newbie pressure 20 and having leaks in nasal pillows

[doctorstephanie]

I have been on a CPAP machine just over a week now. I have a liberty mouth cover with nasal pillows. I am using it every night, but it wakes me every night with loud leakage from the nasal pillows. I believe it is due to the high pressure of 20 (my sleep study was "very bad" according to my therapist) and the nasal pillows not staying in tight. I tried a full face mask and found it hurt the bridge of my nose and leaked a lot around the side of my nose. I am a mouth breather. I am also having a hard time keeping enough moisture in the machine to last through the night. The therapist put it on a 3.5 moisture/heat level and it is dry every morning when I wake.

Any suggestions of alternative masks or ways to keep the nasal pillows from leaking would be very much appreciated.

[Sireneh]

Have you tried a different sized pillow? I am stuck using a medium right now while I wait for a size small that I ordered to arrive. I left it a little late and didn't order until my original size small was mushy and quite useless. I threw it away and started using the medium and it leaks like crazy. Tonight I plan to use pantyhose to try and secure it a little better and hope the small arrives this week.

Check the user guide that came with the mask. I think most of the nasal pillows can stand a pressure up to 20.

[FizzyWater]

Usually a quick tug-and-replace takes care of leaks for me (with the Swift FX), although it can be frustrating if it wakes me up.

One thing I've been trying recently is to have the hose go up over my head (attached to the headgear with some velcro cable ties I have for computer cables). It seems to hold it up against my nose with a little less shifting, although I think I have more trouble getting it on and in a comfortable position when I initially go to bed.

And yes, I had to experiment with pillow sizes, too. The extra small "felt" better, but it whistled like crazy. It was suggested to me that was actually a form of leaking. The small seems to do away with the whistling. I'm going to try the medium next, just to make sure I'm using the "best" size for sleeping all night.

[Sireneh]

The extra-small whistled for me, too, FW.

[77Godspeed]

I had the same problem, tried 5 different mask, the hybrid works for me.
Good Luck

[apneawho]

A pulmonologist told me she does not like to use nasal pillows for pressures higher than about 12. I am new to all of this so I can't form an opinion yet. Each individual case is unique as you can see by reading all the posts. I am on a pressure of 14 and have done very well with the ResMed Swift Fx nasal pillows XS size. Very minimal leak and comfortable for me. This was my first mask choice and I have not had to change out. I have a lot to be thankful for. I am still not feeling tons better but I was doing a lot of damage to my body over the years and it just didn't dawn on me or any doctors what was going on. I imagine it will take some time to repair things. My husband said he can tell an outward difference in my body and my attitude and mood. Yay!

[dwynne]

A pulmonologist told me she does not like to use nasal pillows for pressures higher than about 12.

I was told the same thing. During my sleep study I started out with pillow but had to switch to a mark once the pressure got pretty high.

Note that during the study they used CPAP (C = constant), my machine is a bi-level PAP so I would like to try pillows again to see if I have better luck without the constant high pressure. I am set at 15/11 for now, but probably will crank it up some more after my next sleep doc visit.

[Sleepy Taz]

I use the Opus 360 at a pressure of 17. I changed the setting to 19 once and had no problems. Had the same problems with the mirage liberty and never could keep it from leaking. Do a search for nasal pillow leaks and you will get many ides to help you correct your problem.

[Janknitz]

I just cannot understand why so many clinicians think that nasal pillows are not good at higher pressures. The higher the pressure, the more inflated the nasal pillow, so it sits up well against your nose and seals beautifully. And with humidified air, it's not uncomfortable having that air flow in the nose, I can barely feel it. It also helps keep my sinuses clear. Nasal pillow masks are so lightweight and don't prevent you from seeing, scratching your nose, etc.

Nasal masks and FF masks that have air cushions are constantly pushing away from your face when filled with the air pressure, and the higher the pressure the more difficult they are to seal. They are heavy and uncomfortable, and often very leaky. I cannot see why they are preferred by clinicians for people who need higher pressures.

BTW, if your pressure is 20, I'm surprised they put you on a CPAP/APAP. You might do better with a bi-level where your pressure can be dialed in a little more accurately and you can get additional exhalation relief if needed.

[Sheriff Buford]

I'm a mouth-breather too and the full face mask leaked too much and rubbed blisters. Check out my mask... see what you think.

Sheriff

[davelikesbeer]

I just cannot understand why so many clinicians think that nasal pillows are not good at higher pressures. The higher the pressure, the more inflated the nasal pillow, so it sits up well against your nose and seals beautifully. And with humidified air, it's not uncomfortable having that air flow in the nose, I can barely feel it. ...

+1

I agree. I've not been on APAP for long, but in my short experience, I've used both a nasal pillow as the nasal mask. The reason I tried the pillow was because the mask leaked so much.

My pressure is set from 16 to 19. I do not use the ramp feature specifically because I don't want to be woken up because my mask develops a leak at higher pressures.

If the doctor cannot give a real reason for why one should not use the nasal pillow, then I would say just use what works for you. I suspect some doctors may simply be assuming that with increased pressure, there is an increase in likelihood of leaks. Since everyone's faces are different, just use the mask that works best for you.

While I'm mostly happy with the swift fx, I wish there were an easier way to try a large variety of masks.

Dave.