Mask issues

[SnoringinDXB]

So, I am 3 nights into my xPAP life. My AHI has been 0.7, 0.3 and 0.1 over the three nights. These are superb numbers and I couldn't be happier, except......

Masks! I wanted a basal pillow mask (Swift FX) as this is what I had during my sleep study. They only had the Swift LT so I started using that and they have ordered the FX. After 2 nights of mask use I had soreness and some redness in my right nostril due to a deviated septum. The rest of the LT experience was great, including having the hose clipped to the top of my head, something I had not considered before.

Thinking the septum soreness was probably going to just get worse, so I decided to go with a nasal mask. I got in touch the with medical supplier and they delivered 3 masks to my office yesterday. They said try all 3, take a couple of weeks if you have to, and tell us which one you want to go with and then return the others. Good service, can't ask for more. They are the Mirage Softgel, Activa LT and Micro. I started with the Softgel last night. I didn't like it straight away but I stuck at it. It sits really heavily on my top lip...in fact it is close to swallowing up the top lip entirely. It felt a lot more claustrophobic than a pillow mask. I got up for the bathroom in the middle of the night and trying to get the damn thing off was ridiculous. Maybe I should have just disconnected the hose (after switching the S9 off to preserve data integrity, which I do in all cases), but anyway. In the end I got so hacked off with it I wrestled my way out. On returning from the bathroom, I just couldn't face the Softgel again, so I swapped back to the Swift LT. Septum is a little sore once again but less so because of fewer hours of LT usage than normal.

I will try the Activa LT and Micro, but as they are essentially the same broad designs, I doubt I will like them any better than the Softgel, but I will try to keep an open mind.

I've had a great start to xPAP use - it is not great to have to use one but so be it - now just want to get some resolution about masks!

[Tino2You]

You are so ahead of the game! The process of finding YOUR mask is probably the most daunting. Sometimes the perfectly comfortable mask will leak like crazy or as you found out, the mask that is most therapeutic kills your face.

Hang in there! There is a reason there are hundreds of masks on the market. If you had a positive experience with the Swift FX then light the fire under your provider to get you one. As an alternative, does eBay ship to Dubai? If so, you can piece together what you need (head gear, swivel and pillow) and have them expressed to you.

Keep the faith,
-tino

[Pugsy]

Nasal pillow masks shouldn't cause anything but very minor tenderness at the nostril or septum area. If there is more than very minor tenderness (after all it is pretty much virgin territory never having anything touching it) then the most common cause is either the straps are too tight or you have the wrong size nasal pillow. If you look in the mirror and the mask is pulling the nose upwards just a bit giving you a "piggy" nose...the straps are too tight for sure. There shouldn't be any movement of the end of the nose.

Here in the US we suggest Lansinoh lanolin ointment with just a little applied to the nostril area to help with minor tenderness.
I don't know if you would have a similar product available where you live. Just a tiny bit on and right inside the nostril will help. Breastfeeding moms use it to help with nipple soreness.

Some videos on how to fix nasal pillow masks.
http://www.cpaplibrary.com/nasal-pillows.html

The Swift LT is a good mask but the Swift FX is newer and a bit softer on the nose area because no hard plastic parts. Less chance for the nose to get sore.
Though I did use the Swift LT for well over a year before the Swift FX was released...so I know it can be a comfortable mask.
I am thinking you either have the wrong size nasal pillow (can you try a different size) or you have the straps a little bit too tight and maybe not equal tension on the straps.

[khauser]

If by Nasal Septum you mean internally (as I think you do) I think your pillows are too small or too big. Too small would make them go inside too far, and cause this issue. Too big could make them actually 'fold' a little and present a sharp edge.

Septum also refers to the external part of the nose between the two nostrils, and if this is where you are sore I'd suggest the mask is too tight.

This concurs with everything Pugsy says, but I will mention that for me the Swift LT is more comfortable than the FX. That's one of those preference things, though ... and you already have experience with the FX...

[herefishy]

Been an Activa fan for years - hope it works for you.

[SnoringinDXB]

Thanks all.

I am going to try the Swift LT again tonight but have gone from M to L pillow size - I already know S is too small. I'll see how that works. I'll also check the tightness of the straps. I know after just half a night of a nasal mask that pillow masks are the one for me. I liked the Swift FX for its minimalist style, but I am really liking the LT for clipping the hose up over my head - takes away any concern about the hose when I turn over. I am an almost 100% side sleeper

As for the nasal problem...from the outside my septum (the divider between the 2 nasal holes) is normal. Go inside 0.5cm or so on the right, and there is a vertical column of cartilage that bulges slightly towards the bottom. That's what is causing my problem (although for now it is minor). I'm hoping that the adjustments you've suggested will reduce or remove the problem. I'll also see if I can find the ointment you recommend. if breastfeeding mothers use it, there is a good chance I will be able to get it something very similar anyway.

Thanks the for the advice and support. I've never really had a medical issue before and was always a bit mystified by the need for support groups for people with issues. I am no longer mystified.

[chunkyfrog]

Geometry differs with various nasal pillow masks, as does the position and size of our nares.
I could not use the Swift LT, or the Aloha, but the Swift Fx is just the right angle and position for "goldifrog".
I'm having excellent results with the Tap Pap, but I'd be surprised it you could find it in Dubai.

[khauser]

Geometry differs with various nasal pillow masks, as does the position and size of our nares.
I could not use the Swift LT, or the Aloha, but the Swift Fx is just the right angle and position for "goldifrog".
I'm having excellent results with the Tap Pap, but I'd be surprised it you could find it in Dubai.

Perhaps CPAP.COM ships to Dubai? I have no idea of the cost, though...

[Pugsy]

The Swift FX can be routed over the head...just takes a bit if ingenuity to figure out something to hold the hose in place attached to that top strap or you might see if you can rig up some sort of hose management system.
See these ideas.
viewtopic.php?t=10640

The Aloha mask is very similar to the Swift LT...might look at it if you can. I think it is a better version of the Swift LT...sort of what the LT could have been if it was improved upon. I gave it a try and it ranked real close to the Swift FX.

That little bump inside the nose is probably getting some unwanted pressure on it...might be a combination of nasal pillow size and tension on the straps and watch that back strap too.
The nasal pillow masks can be worn really loose and still work. When I was using the Swift FX I could slip my hand easily under that top strap...
I do a lot of tossing and turning. I personally never cared for routing the hose over my head...tried it and I found it more annoying but I know a lot of people do prefer it because it allows for more movement with less chance of the mask being tugged on.

CPAP.com isn't allowed to ship any ResMed products outside of the US and that includes mask parts...darned old ResMed.
They will ship internationally as long as the manufacturer doesn't ban the shipment of their products.

[khauser]

The Swift FX can be routed over the head...just takes a bit if ingenuity to figure out something to hold the hose in place attached to that top strap or you might see if you can rig up some sort of hose management system.
See these ideas.
viewtopic.php?t=10640

The Aloha mask is very similar to the Swift LT...might look at it if you can. I think it is a better version of the Swift LT...sort of what the LT could have been if it was improved upon. I gave it a try and it ranked real close to the Swift FX.

That little bump inside the nose is probably getting some unwanted pressure on it...might be a combination of nasal pillow size and tension on the straps and watch that back strap too.
The nasal pillow masks can be worn really loose and still work. When I was using the Swift FX I could slip my hand easily under that top strap...
I do a lot of tossing and turning. I personally never cared for routing the hose over my head...tried it and I found it more annoying but I know a lot of people do prefer it because it allows for more movement with less chance of the mask being tugged on.

CPAP.com isn't allowed to ship any ResMed products outside of the US and that includes mask parts...darned old ResMed.
They will ship internationally as long as the manufacturer doesn't ban the shipment of their products.

So he can get the Tap Pap then ... it's not a ResMed product, right? But I do remember that another forum member needed someone to ship it to them, not sure why. I think they were in New Zealand or Australia...

What do you do with the host from the Tap Pap? It's really angled to go up.

[SnoringinDXB]

The medical supplier seems to have exclusively ResMed gear. I can ship stuff in from the US and UK as we have an account with a courier company. The costs have gone up so much in the last couple of years, I think I might have to go out and sell our first-born to finance it.

I am cautious about laying out USD 100 plus on a mask that might not work for me and then maybe have return issues (and costs) - that's if they would accept foreign returns.

i think for now I will carry on with the LT and try the suggested adjustments. I am in the UK in a couple of weeks so I might see what i can find there too.

[cosmo]

Hopefully the inside of your nose will adapt and get used to the pillows after a while. I started off using a full face mask for 2 nights, nasal mask for 2 nights then onto nasal pillows. Once I tried the nasal pillow, I knew this type was the one for me.

[hyperlexis]

Well I hope the DME didn't charge you or your insurer for at least one of those because they ripped you off. The Softgel and the Activa LT are both the same mask(!) -- the only thing different is the cushions are interchangeable and designed to be so, per ResMed. So basically, you can switch out the cushions depending on your mood. Either gel or the super flexible Activa type. So one mask should go back for a refund, but keep the cushions.

That said, you should really give the masks more of a chance. Unfortunate they sent you three at once so it will be harder to get a well-rounded opinion of all three within a month. I usually force myself to use a new mask for at least two to three weeks before I pass judgment, unless its a mask with a really bad problem like the PR Amara that caused pressure sores on my nose that only worsened with time.

ResMed makes some of the best, quietest masks out there -- and those quick clips for the lower headgear staps or even just the quick hose release should have popped you out of the mask with no probs at all. Perhaps you should re-review the use videos and written instructions on ResMed's site.

Give each of the masks a fair chance and I am sure you will get used to them and indeed really enjoy them -- one frustrating night is simply not enough time to fairly judge. And hip-hopping around to different masks won't be good either.

Good luck!

[Pugsy]

So he can get the Tap Pap then ... it's not a ResMed product, right? But I do remember that another forum member needed someone to ship it to them, not sure why. I think they were in New Zealand or Australia...

What do you do with the hose from the Tap Pap? It's really angled to go up.

The guy in New Zealand was under some time constraints due to availability of the Tap Pap there...not yet available and was wanting to have something set up for the later part of April. Taking a little holiday and wanted the kinks worked out.
He could have used cpap.com but the 30 day return thing puts a serious cramp in time to try out the mask due to time involved shipping overseas and the unknown factor of customs...and maybe getting it back to cpap.com if he hated it in time to get his money back.
So he and I worked out a little private deal if he hated it. It doesn't sound like I will be getting it back though.
Using the Tap Pap free insurance thing and ordering from cpap.com is probably going to have some serious downsides to it.
Customs can really mess up the time frame and we can't do anything about it.

I don't like a hose management system myself. My preference has always been to route the hose laying on the bed and around the top of my bed pillow. So it just lays on the bed and moves when I move. It was my preference even back when I was using the Swift LT. I just didn't care for it to be attached to my head (remember less stuff attached to me thing that I prefer) and I tried routing the hose through the headboard (old iron antique bed so lots of scroll work) but I just found it annoyed me more than just laying the hose flat on the mattress and bring it around the top of the bed pillow when I am on my side away from the machine.
I toss and turn and never really notice the hose at all...but it has been that way with every mask I have used. It goes "up" but not over my head as in attached to something. Tap Pap routing is perfect for the way I have always routed my hose.

[SnoringinDXB]

I tried the L size pillows on the Swift LT - too big and instant leaking - so I went back to M and no leaking. I tried loosening the straps. I am not sure it made a lot of difference to the pillow pressure against my nose, but one thing it did seem to make worse was the rubbing of part of the headgear assembly straps on the top of my ears where they join my head. I found it quite distracting. I didn't have that problem with the Swift FX during my sleep study as far as I recall.

Nose soreness is at the normal level - nothing too serious. I think I would rather put up with it than use a nasal mask, although I am going to try the nasals some more as one night is not enough to judge on, even though I have an inkling they are not for me.

Hyperlexis - I am in the Middle East, so there is a different healthcare system. Private medical insurance doesn't cover OSA treatment. Everything is paid out of my pocket. Thankfully the medical supply company isn't charging me for the 3 different nasal masks so I can give back all 3 if I want. They will also swap the LT for the FX. I'm thankful these guys are so flexible.