My husband has been using his new cpap a Resmed Escape II. His pressure is set to 16. He is having difficulty when he exhales, he says that he can't seem to exhale completely through his nose pillow. His nose is not stuffy. He is using a chin strap and a swift LT with nose pillows. He is very frustrated, any suggestions would be wonderful.
Thank you
Trouble exhaling with nose pillows
6 posts
• Page 1 of 1
Re: Trouble exhaling with nose pillows
Welcome to the forum, sleeplesswife! I'm sorry that your husband is having such difficulty.
It does take some time to get used to CPAP. Your husband's pressure of 16 is high enough that I imagine exhaling would be difficult. Unfortunately, he has the most basic machine. The ResMed Escape II doesn't have any "comfort" features at all. The only thing that can be adjusted on that machine is the Ramp setting, which starts the pressure low and then slowly builds up to the prescribed pressure of 16. There are two Ramp adjustments: (1) the Ramp starting pressure and (2) the amount of time it takes for the machine to get to the prescribed pressure.
You mentioned that he hasn't had his Escape II machine very long. I suggest that you return to the DME supplier ASAP and exchange the Escape II for a ResMed Elite II. The Elite II has a comfort feature called EPR (exhalation pressure relief), which lowers the pressure on exhale. This makes it easier to breathe out. Even if he uses EPR, it'll take some time to get used to exhaling with the machine, though. It's a common issue. But, believe it or not, over time he will not even notice it!
The Elite II should not cost you any more than the Escape II. The DME supplier uses the same insurance code for billing, regardless of whether it's a basic machine, such as the Escape II, or a more sophisticated machine such as the ResMed Elite II or AutoSet II. The DME suppliers often sell the most basic machine because they make the most profit. Unfortunately, that's often not in the best interest of the patient.
There is also a BiPAP machine, where the inhale and exhale pressures are set separately. But a patient usually needs to "fail" regular CPAP before that is prescribed. At some point it may be determined that a BiPAP would work better for your husband, but I know that many people are able to use a regular CPAP at his pressure of 16 when there is an exhalation relief feature such as EPR.
The other possibility is that his nasal pillows may be too small for him. He could try the next-larger size pillows and see if that helps. But I suspect it's more a pressure issue and he needs a more sophisticated machine. Also, he may find it easier to breathe using a full-face or nasal mask, rather than the nasal pillows. The nasal pillows don't always work well at higher pressures.
So, while he's at the DME getting a better machine, he should try on several other mask types and see if one works better for him. Masks come in different sizes, and they need to be carefully fitted while under full therapy pressure. He needs to be able to move his head around (preferably while laying down) to make sure it doesn't leak. Most DME suppliers allow mask exchanges within 30 days, as the major manufacturers allow returns. Ask what your supplier's policies are and be persistent in finding the right mask. It is a very important part of comfortable therapy!
I hope he'll keep working with the CPAP machine and masks. It is SO important to our health that sleep apnea is treated! It does get easier once the kinks are worked out. Many of us have faced the same challenges initially and overcome them. We're glad you found us!
~ DreamOn
It does take some time to get used to CPAP. Your husband's pressure of 16 is high enough that I imagine exhaling would be difficult. Unfortunately, he has the most basic machine. The ResMed Escape II doesn't have any "comfort" features at all. The only thing that can be adjusted on that machine is the Ramp setting, which starts the pressure low and then slowly builds up to the prescribed pressure of 16. There are two Ramp adjustments: (1) the Ramp starting pressure and (2) the amount of time it takes for the machine to get to the prescribed pressure.
You mentioned that he hasn't had his Escape II machine very long. I suggest that you return to the DME supplier ASAP and exchange the Escape II for a ResMed Elite II. The Elite II has a comfort feature called EPR (exhalation pressure relief), which lowers the pressure on exhale. This makes it easier to breathe out. Even if he uses EPR, it'll take some time to get used to exhaling with the machine, though. It's a common issue. But, believe it or not, over time he will not even notice it!
The Elite II should not cost you any more than the Escape II. The DME supplier uses the same insurance code for billing, regardless of whether it's a basic machine, such as the Escape II, or a more sophisticated machine such as the ResMed Elite II or AutoSet II. The DME suppliers often sell the most basic machine because they make the most profit. Unfortunately, that's often not in the best interest of the patient.
There is also a BiPAP machine, where the inhale and exhale pressures are set separately. But a patient usually needs to "fail" regular CPAP before that is prescribed. At some point it may be determined that a BiPAP would work better for your husband, but I know that many people are able to use a regular CPAP at his pressure of 16 when there is an exhalation relief feature such as EPR.
The other possibility is that his nasal pillows may be too small for him. He could try the next-larger size pillows and see if that helps. But I suspect it's more a pressure issue and he needs a more sophisticated machine. Also, he may find it easier to breathe using a full-face or nasal mask, rather than the nasal pillows. The nasal pillows don't always work well at higher pressures.
So, while he's at the DME getting a better machine, he should try on several other mask types and see if one works better for him. Masks come in different sizes, and they need to be carefully fitted while under full therapy pressure. He needs to be able to move his head around (preferably while laying down) to make sure it doesn't leak. Most DME suppliers allow mask exchanges within 30 days, as the major manufacturers allow returns. Ask what your supplier's policies are and be persistent in finding the right mask. It is a very important part of comfortable therapy!
I hope he'll keep working with the CPAP machine and masks. It is SO important to our health that sleep apnea is treated! It does get easier once the kinks are worked out. Many of us have faced the same challenges initially and overcome them. We're glad you found us!
~ DreamOn
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rosiefrosie
- Posts: 680
- Joined: Tue Mar 07, 2006 7:05 pm
- Location: MN
Re: Trouble exhaling with nose pillows
I agree with DreamOn. They gave you the basic machine. If you can, take it back and get the ResMed Elite II, stay away from the escape machines. Also make sure that the nasal pillows are the right size and not strapped on too tight. Good luck!
rosie
rosie
_________________
| Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame) |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: 7.4 pressure setting |
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Jersey Girl
- Posts: 690
- Joined: Thu Feb 04, 2010 9:28 am
Re: Trouble exhaling with nose pillows
Dear Sleeplesswife,
I have a Swift LT for her, and I can tell you that my biggest problem was exhaling through it, and I have a pressure of 8. What I found was the following:
1. I had to loosen my straps on the mask so that they were just tight enough to make a seal
2. I had to angle the cushion that the nasal pillows sit on just right (it's hard to find just the right angle)
3. I found that for some reason it was easier when I was laying on my side, rather than on my back. It allowed me to relax more when I was laying down in my most comfortable position.
I have heard that the new Swift FX does well under higher pressures - you might want to ask the DME if you can try one.
Also, some of us just prefer to have the air swirling over our noses, rather than straight up. I find the pressure feels like it is less in my Comfort Gel Nasal Mask than it does with nasal pillows on my Swift LT for her. If he does get a nasal mask, he may want to try a special cpap bed pillow that allows room for the mask: such as a countour living cpap pillow from contourliving.com or a regenesis buckwheat pillow from pursleep.com. Other comfort items are available through http://www.padacheek.com - she makes lovely fleece covers for the straps on the masks and hose covers as well.
I think that adjusting to CPAP is a process, and trying other masks/products until you find just the right one is to be expected. Please keep us posted on how your husband is doing.
Best regards,
Jersey Girl
I have a Swift LT for her, and I can tell you that my biggest problem was exhaling through it, and I have a pressure of 8. What I found was the following:
1. I had to loosen my straps on the mask so that they were just tight enough to make a seal
2. I had to angle the cushion that the nasal pillows sit on just right (it's hard to find just the right angle)
3. I found that for some reason it was easier when I was laying on my side, rather than on my back. It allowed me to relax more when I was laying down in my most comfortable position.
I have heard that the new Swift FX does well under higher pressures - you might want to ask the DME if you can try one.
Also, some of us just prefer to have the air swirling over our noses, rather than straight up. I find the pressure feels like it is less in my Comfort Gel Nasal Mask than it does with nasal pillows on my Swift LT for her. If he does get a nasal mask, he may want to try a special cpap bed pillow that allows room for the mask: such as a countour living cpap pillow from contourliving.com or a regenesis buckwheat pillow from pursleep.com. Other comfort items are available through http://www.padacheek.com - she makes lovely fleece covers for the straps on the masks and hose covers as well.
I think that adjusting to CPAP is a process, and trying other masks/products until you find just the right one is to be expected. Please keep us posted on how your husband is doing.
Best regards,
Jersey Girl
_________________
| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Pressure - 8, CMS 50D+ Pulse Oximeter, Regenesis cpap pillow, Pursleep scents, padacheek fleece hose covers |
Happiness is from the heart out, not the world in.
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sleeplesswife
Re: Trouble exhaling with nose pillows
Thank you so much for the replies. He has had the machine since November 09, I believe. I'm not sure at this point if the DME will allow an exchange. Our insurance is also finicky, I will have to check. Perhaps changing to a hybrid mask may work. I have phoned the DME supplier and will discuss with them.
Re: Trouble exhaling with nose pillows
How kind of you to look into this for him. It took me a week or so to get used to exhaling against 18cm2 through my tiny, pathetic excuses for nasal passageways. After that, I was used to it, but I could never stay asleep for more than an hour or the aerophagia (air swallowing) would wake me up. If your husband really needs to stay at 16cm2, then I would simply tell him to stick with it, use the machine during the day when reading or watching TV, and eventually it won't be hard to breathe against 16cm2. At least, that was my experience.sleeplesswife wrote:My husband has been using his new cpap a Resmed Escape II. His pressure is set to 16. He is having difficulty when he exhales, he says that he can't seem to exhale completely through his nose pillow. His nose is not stuffy. He is using a chin strap and a swift LT with nose pillows. He is very frustrated, any suggestions would be wonderful.
Thank you
6 posts
• Page 1 of 1