Respironics ComfortLite Nasal Interface

Hi Liam,

Glassgal here. Most of us here on this forum have been to the place where you are at. It is not fun, but please don't give up. Your health will improve so much when you can find the right combination of machine and mask.

I have the NasalAire II, which I threw across the room one night. I went back to the sleep lab and they actually gave me a sample unit of the NAII which was bigger (thanks Roger!). Apparently the trick with the NAII is not to get it too small -- it leaks and moves around, making noise and severely annoying the inside of your nose. I don't think that I would have accepted the size that I now like in the sleep lab, as I was sleep deprived, frustrated with all the wires and all, and just cranky. I know that it sounds strange to get a size larger than you think that you need, but it has worked well with me, as well as the headband tweaking that I have been doing (see other posts on this subject). I guess that the point that I am trying to make is that everyone is built differently, and has different priorities. I don't like anything on my head, and the NA II has a soft, less strappy head gear. I have had a lot of sinus problems and the heated humidified air (and maybe the high pressure -- I'm at 14) have actually improved the sinus problems. One of the reasons that I did not like the nasal mask during the study was pressure on the sinuses that run alongside the nose and pressure on my upper lip/teeth. The nasal pillows (ie the Swift, Breeze, etc.) seem to have hard headgear to hold them in place, which I could not stand, so the NAII was the best of a bad lot. I have tweaked it to suit me -- I usually make things my own with modifications!

With that said, PLEASE don't give up the effort to find what works for you. I know that it sounds like I own stock in Inomed -- I don't -- it is just the one that works for me, and the message here is to keep trying until you find a solution that you can live with (and sleep with!), and don't give up. By the way, the saline gels really help with inside the nose irritation if you have problems with that. I am now 100% compliant and sleeping better every night and feeling better every day.

Hang in there Liam -- and keep on trying different combos! Your sense of humor/sarcasm is wonderful -- don't lose it over all this!

Aloha,

Jane

Liam,

Thanks for the detailed answers. You sound remarkably rational considering the situation. The mask issue is the toughest one to resolve. I am lucky enough to have not needed a full face yet, although I am at the height of one nasty head cold right now. What I have found that works for me is to use the swift with my hummidifier on 4(of5) and the heated hose. The air is a little sticky but the high hummidity loosens the congestion enough to allow a free flow of air through my nose. It actually is easier for me to breathe at night than during the day with this set-up. One "from the hip" suggestion I have (rested gal's creation) is to try using your Activa as a mouth only mask. I have not actually testted this, but the way it works is to pull the cusion down over your mouth and locate the top of the cushion just under your nose with enough pressure to close off your nostrels. Can't hurt to try (maybe test it with a short nap). I'll keep thinking of some more ideas. My advice is to try to get the mask thing somewhat resolved before you worry about another machine.

OK, some more things I've noticed after tonight's failed attempts to sleep with the mask.

First, apparently they turned OFF C-FLEX on my Pro-2 when they gave it to me. I turned it on, and breathing became a bit easier. Not enough, however.

Second, the Activa... The problem is the thing inflates so much, and the vent holes are so close to the hose, that I'm not sure I'm efficiently venting my exhalations, and I think unless I breathe really deeply, I'm not getting enough fresh air. Since deep breathing is not standard during sleep, it means I end up staying awake, focusing on deep breaths.

Third (and I just mentioned this elsewhere as well), I'm noticing a phenomenon whereby as I get anywhere even CLOSE to sleep, I start having what I can only assume are central apneas: I just forget to breathe. My throat isn't closed, I certainly CAN breathe. I just.... don't. This, too, keeps me focusing on my breathing and making sure it happens, and so my brain never shuts down enough to let me get to sleep. (It doesn't dare, for fear that I'll just stop breathing entirely).

I'm not sure anything mask related is going to help that.

Oh, and I tried the humidity on 4 out of 5 today, started getting condensation in the hose, and it was like trying to breathe soup. I definitely don't like using H/H. Pass-over humidification if it's really dry, otherwise, nothing.

Liam, who certainly can't be said to be "all wet".

Liam, when I was having runaway pressures on the 420E I felt like you, that I had to breathe very long and deep. I didn't have trouble exhaling but it would wake me up and it was not a comfortable feeling. You might try loosening the straps on your mask a bit. What effects the seal is the air pressure. That might help there. I don't know what else to suggest except the Remstar Auto with CFlex might suit you better. The Pro is a straight CPAP isn't it? I don't have any experience with them, so I'm not familiar with the different models.

"First, apparently they turned OFF C-FLEX on my Pro-2 when they gave it to me. I turned it on, and breathing became a bit easier. Not enough, however."

Did you set the C-flex on level 3? For me, on 3, the back pressure is non-existant.

"Second, the Activa... The problem is the thing inflates so much, and the vent holes are so close to the hose, that I'm not sure I'm efficiently venting my exhalations, and I think unless I breathe really deeply, I'm not getting enough fresh air. Since deep breathing is not standard during sleep, it means I end up staying awake, focusing on deep breaths."

This is not a technical problem for you. This one is in your head. Don't concern yourself with "imagined" problems. You seem to have enough "real" ones to focus on. Repeat after me: "I AM getting enough fresh air."

"Third (and I just mentioned this elsewhere as well), I'm noticing a phenomenon whereby as I get anywhere even CLOSE to sleep, I start having what I can only assume are central apneas: I just forget to breathe. My throat isn't closed, I certainly CAN breathe. I just.... don't. This, too, keeps me focusing on my breathing and making sure it happens, and so my brain never shuts down enough to let me get to sleep. (It doesn't dare, for fear that I'll just stop breathing entirely)."

Another "imagined" problem you don't need to concern yourself with. I you could watch a video of yourself (or anyone else for that matter) you would be supprised how shallow we all breathe when we sleep. It's a natural occurence. You body is lying motionless, your heart rate is low, there is much less volume of air required and our marvelous brains adjust for this so that we can sleep without disturbance. Besides all this, you have air blowing in your nose at 8cm pressure. Don't fear that you will just stop breathing entirely.

In reading about your experiences, I think you are having more issues with the anxiety of using the equipment than the actual function of the equipment. All I can say is trust that this thing works and try to relax. You have some of the best equipment available. As much as we tout the Autos, the REMstar Pro w/C-flex is a great machine. Your titrated pressure of 8cm is at a very tolerable level. The Mirage Activa is the best mask out there. You've managed to avoid the minefield of bad equipment. Let the good stuff you have work for you. Lie down at night with the confidence that you have gotten great therapy and now you can let it do it's job while you finally get some much need rest.

All easier said than done, but it is all the truth. You are in good stead, rest assured.

wading thru the muck! wrote:Did you set the C-flex on level 3? For me, on 3, the back pressure is non-existant.

So far, I've tried 1 and 2. I'll try 3 tonight.

The Muckster wrote:This is not a technical problem for you. This one is in your head.

Would that it were so simple, my good man. Would that it were so simple.

The Grand High Muckety Muck wrote:In reading about your experiences, I think you are having more issues with the anxiety of using the equipment than the actual function of the equipment.

Yeah, I know. But unfortunately, I don't seem to deal very well with anxiety, so like with my depression, trying to "just snap out of it" doesn't so much work. But I'm trying.

Liam, who is very trying.

Liam,

I'm not telling you to "just snap out of it." Just pointing out that the dificulty is not with the equipment, so new equipment won't solve the problem. My best suggestion is to try to find some distraction from the experience. That will be different for everybody. For me I find subject to think about that requires deep thought. Before I know (or actually don't know it) I'm sound asleep.

Liam, I know this basically complete change in lifestyle --or at least one third of it,-- is a bit overwhelming. We are asked to sleep with all this stuff over our nose, around our head, stuck up our nose or in our mouth, with an umbilical cord following us no matter which way we turn. On top of that the threat of death if we do not comply or at the very least a return to our previous exhausted state.

This forum is proof positive that you can overcome all this paraphernalia and wake up the next morning with at least some semblance of "feeling better", and then "better" and then "fantastic". All those numbers who give up or only give a half-assed attempt at compliance probably do not have the benefit or in the past, a forum like this where ideas and solutions can be shared.

I have a friend who has been on straight CPAP for about 5 years. She wakes up every morning with her mask in her mouth (literally). She only just heard of APAP a few months ago. She has tried nearly every mask that has come down the turnpike. I told her probably the reason she keeps getting her mask knocked off is her pressure is not high enough or too high. An autopap sounds like a great solution for her. In fact I'm loaning her my 420E for the night in March when I see her. Her machines have all been noisy monsters. I think she is going to be pleasantly surprised how quiet they now are. Even with all her problems she has been 100% compliant and feels like hell if she doesn't sleep with it or it comes off during the night and she sleeps most the night without it. She says even a few hours have a definite negative effect. She knows she NEEDS this machine.

Have you tried the suggestions about wearing it around the house during the day on the weekends or while watching TV without the machine attached and then with? This is what I did and it made a big difference in early compliance. You'll find out that even without the machine you can breathe quite easily with the mask on thanks to the vent ports so even if there is a power failure and the mask is attached to the hose, you aren't going to suffocate.

Realize that your depression could be caused by your apnea. And possibly the anxiety as well. Realize that with compliance these most likely will diminish and go away completely.

I know you are really trying, but this is really something you kind of have to make up your mind to do (like quitting smoking). You have to be strong, you have to know the consequences if you don't, and the benefits if you do.

If what you are currently using is not comfortable there are alternatives. Thank God! Can you imagine a world with only one machine and one mask, whether they leaks, made noise, hurt, or were ineffective? We are really very lucky to have so many to chose from for just the right therapy.

Hang in there. Besides if you quit, I know there are lots of us who will miss your posts and your sense of humor.

Janelle wrote:Hang in there. Besides if you quit, I know there are lots of us who will miss your posts and your sense of humor.

Hmmmm. Well, if you talk to my wife, I think you can have it. She gets "Liam Sense of Humor Overload".

Seriously, thanks for the encouragment. I think I'm going to try a somewhat unorthodox plan for a bit and see what happens:

Interestingly, I have always found that I got my best sleep when I was exhausted. Not sure why that would have any effect on apnea, or maybe my brain just finally gives in and crams in as much REM sleep as it can, in spite of (or in between) apnic events. Or maybe I sleep on my side more when I'm exhausted(a position in which I have few or none).

Either way, I think what I'm going to do is use this thing two nights on and one night off. Well, not OFF entirely, but like last night. I'd been averaging probably an hour of sleep per night over the previous 3 days, and maybe 2.5 hours over the time I'd had the machine.

So last night, I put it on, KNOWING I was exhausted, KNOWING that come hell or high water, I should fall asleep, machine or no. Apparently, the experssion is not "come hell, high water, or a bulky CPAP contraption hooked to your face", because after an hour, I was no closer to sleep... so I took it off. Slept beautifully.

This morning, I feel quite well rested. Still have some residual effects of the long sleep deprivation, but most of them are gone. Which gives me renewed energy to keep trying this stuff.

So yes, the conventional wisdom is to keep using it until you acclimate, and let your body forget the old way of breathing, but I've always been a bit unorthodox, and I think for me the better part of valor is keeping my spirits up, my depression down, and my paychecks coming in (man, I was worthless at work towards the end of last week).

Liam, wide awake, wife in a class all day, ready to "tear it up" and "go wild" reading CPAPTALK.COM.

Liam,

You're a smart guy, whatever plan you come up with to attack this machine...go for it!

Glad to see your back in this world, however you managed to get here.

wading thru the muck! wrote:Glad to see your back in this world, however you managed to get here.

Thanks, Wading. On the whole, I think I'm a lot more fun to be around when I've had sleep.

And, based on this morning, a lot more verbal in on-line forums as well.

Is it Liam, or is it Memorex (on auto-repeat).