Do nasal pillows and I just need to break up?

I'm really frustrated, really tired, and just want someone to tell me it's going to be okay.

Hi. I'm a new CPAP user. I was diagnosed with OSA after having to do two in lab sleep studies, the second in November of 2019. After a long uphill battle with my referring doctor to actually get the paperwork to the CPAP vendor so that they could supply me one, my CPAP arrived in the mail two weeks ago (the vendor was not connected in any way to the sleep lab). Machine: ResMed AirSense 10 AutoSet and mask: ResMed AirFit P10. They sent me a VERY different mask than I had tried at the sleep lab (there, I'd used a nasal prong style mask. When I said this to the CPAP vendor, the person on the other line acted very confused and said she'd never heard of this), but same size (size small). Well, I might as well try it out!

My very first night, I slept fairly well after adjusting and adjusting and adjusting the mask, but woke up with a nose that was EXTREMELY tender, even moreso to the touch, and pretty red. I called the CPAP vendor to see if they had smaller nasal pillows, thinking this was a problem. They did, and sent me some extra small nasal pillows. As the day progressed, my soreness of my nose lingered. When I got home around 8pm, I looked at my nose, and noticed that on the skin above the nostril (right about where the flared end of the nasal pillow would rest against the nose) was very raw on the left side, and there was a sort of golden crust on it. Not great. When I went to go to bed a couple of hours later, it had developed into a blister. Not great. I tried the CPAP again anyway, having cleaned everything according to instructions in the morning (using antibacterial soap), and went to bed. I woke up feeling pretty good...until I looked in the mirror. The blister was now obviously infected, and there were obviously signs of infection on the skin close by, and on the other nostril as well. I panicked, left a message for my dermatologist, stopped using the machine, and went about my weekend.

Monday afternoon, I go to the dermatologist, and he confirms my fears: I have a staph infection. I had already been using antibiotic ointment over the weekend, so it looked a little better, but he gave me some prescription strength and some oral antibiotics and we talked about how to prevent this in the future (he mostly advised to look into a CPAP sanitize, and use the ointment at any sign of raw skin. He said to soak the mask in alcohol for a few minutes, but I worry about how that would affect the mask and warranty).

Anyway, two nights ago, my nose was healed, my CPAP had just been cleaned, and I felt ready to try again. I'm a side sleeper, and once I got comfortable, I started trying to get the mask to sit right. I could. not. get. it. I went to bed at 10pm and was literally up until 4am trying to get this thing to sit right. Yes, there were tears. Mostly, the issue is that, no matter what I do, there is no air coming out of the nasal pillows, like they're pressing against some part of my nose or another. I had a lot of time on my hands, so occasionally I'd Google the issue. I got a lot of advice, which I tried: making sure the nasal pillows were in the correct position before I put the mask on. Squeezing the sides of the pillows to restore their shape. Reseating the mask a few times to make it settle correctly. Adjusting the strap to tighter or looser. When I finally got a somewhat comfortable position and fell asleep, I was fine and I couldn't feel it at all after a few minutes. I woke up still tired (because I got a phone call early-ish in the morning and didn't get enough sleep), and hoping against hope that the next night wouldn't be so bad.

Last night wasn't that bad. I finally got them to sit right around 1am, right after I got so frustrated I was ready to chuck the whole thing and say forget it. Is this going to be how it's going to be forever, or will I eventually get the hang of this? Do I have a weird nose structure or something? Any tips or tricks from other weird nose people?

So exactly which model machine and which mask are you using?
viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html
We can't offer any mask fitting advice other than general stuff without knowing exactly which mask is being used.

There are prong masks and it's highly unlikely that you were given one of those.
https://www.cpap.com/cpap-masks/nasal-prong-cpap-mask

and they are NOT the same as nasal pillow masks
https://www.cpap.com/cpap-masks/nasal-pillow-cpap-mask

Nasal pillow masks don't touch anything inside the nostril. If they do then either the wrong size is being use or the headgear is simply too tight. If you look in the mirror and the first thought through your mind is "piggy nose" then you have things way too tight.
It's probably the most common error made when people are using a nasal pillow mask.

TinyAwesome wrote: ↑

Mon Mar 09, 2020 3:20 pm

I'm really frustrated, really tired, and just want someone to tell me it's going to be okay.

<snip>

Monday afternoon, I go to the dermatologist, and he confirms my fears: I have a staph infection. I had already been using antibiotic ointment over the weekend, so it looked a little better, but he gave me some prescription strength and some oral antibiotics and we talked about how to prevent this in the future (he mostly advised to look into a CPAP sanitize,

welcome to the zoo! sorry you are having trouble. please do as pugsy asks. there are many, many masks and the advice you'll receive will depend very much on which mask and maybe even machine you have.

i just wanted to highlight that one piece that i quoted above. i really, really and REALLY hope that he wasn't talking about SoClean. if so, and you haven't purchased it, don't buy it! it's a total waste of money, it's dangerous and it doesn't do anything that you can't do with soap and water.

just wanted to get that out there.

good luck!

Just a word of general encouragement ... Sleeping with a device blowing air up your nose is highly unnatural, it is not something that comes easy. But there are tons of options available now, the technology is very advanced with OSCAR etc., and the people here are incredibly helpful. Sleep is a necessity. Perservere! It should work out fine and will be well worth it!

Sorry, all! I put in the machine and mask info when I was filling out my profile and assumed it'd automatically show up on my post.
Machine: ResMed AirSense 10 AutoSet
Mask: ResMed AirFit P10

Pugsy wrote: ↑

Mon Mar 09, 2020 3:40 pm

There are prong masks and it's highly unlikely that you were given one of those.
https://www.cpap.com/cpap-masks/nasal-prong-cpap-mask

Nasal pillow masks don't touch anything inside the nostril. If they do then either the wrong size is being use or the headgear is simply too tight. If you look in the mirror and the first thought through your mind is "piggy nose" then you have things way too tight.
It's probably the most common error made when people are using a nasal pillow mask.

Actually, the first nasal prong mask on that link looks exactly like what I had during the sleep study. They first had me on a small face mask, but I have EXTREMELY sensitive skin, and the seal on my skin bothered me immediately.
Well, they definitely touch the inside of my nostrils, I have the headgear on the loosest according to the YouTube video they sent me (for the ResMed AirFit P10, it says to place the split strap wider apart. I placed them as wide apart as I possibly could), and I have the smallest nasal pillows they make so I'm not sure where to go from here.

zonker wrote: ↑

Mon Mar 09, 2020 4:31 pm

i just wanted to highlight that one piece that i quoted above. i really, really and REALLY hope that he wasn't talking about SoClean. if so, and you haven't purchased it, don't buy it! it's a total waste of money, it's dangerous and it doesn't do anything that you can't do with soap and water.

I didn't end up purchasing it! I called my CPAP vendor, they advised against it, and my insurance doesn't cover it, so that was that.

TinyAwesome wrote: ↑

Mon Mar 09, 2020 9:12 pm

zonker wrote: ↑

Mon Mar 09, 2020 4:31 pm

i just wanted to highlight that one piece that i quoted above. i really, really and REALLY hope that he wasn't talking about SoClean. if so, and you haven't purchased it, don't buy it! it's a total waste of money, it's dangerous and it doesn't do anything that you can't do with soap and water.

I didn't end up purchasing it! I called my CPAP vendor, they advised against it, and my insurance doesn't cover it, so that was that.

What a relief!
Even doctors can exhibit evidence of "ignorance".
(Especially if the own stock in SoCRAP)

If the smallest nasal pillow is trying to crawl up inside your nose then you need to go larger in size and not smaller.

Nasal pillow masks like the P10 rest gently against the outside of the nostril opening. Absolutely nothing touches the inside of the nose.
I have worn extra small nasal pillows in every nasal pillow mask I have ever used over the years until the P10....I had to move up to the small size because the extra small tried to crawl up inside my nose.

The P10 headgear is a bit "snug" for some people it seems like. I know it was for me until it got stretched out a little. I even had some nose discomfort and it felt like my nose ran into someone's fist....and I had been using nasal pillow masks for years when I tried the P10 and I had it as loose as I could get it.
So see if you can stretch that headgear out a little.

Or look at the other masks available and see if something else looks interesting to you.
I am using the Bleep...no headgear at all...nothing inside the nose at all...no sizes to mess with. Just stick them on and I am done.

Pugsy wrote: ↑

Mon Mar 09, 2020 9:27 pm

If the smallest nasal pillow is trying to crawl up inside your nose then you need to go larger in size and not smaller.

Nasal pillow masks like the P10 rest gently against the outside of the nostril opening. Absolutely nothing touches the inside of the nose.
I have worn extra small nasal pillows in every nasal pillow mask I have ever used over the years until the P10....I had to move up to the small size because the extra small tried to crawl up inside my nose.

The P10 headgear is a bit "snug" for some people it seems like. I know it was for me until it got stretched out a little. I even had some nose discomfort and it felt like my nose ran into someone's fist....and I had been using nasal pillow masks for years when I tried the P10 and I had it as loose as I could get it.
So see if you can stretch that headgear out a little.

Or look at the other masks available and see if something else looks interesting to you.
I am using the Bleep...no headgear at all...nothing inside the nose at all...no sizes to mess with. Just stick them on and I am done.

Hm. I don't feel like they're going up my nose, it's more the angle, which once I get that right they're totally fine and don't move at all and I don't even notice they're there. But maybe it's the headgear, I don't know at this point. I sort of wish they would give you a beginner's class for this. I'll try to stretch the headgear. I tried the smalls and they are physically painful (like you said, feeling like my nose ran into someone's fist...all day the next day). The smalls are also the ones that gave me the nasty raw skin above my nostrils and the lovely infection that came with it. The first night back on the CPAP machine after that cleared up, I switched between the extra smalls and the smalls, and the smalls were so dang uncomfortable that I switched back.

TinyAwesome wrote: ↑

Mon Mar 09, 2020 9:12 pm

zonker wrote: ↑

Mon Mar 09, 2020 4:31 pm

i just wanted to highlight that one piece that i quoted above. i really, really and REALLY hope that he wasn't talking about SoClean. if so, and you haven't purchased it, don't buy it! it's a total waste of money, it's dangerous and it doesn't do anything that you can't do with soap and water.

I didn't end up purchasing it! I called my CPAP vendor, they advised against it, and my insurance doesn't cover it, so that was that.

<whew!> you dodged a bullet there.

The P10 is one of the most easily "accepted" masks you can get. But that does not mean it is perfect for everyone. I suspect two things. First is the size of the cushion. You can buy these masks as a fit pak that has three nasal cushion sizes. I suspect you need to try a medium size. Not just the size of your nostril opening, but also the space between them is critical with these type of masks. Second is fitment. Not the easiest thing to master on the P10, and your statement saying you cannot seem to get it loose enough is telling me the nasal cushions are too tight against your nose. Proper fitment often feels too loose at first, and once the pressure builds it tends to seal well. I always clean the cushions AND my nostril area with a baby wipe right before putting them on. Gets rid of the oils and stuff and makes them seal better. Without excessive tightness.

Reading about your troubles with the mask, I think the ResMed N30 might be a mask you would want to try ( not the N30i, that is completely different ). This mask only contacts the skin area outside of the nose, cannot aggravate the edge of the nostril. It also has an adjustable head strap, which actually can be fitted on the P10 you already have and seems to be a better design.

TinyAwesome wrote: ↑

Mon Mar 09, 2020 9:01 pm

Sorry, all! I put in the machine and mask info when I was filling out my profile and assumed it'd automatically show up on my post.
Machine: ResMed AirSense 10 AutoSet
Mask: ResMed AirFit P10

Did you click on the submit button after you filled out your equipment profile?
It's still not showing up and usually when that happens the submit button didn't get clicked on or it didn't stick.

TinyAwesome wrote: ↑

Mon Mar 09, 2020 9:54 pm

Hm. I don't feel like they're going up my nose, it's more the angle, which once I get that right they're totally fine and don't move at all and I don't even notice they're there. But maybe it's the headgear, I don't know at this point. I sort of wish they would give you a beginner's class for this. I'll try to stretch the headgear. I tried the smalls and they are physically painful (like you said, feeling like my nose ran into someone's fist...all day the next day). The smalls are also the ones that gave me the nasty raw skin above my nostrils and the lovely infection that came with it. The first night back on the CPAP machine after that cleared up, I switched between the extra smalls and the smalls, and the smalls were so dang uncomfortable that I switched back.

Welcome.

Lanolin cream from the babies section can help the raw nasal skin. I found that discomfort went away after a couple of weeks.

The strap position varies the angle and tension somewhat. I usually have one strap going over the top of my head and the lower one going behind my head, just above my neck. There are some how-to videos linked on the Resmed product page.

https://www.resmed.com/en-us/sleep-apne ... irfit-p10/

realshelby wrote: ↑

Tue Mar 10, 2020 5:58 am

I suspect you need to try a medium size. Not just the size of your nostril opening, but also the space between them is critical with these type of masks...
I think the ResMed N30 might be a mask you would want to try...

Yes! I think I'm going to call my CPAP vendor and get some medium cushions. I tried the smalls again last night, and they weren't as uncomfortable as they were in the beginning, but I kept having to spread them apart to keep them from just hitting my septum. After fighting with them for over an hour last night, I got frustrated and turned the machine off. I guess I was tired enough that I figured crappy, unhealthy sleep is better than no sleep at all. If this doesn't work, I'll suggest the ResMed N30 to them and see what they say. Thank you!