Dreamwear and Brevida masks, leaks, deviated septum

[Dyssomniac]

After experiencing an AHI of 8.06 with a number of centrals on my second night with my new AirSense 10 AutoSet used with a Dreamwear nasal cushion mask and Caldera Releaf cervical collar, I thought I'd switch to the Brevida nasal pillow mask that I also received to see what kind of results I got with it. The good news is my AHI was down to 1.74 and centrals were very few, but leaks went through the roof.

I wore the Brevida from when I went to bed at 23:21 until 4:32 (see attached). When I started the machine I had the sense that there was a slight leak on the exterior of my left nostril, but hoped it wouldn't be an issue. However, I had the sense of climbing pressure, leaks and percussive mouth exhalations numerous times in the night, and reset the machine six times. Finally, at 4:32, I turned the machine off and changed the mask out for the Dreamwear nasal cushion kit. My final 80 or so minutes of sleep seemed calm by comparison.

One issue that caused me to remove the Brevida was a distinct pain in my right nostril. A fact I'd forgotten for quite some time dawned on me: I have a deviated septum, and the right nostril is bent-shaped.

Some things I'm wondering about now:

-- What caused the pressure to raise from 4.0 to 6.0 and then plateau early in the night (around 23:39)? Would this have been in response to an ongoing leak the machine detected? I don't see any other triggering events.

-- What made the machine start ramping up the pressure again around 4:48, about 10 minutes after I changed the mask to the Dreamwear and turned it back on? I don't see any triggering events there either.

-- Do the kind of leaks shown in the data indicate that I should do more to prevent mouth exhalations (perhaps adding a strap or tape)?

-- Does it seem worth continuing to experiment with the Brevida, and/or the pillow version of the Dreamwear? Would smaller pillows help, or do they need to achieve a seal with the nostrils to work? Air flow within the Brevida did seem quieter than with the Dreamwear, though the end result in this one night was not restful.

[Fats Drywaller]

The Brevida's nosepiece is different from a lot of others, in a couple of ways. First, although it's very soft, it is more invasive, so I assume it's probably not right for someone with the particular deviated-septum problem that you describe. The nostrils do need to be clear and straight for this mask to be comfortable. Otherwise it's probably better to use a type whose nosepiece is designed to rest outside the nostrils. The Dreamwear nas-cushion, not pillows, would be great if only that one weren't so leaky when sleeping any way but on one's back.

The only helpful (practical) thing that occurs to me about that point, before you give up on the Brevida, is that a smaller nosepiece would seem to be indicated, to avoid irritating that bent nostril as much. However, that also provides less air flow, and the exterior of it, if it doesn't fit your nose as well, might not seal as well as the larger size. I don't know. All you can do is try it.

My second point is about the leaks. That's an easier problem, but this might be irrelevant if you need to stop using the Brevida anyway because of your different nose morphology. I haven't had any major annoyances from leaks, and the Brevida and I get along fine, once I realized that I have to use the size-L nosepiece and occasionally do a quick re-sealing of the cushion during the night if it gets pushed aside slightly as I shift around in bed. All that consists of is pulling the nosepiece away from my nostrils slightly and letting it fall back again, pulled by the elastic, while wiggling it around a little bit so that it seals again. I'm sure that's a common sort of thing with any mask. Also, if it's persistently too leaky, that's an indication that the strap is too loose and you need to take up a little bit of slack with the velcro. Of course you don't want it to be actually tight, certainly not to the point where you notice that and get headaches or other pains, but on the other hand simply having the nosepiece rest loosely against your nostrils isn't good enough to make a seal. It has to be snug. You'll also need to take up slack once in a while as the strap stretches from use, over the weeks and months. So the velcro is not always a "set it and forget it" adjustment.

In all cases, it's important to make sure that the flexible pillow protuberances have not become inverted in your nostrils, because that's a guaranteed cause of leaks. Also, of course, wash the nosepiece daily with mild soap and warm water, and let it dry before replacing it in the frame. Skin oil can affect the leak rate. If necessary, wash your face each evening before putting the mask on.

If you don't have a mustache, also try shaving before going to bed, because whiskers can also affect the leak rate. If you do have a stache, then again maybe the Brevida isn't right for you.

About your other questions, I don't know and will leave those to other folks.

[Coffee Man]

OP,

You could try to see if the ResMed N30i would work for you. It is like the DreamWear in that the nasal cushion sits under the nose. It is loud, like the DreamWear mask, so I wear earplugs when I use either mask. The N30i is much less likely than the DreamWear to leak as the cushion is triangular and hugs the nose.

I had horrendous pain in my nostril with the DreamWear pillows due to a deviated septum, so I don't think trying the pillows is worth it.

[Dyssomniac]

The Brevida's nosepiece is different from a lot of others, in a couple of ways.  ...

Thanks for all the suggestions. The Brevida is a very nice mask, and I'll definitely try it again with both sizes of pillows. Though it's looking very possible that my crooked septum may disqualify me from any pillows. We'll see.

[Dyssomniac]

You could try to see if the ResMed N30i would work for you. It is like the DreamWear in that the nasal cushion sits under the nose.  It is loud, like the DreamWear mask, so I wear earplugs when I use either mask.  The N30i is much less likely than the DreamWear to leak as the cushion is triangular and hugs the nose.

I had horrendous pain in my nostril with the DreamWear pillows due to a deviated septum, so I don't think trying the pillows is worth it.

Sounds like we're in a very similar boat. The ResMed B30i definitely sounds worth trying. I'm just wondering how many masks I can convince my HMO to provide. So far they've given me a Dreamwear and a Brevida, as well as an F20 full-face as a backup for any nights when the nose is a full-stop no-go. I guess all I can do is ask. Does the N30i come in different sizes? If so, which one worked for you in your case?

Re the noise, from past experience I don't tolerate earplugs very well. I also have significant tinnitus (ringing in the ears), which earplugs only accentuate. I suppose I could try earbuds with white noise. But to be honest the noise of the Dreamwear so far doesn't seem to be what wakes me up. What does is when the machine's pressure starts ramping up, which appears to be primarily due to central apnea events. Jury's still out at this point on how that's going to go.

[jaswilliams]

Re the noise, from past experience I don't tolerate earplugs very well. I also have significant tinnitus (ringing in the ears), which earplugs only accentuate. I suppose I could try earbuds with white noise. But to be honest the noise of the Dreamwear so far doesn't seem to be what wakes me up. What does is when the machine's pressure starts ramping up, which appears to be primarily due to central apnea events. Jury's still out at this point on how that's going to go.

Central Apnoea does not cause pressure increases. Pressure increases are caused by Obstructive Apnoea, Snores and Flow Limitations only. Your pressure increases are caused by flow limitations that more pressure does not clear, in that instance all we can do is limit the machine max pressure

[Fats Drywaller]

If your nose is usually clear enough not to use a full-face mask, and considering the bent nostril, it sounds like maybe you should be trying nasal masks rather than the nasal-pillows type? (Why torture yourself?) The N30i, which is one candidate, looks a lot like the Dreamwear, but Resmed put it in its "N" series rather than "P", so apparently it's not supposed to be considered a nas-pil mask. Cushion, I guess. Anyway, what I was thinking is that beyond that, there are several masks of the more traditional Nasal type that cover the nose and are completely non-invasive, like the N20, Wisp, Pico, and Eson 2.

For reference:

N30i reviews: http://www.apneaboard.com/forums/Thread-...irFit-N30i

N30i discussion: http://www.apneaboard.com/forums/Thread-...esmed-N30i

N30i product page (with links to PDFs): https://pages.resmed.com/CA-N30i-P.html

Resmed nasal masks: https://www.resmed.com/us/en/consumer/pr...asal-masks

Philips nasal masks: https://www.sleepapnea.com/products/masks/wisp
and https://www.sleepapnea.com/products/masks/pico

F&P nasal mask: https://www.fphcare.com/us/homecare/slee...ks/eson-2/

P.S.: Test-driving masks and rejecting most of the ones that you try can be a big hassle, but it's all part of the beginning-CPAP experience, unfortunately. Once you're through that phase, in some number of weeks, you can put it behind you and just use your favorite from then on.

[Dyssomniac]

Central Apnoea does not cause pressure increases. Pressure increases are caused by Obstructive Apnoea, Snores and Flow Limitations only. Your pressure increases are caused by flow limitations that more pressure does not clear, in that instance all we can do is limit the machine max pressure

Can significant leaks cause pressure increases? Last night (the night after the one discussed above), I had a long stretch early in the night where there were zero apnea events of any kind, but the machine still brought pressure up a moderate amount. The only thing I could see going on during that time period was that I was having an ongoing leak with my Dreamwear cushion mask.

[Dyssomniac]

If your nose is usually clear enough not to use a full-face mask, and considering the bent nostril, it sounds like maybe you should be trying nasal masks rather than the nasal-pillows type?  (Why torture yourself?)  The N30i, which is one candidate, looks a lot like the Dreamwear, but Resmed put it in its "N" series rather than "P", so apparently it's not supposed to be considered a nas-pil mask.  Cushion, I guess.  Anyway, what I was thinking is that beyond that, there are several masks of the more traditional Nasal type that cover the nose and are completely non-invasive, like the N20, Wisp, Pico, and Eson 2.

For reference: ...

Thanks, looks like great ideas and much appreciated.

I'm not sure how to get my HMO onboard with trying so many masks, but I guess I'll have to take it one at a time.

Edit: After another night with the Dreamwear cushion, I'm finding it is far from immune from leaks for me. The first few nights I used it it seemed to have a great seal, but last night for whatever reason it was very leaky. So I'll have to do some experiments with that to see if that can be fixed. At one point I became aware that the head straps had gotten out of position and weren't holding the mask on tightly. However, of more concern was the fact that even when the straps were where they should be, I was getting an ongoing leak regardless of whether I tightened or loosened the mask. I'll have to look at that more closely.

[Coffee Man]

The N30i comes in medium frame and small frame. I got them both and use the small frame. The frame sizes seem to match the DreamWear frame size. So, if you try the N30i, I would say use the same frame size as the DreamWear. 4 cushions come in each N30i kit - 2 nasal cushions, and 2 nasal cradle cushions (these are the ones that are triangular in shape, and seem to seal reliably well).