Problems fitting nasal pillows

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Problems fitting nasal pillows

Postby cowlypso » Wed May 25, 2011 10:28 pm

I got the swift fx nasal pillows, because that's what I used during my titration study. I asked the RT at the DME about any other brands or options, since I had some problems during the study, but he said that everybody loves the swift fx and it's the best brand out there. He would not even show me any other options, just sent me home with the swift fx.

I've used them for 3 nights total, including the titration study. At the titration study, I used the medium size and woke up with a very sore left nostril. It took about 3 days for the sore to go away. The RT did give me both medium and small pillows to try. I tried the medium with KY jelly, but it still hurt the left side. I've slept the last two nights with the small size, which doesn't bother my left nostril at all. However, I think it's too small for my right nostril, since I've been having problems with leaks on the right side only. Honestly, I think what I need is a set of pillows with a small on the left and a medium on the right, but I don't think those exist.

I saw my doctor today and she was concerned that the leak is causing problems. My leak rate was overall around 25 for both nights, but the second night there were several periods where it went higher, up to 50. I also had double the AHI the second night, which is why the doctor was concerned.

I have an appointment with the DME tomorrow afternoon to work on this issue. Any suggestions to get the swift fx to work for me? I really like the minimalist design. Other brands of nasal pillows that might work better? I don't know that I can deal with a regular mask. I tried a nasal mask the night of my titration study, and it was awful. I have some sensory issues, and the mask pressing on my forehead along with the air blowing on my nose drove me nuts.

I'm a bit worried, because I keep getting different answers from my DME depending on who I talk to about their mask policy. The one lady I talked to before I got my machine said that technically there is no limit on how many times you can exchange masks, but it's got to be reasonable. The lady I talked to today said that you're only allowed to try two different masks, and after that you have to buy them out of pocket or wait until your insurance will cover a new one. If that's the case, I'm really mad that the RT didn't listen to me and sent me home with a mask that I had problems with at the study, since he essentially used up one of my two free trials.

What if I exchange the swift fx for another mask, and then find that the other mask is worse? If the lady I talked to today is correct, then I'm pretty much stuck with the next mask I take home! Is there any way to get them to just hold onto my swift fx mask there for a week while I try the new one, so that if I decide the swift fx was better I can go back to it?
PR System One REMstar Auto set as CPAP at 8
Opus 360 nasal pillows
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Postby LTee43 » Wed May 25, 2011 11:36 pm

I have a nasal pillows mask and liked it immediately. It might be a fitting problem that your DME can help you with. It came with the 3 sizes of nasal pillows and I was fitted with the medium and the small also fits. The nostril discomfort you describe is basically wind burn! Like I said, if you can get a proper fit, you should do better with the mask.

Most plans give you a 30-day trial period, which I took when I did the transition from the nasal mask. I didn't ask about any what ifs... luckily it worked out for me.

LT
No, I wasn't sleeping. I was checking my eyelids for pinholes!
Equipment: Resmed S8 Escape, Resmed Swift Fx 61500 Nasal Pillows Mask
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Re: Problems fitting nasal pillows

Postby DougVK » Thu May 26, 2011 4:26 am

cowlypso wrote:I got the swift fx nasal pillows, because that's what I used during my titration study. I asked the RT at the DME about any other brands or options, since I had some problems during the study, but he said that everybody loves the swift fx and it's the best brand out there. He would not even show me any other options, just sent me home with the swift fx.

I've used them for 3 nights total, including the titration study. At the titration study, I used the medium size and woke up with a very sore left nostril. It took about 3 days for the sore to go away. The RT did give me both medium and small pillows to try. I tried the medium with KY jelly, but it still hurt the left side. I've slept the last two nights with the small size, which doesn't bother my left nostril at all. However, I think it's too small for my right nostril, since I've been having problems with leaks on the right side only. Honestly, I think what I need is a set of pillows with a small on the left and a medium on the right, but I don't think those exist.

I saw my doctor today and she was concerned that the leak is causing problems. My leak rate was overall around 25 for both nights, but the second night there were several periods where it went higher, up to 50. I also had double the AHI the second night, which is why the doctor was concerned.

I have an appointment with the DME tomorrow afternoon to work on this issue. Any suggestions to get the swift fx to work for me? I really like the minimalist design. Other brands of nasal pillows that might work better? I don't know that I can deal with a regular mask. I tried a nasal mask the night of my titration study, and it was awful. I have some sensory issues, and the mask pressing on my forehead along with the air blowing on my nose drove me nuts.

I'm a bit worried, because I keep getting different answers from my DME depending on who I talk to about their mask policy. The one lady I talked to before I got my machine said that technically there is no limit on how many times you can exchange masks, but it's got to be reasonable. The lady I talked to today said that you're only allowed to try two different masks, and after that you have to buy them out of pocket or wait until your insurance will cover a new one. If that's the case, I'm really mad that the RT didn't listen to me and sent me home with a mask that I had problems with at the study, since he essentially used up one of my two free trials.

What if I exchange the swift fx for another mask, and then find that the other mask is worse? If the lady I talked to today is correct, then I'm pretty much stuck with the next mask I take home! Is there any way to get them to just hold onto my swift fx mask there for a week while I try the new one, so that if I decide the swift fx was better I can go back to it?


That sounds absolutely ridiculous, did you tell him you had no interest in nasal mask, full face mask, nasal prongs, or a hybrid mask? If not then how the heck would he know what mask was best for you. He could have at least had the decency to let you try on another nasal pillow or another type of mask. I would file a complaint. Absolutely ridiculous.
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Postby Janknitz » Thu May 26, 2011 5:46 am

First, it sounds like the Swift FX was not fit correctly. It should NOT cause your nose to be sore. I'm posting the fitting tips from my blog below.

Second, ResMed which manufactures the Swift masks has a return program. If you cannot get the mask to work after trying the fitting techniques, you need a new mask. If you return a ResMed (or other major manufacturer's) mask within 30 days to your DME, the manufacturer will credit the DME and you can try another mask for free. Some DME's are too lazy to do the paperwork, and don't want to swap out the masks, but they are not going to lose money if they do. The trick is to find a DME that's willing to work with you to find a mask that works best for YOU. The mask is the key to therapy. If it doesn't fit, it leaks or hurts, you are not going to get good therapy from your machine.

Try to be polite but firm with the DME--tell them this mask is not working for you and you need to try something else. You expect them to take this mask back and let you try another. (BTW, you should be able to try on and try as many masks as you need until you find one that works--any limits are artificially set by the DME).

Now, before you give up on the Swift, one more try at a good fitting:

Fitting the Mask

Preparation:

With the mask off your face, loosen all the headgear straps.

1. Hold the nasal pillows up to your nose. Don’t put the headgear on yet.

2. Turn on the machine, allowing the nasal pillows to fully inflate.

3. Now put the headgear over your head.

4. Tighten the headgear just enough to stop any leaking. The headgear should be fairly loose. If you can’t get the leaking to stop, trying going UP one size in the nasal pillows and start again.

5. Once you’ve gotten the leaks to stop, lie down in your normal sleeping position and re-adjust the straps as necessary. Remember, the nasal pillows must be fully inflated, and the only way to ensure that is to keep the fitting as loose as possible.

Hint: I sleep almost exclusively on my right side, and I find loosening the strap just a bit on the right while tightening it just a bit on the left compensates for any displacement of the nasal pillows by the bed pillow.

Because this mask fits so loosely, it’s easy to dislodge the nasal pillows. Try these hints:

1. Sew a bit of Velcro hook tape (the stiff side) inside the back strap of the mask. This will keep the straps from sliding around when you move your head on the bed pillow.

2. I find that the weight of the slinky hose causes the nasal pillows to pull away from my nose. I use a hose hanger (hose management system) to hang the hose overhead, and that eliminates this problem. It also points the vents up and away from me and my bedding, an added bonus (I’d love to shoot the person that thought the angle of these vent holes was a good idea on this mask!).

3. Some people (not me) find that using something on your nostrils helps get a better seal. Use a non-petroluem product like Lanisoh cream, KY Jelly, or Ayr Gel. I think this makes the pillows more slippery and contributes to the problems, but others disagree.

You might find your nose a little sore the first night or two, but it should not really hurt and there should be no pressure on your nose. If so, it’s TOO TIGHT! Loosen things up a little.
Phillips Respironics System One Auto A-flex and Humidifier
Encore Viewer 2.0 Software
Swift FX
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Postby cowlypso » Thu May 26, 2011 2:56 pm

I went in to see a different person at the DME today, and she was very nice. She listened to all of the problems I was having with the swift fx and asked a lot of questions. Then she came out with the opus 360 pillows. I'd been looking at the other brands of nasal pillows on the internet, and I honestly never would have thought to try that one because the hose going up over the head looked uncomfortable. But I tried it on, and it felt great. No irritation of my nose, and she had me go back in the recliner to test for leaks. I thrashed my head all over and smooshed my cheek against the recliner and had absolutely zero leaks. I liked the feel of the mask better than the swift fx, because the mask doesn't touch your upper lip at all. I was also pleasantly surprised to find out that you don't have to have the hose secured to the top of your head, you can also just let it dangle.

Extra special bonus: Resmed does not require the DME to send back the swift fx for them to get their refund/replacement. So I got to keep that one too. Can't complain about having a backup!
PR System One REMstar Auto set as CPAP at 8
Opus 360 nasal pillows
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