Used Nasal Mask With ASV - Sinuses Hurt?

[KenTheriot]

Has anyone had this? I was titrated for ASV with a FF-mask (issues of chronic nasal congestion make using a nasal mask regularly difficult), and ended up with pressures much higher than with my nasal mask/APAP (S9) combo. So I'm dealing with the leaks (Quattro and Amara so far) and not succeeding so far. So, last night, after not being able to sleep due to excessive leaks in the Quattro, I switched to my nasal mask (and changed the S9 VPap Adapt mask type to "Nasal." I woke up about 3 hours later with my nasal passages/sinuses burning. It felt like when I get chlorine water up my nose - very irritating and painful. Ironically, SleepyHead reports quite good quality sleep during that time).

Anyway, I wondered if anyone had ever experienced anything like that - painful nasal passages/sinuses after using PAP. I'm just assuming that I was not used to getting such high pressures directly up my nose (the APAP never went above 12 and averaged about 8 in the long-term). And I also assume things will be better after some time has passed. But I wanted to check with the PAP hive-mind to see if anyone has ever had anything more serious result from something like this.

Thanks!

Ken

BTW, I switched back to my Quattro when the pain woke me, and put the Pad-a-Cheeks liner back on that I'd removed for testing. Things were better after that, including the leaks.

[Ladyflower]

I just started therapy this week on the Resmed S9 ASV. My doctor had recommended a FF mask, but I'm slightly claustrophobic and don't like anything over my face so I decided on a nasal mask. From recomendations, I chose the AirFit P10 mask. I had a little bit of discomfort the first night I used it and even now my nostrils are a little sore if I touch them, but I never experienced any burning. I would guess the same thing as you about the pressure. Maybe your nose just needs to get used to it. Even though I was told I might not be able to use the nasal mask, so far it seems like I've had minimal leaks and I'm happy with it.

[KenTheriot]

Thanks LadyFlower,

I think you'll like ASV. When I'm able to go an hour or so with no leaks in my FF mask, it is AWESOME. But it seems like every time I make one breakthrough, another problem pops up. Sigh. Good luck with the ASV!

Ken

[Pugsy]

What is your humidifier set at? Are you using the ClimateLine heated hose..if so at what temp?

Most likely your burning issues were related to humidity or temperature or a combination of both. When using a nasal only mask the air pressure is more direct to the nasal mucosa and sinuses..so greater chance for a bit of discomfort.
You may need more moisture or less..depending on how your nasal mucosa react to the drying effect caused by the volume of air going up the nose when using a nasal mask.
When using a full face mask and mouth breathing the air pressure gets diffused and isn't so "direct" to the nasal cavity.

[KenTheriot]

Pugsy,

I turned humidity down to my normal nasal mask setting of 3. I do have the heated hose and I had that set to its max. Just forgot to turn that down. I hadn't thought of that. Thanks. I'm actually wondering if last night didn't actually correspond to the start of a virus or something. Nose and sinuses have been hurting all day and now the headache. I'll see if it gets better tomorrow.

Thanks again.

Ken

[squid13]

Have you ever tried your heated hose on auto? On Auto it will maintain 80% humidity and you just control the temperature.

[Sir NoddinOff]

Hi Ken. I sometimes use my ResMed S9 Adapt, plus I also use the Quattro FX FFM if my Wisp isn't getting air thru my congested nose. I find my sinuses avoid inflammation if I can equalize the air inflow between my mouth and my nose. When using my QFX, what I have to do is tighten it more than the 'float on your face' people promote... mostly because it simply wants to jump off my face at the higher pressure of ASV therapy. That's means leaks which means bad therapy. Whether you can deal with the extra strap pressure is something you'll have to decide. (I'm trying the F&P Simplus next week) Anyway, using the Padacheek is the first positive step. The second is shaving all the stubble off your face for a leak free fit. The third is using some device to support your chin, whether it be a Ruby chinstrap or this, a bike cuff strap:


You've got to get your chin stabilized so that it doesn't drop back and compromise the seal of the mask. Fourth, you have to force your lips to part a little bit... this sounds crazy, but what I do is put a small strip of 3M multipore tape from the center of my upper lip to the tip of my nose. This pulls up my lip a little bit so it won't close automatically while I'm asleep. This takes few days to get used to but is in no way uncomfortable. Fifth: there will likely be a bit of dry mouth in the process, however search this website for dry mouth solutions. Okay. so this little writeup kinda gives you a few ways to go. Some of these tips may work for you and some may not, but contact me if you find something's not working, and especially if something's working great. SNO

[KenTheriot]

Thanks SNO. Those are some good ideas. I have no problem with my mouth opening. It does that automatically and always has. But having that strap supporting my chin like you show in your picture seems like a great idea. Where did you get the strap? Is it just a generic velcro strap?

Squid - yes I have tried it on Auto. It was like that when I got it from the DME. But I changed it because I wanted more humidity. I was getting dry mouth when using the Quattro FFM. But maybe I should try Auto if I ever decide to try using my nasal mask with the ASV again. I've been waking up and swapping the "brain" of my S9 from APAP with nasal mask to VPAP Adapt with FFM when one or the other is giving me trouble. I think I'll stick to that strategy - keeping the nasal mask matched with the APAP and the FFM matched with the ASV.

Thanks again everyone for all the help. This forum is truly awesome! I will do my best to be more of a "giver" rather than always being the one taking the ideas from everyone.

Cheers!

Ken

[Pugsy]

The humidifier set to Auto with the Climateline should give you 80% humidity delivery no matter what temperature you are using.

When you set it to manual and have humidity and temperature independent of each other...that setting of 3 isn't going to give you as much moisture as the 80% available on automatic.
We are never told what the independent settings give because there's no way to know since ambient humidity plays a big factor but I would bet my last dollar you would get more humidity on Auto than you do on manual at a setting of 3.

[Sir NoddinOff]

Thanks SNO. But having that strap supporting my chin like you show in your picture seems like a great idea. Where did you get the strap? Is it just a generic velcro strap?
Ken

Actually I just found it in the road as I was bicycling. I find various cuff straps about three times a year, so have a great stash for a rainy day! People just tend to have them too loose and they fall off.

You can find some various types in bike shops or on the internet but try to avoid any that are too stiff or are made of pure nylon. After all, you have to wear it all night so it should be soft and comfy. Laid out flat it should be at least 12 plus inches long. Mine seems to be a poly and cotton blend. If I find a source that sells the type I have in my pic, I'll let you know. I like mine and would even be willing go to a seamstress to get that exact type made once mine wears out. Ruby chinstraps are fine, as are all the rest, however this minimal type is pretty cool. I don't remember where I read about this solution but it was here on CPAPtalk. EDIT: I just remembered: some folks have cut up old headgear straps and made some under the chins straps with those segments. I tried one once and it was fine.

[chunkyfrog]

I would imagine repurposing the back strap on a Swift FX if you needed something a little narrower.