Columella nasi pain while wearing Nuance nasal pillow, need new mask recommendation.

[nbritton]

Hi,

Last night was my first day using an PAP machine. I had trouble initiating sleep and it also felt like I slept very lightly, but I did wake up feeling refreshed for the first time in a long time. I'm using a Philips DreamStation Auto CPAP with Humidifier and a Philips Nuance nasal pillow in combination with a Philips premium chin strap. The machine is currently set to auto with a range of 8 to 14 cm and an a-flex setting of 3. Upon waking up the machine said the 90% pressure was 9 cm and my AHI was 0.5. 

I remember when I was trying to fall asleep I felt discomfort on my nasal bridge, I believe this is what primarily kept me from falling asleep. I started the night with a medium sized pillow and then I woke up about three hours later and switched to a large sized pillow, that caused even more discomfort so I quickly switched it back to the medium. When I woke up this morning I felt a lot of pain on my nasal bridge.

Are there any tips for reducing the discomfort?

I think what I really need is a new mask for a number of reasons:

1) The Nuance nasal pillow caused discomfort and pain on my nasal bridge.
2) I have a prescription face cream that I must use every night to prevent acne breakouts, the cream needs to be applied liberally and it leaves my face clammy throughout the night.
3) When not using PAP, I'm typically a mouth breather because sometimes have a hard time getting enough air flow through my nose.
4) The chin strap sorta prevents me from using the cream because the strap is made of cloth and it contacts my chin, my upper chin is where I typically have lots of breakouts.
5) The chin strap slipped off twice over the corse of the night.
6) When not using PAP, I often sleep on my stomach or sides, and I frequently toss and turn throughout the night due to pressure points and limbs getting numb. This may change now that I can presumably sleep on my back with the assistance of my APAP machine, but for now I should probably assume that my old sleeping habits will continue for the time being.
7) I often get up at least once a night to go to the bathroom, so ether the mask should be able to come off and put back on quickly or it needs a quick disconnect feature.

Can anyone recommend a new mask that can accommodate my needs? I tried using the Respironics mask selector tool and it recommended the DreamWear Gell Pillows or Nasal Cradle masks. I like most of the feature of these masks but I'm worried it will cause nasal bridge discomfort just like the Nuance did. It also doesn't address the need of having to wear a chin strap to keep my mouth shut.

Thanks

[Fats Drywaller]

Clarification, please? Bridge of nose is upper bony part of nose, not nostrils. Where is the pain that you're having?

[nbritton]

Clarification, please?  Bridge of nose is upper bony part of nose, not nostrils.  Where is the pain that you're having?

I'm sorry, I got the anatomy wrong, for some reason I thought the nasal bridge was the part between the nostrils, what I meant to say was the columella. I'm going to post a new thread because my original post here is fundamentally flawed.

Moderator note: I have merged your two threads to preserve all responses.

[mesenteria]

"...
3) When not using PAP, …"

Why would you ever not use your PAP?  This is almost certainly a mistake, and you would be strongly advised to discontinue sleeping without it.
"...

"...4) The chin strap sorta prevents me from using the cream because the strap is made of cloth and it contacts my chin, my upper chin is where I typically have lots of breakouts..."

You should probably have several chin straps, with a hefty supply washed and ready to use...new...each night.  Do not use more than one night...?  I know, it adds to complication and work load, not to mention expense, but what reasonable alternative do you have?



"...5) The chin strap slipped off twice over the corse of the night...."

Already addressed in my previous comment.  Not to put pressure on you, but you'll have to deal with this soon, and constructively, because it will only serve to diminish the quality of the sleep you desperately need.  You say you already get up at least once to pee, and that, itself, is an interruption.  You need another one or three like you need a hole in your head.

It's a combination of factors from its shape, the materials and their combined stretchiness, the way its engineered to fit, the shape of your head, your head's size, and the way you move and put pressure on the chin strap when relaxed and when changing positions (scrubbing it off as you turn and re-lay your head).  You need a different chin strap, or perhaps you could consider taping (I do, but I can't recommend or suggest that remedy to you for a number of reasons).


"...6) When not using PAP, I often sleep on my stomach or sides, and I frequently toss and turn throughout the night due to pressure points and limbs getting numb. This may change now that I can presumably sleep on my back with the assistance of my APAP machine, but for now I should probably assume that my old sleeping habits will continue for the time being..."

I wouldn't if I were you.  I had to modify my sleeping habits from the get-go.  Fortunately, I eventually taught myself to sleep on both sides once again, even with my nasal pillow.  But in any event, this last quote of yours puts the slipping chin strap, and my claims for why you have experienced it, into a solid footing IMO.


"...7) I often get up at least once a night to go to the bathroom, so ether the mask should be able to come off and put back on quickly or it needs a quick disconnect feature."

Most masks can disconnect from the hose quickly, some at the top of the headgear, some right at the mask.  If a full face coverage-type-mask, it could be either one.

[nbritton]

Hi,

Last night was my first day using an PAP machine. I had trouble initiating sleep and it also felt like I slept very lightly, but I did wake up feeling refreshed for the first time in a long time. I'm using a Philips DreamStation Auto CPAP with Humidifier and a Philips Nuance nasal pillow in combination with a Philips premium chin strap. The machine is currently set to auto with a range of 8 to 14 cm and an a-flex setting of 3. Upon waking up the machine said the 90% pressure was 9 cm and my AHI was 0.5. 

I remember when I was trying to fall asleep I felt discomfort on my columella nasi (the part of your nose that is between your nostrils), I believe this is what primarily kept me from falling asleep. I started the night with a medium sized pillow and then I woke up about three hours later and switched to a large sized pillow, that caused even more discomfort so I quickly switched it back to the medium. When I woke up this morning I felt a lot of pain on my columella nasi.

Are there any tips for reducing the discomfort?

I think what I really need is a new mask for a number of reasons:

1) The Nuance nasal pillow caused discomfort and pain on my columella nasi.
2) I have a prescription face cream that I must use every night to prevent acne breakouts, the cream needs to be applied liberally and it leaves my face clammy throughout the night.
3) When not using PAP, I'm typically a mouth breather because sometimes have a hard time getting enough air flow through my nose.
4) The chin strap sorta prevents me from using the cream because the strap is made of cloth and it contacts my chin, my upper chin is where I typically have lots of breakouts.
5) The chin strap slipped off twice over the corse of the night.
6) When not using PAP, I often sleep on my stomach or sides, and I frequently toss and turn throughout the night due to pressure points and limbs getting numb. This may change now that I can presumably sleep on my back with the assistance of my APAP machine, but for now I should probably assume that my old sleeping habits will continue for the time being.
7) I often get up at least once a night to go to the bathroom, so ether the mask should be able to come off and put back on quickly or it needs a quick disconnect feature.

Can anyone recommend a new mask that can accommodate my needs? I tried using the Respironics mask selector tool and it recommended the DreamWear Gell Pillows or Nasal Cradle masks. I like most of the feature of these masks but I'm worried it will cause columella nasi discomfort just like the Nuance did. It also doesn't address the need of having to wear a chin strap to keep my mouth shut.

Thanks

[nbritton]

Clarification, please?  Bridge of nose is upper bony part of nose, not nostrils.  Where is the pain that you're having?

I'm sorry, I got the anatomy wrong, for some reason I thought the nasal bridge was the part between the nostrils, what I meant to say was the columella. I'm going to post a new thread because my original post here is fundamentally flawed.

Please delete this thread if possible.

Moderator note: To preserve all responses, the two threads have been merged.

[Fats Drywaller]

This is assuming that a nasal-pillows or nasal-cushion mask is right for you, which I don't know to be the case. Maybe a full-face mask would be better for your combination of conditions and requirements? I can't say. But if nas-pil or nas-cush is good in general, then try the Brevida from Fisher & Paykel. I've raved about it here and here and here and here. No nose pain, not at all like the nas-pil types that have hard lumps pressing against the nostrils. The Brevida has no hard lumps.

The Dreamwear is also comfortable IMO, and is great in a bunch of ways, both nas-pil and nas-cushion. But it's noisy because the air travels through the hollow silicone frame/headgear. Recent reports say that the same is true of the new Resmed N30i. If you find that the Russian heir, oops I mean rushin' air noise is soothing, like waves on a seashore, then that's great and you'll probably like the Dreamwear. But if the noise would keep you awake, then skip it. I found the Dreamwear cushion nosepiece to be more leaky than the nas-pil nosepiece when side-sleeping, but it's not a huge deal because those are interchangeable using the same frame & headgear. But they aren't included in the same mask package, so you'd need to buy at least one separately.

Always get all sizes of nas-pil and/or nas-cushion nosepieces whenever you get a mask from a DME, and try to get as many of those components as possible when buying the packages yourself from a retailer. Often you'll need a larger size than you expect, regardless of size of nose. It doesn't seem to be determinable in advance. You just have to try some sizes at home and see what works best.

The Dreamwear also has three sizes of frame, and using the wrong size will result in grief, so you have to be careful about that and, once again, possibly buy, or request from DME, the correct size for you if it's not Medium, which is the only one included in the full package.

[nbritton]

"...
3) When not using PAP, …"

Why would you ever not use your PAP?  This is almost certainly a mistake, and you would be strongly advised to discontinue sleeping without it.
"...

"...4) The chin strap sorta prevents me from using the cream because the strap is made of cloth and it contacts my chin, my upper chin is where I typically have lots of breakouts..."

You should probably have several chin straps, with a hefty supply washed and ready to use...new...each night.  Do not use more than one night...?  I know, it adds to complication and work load, not to mention expense, but what reasonable alternative do you have?

"When not using PAP". I was not trying to say that I don't use it or that I was planning to discontinue using it. I was simply trying to refer to my sleep before I had the APAP machine, I've only had the machine for one night.
Multiple chin straps that I use in rotation and wash in the washing machine could potentially be a solution, thank you for that suggestion.

[Gideon]

1) The Nuance nasal pillow caused discomfort and pain on base on the nares of the nose. my nasal bridge. Avoid the masks that touch the nares of the nose like pillow, prong, or hybrid masks.  Look at nasal masks which seal around the entire nose structure and on the upper lip below the nose or a full face mask
2) I have a prescription face cream that I must use every night to prevent acne breakouts, the cream needs to be applied liberally and it leaves my face clammy throughout the night.
3) When not using PAP, I'm typically a mouth breather because sometimes have a hard time getting enough air flow through my nose.
4) The chin strap sorta prevents me from using the cream because the strap is made of cloth and it contacts my chin, my upper chin is where I typically have lots of breakouts.  Use a soft cervical collar instead of a chin strap.  They work very well for both mouth breathing and positional apneas 
5) The chin strap slipped off twice over the corse of the night. Use a soft cervical collar instead of a chin strap. 
6) When not using PAP, I often sleep on my stomach or sides, and I frequently toss and turn throughout the night due to pressure points and limbs getting numb. This may change now that I can presumably sleep on my back with the assistance of my APAP machine, but for now I should probably assume that my old sleeping habits will continue for the time being. There is no reason you shouldn't be able to sleep on your side using a PAP, stomach will be more difficult but not impossible.
7) I often get up at least once a night to go to the bathroom, so ether the mask should be able to come off and put back on quickly or it needs a quick disconnect feature.  Most masks should allow this.

Can anyone recommend a new mask that can accommodate my needs? I tried using the Respironics mask selector tool and it recommended the DreamWear Gell Pillows or Nasal Cradle masks. I like most of the feature of these masks but I'm worried it will cause nasal bridge discomfort just like the Nuance did. It also doesn't address the need of having to wear a chin strap to keep my mouth shut.

Masks are very personal, what works for me may or may not work for you.  They HAVE TO BE tried on, under pressure and lying down.

Fred

[Fats Drywaller]

About masks in general:  Read the Mask Primer wiki article for starters.  There's also a lot of good information in the Mask Reviews forum, but it takes a long time to slog through all of that (not that you would want to read every thread).  The mask information isn't limited to those two places; it's scattered all through the discussion threads (over many years) in the main forum, so it's also necessary to search and read quite a lot when you're learning about this stuff.  The most basic thing is to search for the name of the mask in the thread titles (those become the web-page titles) and read the various opinions, recommendations, and especially complaints about the product.  The gripes about a mask's bad points are important because they could let you cross that one off your list, save some money and/or time by not trying it, and go on to the next one.

Also useful is to browse the web sites of the major brand names, which are Resmed (resmed.com), Philips Respironics (sleepapnea.com), and Fisher & Paykel (fphcare.com).  With each of those, drill down to the page where the masks are introduced (from there, it'll branch to full-face, nasal, and nasal-pillows categories), and bookmark that page; then you can go back to it later to learn more about another mask that you're interested in.  The main things to get from the manufacturers' web sites are not the advertising hype, but first the PDFs of the user's guides and spec sheets, and second the photos of the masks.  You can learn quite a bit from the photos.  If you want minimal headgear for whatever reasons (not liking a lot of skin contact or having that interfere with the face cream), then you can immediately reject the masks that have maximal headgear.  And so on.

It's likely that any questions you have about any mask except a recently introduced model (and sometimes even that) have already been answered in discussion threads, so always try a search first.  If you want, you can use an outside search engine instead of the local one ... for instance, with google, just add site:apneaboard.com to the search terms.