pressure to help make the exhale easier but you get nothing unless you are using at least 6 cm. Play with the settings...1, 2 and 3 and pick the one that feels the best to you. Don't worry about the number...just pick/use what feels the best to you in terms of breathing rhythm.

[ChicagoGranny]

The humidifier is maxed at 5 (System One).

Why maxed? Do you live in an arid climate? If not, you probably have it set too high contributing to congestion and your feeling of being too hot.

What climate do you live in and what are your bedroom conditions (temperature & humidity)?

Pad a Cheek - was still hot and uncomfortable

What is your bedroom temperature? Does it make sense to turn the A/C thermostat down?

exhalation is very difficult with the amount of pressure it takes to breathe through the vent mesh.

Sorry, but I don't understand what "vent mesh" you were trying to breathe through.

I've always had problems breathing through my nose, in addition to athsma and allergies.

Part of being a successful CPAP user is taking care of those problems. Have you seen an ENT/Allergist? If you have not seen one recently, I recommend you have a consultation. He should examine your airway and he might test you for allergies on the first visit. The good ones can do a lot for you. Treatments have improved in the last ten years.

[Pugsy]

I started therapy with a Respironics machine. I loved AFlex once I finally got a machine that had it and I had been using 10 cm pressure without any relief which was doable but oh it was so sweet once I got a chance to try AFlex. To me it made it feel like I was just breathing normally and not even using the machine.
Hopefully this will help you stay longer with the mask.

Also...I have found that the added humidity actually seems to help any congestion issues I might have.
Often I might go to bed slightly congested for some reason and wake up with the clearest breathing ever.
My nasal mucosa likes lots of moisture. Even when I have had a cold I have been able to get the nose opened enough to use my nasal pillow mask. That's why I never got a full face mask...never needed one and sure didn't want one.

[karmamatic]

Why maxed? Do you live in an arid climate? If not, you probably have it set too high contributing to congestion and your feeling of being too hot.
What climate do you live in and what are your bedroom conditions (temperature & humidity)?
What is your bedroom temperature? Does it make sense to turn the A/C thermostat down?

Sorry, but I don't understand what "vent mesh" you were trying to breathe through.

Part of being a successful CPAP user is taking care of those problems. Have you seen an ENT/Allergist? If you have not seen one recently, I recommend you have a consultation. He should examine your airway and he might test you for allergies on the first visit. The good ones can do a lot for you. Treatments have improved in the last ten years.

The humidifier is maxed because I tend to mouth breathe and on lower settings my mouth was getting dried out. Room temp is about 75-77 with A/C on, and humidity, no idea. Midwestern climate, not arid.

The AirFit P10 mask uses a plastic mesh as its vent. Especially with no exhalation relief, the medium nasal pillow builds up a good amount of pressure to breathe against.

I've seen an allergist in the last 3 years, but got no satisfying solutions aside from learning (surprise!) that I'm allergic to pet dander and house dust, which are unavoidable for me. No over the counter medication I've ever taken has given much relief. Corticosteroid asthma inhalers seem to calm down my sinuses as well as my lungs, strangely enough. Fenofexadine and Nasocort have a small add-on effect. Currently I'm the best I've ever been in that regard. I would like to consult with an ENT because I still have a feeling that my nasal passages are constricted by something more than inflammation.

[karmamatic]

Are there any reports of health insurance companies refusing coverage for changing machine settings?

[Pugsy]

Insurance companies rarely even know what settings are being used or even if they are effective or not. They only care about hours of use so they aren't paying for something that you aren't using.
They won't know that you changed anything and if they did they wouldn't care.

Now they will probably care about the 3 hours of average use. Have you checked to find out what is required in terms of usage compliance? Most often it is 30 days with at least 4 hours of usage for 70% of the 30 days.