Even my CPAP "professionals" don't know how to help me.

[Nozzzzz's]

I need some serious help...first let me say I am new to the community, and have learned SO much from all of you over the past couple of weeks...so THANK YOU. I am having an issue that is driving me insane and I'm hoping someone can help. Was diagnosed with an AHI of 98. Got an Airsense 10 with ResMed AirFit P10 Nasal Pillow Mask with the large pillows. First 2 nights, the sound was a bit noisy...felt like air was escaping...AHI was 2.6 - 3.0. Third night, despite doing everything the same, the machine was noticeably very quiet and my AHI was 1.0! Tried over the course of the next week to duplicate the quietness and 1.0, and couldn't. Even went back to CPAP folks to be refitted...was given a new mask and pillows. Continued having the same issues, but with AHI remaining between 2.5 and 3.5, I decided to just live with the noise (sounds like a constant "SSSSSSSSSSSSSSSSS" with air blowing out from where the pillows connect to the mask).

Last night, I turn the machine on (no ramp, 12 right off the bat) get the same SSSSSSSSS noise. I decided to change my chinstrap because the one I had on was uncomfortable. I shut the machine off for 2 minutes to change the strap and put my mask back on...boom! Everything is super quiet again, and I score an AHI of 1 in the morning. My wife has noticed the sound difference each time. Now, I want that back, but can't figure out how to duplicate it. I have tried lanolin to no avail, I have washed everything as instructed, tried fitting every size of nasal pillow at every angle. I have to say they "feel" right every time I put them on, despite the noise level. The CPAP pros are throwing their hands in the air and telling me to try different nasal pillows. The ones I have feel right...I don't think that's the issue...HELP!! Thanks for any guidance you can offer.

[palerider]

they're either leaking around your nose, or they're not. you shouldn't feel air except out the front of the mask at the vents. there's nothing else to ssssssss on a p10, and the vents don't ssssssss well, unless someone sticks them in your ear, as had happened to me a couple times.

[Nozzzzz's]

Thanks palerider! They're definitely not leaking from around my nose. There is a lot of air coming from where the pillows connect to the hose. Tried new pillows and an all new mask...still an issue. The baffling part is that although I had the issue last night, after shutting the machine off and turning it on...it worked correctly (or what I think is correctly). SOOOO frustrating...

[Pugsy]

I am sitting here looking at my P10...the little webbed holes under the pillow...on either side of the hose...is that where you feel the air coming out? Those are the vent holes and it's normal but those are silent. This mask is pretty much totally silent when working properly and the amount of air coming out of those holes is minimal...I have to put my hand an inch away to feel any vented air. Any further away from the vent holes I can't feel anything at all and my pressures are only a tiny bit below yours.

Is the nasal pillow hard to remove or easy to remove? Is it possible the air is coming from where the nasal pillow sits in that little plastic thingy (don't know what to call it).

[Nozzzzz's]

Hi Pugsy - my vents work the same when everything is "right". On the nights when it is not working right, the air flow seems stronger and it is escaping from where the pillows clip on to the mask. I have reseated them, changed them, tried new ones (even the mask), and it doesn't help at all. I can't figure out what I'm doing differently that makes it go from right to wrong. It doesn't feel like nose leaks, and the machine/tubing is significantly quieter when it's right.

[palerider]

I can't see how, unless you're not getting the pillows clipped into the cradle(?) properly, there can be a leak.

you can take the strap off the mask, take it into the bathroom, put your fingers on the nose holes, and blow, you shouldn't see bubbles from anywhere except the vent mesh. if you're getting leaks where the pillows clip into the cradle, then you're either not clipping them in right, or... something I dunno.

[poppi2]

....then you're either not clipping them in right, or....

When the P10 pillows are properly positioned, you will hear a pleasing snap into the cradle.

[chunkyfrog]

The pillows have tabs at the top and bottom that clip into the frame.
The bottom tab is larger than the tab at the top. Each tab mates with a similarly-sized slot --when properly assembled.
Nightly assembly could increase the odds of this happening the other way around.
If one happens to get the pillow upside down, there would be a fierce racket.
Or maybe that is not the problem at all.
When all is good, the hose points down, not up.

[Pugsy]

Sounds to me like the pillows aren't seated (stuck) in the cradle (yes, that's a better word I couldn't think of earlier) properly and/or completely.
Did you change cradles when you got the new mask? Or are you still using same cradle but with new pillow?
Wonder if maybe there is a crack in the cradle somewhere????
I wish you lived closer...then I could put my grubby little paws on it and I bet I could get it figured out.
Putting the pillows in the cradle upside down would/should be obvious. They won't "click" if put in upside down.
You aren't trying to wear them upside down are you?
Have you watched the fitting video to see if maybe you missed something.
Cpap.com has a nice fitting video

Get the mask out in the broad daylight so you can see really well and look closely at all the connections. Make sure you hear that "click" when you put the pillow in the cradle.
There's an incomplete seal somewhere or maybe a crack in the cradle allowing the leak.

[Nozzzzz's]

The clips make it so it's virtually impossible to put on wrong...big tab goes in big slot, small tab goes in small slot. It's definitely not the clips being wrong or the pillows being snapped on incorrectly. I actually did all of this while the tech was watching. I know I sound crazy, but the problem is sooooo random. What I'm experiencing may very well just be what everyone refers to as leakage...the only thing that makes me skeptical about that is that I have spent SO much time putting the mask on in various ways to avoid it (changing angles, pillow sizes, new mask, using lanolin, etc). I have had two different techs fit me for the pillows and both said that they're on correctly. If I'm assuming that they are on correctly, is there anything else that could be causing the machine to be loud and windy one night and quiet and controlled the next?

[archangle]

Take off the mask. Turn on the machine. Plug the ends of the the pillows with your fingers. See if you can figure out where the air is leaking out.

There is an exhale vent somewhere on the mask where it is supposed to leak, but that should be fairly quiet. I haven't seen your P10 mask up close, but the vent is usually a bunch of small holes. The vent may make a little noise, and it will get a little noisier if there's something in front of it like your pillows or a cover.

What you're describing really does sound like the pillows just aren't fitting right and sealing to your nose. Try wiggling the mask, pushing, etc. to get it to seal correctly. You can also try to push on the mask with your fingers and create a leak and see if it sounds the same.

See if you can feel the leak. See if you can fiddle with the mask by pushing and pulling in various places to cause the leak between the pillows and the hard part of the mask.

SleepyHead will show you the leak rate, which should tell you if you have an unintentional leak somewhere. You'll want the 0.9.8-1 or later version to work with your A10 machine. The download site seems to be down at the moment, though. http://sleepfiles/com/SH

[Nozzzzz's]

Sounds to me like the pillows aren't seated (stuck) in the cradle (yes, that's a better word I couldn't think of earlier) properly and/or completely.
Did you change cradles when you got the new mask? Or are you still using same cradle but with new pillow?
Wonder if maybe there is a crack in the cradle somewhere????
I wish you lived closer...then I could put my grubby little paws on it and I bet I could get it figured out.
Putting the pillows in the cradle upside down would/should be obvious. They won't "click" if put in upside down.
You aren't trying to wear them upside down are you?
Have you watched the fitting video to see if maybe you missed something.
Cpap.com has a nice fitting video

Get the mask out in the broad daylight so you can see really well and look closely at all the connections. Make sure you hear that "click" when you put the pillow in the cradle.
There's an incomplete seal somewhere or maybe a crack in the cradle allowing the leak.

Pugsy, I looked carefully for cracks/splits...last night it was noisy...shut the machine and removed the mask for 2 minutes to change my chinstrap, put my mask back on, started the machine and it was blissfully quiet...maddening. I really appreciate all of you trying to help!

[Pugsy]

When you fitted the mask in the presence of the DME tech did you hook it up to a machine (or preferably your machine) to see if it was silent?

No...nothing else that I can think of to make the noise level that drastically different.

If you hear the hiss and you feel air where there shouldn't be air...something is incompletely sealed.
If you feel air coming at the cradle and you are certain it is NOT the vent holes...there's a leak in there from something somewhere.

What is the leak rate showing on the software or simply on the machine's LCD screen?
Too late to see the LCD screen report though...it resets to zero at 12 PM>

[chunkyfrog]

Do you have a cat?
Just a wild hair, but hold the tubing up to the light and look very closely.
--both the big tube and the little one on the mask. Look for pinholes or tears.
I'm baffled.

[Julie]

I wonder if something tiny (a crumb, cat hair, ??) hasn't somehow gotten into the area somehow, and depending on how you put on the pillows, it partially blocks the air, and then a minute later when you jiggle the thing, it moves away... I'm talking really tiny 'something' reacting to minute little movements, even when it's on you. Just an idea, but I have no idea of how to prove it and not being familiar with the mask, no idea of how to change it.