Pros and Cons of nasal pillows

SleepingUgly wrote:Can anyone speak to whether using nasal pillows causes the nostrils to permanently expand? I was just thinking of trying nasal pillows again, but if that's true, no thanks!

I think it's been spoken to above. Personally, I think the notion that properly fit and worn nasal pillows cause the nostrils to expand is pure BS, but others disagree and have a right to their opinions. Until someone shows me a peer -reviewed, scientific study saying otherwise, I'll stick to my assertion that it won't cause your nostrils to permanently expand and allowing the fear of expanded nostrils to keep you from a very comfortable and good mask makes no sense.

Tissues naturally expand in response to pressure over time. Post-pregnancy "stretch marks" is a common example of this phenomenon. With nasal pillows, we have pressure expanding the nares for 6+ hours a night over a period of years.

It is disingenuous to call the possibility of permanently expanded nares "BS" due to the lack of peer-reviewed studies. Doing so would be akin to Phillip Morris Tobacco saying, back in the 1960s, that there are no peer-reviewed studies showing that smoking causes emphysema.

Fortunately, we live in an era where information is much more available than it was in the 60s. Do with it what you will.

"The phenomenon of tissue expansion of the skin and underlying soft tissues has been observed commonly in pregnancy, slow-growing tumors, and fluid collections, where the local tissue expands and enlarges in response to the tension generated by the increased volume of the mass. This response has been found to be a metabolically active process with increased mitotic activity and vascularity of the expanded skin and has been applied clinically as an important skill in the armamentarium of the reconstructive surgeon."

http://emedicine.medscape.com/article/1822400-overview

Perhaps the question should be if 18 hours of relaxation can overcome the 6 hours of expansion...

HoseCrusher wrote:Perhaps the question should be if 18 hours of relaxation can overcome the 6 hours of expansion...

Excellent question. Or, to put it another way, does the mitotic activity that results in new tissue growth require constant tension?

IMO, I think that the nostrils, being rimmed and supported by cartilage, might not be as susceptible to stretching as a pregnant woman's abdominal skin is. And, even if they did stretch a bit, I doubt it would be that noticeable.

Tissues naturally expand in response to pressure over time. Post-pregnancy "stretch marks" is a common example of this phenomenon. With nasal pillows, we have pressure expanding the nares for 6+ hours a night over a period of years.

So, let's extrapolate here (if you can do it, so can I). We have continuous or intermittent pressure applied to our airways for 6 to 8 hours every night too--wouldn't we also expect to see some "tissue expansion" there if the pressure was sufficient? This mucosal tissue lining our airways is highly vascularized, and would seem to be very responsive to such tissue remodeling.

I'm not sure if that would result in a more open airway or a more narrow one (from the mitotic activity creating new tissue), but if the former were true, CPAP would be a cure rather than a treatment. And if the latter were true, we'd get much worse over time. Hmmm????

I still don't think the pressure is sufficient to worry about this.

Emilia wrote:IMO, I think that the nostrils, being rimmed and supported by cartilage, might not be as susceptible to stretching as a pregnant woman's abdominal skin is.

But the nostrils aren't exactly "rimmed" by cartilage at all. See image, attached (if I did it right!).



edit: cartilage, like bone, is a living tissue that can and normally does change in response to pressure.

Janknitz wrote:So, let's extrapolate here (if you can do it, so can I). We have continuous or intermittent pressure applied to our airways for 6 to 8 hours every night too--wouldn't we also expect to see some "tissue expansion" there if the pressure was sufficient? This mucosal tissue lining our airways is highly vascularized, and would seem to be very responsive to such tissue remodeling.

I'm not sure if that would result in a more open airway or a more narrow one (from the mitotic activity creating new tissue), but if the former were true, CPAP would be a cure rather than a treatment. And if the latter were true, we'd get much worse over time. Hmmm????

The upper airway becomes more compliant ("stretchy", "flexible", etc.) beyond the nares. The pressure that the nares "see" with nasal pillows is greater than the pressure farther back in the nasopharynx due to this compliance. Same reason the lungs don't get "blown out" with CPAP; they're more compliant.

Bottom line is that the pharyngeal tissues farther back are more flexible than the nares, and would therefore be less likely to respond to the pressure with increased mitotic activity and neogenesis.

edit: this increasing compliance, along with the increasing volumes as we go down the respiratory tract, is responsible for the pressure gradient that assists our diaphragm during inhalation.

My understanding is that the CPAP research studies measure these pressures intrapharyngeally, not in the nose. (One reason I'll never volunteer!)/ And that's how the machines are calibrated.

In any case, tell you what--when my nostrils start growing (as you insist they will) I promise to change my avatar.



How's that????

KimberlyM wrote:I am considering getting my first nasal pillows. I am considering the Swift Lt. I have read that some people say they dry out their sinuses and produce pressure. What are your experiences? I would like to hear all of your pros and cons and which kind of pillow you use. I am a back and side sleeper, currently using a nasal mask. I have the narrow slotted type nostrils and had read the Swift Lt is best for that, anyone have other suggestions? Thank you everyone and Happy Holidays!

KimberlyM, I hope that you are not deterred from trying nasal pillows based on some "fleshy-nosed" assertions of dire consequences.

You may encounter other problems using nasal pillows that affect your therapy, such as mouth breathing, but, properly fitted, nasal pillows can be a godsend for those of us who cannot tolerate anything covering our face.

After seven plus years of exclusively using nasal pillows, my very average nose has not changed one iota.

Amigo wrote:

KimberlyM wrote:I am considering getting my first nasal pillows. I am considering the Swift Lt. I have read that some people say they dry out their sinuses and produce pressure. What are your experiences? I would like to hear all of your pros and cons and which kind of pillow you use. I am a back and side sleeper, currently using a nasal mask. I have the narrow slotted type nostrils and had read the Swift Lt is best for that, anyone have other suggestions? Thank you everyone and Happy Holidays!

KimberlyM, I hope that you are not deterred from trying nasal pillows based on some "fleshy-nosed" assertions of dire consequences.

You may encounter other problems using nasal pillows that affect your therapy, such as mouth breathing, but, properly fitted, nasal pillows can be a godsend for those of us who cannot tolerate anything covering our face.

After seven plus years of exclusively using nasal pillows, my very average nose has not changed one iota.

Thank you Amigo, I appreciate your input and the fact that you have used them 7 years with no ill-effect. I am not deterred at all. There are many things in life much more disfiguring than having my nostrils slightly flared. My goal is to actually sleep at night instead of struggling with the equipment and being exhausted all day. I am sure the lack of sleep and oxygen desaturation are taking a much worse toll on me than flared nostrils ever could.

Well said, Kimberly M! This has been my concern with this thread and why I've been a little mouthy about this--I probably should have refrained from the BS remark, but here's where I'm coming from, illustrated very nicely by Sleeping Ugly:

SleepingUgly wrote:
Can anyone speak to whether using nasal pillows causes the nostrils to permanently expand? I was just thinking of trying nasal pillows again, but if that's true, no thanks!

I have a grave concern that Miss "Helpful's" suggestions will put people off trying nasal pillow masks, and there is a certain subset of people who may not have CPAP success without nasal pillow masks because their facial structures, sensory issues, phobias, etc. make it impossible for them to use a FF or nasal mask, especially in the early and very crucial adjustment period.

It would be a total shame to put some people off of ever trying nasal pillows because they might get enlarged nostrils. Perhaps that's a person who will give up on CPAP altogether because he or she cannot get comfortable with the other types of masks and is now afraid to try a nasal pillow mask.

Vanity is one of the things we all have to overcome when adjusting to CPAP. Before I was treated, one of my biggest fears was the mask. I knew I had SA for many years, but I would not get tested and treated because I feared the appearance and discomfort of a CPAP mask. It was a revelation to find a mask I could be so comfortable in, and that went a very long way toward building my acceptance of CPAP.

I think it's very possible that people may use the fear of enlarged nostrils as a reason to give up on CPAP therapy altogether, regardless of the very real and significant health consequences. Miss Helpful may have fancy scientific jargon and pictures, but she still has NO proof that any of this applies to the use of nasal pillow masks. An individual who decides to avoid the use of nasal pillows—and perhaps CPAP altogether—because he or she is convinced by Miss Helpful’s arguments that nasal enlargement is sure to occur could face serious health consequences as a result. I don’t see that as very “helpful” at all!

Been using pillows since I became a hosehead Aug 20, '07, 100% compliant for every intentional sleep session including naps. Far as I can tell, my nostrils are the same size as they were before I began this journey. Techs recommend the medium size to me but I prefer the increased airflow with the large pillows -- both seal well, the large a bit better. I have long slotted nares, the kind the pros so often insist can't be sealed with a pillow mask

The day I start dreaming of my nose turning into a pig nose instead of me being a goose being fattened for foie gras by being force fed air by the CPAP is when I'll start worrying about my nostrils being permanently widened by the FX's nasal pillows.

SleepingUgly wrote:Can anyone speak to whether using nasal pillows causes the nostrils to permanently expand? I was just thinking of trying nasal pillows again, but if that's true, no thanks!

I seriously doubt that would happen to adults. To infants, yes; but, I doubt it would happen to adults. Even if it did happen to a nasal pillow wearing adult, I'd think the change would be so slight it would be virtually unnoticeable. Or temporary for a few minutes when the nasal pillows mask was removed in the morning. Just my opinion. I don't know it for a fact.

Normal aging might be responsible for slightly larger looking noses/nostrils in adults as the years go by, even if the nose hasn't been within a mile of nasal pillows:
http://www.doctoroz.com/blog/arthur-per ... row-we-age

All I know is I've been using nasal pillows masks every night for seven years. Hasn't changed my nostrils a bit.