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Permalink Reply by Melodie on January 2, 2009 at 12:48am

Hi, this is Melodie. I first started out with a C-PAP and the ResMed Mirage Swift II Nasal Pillows, but the first RT gave me the "small" pillows and I really needed medium........I later got the medium and it fit better. About a month after being on the C-PAP, my Pulmonologist ordered a third sleep study and found that I have central sleep apnea, and changed me to the newest Respironics Bi-PAP Auto SV, which is bled into my oxygenator at a rate of 4 liters per minute, I also have the heated humidifier with my newer machine and am still using my ResMed Mirage Swift II nasal pillows.

I saw my Pulmonologist on December 31st and he had some newer masks and nasal pillow devices in the exam room I was in, and I tried on a new triangular nasal pillow mask by Respironics that did NOT make me feel claustrophic and gave me a much better seal, so I asked if I could try it - and the physician wrote the order for my DME (Durable Medical Equipment) supplier to bring me this newer nasal pillow-type mask early next week. I cannot wait to try it, and my physician said that it will keep me from getting the leakage I was experiencing with my current nasal pillows, as I am waking up with extreme "dry eyes", and the physician said that was due to leakage.

Once I receive my new Respironics triangular nasal pillow mask, I will let you and everyone else know how I like it and also provide the specific name/item number for it in case anyone else wants to try it.

Hope I have been helpful in some way.
Kind regards,
Melodie

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Permalink Reply by Melodie on January 2, 2009 at 1:04am

Rock,
May I ask which mask systems YOU prefer? I am curious to know with you being a registered Respiratory Therapist, exactly which mask systems you like the best and why.

I am extremely claustrophobic and cannot tolerate any type of face mask, that is why I was put on the nasal pillows right off. Also my DME supplier recently told me that about 85-90% of their patients are now switching from full face masks to the various types of nasal pillow mask systems as they as not nearly as "intrusive" as the full face masks are.

Thanks and I look forward to hearing about YOUR favorite mask systems!
Melodie

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Permalink Reply by Rock Conner RRT on January 2, 2009 at 7:15am

Thanks Sue!

Sue Ward said:

Hi. I first started out with the nose pillows. It dried my nose out and I got sores way up in my nose. So, I asked for a face mask. That was great but I did not have a heated humidifier and my mouth dried out so bad my tongue stuck to the roof of my mouth, and it was horrible. I talked with a friend and I found out that there are heated humidifiers. Now I have one of those heated humidifiers and am using the nose pillows again. It is great!!!! The air now has moisture that is warmer and it does not make my nose sore anymore. I was pulling the mask off in my sleep and throwing it. Last night I slept well and woke up feeling much better.

Hope this was helpful. sue w

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Permalink Reply by Rock Conner RRT on January 2, 2009 at 7:39am

Thanks for the input, Melodie. I hope that new mask is the one! Please advise on your experience with it.

I briefly describe & show out display of the three primary mask systems: full face mask, nasal mask, & nasal pillows. I try to be transparent with my bias when discussing mask options with patients, and give each patient enough info to empower him or her to decide what's best.

The seal of each mask can be expressed linearly. Just imaging cutting up the seal device & laying it out on a line. The full face mask has the longest seal. The nasal mask seal is shorter when laid out, & the nasal pillows seal is the shortest of the three. A shorter seal perimeter means less leak opportunity, so the nasal pillows win there. Further, the skin at the outside of the nares is relatively flat compared to the nooks & crannies encountered by the nasal mask & full face mask seals. Less leak opportunity & fewer pressure sore problems. Advantage again to nasal pillows. Finally, nasal pillows systems tend to have less restrictive headgear systems, so they are easier to don & doff. So nasal pillows are my favorite. That's what I wear when I'm not testing a new product, & that seems to be what a plurality of my patients end up using.

My favorite nasal pillows system is the Breeze by Puritan Bennett. It accommodates nares of differing diameters & set at unusual angles, is easily & quickly fit to each patient, & is as easy to put on & take off as a baseball cap.

Instructor bias is a factor, so I encourage everyone who fits xPAP mask systems to be aware of his or her bias & make efforts to get each patient into the RIGHT system, not your favorite.

Rock

There's not one mask system that's best for everyone, or I'd dump all the others & simplify my inventory! Full face masks are wonderful for folks who can't keep their mouth closed, even with a chin strap. There are reasonable people who just don't want anything stuck up their nose, and for them nasal masks are a good option. I ask how the titration mask was perceived, & go from there. If a full face mask was used & the patient complains of having felt claustrophobic, I emphasize the nasal pillow & nasal mask options. If nasal pillows were used in titration & disliked, I show the full face & the nasal mask

Melodie said:

Rock,
May I ask which mask systems YOU prefer? I am curious to know with you being a registered Respiratory Therapist, exactly which mask systems you like the best and why.

I am extremely claustrophobic and cannot tolerate any type of face mask, that is why I was put on the nasal pillows right off. Also my DME supplier recently told me that about 85-90% of their patients are now switching from full face masks to the various types of nasal pillow mask systems as they as not nearly as "intrusive" as the full face masks are.

Thanks and I look forward to hearing about YOUR favorite mask systems!
Melodie

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Permalink Reply by Melodie on January 2, 2009 at 9:33am

Rock,
Thank you so much for that fabulous description of how you go about fitting people for the various types of mask systems and the pros and cons of each! I wish there were MORE Respiratory Therapists out there like you!!!!!!!!!!!! The only choice I was given to start out, was at the hospital for my sleep study - and they first came at me with a full face mask, to which I had a full blown panic attack; then they came back with the nasal pillows, and that was perfect for me.

It has ONLY been in my Pulmonologist's office that I have seen some of the wide variety of various mask systems, and if you start asking him about them, he will explain what little he knows about them and let you try some on there. That is how I came across this new nasal pillows system I am getting!

I have a friend here in town that does NOT have a computer, but she was never fitted for any kind of mask and given no choice at all, and she hates the contraption that was given to her. She is also any oxygen patient and her DME-RT didn't even bleed her oxygen into her C-PAP, nor show her how to use any of the equipment! I cannot believe how she has been treated! To say the least, she is dropping her current DME provider and changing to the same provider that I utilize.

Again, thank you so much for your reply!
Melodie

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Permalink Reply by sleepycarol on January 2, 2009 at 11:34am

My favorite mask is by far the little known Aura/Headrest. I love that mask and wish the DME carried it!!!!!!

I have used this mask for 9 or 10 months and wonder what I saw in any of the other masks that I have used.

It is not for everyone and many do not like -- yet I feel it should be an option. It is light weight, little face contact, seals great, and easy to clean.

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Permalink Reply by Melodie on January 2, 2009 at 11:54am

sleepycarol said:

My favorite mask is by far the little known Aura/Headrest. I love that mask and wish the DME carried it!!!!!!

I have used this mask for 9 or 10 months and wonder what I saw in any of the other masks that I have used.

It is not for everyone and many do not like -- yet I feel it should be an option. It is light weight, little face contact, seals great, and easy to clean.

Carol,
Can you take or send a picture of your mask system? I would love to hear about it more and see it if possible. Where did you obtain it, if you don't mind me asking? Is it a form of nasal pillows? Please state the name of it again, with model number and item number so that I can look it up on Direct Home Medical on the internet, that is where I found the Snuggle Fleece Hose Covers. Here is their site: www.directhomemedical.com
You can purchase all kinds of equipment there, some you must have a physician's order for, such as the PAP machines specifically.
I would really like to know more about your specific mask system if you like it so well.
Thanks!
Melodie

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Permalink Reply by sleepycarol on January 2, 2009 at 12:00pm

Here is a link to the one I use: http://www.directhomemedical.com/masks-cpap-bipap/everest-headrest-...

Many "deconstruct" it taking the headgear off totally. I left the headgear attached and since the headgear is big (the only downside in my opinion) I use a headband stablize it. I put the headband from the front (right above eye level) and around to the back and tuck in the original headgear under the headband. I can toss and turn and it stays secure for me. The outlet for the exhaust is up higher and I like that. Some people have complained it is noisier -- but I haven't noticed it being any louder than my other masks.

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Permalink Reply by Melodie on January 2, 2009 at 2:56pm

Thanks for this info Carol! I will look up your particular mask system and see what I think. I see that you also utilize "DIrect Home Medical", I really like their site and have purchased several items from them. I love the cleaning wipes, and the Snuggle Fleece Hose Cover that I purchase from them!!!!!!!!!!!!!!! I use the wipes for my nasal pillows ONLY, and they are fabulous and handy..........
Melodie

sleepycarol said:

Here is a link to the one I use: http://www.directhomemedical.com/masks-cpap-bipap/everest-headrest-...

Many "deconstruct" it taking the headgear off totally. I left the headgear attached and since the headgear is big (the only downside in my opinion) I use a headband stablize it. I put the headband from the front (right above eye level) and around to the back and tuck in the original headgear under the headband. I can toss and turn and it stays secure for me. The outlet for the exhaust is up higher and I like that. Some people have complained it is noisier -- but I haven't noticed it being any louder than my other masks.

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Permalink Reply by sleepycarol on January 2, 2009 at 3:12pm

I don't use Direct Home Medical -- I just copied the link. I DO use this particular mask --just didn't get it from them.

They do seem to have a wide variety. I have purchased from www.cpap.com. They do offer price matching on items --means if you can find it cheaper they will honor the lower price.

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Permalink Reply by Mike on April 27, 2009 at 2:24am

My favorite masks are:

nasal pillows: ResMed Swift LT- ResMed Swift LT for Her
nasal mask: ResMed Mirage Activa
full face mask: i don't have a favorite full face mask

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Permalink Reply by Judy on April 27, 2009 at 8:12am

At my first titration we used the Breeze. I was okay w/it. BUT - I only slept 42 minutes out of 6 hours of bed time. *sigh* So they brought me back in for a second titration. We started w/the Breeze again but in short order I was getting tender & sore in the left nasal passage. *sigh* (I realize now it was probably the hose off to one side the most likely caused that). The tech switched me to the Fisher & Paykel HC 407. I only slept 98 minutes out of 6 hours bed time. *sigh* But they said the two combined titration studies gave them the 2 hours sleep they needed for Medicare and to determine what pressure I needed.

So - off to the local DME supplier's. I was prepared to ask for the 407 but saw the original Swift on one of the model heads and was impressed w/how little there was to it and asked for that one. It didn't take me long to determine that I HATED that side hose attachment.

Since the sleep lab had let me keep the 407 used during the last titration I used that instead. But, truthfully, the 407 was too long and NOT a good fit. I didn't know that the HC 406 was the same mask except smaller or I would have asked to try it. Instead the ComfortLite 2 was suggested. I rather liked the CL2 nasal pillows - UNTIL, due to the pressure NOT doing the job for me I was scripted a loaner APAP for 3 weeks.

I had been given the Resmed S8 Elite w/EPR I had asked for and the loaner was a Respironics pre-M Series Auto w/C-Flex and NO humidifier. I was told they didn't have a humidifier for it. Since the Resmed Humidaire 3i integrated heated humidifier can't be used w/a Respironics device I had to use the Respironics APAP w/o humidification. W/in one night I had very sore nasal passages. By the third night using the APAP was out of the question. I went into my sleep lab and told them what was going on. They were able to come up w/a passover humidifier to loan me. One night w/that passover and I was waking up COLD all over, not just my nose but ALL OVER, even w/TWO comforters, blanket, sheet and fleece PJs. The second night w/that passover humidifier was the FINAL disaster. My nasal passages were so chapped the air pressure was like pouring salt on a raw wound.

A friend I'd met on the TAS forum snail-mailed me his extra Fisher & Paykel HC 100 stand alone heated humidifier. I went 3 nights w/o that APAP and used the Ayr Saline Nasal Gel that had been suggested to me in the cpaptalk forum. Aahhhhh. Relief! Bless that friend and the HC 100! I could use the loaner APAP again. But NOT w/the CL2 nasal pillows. I switched to the simple nasal cushion that came w/it and much preferred it.

I probably used the CL2 3-4 months but the headgear just wasn't that stable. It was thinning my hair, breaking off the ends and causing my scalp to be quite sensitive. I had had some other problems not related to the mask or the humidifier w/this local DME supplier and was getting my 02 supplies from a different local DME supplier. I talked to them about the difficulties I was having w/the DME supplier I had gotten my Resmed from. I asked if they would be willing to supply my CPAP supplies (other than the Elite for which I was still stuck w/the original DME supplier) and when I explained my problem they agreed. They sent one of their staff to my house w/a carful of masks!! I tried several that they let me try for a week at a time. Once they showed me the Respironics Simplicity simple nasal cushion and I tried it I was hooked. I did have a problem w/the headgear being too big but it was a simple fix to "shorten" the center strap. I've used the Simplicity even since.

I have "trialed" both the Swift LT nasal pillows and the OptiLife nasal cradle cushion system and really liked both quite well. I still prefer my Simplicity but wasn't able to give the OptiLife a fair trial due to some needed pressure adjustments and the need for a reliable mask for accurate data. I'm going back to trying the OptiLife again. I want to fairly try both the cradle cushion and the nasal pillows. I don't really expect that I would permanently switch to the OptiLife from my beloved Simplicity - but one never knows!

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