Nasal Pillows Help !

Hello Forum,

To start, I am new to the CPAP world (about 2-3 weeks in). I have had sleep apnea for many years without realizing it. I had deviated septum surgery at the end of last year, but even with this surgery I still feel that I get more air in through mouth breathing...I think my nostrils are rather narrow.

When I went forward with the sleep study, I mentioned I would like to try a less claustrophobic mask at first since I now could breathe through my nose (although not as great as I would like). I was assigned a ResMed S9 with Humidifier and Swift FX Nasal Pillows. Getting used to breathing and exhaling through my nose was difficult but I think I got used to it. When I started feeling euphoric in the morning instead of groggy I believe that means it's working? My initial air pressure was set to 4 but I called my rep to see if I could increase it to 6, which feels like much more airflow...However sometimes I feel like I don't feel air coming into my nose...so my questions are this:

1) Should I always feel airflow coming into my nose? or should the airflow only come into play when I'm dosing off? Sometimes I try to hold my breathe to see if the airflow improves.

2) How do I know if it's leaking or not? I sometimes hear air but sometimes it's from the exhaust port...what's the best way to tell?

3) Could the nasal pillows be too big or too small ? I'm not sure what size I'm using to start with but I'll find out.

4) The mask was rather tight around my face the first week or so, but I adjusted it this past week to loosen it but now I am not sure if it's working as well. Could this have caused this issue? the mask even though looser still leaves lines on my face.

5) Sometimes the mask pulsates/clicks which I believe is from water (I do not have a heated tube) is this normal ?

Welcome to the forum.

What machine are you using? Hopefully it is a full data machine and you can use the software to evaluate leaks (and other stuff).

slicks54 wrote:1) Should I always feel airflow coming into my nose? or should the airflow only come into play when I'm dosing off? Sometimes I try to hold my breathe to see if the airflow improves.

Actually when you get used to it you won't feel much air flow. It's amazing but what feels like a hurricane at the beginning of the night quickly becomes a gentle breeze.
Don't try holding your breath...it won't work.
Instead just put your hand over the vent holes for confirmation that the machine is on.

slicks54 wrote:2) How do I know if it's leaking or not? I sometimes hear air but sometimes it's from the exhaust port...what's the best way to tell?

Sometimes it's hard to tell the difference between the air from the exhaust/vent holes and the nasal pillows because they are so close together. Normally leaks at the nasal pillow/nostril area are rather loud....whistling or vibratiing.
The best way is to use the software to see if leaks are excessive or not. If you are questioning if it is leaking at the nasal pillow/nostril area then it probably is not leaking there. Most of the time leaks in that area are so annoying that there is no question about them.

slicks54 wrote: 3) Could the nasal pillows be too big or too small ? I'm not sure what size I'm using to start with but I'll find out.

Could be either...also if using a smaller size it can make that already low 4 cm pressure feel like even less air is moving.
Size of nasal pillow is clearly marked on the nasal pillow. If you compare the different sizes (assuming the DME gave you all the sizes that come in the package) you can see the difference in diameter of the inner cone opening as well as the barrel of the nasal pillow.

slicks54 wrote: 4) The mask was rather tight around my face the first week or so, but I adjusted it this past week to loosen it but now I am not sure if it's working as well. Could this have caused this issue? the mask even though looser still leaves lines on my face.

Actually looser is probably better. The pillows have to be able to expand to seal properly. Most people do get the straps too tight to start with. When I used the Swift FX I could put all my fingers underneath that top strap and I still got a near flat leak line.
The strap marks....are you using the little skinny covers provided for the side straps? If not give them a try but to be honest they are rather lame. I always used a heavier fleece side strap cover.
Easy to make your own if you are handy...or buy them
http://www.padacheek.com/PAC_SwiftFX.html

slicks54 wrote:5) Sometimes the mask pulsates/clicks which I believe is from water (I do not have a heated tube) is this normal ?

Might want to see about getting the heated tube. If you are already experiencing moisture in the mask...just wait till winter gets here.
Also, sometimes there is moisture in the barrel of the nasal pillow. It's from the moisture in our own exhaled breath in combination with the cooler air in the bedroom causing the release of the moisture when the warm exhaled air gets cooled in the nasal pillow barrel.
Even with a heated hose this can happen...for that reason I usually suggest that a person try the barrel cozy. It offers a little extra insulation to help keep that exhaled air from cooling and releasing the moisture and it's super comfy too.
http://www.padacheek.com/PACSwiftII_Barrel_cozy.html

It's totally amazing how much noise just a little water in the mask or hose can make. And if not noise the cold shower spray out the vent holes is pretty rude awakening.

Since you are new to the therapy and may be wanting to try different masks...you might not want to invest in extra comfort features just yet until you decide that this mask is going to be your primary mask...that's totally understandable.
You can make your own strap covers easily enough with some scraps of fleece. The barrel cozy is not so easy but can be done..be sure to not block the vent holes.

So let's figure out exactly which machine you have to start with and go from there in regards to evaluation leak and therapy.
If it is a ResMed machine...exactly what does it say on the machine up by the LCD screen?
If it is a Respironics machine...turn the machine over and look on the bottom of the blower unit for a 3 digit model number...may have DS or REF in front of the 3 digits. Tell us the 3 digits and we can know for sure exactly which machine...sometimes what it says on the top of the machine isn't always all the information.

Thank you so much for your response Pugsy!

I'm using a Resmed S9 with Humidifier.

What I notice is that I don't get much data information from the info section of the device. There are reports but don't give any real statistical information...unless this info needs to be unlocked somehow ?

There should be some other words up on the machine by the ResMed name.
Escape
Escape Auto
Elite
Autoset

which of the above does it say?
They don't all collect useful data...that's why I ask which one.

Yes, there is a setting in the clinical menu that probably needs to be turned on for the on screen data to show up.
Sleep Quality....factory default is for "usage" and that only gives hours of use.
Also you may need for the menu setting to allow you to see the on screen data collected to be turned on so "patient" can view the data.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf
Here's the clinical/provider manual that explains how to get to the clinical setup menu so you can turn Sleep Quality to "On".

If you have the Escape or Escape Auto...your machine doesn't gather much useful data...The Escape gathers nothing but hours of use...and the Escape Auto only gathers a gross AHI (no category breakdown) and nothing else useful.
So hope you have the Elite or AutoSet.

SleepyHead works well with the ELite or AutoSet S9 machines. I have that information in my signature line.

When you have time and if you plan on staying around here at this forum if you would register and add your equipment to your profile like I have mine it would help us help you better and faster.
If you would add your pressure to the comments line..that would help too.

Also if you do have a full data S9 machine then someone could send you a private message with information on how and where to obtain the official ResMed software that works with the S9 machines.
You don't have to use it though if SleepyHead suits all your needs. But it is available..

Check out my signature for swift fx fitting tips. Most people prefer larger size nasal pillows because the holes are larger and they feel like they are getting more air. See how it feels to you.

Well it looks like I have an Escape Auto...so not much info on leaks apparently !

Also looks like I have Medium Nasal Pillows

Call up your DME and tell them you want a machine that offers leak reporting.
If they tell you that the Escape Auto offers it...they are lying so tell them to prove it. They can't.
It's not too late to get them to swap out the Escape Auto for a full data machine. Don't harp too much on the availability of the other data...just push leak data. Any machine that offers leak data will also offer the other data.

Did they give you the other sizes of nasal pillows that come in your mask package or did they remove them? Mask setup packages come with 3 different size nasal pillows.
If you got the for Her package with light gray or pink back strap then it comes with XSmall, Small and Medium.
If you got the regular Swift FX package with the dark blue back strap then it comes with Small, Medium and Large.