leaks waking me up, need suggestions please

[College3girls]

I've been using my resmed 9 auto faithfully every night since starting on February 10. I started with a Quattro Air, but had such horrid, and debilitating aerophagia that I switched to a Nuance Pro nasal pillow with a Puresom Ultra Chinstrap (doesn't stay on well).

I tried the small pillows for over 2 weeks, but kept waking because they seemed to go into my nose too far or at the wrong angle. There were times I would wake up because my nose felt like it was completely plugged close. I do not have any congestion issues. I would be able to open my mouth, and feel no positive pressure, so I knew the positioning was not right. I would be fully awake and trying to breath in or out through my nose as hard as I could, and not be able to do so. I would not feel air coming into or out of the pillows, but my machine was on and working. There was air coming out of the exhaust. As soon as I repositioned the pillows, I would again feel air coming in the pillows as expected. This would happen multiple times each night.

The past two nights I have tried the medium pillows, and that is even worse. The slip up or off to the side. Even the slightest leak in this way wakes me. I'm grouchy and tired today as a result. I'm also not liking the strong, cold stream of air that comes out of the exhaust opening of the Nuance. It blows on my hands, which I tend to try to tuck out of the way under my pillow. This aggravates my Rheumatoid Arthritis in my shoulders. My hands turn icy cold, despite using a heated mattress pad. If I try to position my blankets to block the air, I either mess up the seal further, or occlude the opening. Neither of these is good.

I may try going back to the Quattro Air with the chin strap, but I'm hesitant because of the aerophagia. I don't want to go back to that severe aerophagia. I do still have a slight problem with the nasal pillows, but not at a painful, can't function, nauseous level I had with the FF. I did give the Quattro a week before switching to the nasal. And yes, I do occasionally find myself waking because I'm mouth breathing or at least opening my mouth despite the chin strap. Often it has completely slipped off, but not always.

My insurance only covers 50% and I could only try up to two masks in the compliance period. I think I can ask to try something else after March 10, but I'll have to call my DME to be sure. It may be only after 3 months that I can try something else and have it covered by insurance at all.

My question is: is there a method for keeping the nose pillows from slipping up or sideways? How do I know what size to keep trying? I know no mask is a one-size fits all or like by all, but suggestions on what other masks to consider would be appreciated.

I do not want to give up on this. I know I was amazed to have a couple of nights where I slept so well I actually remember dreaming. That hasn't happened in years. My co-worker says she sees an improvement in my coloring, so I know I need this. I'm just struggling to get comfortable and consistent results yet.

Thanks again for any help. I do have sleephead and can post graphs if that is helpful to anyone. Just let me know what I should post. My AHI is good. My mask fit starts out good; I always do that as part of my bedtime routine. I can tell when I was awake and had Centrals, but I do have Centrals showing when I think I am asleep as well, but that is not a surprise, since my diagnoses was mixed apnea. Beyond that, I really haven't figured out how to interpret my flow limitations, respirations, etc, and I don't know if that is important or not.

Again, thanks in advance for any input from the folks who have been doing this a lot longer than I have.

[Julie]

Have you tried lowering your min. pressure by a bit - it apparently can help aerophagia sometimes.

[Wulfman...]

What are your pressure settings? (It would help if you would add them to your profile)
What is the nature of your "leaks"?
Are the leaks pressure-driven (excessive pressure)?
Are the "Centrals" showing up at higher pressures?
When you look at your reports, at what pressure are the leaks occurring?

Could you post a report for folks to look at?


Den

.

[Pugsy]

Take a look at ResMed's latest nasal pillow the AirFit P10. It's a really nice mask.
https://www.cpap.com/productpage/resmed ... dgear.html
The venting is diffused so no longer a strong stream of cold air blowing on your hands.
Nasal pillow masks shouldn't easily slide from side to side if properly fitted nor should you have episodes where there isn't any air flowing in the pillows. Something isn't fitted properly or they aren't staying inflated.

[DRONE]

OK, so this is just my opinion, but I don't see how anybody can use nasal pillows with a mask that doesn't have an integrated chin strap. Seems like the AirFit mentioned above or your Nuance are doomed to fail. All of 'em. I realize that lots of people use them, but I'm much too restless a sleeper. They wouldn't stay in place for 15 minutes after I fell asleep!

I use an Optilife. The way this mask works is you have stretchy straps that go over your head and another stretchy strap that goes under your chin. The mask for the nasal pillows is attached to both the head straps and the chin strap. First you tighten all the straps until the overall tightness level feels "right". Then you lengthen the head strap and shorten the chin strap, or vice versa, to adjust the height of the mask on your face. So, if you want, you can have this thing really really tight, but have the nasal pillows just barely touching your nose. Or you can have the pillows jammed up there really hard but have the straps set to be loose. It's all about letting you decide what fits and what works. Once you get it right, it really stays put. For several years now my machine says "0% leakage" every time I check.

The key here is that the chin strap is part of the mask, not a separate strap. When you buy a new one, it comes with 4 pillow sizes so you can find the right one pretty easily.

If you decide to try one, my suggestion is to lengthen the strap over the top of your head until the strap that goes behind your head just clears the top of your ears. Then start fussing with the cheeks and chin to get the mask at the right height and get the overall tightness where you want it. Also, fleece covers on the chin and the cheeks help a lot with comfort.

If your DME doesn't have this mask, you can find them on eBay and Craigslist for about $75 cash.

[robysue]

OK, so this is just my opinion, but I don't see how anybody can use nasal pillows with a mask that doesn't have an integrated chin strap. Seems like the AirFit mentioned above or your Nuance are doomed to fail. All of 'em. I realize that lots of people use them, but I'm much too restless a sleeper. They wouldn't stay in place for 15 minutes after I fell asleep!

I'm sorry that you don't see how a nasal pillows mask can work without a chinstrap and I'm happy that the Optilife with its chinstrap works for you.

But it's important to remember that mask choice is very highly personal and statements that imply that all masks of a given type are "doomed for failure" for most users is plain misleading.

I'm a pretty active sleeper, but not as active as I was pre-CPAP. I don't know why, but the Swift FX stays on my nose like it's glued there. I know that's not true of everybody, but for me, the Swift FX handles my tossing and turning pretty well---as long as the pillows are not worn out and the back strap is not too stretched out.

I use an Optilife. The way this mask works is you have stretchy straps that go over your head and another stretchy strap that goes under your chin. The mask for the nasal pillows is attached to both the head straps and the chin strap. First you tighten all the straps until the overall tightness level feels "right". Then you lengthen the head strap and shorten the chin strap, or vice versa, to adjust the height of the mask on your face. Once you get it right, it really stays put. For several years now my machine says "0% leakage" every time I check.

That chin strap would drive me bananas. (I did try the Optilife on when I first started PAPing.) But I'm very sensitive to physical stimuli and even the minimal strapping of the FX took an extremely long time for me to get used to. I love the Bella loops, but I've got attached earlobes and can't wear them but every once in a while.

[HerbM]

Some of us can just close our mouth and (as long as we don't have nasal congestion) breath through our nose with the pillows.

Being able to do this surprised me greatly, but trying it the first night it worked immediately, and I have never once considered opening the chin strap I bought along with the P10.

Were I to open my mouth the air coming in my nose and out my mouth would awaken me almost instantly.

If my nose totally stopped up unexpectedly, that would pretty much wake me up as well.

I am very new at this, but from everything my limited experience with the P10 and having read every review that was available it is pretty clear that IF you can breath through your nose AND you can find a way to keep your mouth closed, then the P10 is pretty much "the mask to beat."

[M'ohms]

When I use a nasal pillow, I have the same problem with it sliding around. I take an ordinary stretchy headband (approximately 2inches wide) and stretch it over my head on top of the nasal pillows. This system not only holds the pillows in place, but also keeps my bed pillow from touching them.

[robysue]

I've been using my resmed 9 auto faithfully every night since starting on February 10. I started with a Quattro Air, but had such horrid, and debilitating aerophagia that I switched to a Nuance Pro nasal pillow with a Puresom Ultra Chinstrap (doesn't stay on well).

I tried the small pillows for over 2 weeks, but kept waking because they seemed to go into my nose too far or at the wrong angle. There were times I would wake up because my nose felt like it was completely plugged close. I do not have any congestion issues. I would be able to open my mouth, and feel no positive pressure, so I knew the positioning was not right. I would be fully awake and trying to breath in or out through my nose as hard as I could, and not be able to do so. I would not feel air coming into or out of the pillows, but my machine was on and working. There was air coming out of the exhaust. As soon as I repositioned the pillows, I would again feel air coming in the pillows as expected. This would happen multiple times each night.

If Nuance Pro used air filled double cones for the seal, I'd suspect that the inner cone had become inverted. That happens on the Swift FX when the pillows are getting past their prime, and once one of those inner cones is collapsed, it seems (to me) that there's no air getting into the nose, even though the jet exhaust flow from the vents keeps on going strong.

I wonder if something similar is going on even though the Nuance Pro has gel-filled pillow cones for providing the seal. Is it possible for the cones on the Nuance to become inverted??

Let me see if I can summarize the situation correctly: Right now, you wake up and sense something is wrong. So you first open your mouth and don't feel any air coming through the large open mouth. Then you check to see the exhaust flow is still there to verify the machine is on. And then you reposition the pillows, which typically fixes the problem.

How many times a night does this happen?

If it's only happening once or twice a night, then one way to address the problem might be to reposition the pillows first and see if that fixes things. I know that when I spring a rare leak with my Swift FX, I'll now tug on them and reseat them to fix the leak without having to wake all the way up. But it is a learned skill and when I was a newbie, this seemed almost impossible. Still it's something to work on.

The past two nights I have tried the medium pillows, and that is even worse. The slip up or off to the side. Even the slightest leak in this way wakes me. I'm grouchy and tired today as a result. I'm also not liking the strong, cold stream of air that comes out of the exhaust opening of the Nuance. It blows on my hands, which I tend to try to tuck out of the way under my pillow. This aggravates my Rheumatoid Arthritis in my shoulders. My hands turn icy cold, despite using a heated mattress pad. If I try to position my blankets to block the air, I either mess up the seal further, or occlude the opening. Neither of these is good.

Whatever you do, do NOT try the Swift FX. It's exhaust flow is intentionally designed to blow down instead of out, and it feels like a jet plane.

Only solution I ever found was to put my head under the blankets. Yes, I worry a bit about the covers blocking the air, but that doesn't seem to be that big of an issue. I'm really hoping that when I'm eligible for a new mask that the new Resmed AirFit P10 will work for me because of the diffused exhaust flow. (I'm a bit worried, however, by the fact that there are some rigid plastic pieces that don't appear to be as comfortable as the completely flexible Swift FX)

I may try going back to the Quattro Air with the chin strap, but I'm hesitant because of the aerophagia. I don't want to go back to that severe aerophagia. I do still have a slight problem with the nasal pillows, but not at a painful, can't function, nauseous level I had with the FF. I did give the Quattro a week before switching to the nasal. And yes, I do occasionally find myself waking because I'm mouth breathing or at least opening my mouth despite the chin strap. Often it has completely slipped off, but not always.

Is it the chinstrap that's slipped off or the mask??

At any rate, aerophagia is not pleasant to deal with. And that's got to be a major factor in figuring out whether any mask setup has the potential to work for you or not.

How bad are the leak lines? And how much mouth breathing are you doing? If it's only a bit now and then and your leaks mainly stay out of Large leak territory, then comfort (and sleep) beats out trying to eliminate the last bit of leaking.

My insurance only covers 50% and I could only try up to two masks in the compliance period. I think I can ask to try something else after March 10, but I'll have to call my DME to be sure. It may be only after 3 months that I can try something else and have it covered by insurance at all.

Call your insurance company yourself. Don't just ask the DME about your coverage. It may be difficult to get an answer out of your insurance company, but even so, it's worth trying to find out from them what your coverage really is.

My question is: is there a method for keeping the nose pillows from slipping up or sideways?

Tips for keeping the pillows from slipping around:

1) Lansinoh---as in the nipple cream sold to nursing mothers. For some people, the tackiness of the lanolin helps keep those pillows in place. For others, it winds up making things move around even more since the lanolin can melt and become more liquid. You don't want too much since the problem with it becoming slippery seems to be worse if you use to much.

2) Getting the headgear appropriately tight and in the proper position is critical. The Nuance pro has two head straps, and if either of them is in the wrong place, the chance of slipping goes way up. You don't want the straps too tight or the straps will pull the pillows out of place and create all kinds of problems. And if possible, you need to fit the mask while lying down. If you're a side sleeper, you may find that you'll need to adjust the side tabs that hook into the gel-straps in an asymmetric fashion.

3) It looks as thought the back strap of the Nuance Pro is not adjustable, although the top and sides are. It could be that the default size of the back strap is just plain too large (or small) for your head, and hence it does not provide adequate stability. A different nasal mask with an adjustable back strap may help.

4) After you turn the machine on and you're lying down in the position you intend to try to go to sleep in, gently tug the pillows away from your nose a smidge and then let them settle back down onto your nostrils. You may need to do this more than once to get the angle of the pillow cones "just right" for your nose and your mask. When you do wake up to a leak OR to the no air problem, first try tugging the pillows away from your nose and letting them settle back down. If that fixes the problem, you're done. If not, you can wake up more alertly to see what else might need to be done.

How do I know what size to keep trying? I know no mask is a one-size fits all or like by all, but suggestions on what other masks to consider would be appreciated.

For most nasal pillows, you want the base of the cone to be ever so slightly larger than your nares (nostrils). If the base of the cones are too small, then too much of the cone slips into the nostril and it's really uncomfortable (and difficult to seal as well). If the base of the cone is too large, the pillows will slide around too much, but they won't be sliding into the nostrils. When the pillows are too large, sometimes they also tend to cause piggy nose even when the straps are appropriately adjusted.

Thanks again for any help. I do have sleephead and can post graphs if that is helpful to anyone. Just let me know what I should post. My AHI is good. My mask fit starts out good; I always do that as part of my bedtime routine. I can tell when I was awake and had Centrals, but I do have Centrals showing when I think I am asleep as well, but that is not a surprise, since my diagnoses was mixed apnea. Beyond that, I really haven't figured out how to interpret my flow limitations, respirations, etc, and I don't know if that is important or not.

Give it time to sort out all the stuff that SleepyHead is telling you.

For now, concentrate on the leak line: You suspect that even (some) small leaks are bothering you. You know you're doing a bit of mouth breathing. If you can figure out a way to fix the leak problems and the "no air coming in through the pillows' cones" problem, then with a bit of luck, you'll actually start sleeping better. Once you are sleeping reasonably well with the machine everynight, then you can start worrying about all the other data and whether you really need to be worried about it.

And if you have no idea on how to interpret your leak line, post some typical ones. Be sure to indicate whether you thought you woke up doing any mouth breathing during the night for the data you post.

[Janknitz]

Read my fitting tips below for the Swift FX. I know you have a different mask, but the fitting tips may still help.

If those tips are unhelpful, you should try going up to the largest size nasal pillows--sometimes a larger size works.

Finally, the manufacturers of various masks permit the DME's to take the masks back for credit if they fill out the proper paperwork. So it may be that you can swap out the masks you have for others. It takes time and experimentation to find the right mask for yourself. A DME who understands that the mask is the key to meeting the compliance requirements so that the machine will be reimbursed by your insurer should be helpful to make sure you really can sleep with the mask.

[College3girls]

Thanks to everyone who responded. I'll try to answer everyone's questions to clarify my situation in this post.

I am on auto pressure, with a range of 6-18. I found I'm most comfortable at a short 5 min ramp of 4.

The leaks are sneaky little streams of air that occur at the sides of my face, or the issue of my nose being completely occluded by the pillow. I always start the fix for either situation by pulling on the pillows and resetting them. I do not turn on a light or get up. I don't want to wake my husband if I can avoid it; he has to get up very early, 4:30 am most days, to go to work. His getting up usually does not wake me. The leaks do not appear to be pressure driven. My pressures tend to hang around 8-11. Some of the Centrals are occurring when I know I was awake and fixing a leak. Generally when I first go to bed, and again usually at 6ish in the morning I see small groupings of centrals that I know are just mask adjustment generated. The leaks all seem to be due to mask position.

I'm beginning to think I'm between the medium and small size pillows for the Nuance Pro. It is also possible the back, nonadjustable strap, is too large for my head. The weight of the tubing seems to pull the pillows out of place. I don't feel the age of the pillows is at all a factor here. I only used the small 2 weeks, and the medium 2 nights. I switched to the medium because I think the small are just a bit too small. I don't think the pillows are inverting, but again, I don't take everything off and turn on light to look. I'm sure I don't have anything too tight. If anything, maybe the headgear is too loose. I tried adjusting the chin strap tighter, but that made my jaw ache, and still didn't keep my mouth closed. I don't think the mouth opening is severe, and the chin strap seems to be doing something most nights. I did try not using it 2 nights. I definitely had my mouth open too much on those nights.

I will look carefully at the other models of nasal pillows suggested. It is the chinstrap that is slipping off, not the headgear of the mask. I do like the idea of finding something that doesn't blast out the exhaled air the way the Nuance does. I'm also going to try the suggestion of a headband to hold the pillows in place. I'm a side sleeper, and with the arthritis, I do turn over from side to side during the night. I'll tighten up the head gear just a tad too. Even though I think the small pillows are too small, and the medium too big, just for kicks, I'll see how the large feel at some point before bed tonight.

I'm not at my usual computer right now, so I don't have access to my sleepyhead data. I will try to post the requested graphs later today.

[Too tall]

I have the same issues. I'm constantly adjusting it all night. I'm sure you know this but those things can be installed upside down (which I've done a couple of time) and it will leak much worse.

Has anyone tried one of these things, I saw it advertised on TV.

https://www.nomask.com/index.cfm

[library lady]

Do you have mask liners? I couldn't control the leaks and noises of my Quattro Air until I got some - the first couple weeks, my sleepyhead graph showed leaks all over the place, but hardly any of them woke me up. Last night, I had a fairly steady line on the graph. I googled mask liners to find out where I could get them, the brand names, etc. and bought several kinds to try out. One I have discarded because the fabric was suffocating even though I could breathe just fine. The next one I tried worked as far as not waking me up, and the third one is the one that produced the flat line last night.

[Stormynights]

I have the same issues. I'm constantly adjusting it all night. I'm sure you know this but those things can be installed upside down (which I've done a couple of time) and it will leak much worse.

Has anyone tried one of these things, I saw it advertised on TV.

https://www.nomask.com/index.cfm

I tried that one, but for me it was a failure. I have had a problem finding the right mask for me so I have tried most every mask out there. My leaks have not been terrible, but I am waking up too many times during the night with leaks. Now I am using the Nuance and the P10. I thought the Nuance was the best for me because of the gel pillows, but now I think the P10 is better because of the headgear. I don't wake up nearly as often with either of these masks. They are both good for me.

[College3girls]

Last night was a much better night. I carefully checked the fit of both the small and medium pillows. I am really between sizes. I decided to try the small again, and added the suggested headband solution. This worked great! For the first time, I could lay my head on my pillow and not have to hang off the edge of the pillow. Nothing moved. I could go from side to side. I was also able to tuck the tubing outside my blankets and keep that high stream exhaust away from me.

The only issue that developed- I woke myself up, maybe only twice, opening my mouth. Hopefully I start sleeping through that, or stop opening my mouth, which would be even better.

Even with the mouth opening, I didn't have as much sleep disruption as with the leaks. I don't think the mouth leaking will be a big issue. If it gets worse, I'll be back on the forum for info on taping. I don't have any claustrophobic issues, so taping wouldn't be an issue ,except I am very sensitive to adhesives.