Chin Strap/Mask/Sinus Help

Hello -

After about 1.5 weeks on CPAP, I need more advice - this time about masks, chin straps, sinuses, etc.

First the good news - I've been able to sleep with CPAP for 7+ hours every night, keep my AHI under 2.5 every night, and I verified the last two nights that my 02 was at 94+ most of the night, except for one short drop to 93 last night - Before CPAP, my lows were 88-89 and much of the night was at 90 before. Now, it looks like most of my night is at 95.

I've currently got two masks at home, the one in my profile and the Swift FX Nano. Neither one are perfect for me, but I've been putting off getting back to the DME to swap, because I'm afraid they may be giving up something Ok for something Awful. My neck doesn't like the Mirage FX headstrap, and the the bottom of my nose doesn't like the Swift FX Nano - plus I get some higher leak rates than I'd like on the Nano, although my AHI has been below 2.5 every night since I started on my CPAP and I always get the smiley face for mask fit. The leaks ARE waking me up during the night though, so I need to get that under control for better sleep quality.

Also, with the Nano, I added a Padacheek mask liner, but that puts the mask so close to my eyes that my eyelashes are touching the liner so I'm waking up with watery eyes in the morning. With both masks (more so with the Nano), I feel like I'm getting leaks at the bridge of my nose, but I can't feel there air. It may just be that cooler air is blowing up around the top of my nose when I inhale, so that is making me notice that there is cool air coming in that direction?

The last several nights I've worn the Swift FX Nano + Resmed chin strap and I've had problems with the chin strap moving and allowing my mouth to open during the night. Resetting the chin strap from bed without a mirror is not a smooth process either I've ordered a different type of chinstrap to try, but are there any other suggestions for me? I'm contemplating trying the Airfit P10 and the Wisp, but my 30 days of free swap outs is only 2 weeks away from being done. I'm tempted to just pay out of pocket for the stuff I want to try, but then I feel guilty for spending money when in theory I should be able to get the first "right" mask covered under insurance if I can pick it out in the first 30 days. Last time I showed up without my old mask, they didn't say a word about bringing it back, they just swapped me out in the system, so maybe that is what I need to try again.

I'm still fighting sinuses and sore throat that started up with CPAP. I currently have the machine set on 3.5 humidity + 74 degrees. When I put it on auto climate where I just adjusted the temp, my sinuses and nasal passages were feeling especially angry in the mornings, so I swapped back to the settings where temp and humidity are separate. I've also started using the Calm oil from Pursleep, in the hopes that the Eucalyptus would help. Clear seemed to aggravate my sinuses worse, so there is probably an oil in there I'm sensitive to as I have a lot of allergies. Every morning and evening now, I'm rinsing sinuses with a hypotonic solution and my Neilmed Sinugator. My sinuses are still runny, but not as congested as a couple days ago. My throat, however, is hurting worse each day, likely due to the runny sinuses. I do have allergies as well, so am already on Patanase and Nasonex nasal sprays. I just went off my singulair (part of my allergy meds - not for asthma) to see how I did without it for sinus inflammation, but may need to start back up if it will help the current sinus situation.

Do you have any suggestions for me in regards to trying out masks, chinstraps that don't come loose in the middle of the night, or sinus challenges?

Thanks!!

Have you tried an even lower humidity setting? Your nasal mucosa and sinuses may just prefer less humidity?

Mask preference is a crap shoot...you already know that. The Wisp cushion is very similar in construction/shape and as to where it hits the bottom of the nose as the Nano cushion. Also if your neck doesn't like the straps on the Mirage FX...it may not like the straps for the Wisp...look at the Wisp closely.

The P10 nasal pillows...sweet little mask. It won't bother your neck I don't think...it doesn't bother my neck and I can't wear anything with those lower back straps because I have a bad neck.
The P10 would be my first thought for you to try next. The Wisp you likely will have the same issues with its cushion since it is so similar to the Nano plus the headgear itself may not suit your neck.

Now of course you could buy out of pocket from cpap.com and get the free return insurance that comes with it and not burn up a swap at your DME. If it were me...I would keep doing the swapping at DME as long as I could and then use my own money and cpap.com and the return insurance thing.
Up to you though.

Let me know if the Wisp doesn't scare you off too bad...I think I may have one you could have for cost of postage..new with all the cushions. Only thing I ask beyond postage is that if you hate it....offer it on the forum for free to someone else...it's a good mask and a lot of people do use it successfully and I hate for masks to go to waste.
There are people who getting a slightly used mask won't bother. I used to do it all that time. It was the only way I could afford to test things.
Unfortunately I don't have an P10s to offer you...but I might have a Respironics Nuance nasal pillow mask.
Just let me know.

Thanks for the offer, Pugsy!! I think while I still have free swaps at the DME, I should use them, so I will get an appt to head back in there. If someone else needs your offer, I don't want to use it up when I still have free swaps. I may check back with you after my 30 days are up if I'm still not happy with my mask and see if you still have anything to play with.

For humidity, I think this is what I'm going to try, since I am feeling better than 2 days ago with the current settings, leave there for 2 days to see if I get any further improvement. Then, switch settings for 3-4 days and try that, and just keep moving it until I find something comfortable. I wish there was more of a science to getting that part right! From your experience, how many days does it usually take to "test" a humidity level?

Do you use a chin strap with your P10s? I'm finding that the straps of the Resmed chin strap seem to be in the same place as the head gear for my Nano and am wondering if that is why I'm having chinstrap issues?

I don't use a chin strap...having for over 5 years now.
Back when I was first starting therapy I was doing a little mouth breathing (out of habit and not because nose was congested) and the chin straps I tried were pretty much a PITA...though I tell you I had more success with a cheap $1 sweatband from Walmart athletic department than I did from anything else.
I finally just opted to tape my mouth but that's not something someone with any hint of nasal congestion should do.
Back when I was trying chin straps...the ResMed and the Respironics straps were beyond useless for me.

Have your looked at the Ruby adjustable chin strap? I hear a lot of good things about it.

Are you putting the chin strap over or under the mask straps? It's not set in stone to do it one certain way.

Finally...how much mouth breathing are you doing? I finally just did away with trying to keep my mouth closed 100% of the time because to tape or chin strap was causing more sleep disruption than a little bit of mouth breathing leak was hurting my therapy. I quit worrying about perfection on that leak line.
As long as leak line is below large leak territory and I sleep well ...I don't care if it isn't the prettiest of leak lines.
And if I do venture into large leak territory...it never lasts long and doesn't go horribly far into large leak territory.
Like the other night I had 10 minutes at 29 L/min (with my S9 machine above 24 is my no man's land) out of 7 1/2 hours of sleep. 10 minutes isn't the end of the world and it's not like my therapy immediately went in the trash the second the leak with over 24.