Nasal pillow question....

[antcyd]

It's been a month since starting CPAP and am sleeping more through the night but still waking up alot because the nasal pillows are hurting the inside of my nose. How are they supposed to fit? How do you know if they are fit right? I went from a small to an xsmall so I am using the smallest ones. I am using AYR ointment as advised on here. I dont know what else to do. I DREAD going to bed every night....

[Dreamcatcher]

It's been a month since starting CPAP and am sleeping more through the night but still waking up alot because the nasal pillows are hurting the inside of my nose. How are they supposed to fit? How do you know if they are fit right? I went from a small to an xsmall so I am using the smallest ones. I am using AYR ointment as advised on here. I dont know what else to do. I DREAD going to bed every night....

Have you thought of trying a full face mask? It may solve your problems.

[BabyDoc]

My bet is you are using pillows that are too small. The pillows DO NOT go inside of your nostrils. The air opening in the pillows are to go over the outside of your nostrils. The silicone that surrounds the air opening rest outside on the skin part of your nostrils and provide a seal around your nostrils. The trick is to adjust the straps that go behind and under your ears just tight enough to keep the pillow in place on the outside of your nostrils and not too loose where you have leaks. If your pillows are too small or you tighten the straps too tight, the pillow will either be forced inside your nostrils causing mucous membrane irritation, or will cause pressure on the cartilaginous portion on the bottom of your nose and make your nose hurt.

If you need to error one way or another, I would use a larger pillow and loosen the straps. Move the pillow slightly from side to side until you get a seal on the outside of your nostrils. If everything is comfortable and you aren't getting a leak, try turning your head and see if it now begins to leaks. If it does, tighten the lower straps just a bit more to stop the leak, but stop tightening, the moment you are getting any discomfort. If you can get it to seal without a leak only when it is relatively loose, but begin getting leaks when you turn your head from side to side, you may want to try a chin strap in order to avoid overtightening the nasal pillow straps. A chin strap will wrap not only under your chin but will wrap along the side of your face, over the nasal pillow straps and will keep the nasal straps and pillow in place. I actually do this myself and have a 0.0 median leak. When I make bathroom trips during the night, I disconnect the small hose from the larger Climateline tubing. The pillows are still snug enough to avoid leakage but still moveable enogh that I can give my nose a rest and pull them up slightly onto the bridge of my nose, when I want to.

Again, remember these are pillows. Your nostril rests on the pillows. The pillows don't rest inside of your nose. Keep the pillows large enough for your nostrils to be able to do that. Keep the straps loose enought to be comfortable, but not too loose that they leak. If you can only avoid leaks by having them uncomfortably tight, be sure you aren't tightening the strap that goes over the top of your head. Tightening that strap too much will force the pillow upward into your nose or cause too much pressure on the cartilage of your nose. Work with the straps that go around the back of your head if you have to tighten any straps.

[mjbearit]

On my mask it would be very easy to put the section with the nasal pillows on upside down and since they are slightly canted in towards each other at the top part of your nose it would make a difference how they fit. This could cause pain I would think if they were in the wrong way.

Assuming this is not your problem (yeah, I'll assume I am the only one who put the whole mask back together upside down the first time and had to take it completely apart), nasal pillows are just not for everyone. Maybe you need a different type of mask. Or even a different type of nasal pillows. You should be able to get some help from your DME in the form of a different mask or whatever if you need it.

[JJJ]

On my mask it would be very easy to put the section with the nasal pillows on upside down and since they are slightly canted in towards each other at the top part of your nose it would make a difference how they fit. This could cause pain I would think if they were in the wrong way.

Assuming this is not your problem (yeah, I'll assume I am the only one who put the whole mask back together upside down the first time and had to take it completely apart), nasal pillows are just not for everyone. Maybe you need a different type of mask. Or even a different type of nasal pillows. You should be able to get some help from your DME in the form of a different mask or whatever if you need it.

You are not the only one who put a nasal pillow mask together upside down the first time.

I have used an Opus 360, a Swift FX, a Swift FX with Bella loops and a Swift LT. Getting a proper fit and adjusting the headgear to stop leaks when you roll over is really hard. And the slightest maladjustment results in a painful nose.

One thing the manufacturers need to do is make a dozen different pillow configurations. My nostrils are straight up and down, | |, not canted / \, but every nasal pillow I have tried has canted pillows. Plus, the pillows have too much space between the left and right side, as though they were designed for people with a wide septum. Giving the user more pillow options would help a lot.

And since I am griping, I also wish the manufacturers would provide pictures of the pillows so I could see exactly what they look like. Usually there is just one picture, taken at an angle, and it is impossible to see what the actual holes look like. So you buy the mask and discover the pillows were designed for some average nose that no one really has.

[PaulaO2]

My bet is you are using pillows that are too small. The pillows DO NOT go inside of your nostrils. The air opening in the pillows are to go over the outside of your nostrils. The silicone that surrounds the air opening rest outside on the skin part of your nostrils and provide a seal around your nostrils. The trick is to adjust the straps that go behind and under your ears just tight enough to keep the pillow in place on the outside of your nostrils and not too loose where you have leaks. If your pillows are too small or you tighten the straps too tight, the pillow will either be forced inside your nostrils causing mucous membrane irritation, or will cause pressure on the cartilaginous portion on the bottom of your nose and make your nose hurt.

@BabyDoc: Nasal pillows DO go inside the nostrils up to the first ring or bulge which is the part that creates the seal. Unless I am visually not picturing what you are saying, and unless I have been using them wrong for the past 9 yrs or so...

@antcyd: If you are experiencing nasal pain, you are probably using too small a size. I suggest going up vs going smaller. It could also be that you have an allergy or sensitivity to the silicone but I am betting you are using too small a size. It would seem to be counter intuitive but a lot of things about CPAP use are.

Which mask do you use? I didn't see where you mentioned that in this thread.

[antcyd]

I am using Swift FX. And what is hurting feels like the cartilige in the middle of my nose, on both sides. So the pillows are supposed to just rest under my nose, not in my nose?
Can I just tell you all how much I HATE my DME!!! Why dont they have someone show you how this stuff is supposed to work? I am so grateful to have found you all!!!

[PaulaO2]

A video on how to use the Swift FX. It has a good section on how to size.

http://www.youtube.com/watch?v=wcRRbCMu_tk

Yes, the first bit of the nasal pillow goes inside the nostril. How else would it form a seal? Nasal masks go over the nose and form a seal via pressure on the cheeks and the bridge of the nose. Nasal pillows form the seal by pressing on the skin just outside the nostrils or just barely inside, depending on the style.

[zonk]

It's been a month since starting CPAP and am sleeping more through the night but still waking up alot because the nasal pillows are hurting the inside of my nose.

sleeping through the night is a good indicator. You don,t get this problem with nasal masks might worth a try.

[bingo49002]

I can tell you that I wore the Swift FX too tight the first night and the bottom of my nose was sore for about an hour after removing. The mask should have come with 3 sizes, S, M, and large. I tried all 3 and settled with the M. Your leak data will tell the real story as to the correct fit. With the Swift FX, I found that for me the tighter the mask--the worse the leak. Good luck.