Nasal pillows questions

After a disastrous 2 months with the Flexifit 407 - each night after 2-3 hours I would wake up with an overpowering urge to rip the mask off, which I usually acted on - I have switched over to the Optilife nasal pillows and it's as huge improvement. Still, it's not all great...
It's only been about a week, but first off I can't figure out whether I'm a medium or a large in the pillows.
The large is a little more comfortable, but the holes seem almost as big as my nostrils, and it's more prone to leaks. The medium seems to get the best seal...I keep going back and forth.
I have a technical question about how the pillows work--when you exhale is the air supposed to flow back down into the holes, or is it supposed to be pushed out the sides? I find that when I go to sleep I have a hard time exhaling but once I fall asleep, if i wake up here and there, i notice it gets easier and my breathing gets into a natural rhythm (I'm at 9cm pressure and i usually ramp for 5-10 mins).
I still am waking up--but it's usually 430a instead of 1230a or 130a with the nasal mask. My wife now sleeping in the same room gives me "incentive" to leave it on and try to go back to sleep, but it's usually tough. I have some issues with "pulling" because I'm a side sleeper...
The straps bother me--I find it hard to adjust them so they are loose enough to be comfortable, but without causing leaks.
I did try a Swift LT that the technician brought over, and it seemed very comfortable, but it sounded too loud at first blush...maybe i should give it another try?
Open to any and all advice. Main question is how long do people usually experiment with a mask before giving up and moving on to another one? My first experience--2 months...seems way too long in hindsight.

maskracer wrote: . . . I can't figure out whether I'm a medium or a large in the pillows. . . .

With my Swift II and LT, I can use all three sizes--small, medium, large--without any problem. I usually use the large just becuase it takes a few seconds less to get used to breathing out into the larger holes, I think.

maskracer wrote: . . . when you exhale is the air supposed to flow back down into the holes, or is it supposed to be pushed out the sides? I find that when I go to sleep I have a hard time exhaling but once I fall asleep, if i wake up here and there, i notice it gets easier and my breathing gets into a natural rhythm (I'm at 9cm pressure and i usually ramp for 5-10 mins). . . .

The air should go back into the holes. EPR can make it easier to exhale, since it sounds like you are using your machine in straight CPAP mode. Changing your EPR setting, though, may mean you would need to raise your overall pressure, I don't know. Just a thought.

maskracer wrote: . . . I did try a Swift LT that the technician brought over, and it seemed very comfortable, but it sounded too loud at first blush...maybe i should give it another try? . . .

Personally, I find the mask very quiet. It is my favorite so far. But masks are a very personal thing. One person's perfect mask can be another person's nightmare.