Can't exhale with Nasal Pillow. NORMAL????

[Beckaboos]

Hello,
I have been using a CPAP machine for about a month. I have the Philips Respironices REMstar. I started out with the Nasal Mask and have had a hard time adjusting to it. I just switched to a Nasal Pillow. My problem is that with the nasal pillow I feel like I can't exhale. My pressure is set at 9. My question is this......should the pressure be less when using a Nasal Pillow in compared to using a Nasal Mask?

[NotLazyJustTired]

That's not normal. A couple of possibilities: 1) you have the mask too tight. Nasal pillows should be just tight enough to sort of float on your nares without leaking. 2) You have the wrong pillow size. I recently moved from a small to a medium. It made a world of difference.

[kaiasgram]

What NotLazyJustTired said about pillow size is important. And another important point: Not all nasal pillow masks are created equal. I felt suffocated with the Swift FX nasal pillow mask and almost gave up on NP masks. Then I tried the Aloha and it made all the difference, primarily I think because the air holes in the pillows are larger than on the FX. Same size pillow, but larger openings. You didn't say what NP mask you're using, but keep in mind that you can try other models before giving up on NPs.

[Xney]

EPR/c-flex can also help quite a bit - try setting it to 2.

[sleepstar]

Actually this can be a very normal problem to begin with.

Nasal pillows are directly into your nose and can feel like a lot more pressure than a nasal mask. With nasal masks the air has more room to move around and it feels like less air.

Are you using a ramp? If you're not, definitely put a ramp on. Start your pressure at 5 or 6. This will feel easier to breathe. If you can put CFlex on 2 or 3 this will help too as it will decrease the pressure when you breathe out so it's easier to exhale.

Over time you'll get so used to the pressure you'll wonder if the machine is on! At the start though you definitely want to take advantage of those comfort settings (CFlex and ramp) to make it easier before you drop off to sleep.

Starting at 9cm h2o on nasal pillows would feel difficult for a lot of people. Starting the machine at a lower pressure should really help.

Best wishes