Nasal pillows - inhaling ok, but exhaling through mouth

Hi! I have just started using CPAP (as you can see on my profile, Resmed Airsense 10 with Autoset + humidifier + heated tube), and after finding out I unconsciously rip out my full face mask in total panic around 2-3AM, decided to switch to nasal pillows.

I got the pillows this morning and am taking time to get used to them. And it's great to feel fresh air rushing into my nasal airways (I have always been a mouth breather thanks to allergy and nasal swelling) but I can't really breathe out through nose. I feel like I have to fight the air flowing into my nose. It's a battle and literally suffocating. Then eventually I find myself breathing out of my mouth, and lo and behold I find myself snoring again.

+ EDIT: the insides of my nose - nasal airways - swell up (no runny nose) to the point I can feel the nasal airways closing (the walls touching) whenever I use CPAP. Have a heated humidifier, heated tube. Sinus rinse, every day. I take anti allergy medications but they don't really prevent nasal swelling.

+ EDIT2: I have taped my mouth shut, and found out the air that I struggle to exhale against the inflow of the air from the machine kind pools at the back of my throat and literally inflates my cheeks. It's kinda cartoonish but at the same time crazy inconvenient. Has anyone dealt with this before?

When I was a kid my doctor thought I possibly had deviated septum, but I was living in a country with notorious air pollution back then and now have moved to the US Midwest with lots of fresh air. Upon moving here I am no longer fighting sinus congestion.

Currently my setting is auto, starting pressure 4.0, min pressure 5.0 - max[/size] 8.8. I have all classic and typical symptoms of sleep apnea but I haven't been to sleep study yet (I have to wait until June) and am waiting to hear from Singular Sleep for at home test result.

TLDR; Can't breathe out of my nose when on nasal pillows, full face masks give me actual panic attacks at night, and my nasal airways are very narrow compared to others. Is it okay to breathe out through your mouth as long as you are breathing in through your nose? Any tips or strategies to make the nasal pillows work for me?

Thanks!

You are not getting much benefit from the CPAP when your mouth is open..The air is supposed to open your airway, but with your mouth open, it's coming in your nose and out your mouth. If you can't keep your mouth closed you need to tape it shut or go back to the full face mask. With those low pressures, you may not be getting much benefit anyway.. HOw did you determine the pressure settings?

casereport wrote: ↑

Wed Mar 13, 2019 4:06 pm

I feel like I have to fight the air flowing into my nose. It's a battle and literally suffocating. Then eventually I find myself breathing out of my mouth, and lo and behold I find myself snoring again.

Try a larger pillow, and get past that "air flowing into my nose" because there's no more air flowing into your nose with a nasal pillow than there is with a FFM.... ask yourself, where is the air going? Unless you've got gills, or you open your mouth and let it go out there, the answer is nowhere. And if it's not going anywhere, then it'snot flowing into your nose. I've been using nasal pillows for *years*, trust me, you can breathe out with them.

casereport wrote: ↑

Wed Mar 13, 2019 4:06 pm

Currently my setting is auto, starting pressure 4.0, min pressure 5.0 - max 8.8. I have all classic and typical symptoms of sleep apnea

That most likely needs to go up. Unless you have a compelling reason, max should be at 20.

casereport wrote: ↑

Wed Mar 13, 2019 4:06 pm

TLDR; Can't breathe out of my nose when on nasal pillows, is it okay to breathe out through your mouth as long as you are breathing in through your nose?

No

casereport wrote: ↑

Wed Mar 13, 2019 4:06 pm

Any tips?

Keep telling yourself "I can do this!" ... because, you can.

I just experimented with the pressure settings... asking for advice from people who are using CPAP machine. I also talked to a doctor - who is not a sleep doctor - who gave me some off-the-record advice from his experiences working with family members and patients with sleep apnea. Of course, I don't have any test results yet to guide my settings.

I find out that whenever I try using CPAP - whether it's full mask or nasal pillows - my nose gets really irritated and nasal airways swell to the point that they close. I have a heated humidifier, a heated tube, use sinus rinse every day, clean my room every day, etc, etc.

casereport wrote: ↑

Wed Mar 13, 2019 5:59 pm

I just experimented with the pressure settings... asking for advice from people who are using CPAP machine. I also talked to a doctor - who is not a sleep doctor - who gave me some off-the-record advice from his experiences working with family members and patients with sleep apnea. Of course, I don't have any test results yet to guide my settings.

A very successful method is to just start with an auto nearly wide open, evaluate the data, and adjust, rinse, repeat.
Most people end up with much better settings than from the sleep test.

casereport wrote: ↑

Wed Mar 13, 2019 5:59 pm

I find out that whenever I try using CPAP - whether it's full mask or nasal pillows - my nose gets really irritated and nasal airways swell to the point that they close. I have a heated humidifier, a heated tube, use sinus rinse every day, clean my room every day, etc, etc.

If your humidity is low, turn it up, if it's high, turn it down.

palerider wrote: ↑

Wed Mar 13, 2019 8:30 pm

casereport wrote: ↑

Wed Mar 13, 2019 5:59 pm

I just experimented with the pressure settings... asking for advice from people who are using CPAP machine. I also talked to a doctor - who is not a sleep doctor - who gave me some off-the-record advice from his experiences working with family members and patients with sleep apnea. Of course, I don't have any test results yet to guide my settings.

A very successful method is to just start with an auto nearly wide open, evaluate the data, and adjust, rinse, repeat.
Most people end up with much better settings than from the sleep test.

casereport wrote: ↑

Wed Mar 13, 2019 5:59 pm

I find out that whenever I try using CPAP - whether it's full mask or nasal pillows - my nose gets really irritated and nasal airways swell to the point that they close. I have a heated humidifier, a heated tube, use sinus rinse every day, clean my room every day, etc, etc.

If your humidity is low, turn it up, if it's high, turn it down.

Thank you! I will persevere!

I am just trying to find out whether I am wearing the mask right. It's weird that I have no problem inhaling, but when I try to exhale, I feel like the very gel pillows that are allowing me to breathe in without problem are actually blocking my nose - like air I try to exhale has to fight against the air the tube is blowing into my nose. I was wondering if this is something that I have to try and fix (like trying different pillows or just switching to an entirely different mask) or something I would eventually get used to.

LSAT wrote: ↑

Wed Mar 13, 2019 5:17 pm

You are not getting much benefit from the CPAP when your mouth is open..The air is supposed to open your airway, but with your mouth open, it's coming in your nose and out your mouth. If you can't keep your mouth closed you need to tape it shut or go back to the full face mask. With those low pressures, you may not be getting much benefit anyway.. HOw did you determine the pressure settings?

You know, since I got the machine on my own, I had no idea that I am supposed to keep my mouth closed. This is how much of a newbie I am. Thanks.

casereport wrote: ↑

Wed Mar 13, 2019 9:54 pm

- like air I try to exhale has to fight against the air the tube is blowing into my nose.

What did I *JUST SAY* about the air *NOT* "blowing into your nose"?

Try a little experiment for me during the day or early evening when you are under no pressure to sleep.

Go into the setup menu are and turn EPR on and set it to 3
Go into auto mode and set the minimum pressure to 6 and set the maximum to 10 (for now)
See if breathing in through the nose AND exhaling through the nose is more manageable for you.

If you don't know about clinical set up menu and how to get there this manual explains how
https://www.respshop.com/manuals/ResMed ... %20her.pdf

casereport wrote: ↑

Wed Mar 13, 2019 9:55 pm

since I got the machine on my own, I had no idea that I am supposed to keep my mouth closed. This is how much of a newbie I am. Thanks.

Oh, trust me, you're getting the benefit of NOT swallowing all the lies and misinformation that the institutional CPAP suppliers fill everbody's heads with.

palerider wrote: ↑

Wed Mar 13, 2019 10:00 pm

casereport wrote: ↑

Wed Mar 13, 2019 9:54 pm

- like air I try to exhale has to fight against the air the tube is blowing into my nose.

What did I *JUST SAY* about the air *NOT* "blowing into your nose"?

Um, a little confused here. Isn't the machine supposed to produce positive pressure (=which feels like wind, airflow, whatever) that gets literally shoved down my airway so I can breathe? When I turn on the machine, air/whatever it is comes out of the tube, right? Maybe it doesn't help English is my second language? I would really appreciate it if you could further clarify because if there is supposed to be air not blowing into my nose or mouth/nose (full-face mask) I must have done something wrong. Thanks!

Pugsy wrote: ↑

Wed Mar 13, 2019 10:01 pm

Try a little experiment for me during the day or early evening when you are under no pressure to sleep.

Go into the setup menu are and turn EPR on and set it to 3
Go into auto mode and set the minimum pressure to 6 and set the maximum to 10 (for now)
See if breathing in through the nose AND exhaling through the nose is more manageable for you.

If you don't know about clinical set up menu and how to get there this manual explains how
https://www.respshop.com/manuals/ResMed ... %20her.pdf

Thank you so much! I've just tried the experiment.

I think the major issue I have is that my nasal passages promptly swell up whenever CPAP is on (even with humidifier, heated tube, humidification level and temperature adjusted, nasal wash, antihistamine, etc.) and stays that way even if I take off the mask. I got in touch with my old ENT doctor who said I had pretty narrow ones.

Maybe the best solution for this would be to find a full-face mask and customize it with some liners?

casereport wrote: ↑

Thu Mar 14, 2019 11:38 am

palerider wrote: ↑

Wed Mar 13, 2019 10:00 pm

casereport wrote: ↑

Wed Mar 13, 2019 9:54 pm

- like air I try to exhale has to fight against the air the tube is blowing into my nose.

What did I *JUST SAY* about the air *NOT* "blowing into your nose"?

Um, a little confused here. Isn't the machine supposed to produce positive pressure (=which feels like wind, airflow, whatever) that gets literally shoved down my airway so I can breathe? When I turn on the machine, air/whatever it is comes out of the tube, right? Maybe it doesn't help English is my second language? I would really appreciate it if you could further clarify because if there is supposed to be air not blowing into my nose or mouth/nose (full-face mask) I must have done something wrong. Thanks!

Some elementary fluid dynamics here. The CPAP is technically referred to as a "flow generator", it creates an air flow. when that air flow meets your face, and has no where to go, that creates a pressure. pressure is flow meeting a resistance. There's a vent on the mask for the air to go out. The flow generator pushes air into the mask, it meets your face, pressure rises, the fan speed is modulated until just the right amount of air is flowing in, and flowing out of the vent holes to create a desired pressure. If air were being "shoved into" your face, then the machine wouldn't be able to build up pressure.

When you inhale, more air is needed to maintain the pressure, because some of the air in the mask is being pulled into your lungs by your diaphragm, the fan in the flow generator speeds up. When you exhale, less air is needed from the flow generator, and the fan slows down. If the fan didn't speed up and slow down, then the pressure in the mask would drop a lot when you inhaled, and it would shoot up when you exhaled. Most modern cpaps sample the air pressure and adjust the fan speed some 50 to 150 (depending on brand) times per second.

If air were being 'literally shoved down' your airway, then you would blow up like a balloon, and there would be blood and guts all over the walls. Air can't be "shoved down" your airway if it has NO PLACE TO GO!

Yes, there's a *TINY* bit of air that is forced into your respiratory system when the machine first turns on, but from that moment on, there's no airflow into or out of your nose until you pull it in by taking a breath.

Once the machine achieves operating pressure (a couple of seconds since Resmeds offer a gentle slow start), there is *ZERO* air movement into, or out of your nose/mouth *until you take a breath*.

If you choose to think differently, then you're wrong, and you're setting up a mental condition that presupposes you'll fail.

palerider wrote: ↑

Thu Mar 14, 2019 1:01 pm

casereport wrote: ↑

Thu Mar 14, 2019 11:38 am

palerider wrote: ↑

Wed Mar 13, 2019 10:00 pm

casereport wrote: ↑

Wed Mar 13, 2019 9:54 pm

- like air I try to exhale has to fight against the air the tube is blowing into my nose.

What did I *JUST SAY* about the air *NOT* "blowing into your nose"?

Um, a little confused here. Isn't the machine supposed to produce positive pressure (=which feels like wind, airflow, whatever) that gets literally shoved down my airway so I can breathe? When I turn on the machine, air/whatever it is comes out of the tube, right? Maybe it doesn't help English is my second language? I would really appreciate it if you could further clarify because if there is supposed to be air not blowing into my nose or mouth/nose (full-face mask) I must have done something wrong. Thanks!

Some elementary fluid dynamics here. The CPAP is technically referred to as a "flow generator", it creates an air flow. when that air flow meets your face, and has no where to go, that creates a pressure. pressure is flow meeting a resistance. There's a vent on the mask for the air to go out. The flow generator pushes air into the mask, it meets your face, pressure rises, the fan speed is modulated until just the right amount of air is flowing in, and flowing out of the vent holes to create a desired pressure. If air were being "shoved into" your face, then the machine wouldn't be able to build up pressure.

When you inhale, more air is needed to maintain the pressure, because some of the air in the mask is being pulled into your lungs by your diaphragm, the fan in the flow generator speeds up. When you exhale, less air is needed from the flow generator, and the fan slows down. If the fan didn't speed up and slow down, then the pressure in the mask would drop a lot when you inhaled, and it would shoot up when you exhaled. Most modern cpaps sample the air pressure and adjust the fan speed some 50 to 150 (depending on brand) times per second.

If air were being 'literally shoved down' your airway, then you would blow up like a balloon, and there would be blood and guts all over the walls. Air can't be "shoved down" your airway if it has NO PLACE TO GO!

Yes, there's a *TINY* bit of air that is forced into your respiratory system when the machine first turns on, but from that moment on, there's no airflow into or out of your nose until you pull it in by taking a breath.

Once the machine achieves operating pressure (a couple of seconds since Resmeds offer a gentle slow start), there is *ZERO* air movement into, or out of your nose/mouth *until you take a breath*.

If you choose to think differently, then you're wrong, and you're setting up a mental condition that presupposes you'll fail.

Thank you so much! This explains everything.

And everyone around me was telling me that using a CPAP is basically like wearing an oxygen mask. So I thought the machine was actually feeding me air(oxygen)... There is a reason why I am not a STEM major. So it must be something else that's hindering my progress with nasal pillows - poor fit, discomfort, wrong pillows, my deviated septum, etc, etc. But I know that CPAP will work as long as I get the mask right.

Thank you!!

Maybe you'd do better with a hybrid mask?

I'm a mouth-breather who has never been able to find a full face mask that fit right, and I can't use just the nasal pillows. I've got the mirage liberty (there's at least 1 more on the market now too) that has the nasal pillows and a small mask that goes over the mouth but not up and over the nose.