Nasal Pillow - feel like I bumped my nose

[IndyDave]

Hi, brand new user - I have a DevilBiss bilevel Intellipap with heated humidifier. Positive pressure set to 10, exhale at 3, and am using a Resmed Swift-Fx Nasal Pillow. I've only been on this thing for a couple nights now, and I know it will take a while - but I was wondering if anyone else has run into this. After about 2-3 hours, the tip of my nose hurts like its been bumped hard. It goes away soon after removing the mask. I've played around adjusting the straps from snug to loose enough I get some leakage, I've been back and forth between the medium and large nasal pillows a couple times each night. I'm using a dab of Ayr gel plus the humidifier, so its not dry nose or anything - literally feels like I bumped my nose into a door. I thought maybe it was because I'm a side sleeper and I was pushing into my bed pillow, but last night when I woke up, I sat up a bit and read for an hour, and the pain didn't diminish...

Any ideas, or anyone experience this? I can deal if its something that will go away as I get used to the whole cpap/bipap experience, but if I need to move to a full nasal mask, I'd rather know now? Thanks!

[Afterhours]

I am a relatively new user as well and had the same feeling using the nasal pillows. I am now 2 weeks into therapy and no longer have that issue. It should stop bothering
you soon. I figured out that if you move the nasal pillows a bit to a different position it alleviates the pain. Hope this helps.

[IndyDave]

Thanks! I thought i was nuts with that reaction. Glad to know it goes away as you adjust.

[Pugsy]

I found that Lansinoh ointment seem to help with the tenderness a little better than the Ayr gel.
Just personal preference I suppose. With time (as long as you don't have that top strap too tight) the tenderness does fade away. Remember the nostrils are really virgin territory and simply aren't use to having anything touching them with pressure.

One thing you might consider is the barrel cozy from Padacheeks. I got it last February to help with rain out but the first minute I put it on I knew I would be wearing it year round. The silky material feels awesome comfortable against the skin. Not that I really had any issues with the silicone or tender nostrils past the first couple of weeks (used nasal pillows my entire nearly 3 years) but it was just so darn comfortable.

So you might keep this idea on the back burner. Here is the link to the barrel cozy..
http://www.padacheek.com/PACSwiftII_Barrel_cozy.html

[Afterhours]

I also noticed after a few nights that I could loosen the straps just a bt, still keep a good seal, and lessen the pressure on my nose that way.

[GrantT]

Any ideas, or anyone experience this? I can deal if its something that will go away as I get used to the whole cpap/bipap experience, but if I need to move to a full nasal mask, I'd rather know now? Thanks!

I am finding that HOSE MANAGEMENT is the key, at least for me. I have just started another thread about how to get my hose to stay put on my quilt related to this.

I find that the more I control the hose, the looser I can adjust the straps. Leaking for me is always because the hose is pulling to one side or the other or up or down, and I was tightening things more to compensate (and then getting a sore snout). When I find the perfect hose position, my problems go away.

Grant

[IndyDave]

What I finally figured out last night is that its the front part of the pillow pushing up on the bottom of my nose. I have a slight hook, apparently just enough for the pressure to start it aching after a couple of hours. Hopefully my nose will get used to it.
Now I'm still trying to decide with size pillow is right. The medium seems to fit my nostrils well, but every so often they collapse or something - the airflow cuts down, until I fiddle around. I need to put a mirror by the bed so I can see what it is next time. I don't have that problem with the large - but instead more prone to leaking out the sides.
But all in all, I think I'm doing well so far. Three nights so far, and last night I woke up after 3 hours to use the bathroom, and then ended up fiddline around between pillows. Then I slept pretty well for another 3 hours, until something outside woke me up enough I had to get up and investigate, and then I was too awake to bother going back to bed. Looking forward to the weekend, when I don't have to get up on a schedule, and see what happens. It's funny having to tell the people who ask me everyday how its going that I'm actually more tired than usual just because of the acclimation process!

[Afterhours]

Yep, I got my machine a few weeks ago and everyone @ work is thinking that I should be all better overnight!! Trying to tell them that this
is a long, slow process is hard. I was laying in bed last night remembering those 1st nights when my nose hurt, and so glad that it didn't
anymore.

[ryflawyer]

I am still in the "titration study" period, but the first mask I asked for was the nasal pillows because the idea of a mask covering my face freaked me out. I found that it just did not work for me, as if it was tight enough to keep the seal, it hurt like hell, and if it was loose enough not to hurt, it leaked so much there was no point in wearing it. I asked if there something in between the nasal pillows and the full face mask, and they gave me the nasal mask. While it took me a couple days to figure out that the mask I had was too big, once I got the smaller size, I have had no pain issues at all.

[Komodo]

I switch between nasal mask, and the FX pillow. When I use the nasal, I have the hose going over the top of my head. When I first started using the FX,, I did the same thing with the hose, and MY nose felt like I bumped it as well! In the light of day, I examined the mask for any hard parts that would hit my nose and didn't see how it was possible. Then I put the mask on, and using a hand mirror, saw that when I layed down, with the hose over my head, it tilted the mask just enough to make contact with my nose. The solution (for me) was simple enough, by letting the hose hang down towards my chest, it changed the angle of the mask and there was no more contact with my nose.

[crazynan]

I also have the FX and do like it except that I also feel like I have a sore when I use it. I switch off with Breeze nasal pillows. I have been using Breeze for years. You might want to give it a try. Good luck!

[IndyDave]

Thanks everyone for the various suggestions. I thought I was making the adjustment- Sunday night I didn't wake up too often, and my nose wasn't nearly as sore - but then last night I was waking up more than pre-cpap, constantly fiddling with the mask, and my nose really sore to the point where its still a bit tender. Nothing changed from the night before, so I don't know what the deal is.

I've gone about this whole thing non-traditional. I'm uninsured, and my MD and I "knew" I had apnea, just from my snoring and the amount I woke up. Cost of a sleep study was really prohibitive when we really just wanted to see my O2 stats overnight, so we did that several nights in a row using a recording pulse oximeter, which showed my average O2 concentration was around 86%, and had events were it dropped down to 40%. He wanted me on a bipap, and through searching ended up with my Devilbiss Intellipap which can be a cpap or bipap, and had a reasonable price.

For a mask, I went to a local supplier (Apria Healthcare), and was really disappointed. When i called I explained how we went about this, and that I was relying on them for a mask recommendation. They set up an appointment for me at their nearest branch, and went in fully expecting to be able to try on a variety of types and brands of masks. Basically they had 4 ResMed masks, none of which were availble to even try on. For fitting they had plastic templates - like the paper ones you can print out from online. I was actually told that picking a mask is "kind of a crapshoot". I selected the swift FX just because I knew it was popular, and had the different size pillows. It wasn't until they had actually run my credit card that they opened the package and showed me how to put it on. I walked out feeling like they had no idea what they were doing, and still feel that way. So right now, I don't even know if this is the best mask for me. I'll give it another week or 2, then I suppose I need to search out another supplier.

[robysue]

What I finally figured out last night is that its the front part of the pillow pushing up on the bottom of my nose.

Sounds like what my RT calls piggy nose. Even with extremely loose headgear I still have to watch out for piggy nose since I get it now and again.

What I've found works:

1) Ridiculously loose straps---particularly the TOP (silicone) straps. My FX is so loose that it threatens to fall off if the back strap moves up towards the crown of my head. I still get a wonderful seal, and quite frankly I don't know how I do it. And I am a side sleeper.

2) Correct placement of the back cloth strap. Too high, and it pulls the pillows too tight and up against my nostrils and pulls them into piggy nose. Too low and it pulls the pillows back where the tip hits the inside of my nose.

3) Getting the pillows at the proper angle in the first place. If I can feel the tippy-tip part of the cone touching the inside of my nose, I know I don't have them at the right angle (yet). And when the pillows are not at the right angle, I tend to get piggy nose symptoms. So whenever I notice the tippy-tips touching the insides of my nostrils, I reseat the mask by pulling it away from my nose (very slightly) and then when the pillows are fully inflated I gently place them back against my nostrils. Usually I only need to do this once or twice before I'm happy with how the pillows feel---in the sense of me not feeling them at all inside my nose.

3) Running the hose under my covers and lightly hugging the small hose in one hand. This hand is usually my right hand and I tend to hold the small hose an inch or two below the exhaust vent. This allows me to very slightly tug on the hose whenever the pillows feel like they are getting a bit too tight and causing piggy nose. I think I am now even slightly tugging the pillows in my sleep at time. The slight tug does not completely break the seal nor does it fully reseat the pillows; it just slightly readjusts the pillows angle in my nostrils an relieves a bit of the physical pressure that causes the piggy nose.

4) Ample use of Lansinoh if the tenderness gets to be significant. As a newbie, I was using Lansinoh every night. Now, I hardly ever use it. However, I am still using copious amounts of a non-petroleum based lip balm most nights. And I usually slather it around my nostrils as well as the whole area between my nose and my lips.

5) Frequent replacement of the pillows if need be. I've found that my pillows have a very unpredictable life span. I usually use two (or even three) pairs at a time, switching them out every day or every couple of days. Sometimes I'll get several months (two of my current pairs are from December) and sometimes I'll only get a few weeks. Signs that I need to replace them include a high frequency of "cone collapse", a higher than normal leak rate, and a tendency to need to keep the straps tighter than I like, which leads to piggy nose.

[Pugsy]

I second Robysue's idea about "piggy nose"....it is really easy to get that top strap too tight. If there is pain....something is too tight.
There is a video on fitting this Swift FX...have you seen it?
http://www.cpaplibrary.com/mask-education

Also there is a mask trial available that won't break the bank. The masks are used and for $14 (covers postage to you and for returning) you can try a mask for a week to see if you like it.
http://www.cpaplibrary.com/mask-trials
You don't have to purchase a mask to utilize the mask trial. There might be a wait for a popular mask depending on how many people have requested a mask because the supply of each mask model is limited.

[IndyDave]

Thanks again folks. I went with much looser straps last night, and definitely felt less "piggy", but as a slide sleeper I kept pulling the mask away from my nose, and spent a lot of time waking up and fiddling things back in place - the back strap kept riding up on me. I'll have to keep playing to find the right tightness. But I was again having a bad night otherwise, and early this morning I came half awake to realize I've apparently learned to adapt my snoring to the mask. For the few seconds I was doing it and was aware of what was happening, I think my mouth was just barely open, and the snore was more like snorting (again with the pig reference?).

Reading around the forum, it sounds like most people tape their mouths shut to stop this from happening. That seems pretty extreme to me, but I'm willing to give it a try just to see if my pressure settings can bring my AHI down from the 22 it seems to be hovering around. I have to run to the drugstore tonight anyway, so I'll pick up some of the micropore tape. I was wondering exactly how people are doing this taping, and what width of tape you use?

I see my MD again next week, and will have him write me a script for getting a new mask too, in case I need to go that way. With snoring being the issue I'm guessing one that covers nose and mouth is the route to take? I'm not too scared of that, I have worn half face and full face respirators a lot in my life, for hours at a time. But is there one brand/model that I definitely should look at first? Or is a nasal mask alone just as effective? I'm searching for a different supplier here in Indianapolis so I can at least see and handle them first.