Opinions, Will this mask work for me?

[robysue]

That is the PRIMARY CHECK I make during the night -- almost any other fiddling with the mask will move the pillows, especially if you do it AFTER they are inflated under pressure.

I find the easiest way to adjust the pillows during the night is to gently tug them away from my nostrils for just a tiny bit and then allow them to settle back down. It's easy and reliable for me. It's the same maneuver I use to adjust the Swift FX pillows.

Go to bed and avoid "bumping" or moving the mask around as much as feasible.

It is almost impossible to replace the correctly size pillows while under pressure IF you get them moved. Just get up and go back to the bathroom until you learn to avoid this.

This is NOT my experience at all. If my P10 (or FX) pillows do get knocked around when I'm sleeping, all I have to do is tug them them gently away from my nostrils while the machine is still running at full pressure and I am still lying down in my preferred sleeping position and I then let them settle back down against my nose. The whole process takes less than 10 seconds; 20 seconds if I have to tug them twice.

Last night, when I "fixed" the pillow position, I did an 'extra maneuver' which works but may not be pleasant.

Basically, I just made a loose fist and brought it up to my nose as if covering a cough and TAPPED the darn thing back in.

I seldom dislodge the mask but it happened last night and this "tap" basically just FORCED the pillows deep into my nose. This is not the most comfortable position but it works and since I was barely awake, it was no problem to just go to sleep and leave them that way.

The nasal pillows should NEVER EVER be FORCED deep into the nose. If that's the only way you can get the pillows to seal, you've either got the wrong size pillow (most likely too SMALL of a nasal pillow) OR you've got the headgear adjusted incorrectly OR you've got the pillows at the wrong angle.

Note: It's not terrible uncomfortable but it isn't the IDEAL position -- however it is VERY tight against leaks

When the pillows are seated in the IDEAL position, there should be no discomfort AND you should still get a VERY tight seal. And they'll also be pretty resistant to minor jostles and bumps because the double cone will be properly inflated. And that's what makes the seal for the P10 and the FX: The double cones have to have room to properly inflate against the outside edge of the nostrils.

Also, the masks with a swivel have MORE projections that are hard and solid versus the almost immediately soft and flexible hose on the P10.

Personally I find the wide hard "pillows base" on the P10 a bigger and more bothersome "hard projection" than the swivel piece at the top of the Swift FX's short hose. If the P10's exhaust vents were not so good at diffusing the jet stream that characterizes the FX's exhaust venting, I'd not even be bothering with the P10 at this point---primarily because it has more "hard parts" than the FX and those "hard parts" are much more irritating than the FX's one hard part---namely the swivel.

[robysue]

Marnid,

It just occurred to me that there's another thing you need to check as a possible cause for some of your leak problems.

Both the Swift FX and the Airfit P10 pillows are designed with a double cone. It's not uncommon that one or both of the inner cones to become inverted. And it's also not uncommon for a user to not notice the inverted cone. But when the cone is inverted, the pillow does not seal correctly and sometimes the symptom is a leak that seems to be impossible to find (because it feels like it's just part of the intentional exhaust flow). Sometimes the symptom is that the pillow just doesn't "feel right".

So inspect the inner cones of your mask before you put it on and make sure they're not inverted.

[Marnid2014]

Marnid,

The Medicare bean counters are going to look at compliance hours and nothing else. The DME will notice and whip you soundly with a wet noodle when (if?) they recognize you changed the pressures on your own because that denies them the chance to charge somebody for the 10 seconds of work. The doc may need to be reminded that he gave you permission to change the pressure back down, but after that won't mind.

It sounds to me like you over reacted to the "apnea you remembered" and jumped the gun in deciding that you needed more pressure. And the higher (and unnecessary) additional pressure started causing far more problems (in terms of leaks) than it fixed (in terms of reducing an already very low AHI any further).

So my advice: Change the pressure back down. If you have a few events here and there, don't get too worried about them. If you wake up thinking you've just had an apnea, turn the machine OFF and ON to make the wake easy to find the next morning when you look at the data. If this kind of thing is OCCASIONAL, don't make a deal out of it. If you start waking up several times a NIGHT with this kind of feeling on multiple nights during the week, then you've got a bad trend and it's worth thinking about increasing the pressure.

For what it's worth: I do think you'll be able to make the P10 work for you. Remember that you don't have to have a near perfect leak line. You only need a good enough leak line AND sleep. If the leaks are below 24 L/min for the most part AND you're sleeping through them, don't worry about them too much.

In particular you write:

Mr. Smiley showed up both nights. It's a bit hard for me to make a good judgement, but it looks like most of the night I was almost at 0 leak and it peaks for say, 40 seconds and then goes back down to 10, 0, 15, and stays there and then peaks again for 60 seconds etc.

You can ignore leaks that are in the 10-15 L/min range as long as you are sleeping through them.

If the really large peaks (the ones above 24 L/min) are short lived (like less than 2 or 3 minutes) and you are sleeping through them, you can ignore them too---unless they're so numerous that it looks like you're spending significant time above 24 L/min. Use Mr. Green Smiley for getting a handle on this: If he shows up and you don't see any prolonged periods of Large Leaks and you are sleeping through them.

For now only worry about leaks if Mr Red Frowny starts showing up OR if they're constantly waking you up.

Thanks so much. I am going to change it tonight and see where I am with this. I totally agree with you and that is my instinct as well, I guess I am being a little over the top with this at times, I think just having been through this darn Afib thing has thrown me for a loop, I know more than ever a good night sleep is imperative and I just want to make sure I am good with this leak thing. As long as Medicare doesn't take my machine from me, I could care less about the DME, I need to do what is best for me. Oh, and I do check about the pillows being inverted, they are alway's ok so who knows where this is coming from

Thanks

[herbm]

robysue: GOOD POINT about the "double cone" -- I wonder if that is where some of the phantom whistling people report originates.

I agree about not forcing the pillows into the nose -- this was just a case of being mostly asleep and the rare (first?) occurrence of losing my seal so without waking OR THINKING, I just bopped it -- woke up just enough to thing, "Gee, that's not the way I like to wear it; and you know, that ain't bad, so go back to sleep. Snooze..."


Last night, for the VERY FIRST time, I must have knocked the mask off my face and head.

I was awakened by a giant leak, thinking my mask pigtail hose had come out of my machine hose.

Naturally, the mask is so comfortable and "not even there" under normal conditions that it didn't occur to my half asleep brain that it was OFF.

Feeling around, I realized the hose was intact and followed it up with my hand until reaching the mask and realizing it was off.

Shoved it back over my head, and pushed the pillows in for a nice seal and went back to sleep.

My only other though was, "Gee, wonder how long it was off."

Checking SleepyHead this morning show a 22 minute gap in the flow (including the attempt by the machine to figure out what was happening.)

Maybe my head gear is stretching out -- I have been playing with it trying to answer questions for people about how to wear it.

Also, I discovered (and likely long time nasal pillow users know this even though I have never seen it posted):

When taking the pillows out in the morning, do NOT (necessarily) just pull them straight out together. Instead, carefully work them lose and out so they don't pull or tug by catching in your nostrils.

Turns out that the primary (minor) discomfort for me was caused by REMOVING the pillows too abruptly, to many times.

[Marnid2014]

The DME came this morning and reset the clock and put the machine back to 6. I am going to see if this gets me back to where I was originally with hardly any leaks and low AHI. Now at least with the clock not being off my 3 hours, I can see what is going on. I will watch this for about a week and see what goes on and if needed then I will change my pressure to 7 and then see what happens. Last night I tried the FX for her again and it was not bad,


AHI 0.61
AVERAGE LEAKS 5.03
95% 15.60
MAX 19.20.

The worse leak I can account for, I was messing with the mask at the beginning of the night, from there, it settled down

[Gabby]

The DME came this morning and reset the clock and put the machine back to 6. I am going to see if this gets me back to where I was originally with hardly any leaks and low AHI. Now at least with the clock not being off my 3 hours, I can see what is going on. I will watch this for about a week and see what goes on and if needed then I will change my pressure to 7 and then see what happens. Last night I tried the FX for her again and it was not bad,


AHI 0.61
AVERAGE LEAKS 5.03
95% 15.60
MAX 19.20.

The worse leak I can account for, I was messing with the mask at the beginning of the night, from there, it settled down

I'm pleased you have your machine sorted, lets hope it will be smoothe sailing.
Have you given up on the AirFit P10 for now?
We have to do what we have to do...as long as you are comfortable.

[Marnid2014]

The result:

The DME put my machine back down to 6 pressure and I wore the P10 last night, the results were very good so I think I am on my way.

AHI 1.0
MED 1.20
95% 9.60
MAX 13.20

One of the supposed "apneas" did not happen since it flagged, but there was nothing really there. Some of the leaks were at the end of sleep when I was adjusting the mask so they don't count either. All in all I think it was a success. We will see how tonight goes. I know that going down to 6 has helped for sure.