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Maybe... People with Upper Airway Resistance Syndrome (UARS) already have increased flow limitations.
Maybe... Nasal Pillows have nothing to do with it.


Bring it.

Lizistired wrote:Maybe... People with Upper Airway Resistance Syndrome (UARS) already have increased flow limitations.
Maybe... Nasal Pillows have nothing to do with it.


Bring it.

Or.......maybe they contribute to the problem.......especially when using an APAP in a range of pressures (when chasing flow limitations and snoring).

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Guest wrote:

Lizistired wrote:Maybe... People with Upper Airway Resistance Syndrome (UARS) already have increased flow limitations.
Maybe... Nasal Pillows have nothing to do with it.


Bring it.

Or.......maybe they contribute to the problem.......especially when using an APAP in a range of pressures (when chasing flow limitations and snoring).

.

I don't snore and don't chase flow limitations. I am pretty sure my big problem was arousals caused by UARS, but mild enough OSA for a diagnosis(PSG AHI=11, Arousal index was 40+, all during REM). Probably aggravated by reflux...
I am one that doesn't do well with APAP or EPR. I have an AHI of <0.5 at 6 or 7 but still have FL's. If I chase FL's, I get areophagia and arousals.
I haven't seen anything that indicates that the pillows have anything to do with CAUSING FL's.

Thanks Liz.

Report examples below. Swift FX nasal pillows... S9 VPAP Auto with EPAP 9 and IPAP max to 20 and sometimes I see almost 20...never any flow limitations and certainly none with pressure increases associated with any Flow limitations.. Pressure is responding to something but not FLs.
I just don't have the flow limitations that Avi seems to want to harp on. They are not there.

That's why I think maybe it is existing UARS that shows up as FL's. As I said, I had very mild OSA and had forgotten about the UARS and reflux, until the recent post from the LPR reflux forum guy.
I don't think UARS is diagnosed often, at least not if the OSA diagnosis is there. It's just easier to bill and the treatment is the same. I think I have had UARS for years before the OSA developed. Of course I didn't consider apnea for a long time because I wasn't overweight and didn't sleep on my back...
I have consistant FL's in REM. I only chased them up to 9-10cmH2o and wasn't sleeping as well as I was at 7. That was my prescribed pressure. So, I don't chase them. I stayed at 8 for awhile but have since dropped back down to 6-7 since losing 30 pounds.
During my titration, 6cm cleared my apneas but they had to go to 7 to get me through REM.

In my head, as nothing more than a thought experiment, I assume that it is plausible that for some human somewhere on the planet, if that human were unable to move enough air through the small openings of their pillows fast enough (such as right after a sigh), that the increase in effort needed to move the air could, possibly, cause an arousal. What that would get called (FLs/RERAs/UARS/spontaneous arousals/whatever-else-ya-wanna-callits/etc) doesn't matter much to me. But I assume it could be a problem for someone, somewhere. Then again, just about anything could be a problem for someone, somewhere, right? So, if a person isn't getting refreshing sleep using pillows, trying a FFM is certainly something to try. A light sleeper can get an arousal from the perception of one misplaced molecule somewhere in the upper atmosphere on the other side of the planet, after all.

But I am unaware, myself, of there being any documentation that there is a common problem in the larger PAP-user popluation of nasal pillows causing arousals--at least not any more than any other type of mask.

Thanks jnk. You always make me smile.

Avi is telling people that they shouldn't be using nasal pillows period because the nasal pillows cause flow limitations and jagged leak lines. Well, actually he is telling it mostly to men because he seems to worry about their level of care using nasal pillows more than he worries about women who use nasal pillows. He has publicly said that nasal pillows are for women and men shouldn't be using them.

So anyone reading this thread...Avi123 is stating his own personal opinion about something as the gospel and in a way that could possibly be perceived by a newbie that nasal pillow masks offer inferior treatment and might possibly negatively influence therapy and/or mask choice. We are just debunking his "theory" for what it is...hogwash, BS or anything stronger you want to call it.

Someone might have Flow limitations with nasal pillows....sure..but solely because of nasal pillow use?...extremely unlikely and sure not the gospel that he is making his idea out to be. I imagine that we can see flow limitations show up with just about every mask out there including all the full face masks and over the nose masks.

Oh. Thanks, Pugsy. Sorry to hear that Avi is misbehaving again. Poor guy.

Then I would say that just because Avi doesn't know how to successfully use nasal pillows doesn't mean that other people can't figure it out.

And I would say that Avi must know something about some difference in anatomy between the sexes that none of the rest of us know about. And I'm a married man.

A married man who uses nasal pillows, for that matter. Successfully. With a level leak line. And no significant daytime sleepiness from arousals. And I got a mustache. And use an autobilevel.

So THERE, Avi123!

The trick for me is keeping the nose hair well trimmed. And using O-rings to keep the pillows firm against the nostrils. I have got pillows to last over a year that way.

But I am unaware, myself, of there being any documentation that there is a common problem in the larger PAP-user popluation of nasal pillows causing arousals--at least not any more than any other type of mask.

I haven't been able to sleep with anything BUT nasal pillows!

As we all know, masks are a highly individual part of therapy. It is understandable that opinions are strong on the matter, I think.

To me, the most important thing for newbies to understand is that using a different mask interface can change the therapy a lot, so they should not judge the therapy by the first mask they try, or the second, or the third, or the fourth, etc. . . . A few of us are fortunate to be able to make the therapy work with the first mask we try. Others of us have to try many, many masks before we find the one for us. I was fortunate that one of the first masks I tried worked great for me. But I have read of others who have tried over 20 and are still trying.

It has been said that finding the right mask for YOU is the key to PAP therapy. I think it was Rested Gal who taught me that.

I haven't seen anything that indicates that the pillows have anything to do with CAUSING FL's.

I haven't been able to sleep with anything BUT nasal pillows!

Throwing out some thoughts from my experiences......
I've never TRIED anything but full face masks (so I can't say I haven't been able to sleep with anything but them).
But, when I've tried using an APAP, I've had "some" flow limitations show up. (but inconsistently)

About a year after I started therapy, I started learning about things like enlarged turbinates and deviated septums on this forum......which I came to suspect could be part of my problem (although I've never been to an ENT to find out).
I started thinking back to the time I was referred to and had my sleep study and it struck me that none of the "doctors" ever asked me things like: "Can you breathe?", "Do you have any air intake issues?"......or tried to determine any problems I may have had in that regard. I just had the sleep study and they proclaimed that I had Obstructive Sleep Apnea and gave me a prescription for a machine. Well, in retrospect, I HAVE had issues with nasal air intake. I also had my nose broken when playing football in high school. It was straightened, but it wasn't a "perfect" job.

Anyway, MY solution has been to use cool "passover" humidification (shrinks nasal tissue), nasal cleansing before bedtime and straight CPAP pressure.
I reckon I've saved some money by not going to an ENT or having surgery.
I found what worked for me, but I also believe there are alot of users who share these same issues.

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So far I have commented only to posters who use Resmed machines and show their Flow Limitation and Leak graphs in ResScan. ResScan measures the degree of Flow Limitation (FL) by the shape of the respiration waves. As the shape of the wave becomes more FLAT than ROUND so does the FL becomes more elevated.

The following is a graph of my respiration waves showing flat tops and the FL is elevated, accordingly ( and so is the pressure):





The following graph shows more rounded tops waves and the FL is less:



So far I have responded to the following posters who all are using nasal pillows masks, and I have commented about the possibility that their masks could have worsened their Leaks and Flow Limitation:

Judging by the following graphs it’s becoming clearer that nasal pillows masks are affecting treatment by their effects on Flow Limitation (including UARs and RERAs).
Here are a few graphs which were posted, in this forum, by users of nasal pillows masks, indicating that these masks are causing Flow Limitation to rise and also causing jagged (not smooth) leak graphs.

Both of the following by P on Mon May 07, 2012 6:15 pm
Machine: S9 AutoSet™ CPAP Machine Mask: Aloha Nasal Pillow CPAP Mask with Headgear Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control Additional Comments: Software:ResScan 4.1, SH 0.9.2. CMS-50F Oximeter. Neck Roll 2.5" :






By N:

Mask: Aloha Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 ResMed VPAP Adapt; Swift Bella Loops; Aloha Mask; CPAPMax Pillow; Ruby Chin Strap - Size Large; ResScan & SleepyHead:



by BL on Wed Oct 10, 2012 8:30 pm:

Machine: S9 AutoSet™ CPAP Machine Mask: Swift™ LT Nasal Pillow CPAP Mask with Headgear Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control Additional Comments: Also using SleepyHead SW and ResScan:



By Scarlet834:

Mask: Swift™ LT for Her Nasal Pillow CPAP Mask with Headgear

Humidifier: PR System One Heated Humidifier

Additional Comments: Encore Pro 2.2

viewtopic.php?f=1&t=45746&st=0&sk=t&sd=a

avi123 wrote:. . . Nasal Pillows masks may raise Flow Limitation and Leaks. . . . It’s becoming clearer that nasal pillows masks are affecting treatment by their effects on Flow Limitation . . .

If I may ask, Is this your personal theory based on your personal observation, or is there something in print somewhere that has caused you to reach this conclusion?

And if it is your personal theory, do you think it would be prudent for people in this forum to begin basing their treatment decisions on it, or should they wait for some scientific validation of your conclusions?

If someone is having flow limitation problems and they're using nasal pillows, it might be worth trying a nasal mask and seeing a before and after. Or being sure you have the right size pillows.

Without that, I see no reason to claim nasal pillows are a common cause of flow limitations.

My flow limitations look like crap, even with an over the nose nasal mask.

jnk wrote:

avi123 wrote:. . . Nasal Pillows masks may raise Flow Limitation and Leaks. . . . It’s becoming clearer that nasal pillows masks are affecting treatment by their effects on Flow Limitation . . .

If I may ask, Is this your personal theory based on your personal observation, or is there something in print somewhere that has caused you to reach this conclusion?

And if it is your personal theory, do you think it would be prudent for people in this forum to begin basing their treatment decisions on it, or should they wait for some scientific validation of your conclusions?

jnk, sorry, you can't ask, diese Damen können gute Tsimes machen.

The following should be a good guidance for most:

viewtopic/t26622/UARS--A-Critical-Link- ... sults.html

This one is even better:

http://www.chestnet.org/accp/pccsu/uppe ... e?page=0,3