Nasal pillows harder to use?

[allanri]

I've tried using a nasal pillow mask a couple of times, but I find them much more difficult than full face masks, or nasal masks.   The pressure against exhalation seems much much higher than it does with other masks, even with the machine set to the correct mask. Is this normal?  These masks seem much more comfortable to wear during the night, but for me, anyway, breathing seems much more difficult.  Comments?

[upsman]

Actually, I find that nasal pillows are the least intrusive and work better for me. I don't notice the exhalation effort at all when I use mine. Most of the time I hardly even realized I was wearing a CPAP mask. However, the deal breaker is the irritation I get when using this mask. I have used the Lasinoh cream and it doesn't seem to do much good. So I now use my N20 nasal mask exclusively and get pretty much the same therapy and treatment.

It's quite possible you may need to further adjust your comfort settings to eliminate this problem. I'm not knowledgeable enough to suggest any changes, but I would start there.

[Walla Walla]

Normally pillow masks require 1cm or 2cm less pressure than a full face mask to get the same results.

[SteveMac]

Is your machine set to "pillow" type of mask in the settings?   Have you considered adjusting the EPR setting?  Have you considered using APAP mode instead of CPAP, with a lower base pressure (assuming your machine is an Autoset, not entirely clear in your profile)?

[sonicboom]

Actually, I find that nasal pillows are the least intrusive and work better for me. I don't notice the exhalation effort at all when I use mine. Most of the time I hardly even realized I was wearing a CPAP mask. However, the deal breaker is the irritation I get when using this mask. I have used the Lasinoh cream and it doesn't seem to do much good. So I now use my N20 nasal mask exclusively and get pretty much the same therapy and treatment.

It's quite possible you may need to further adjust your comfort settings to eliminate this problem. I'm not knowledgeable enough to suggest any changes, but I would start there.

The Brevida pillows mask is made of soft gel and should not cause nasal irritation.  Give that a try.  I also found that it is also easier to exhale with this mask than the P10s.

[Stom]

The Brevida pillows mask is made of soft gel and should not cause nasal irritation.  Give that a try.  I also found that it is also easier to exhale with this mask than the P10s.

Interesting. For me there are several issues, pro and con, with pillows over regular nasal and full face cushions.

• Inspiratory flow restriction reduction in nostrils. With pillows, my nostrils (which normally collapse if I breathe in to hard) get nicely splinted open with PAP. That makes it way easier to breathe in. Same goes for congestion. Pillows power through congestion better for me than nasal cushions and full face masks.

• Expiratory flow restriction - small nasal pillows feel harder to breath out of to me. The Brevida has cones with small openings, and can, at times, feel harder to breathe out of than it should.

• Elasticity - the nasal pillows can sometimes feel like a pile driver to me. The EPR seemed harsher with pillows than with nasal and FF masks.

[sheepless]

when I was using apap and nasal pillows I found it difficult to intolerable when exhaling against pressure above 13cm. only ever used airfit p10 so don't know how it compares to other types of masks. however, epr made exhaling at higher pressures (any pressure actually) much easier. mildly sore nose quit being sore after after the first week or two. I've never noticed any kind of mask movement coming from machine pulsing.

mouth and lip leaks are common and difficult to tame, but it can be done. unfortunately, none of the ffm's they tried on me during my in lab titration would seal against my beard so options for me are limited.

allanri, did you have the same complaint with each of the different size pillows? also, if too tight (pillows slightly compressed) or not aligned just right, impedance may increase.

otherwise, if ffm & nasal masks work better for you, stick with those.

[allanri]

Thanks for your thoughts, everyone.  

Sheepless, I have tried the small and medium sized pillows for my AirFit P10 mask; both seem restrictive when exhaling. 

SteveMac, yes, my machine is set to "pillows"; I've tried with EPR on and off, and I can't actually detect any noticeable difference.   I haven't tried APAP yet; I'm still trying get my pressures to decent levels (still have a nightly AHI of 10 or so) before I start tweaking things. 

Walla Walla, does that mean one should lower the pressure when using pillows?  Doesn't the machine's pillows setting take all that into account?

[Walla Walla]

[quote pid='269747' dateline='1535142395']
Walla Walla, does that mean one should lower the pressure when using pillows?  Doesn't the machine's pillows setting take all that into account?
[/quote]

Just going by what I've experienced. Whenever I have switched between the two types of masks I've had to make a pressure adjustment. I'm probably wrong but I think the mask setting has more to do with leak reporting and tidal volume reporting.

I'm sure someone will correct me though.

[Mosquitobait]

I had some troubles with pillows until I found that going a size larger improved the fit. Your fixed pressure of 10 shouldn't be an issue. It could simply be the architecture of your nose and face.

The thing is, most people manage pillows fine, but there is a large percentage who never get used to them. Consider a nasal mask then. Still lightweight, still not quite an iguana on your face, but maybe more workable.