Exhaling with the Swift LT

[elmunc]

Hi everyone--

I've adjusted quite well to the Resmed Activa mask ... but it annoys me that it's pretty much impossible to read in bed because the thing is bulky and blocks vision out of one or the other eye. So I thought I'd give the Swift LT (nasal pillows) a try. I used it last night and was really struck by how much harder it feels to exhale with the Swift LT than with the Activa. The pressure feels much more noticeable than with the Activa. It bugged me for several hours -- lots of little wakeups -- so in the middle of the night I just switched back to the Activa.

Is this a common initial reaction to using a nasal pillow mask?

Thanks for any experience/perspective you can share.

--Eric

[Mac33]

I had to go to the LT as a backup for two nights after my comfortcurve nasal mask left big welts on my cheeks from the cheek pads probably because of the cold. The LT was horrible breathing out and much noisier. Last night I went back to the comfortcurve, what a relief.

[pmcall57]

It took me a few nights to get used to exhaling with the Swift LT, so I definitely know what you mean. Now that I've gotten used to it, I like it quite a bit. Well, as much as one can "like" a mask. Pam

[secret agent girl]

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[elmunc]

Why read with the gear on?

Well, at bedtime, if I feel like transitioning straight from reading to going to sleep, without having to first turn on the machine and put on the gear, I like to get it all set up while the light is still on and I'm still awake.

Also, most nights I wake up between 4 and 5 hours after going to sleep, and I often like to read a little during that time before trying to go back to sleep.

[Cosette]

I don't feel I'm getting enough breath with the Swift LT.

[btesterman]

I just got my CPAP yesterday so I've only used it one night. I liked the Swift LT in the DME's office (light, not in the way....) but last night I had the same feeling as you - I kept thinking maybe I didn't have it on right and needed to adjust it so it wasn't being blocked. Evidently that wasn't the problem at all. Your post came at just the right time! I only used the machine for about 3 1/2 hours because of rainout - am making adjustments on that issue and will try it again tonight. I'm glad I have the 30 days to switch masks if I still am not happy with this one after some nights using it. I tried on a new nasal mask that's out but can't remember the name (it was on display so I'll know to show her) that sort of "suctions" to your face to prevent leaks. I had lots of leaks last night but then I kept messing with the pillows trying to breathe easier. Tonight I'll try to keep my hands off the thing and providing I'm not drowning again I'll see how it works out. I also have to keep in mind that I'm a brand new user so ALL masks will seem uncomfortable. I just don't remember having that feeling when I had titration (used comfort gel nasal mask then).

[Cosette]

Have you tried a different pillow size? (S,M,L)

[xiola]

I've found that if I have the nose piece angled wrong, it's harder to breath. if I adjust it slightly, I notice a definite difference in how easy it is to breathe out

[mdintx]

With the LT, I have to use EPR. I set it at 1 and that gives a little assist to be able to exhale.

[sheep1234]

Regarding the comfort of the LT: I had to switch from the S to the XS size. I didn't even know that this size was in my bag until about 1 month into cpap, I decided to browse through my travel bag. The XS fits my nostrils much snugger and so I don't have as much issue with air seeping out.

EPR: I have mine set at 3. I have no problem exhaling against the pressure.

Ramp: I have mine set to OFF. I felt like I was suffocating. Why not just go straight to your prescribed pressure setting???

Humidifier: I have mine set to 2 or 2.5...no rainout and our bedroom is not the warmest of areas. Hubby has thermostat set to 72, but our room is usually chillier than that. I just prefer to breathe cooler air when I sleep.

I played with my gear one day (not night) and adjusted the settings, but not my pressure (9.0) to see what felt the best and went from there?

I do notice that after I put my mask on I feel like I can't "catch" my breath. I think this is because usually without the mask on you would yawn to get that full breath feeling. With the mask on you can't open your mouth, so I usually try to inhale deeply until I feel that yawning/full breath feeling in my lungs. Pain in the butt sometimes, but so were the morning headaches I used to have pre-apnea treatment.

Do you know how to access your settings?

[allinknots]

I had issues with this mask when I first used it, too, but have overcome the problems for the most part. (Please see my past posts on this.)

I'll explain what helped me, however this is a "do-it-at-your-own-risk" kind of thing. (Most people advise *against* altering their masks.)

I felt that it required too much effor to exhale; I didn't feel it was natural to have to forcibly push your air out. I ended up enlarging the exhale ports/holes on my mask. I used a heavy-duty needle at first, and then even used the point of embroidery scissors. I got it to the point where I could exhale and feel that adequate air was escaping. My "numbers" have been pretty good: 1.9 to 3.9 AHI each night. (Resmed Auto cpap.) If anything, I'd think the numbers would show worse than is actually the case since the mask was not designed with "escape"/exhale ports that large.

As far as the difficult-to-breathe-problem when you first lay down: I experience that, too. This is what I do. I lay down on my back with the mask, and adjust the headstrap a bit as needed to feel comfortable. If I feel too "smothered," I loosen the straps a bit. If I feel the nosepiece is too loose or insecure, I tighten a bit. I adjust the nasal pillow part a bit too. (Sometimes it feels like the raised Resmed name on the pillows is pressing too hard on the underside of the tip of my nose, and that I'll wake up with a nose branding! OK, it's not really a branding, just a reddish nose tip. So I loosen things so that won't happen!)

And here is the unusual part: AT FIRST I purposely PART MY LIPS, inhale through my nose and exhale through my mouth. I tilt the nasal pillows ever so slightly with my fingers and HOLD IT IN PLACE at the exact position that gives me the most incoming air, wiggling them a bit here and there to allow optimal air inhalation. I am still holding them there with my fingers, breathing in with my nose, exhaling mainly through my mouth. I do this for about a minute, then I gradually let go. It seems like the pillows have formed and "stuck" exactly the way I was holding them. I gradually close my mouth, while still exhaling through my mouth a bit. (i.e. I begin to close my mouth a bit, still exhaling through it, but also exhaling through my nose.) I do this until I can comfortably inhale as well as exhale through my nose, and then I completely close them and keep my mouth shut.

This whole procedure takes about 3 minutes for me, I'd guess.

I have a theory as to why this works. I think my heart-rate is increased a bit as I'm setting up the cpap, putting on the mask, laying down to go to sleep, etc. I lay down, but my heart is still going fast, and I'm breathing at a harder, faster rate than when resting. The gradual mouth closing bit allows me to inhale more strongly and then exhale the amount I need to in order to allow the next incoming breath. As I relax, my heart-rate slows and my breathing rate slows and is a bit more shallow. That's when I can close my mouth.

After this whole shenanigans is done, I can usually roll to one side or the other and get into my favorite sleeping position.

If you try this and it works for you, please let me know!

hth,
All in Knots

[sheep1234]

allinknots,
What is your EPR set at?

[allinknots]

allinknots,
What is your EPR set at?

EPR is on 3.

All in Knots

[MarylandCPAPer]

(Sometimes it feels like the raised Resmed name on the pillows is pressing too hard on the top part of my nose, and that I'll wake up with a nose branding! So I loosen things so that won't happen!)

Allinknots:

I use the Swift LT for Her mask. The raised Resmed name is on the outside top of my nasal piilows, not facing my nose. Have you tried reversing the position of the nasal pillows to see if it makes a difference? I have only been using the mask for a few weeks (just diagnosed with OSA last month) but I haven't had the problems you describe.