Soreness in and Around Nose with Various Masks

I haven't had any trouble adjusting to using my machine (Resmed Airsense 10) but do seem to be having trouble with comfortable mask fit. Have tried:

Resmed P10 nasal pillow medium - caused soreness just inside left nostril Resmed P10 nasal pillow small - initially seemed better, but same soreness inside left nostril after 4-5 hours leading me to cut CPAP session short (5.5 hours) Resmed nasal mask - caused soreness from mask pressing on my moustache after 4-5 hours leading me to take mask off after about 5 hours

Leak rate is very low, could be that nasal pillow is adjusted too tight, but I have separated the two bands as much as possible without improving the situation.

I haven't tried a full face mask, which is a possibility as I tend to be a mouth breather and sometimes am aware of a small amount of air leaking out of my mouth.

AHI the last 4 nights has varied between 1 and 3.75 with the vast majority of events central apneas so control of my mild sleep apnea is very good.

Suggestions appreciated.

I have tried 5 different masks so far, and I am back to the first mask I tried which is the same AirFit P10 you are using.

Tried a Mirage Quattro full face, and it was a disaster. I couldn't make it stop leaking. It blew air in my eyes and made rude noises. I never got to the point where I could wear it a full night.

I tried a ResMed AirFit F20 full face and it was better, and I managed to wear it a total of about 5 full nights. However it still leaked some, and when I got it to the point where leaks were reasonable it started to make a blister on the bridge of my nose. Gave up on it. I never tried the cloth mask liner trick, and that may have helped.

Also tried the ResMed Mirage FX Nasal mask that my wife uses. It was more comfortable than the two full face masks, but not nearly as comfortable as the nasal pillow, and had all the disadvantages of not covering the mouth.

Tried a F&P Brevida nasal pillow based on some rave reviews of it. It was pretty good and has a much better headgear with a sensible adjustment system compared to the P10. However, it seems to stick out more than the P10 and seemed easier to dislodge when changing positions at night. I had the fit pack and tried both the large and small. But, it in particular irritated the part of my nose between the two nares. I pawned that one off on my wife and she finds it much better than the Mirage FX. The small size restricted flow on exhale, but the large size works for her.

That brings me back to the P10 which I am using again after the mask merry-go-round. I had trouble keeping it on all night, and was opening my mouth letting air out and causing a major leak. I now use a Breathewear Halo chin strap and it sure keeps the mask on all night. It did not totally solve the mouth opening problem, so I reluctantly tried the tape on the mouth trick with 1" medical paper tape. I have now gotten very used to it, and have many night with essentially zero leakage. It is quite the Jerry rigged setup but it works for me.

As for the nose irritation I tried the medium and large insert sizes. The medium sealed better but seemed to go too far into my nose and irritated the skin quite a lot. The large is now working best for me. As for the nose irritation mine seems to be mainly on the exterior edge of the nares. In the morning after taking my mask off and showering I put some OTC 1% hydrocortisone cream on my nose. I found after doing that for a week or two the skin toughened up and I no longer need the cream.

Hope that helps some,

Your problem with the AirFit P10 is quite a common one. I hear it a lot. The only real solution is a different mask. Currently my favorite intranasal mask is the DreamWear intranasal, although you may find the under-the-nose version worth a look. Also, the Nuance is not bad. Both the DreamWear and the Nuance have gel pads in the nasal prongs which are gentler on the nostrils than the AirFit. Most of my patients prefer them. do a bit of googling to see what they look like.

Thanks for your suggestion sleeptech. I assume you mean the "Respironics DreamWear Gel Pillow CPAP Mask" as your favorite. I notice that the under the nose version, the "Respironics DreamWear Nasal CPAP Mask" has a lot more reviews on one site I went to (and people seemed to like it a lot), but for both noise seems to be an issue for many people. I can try a different mask within first 30 days with no charge so looks like I need to go in for a fitting.

PS The central sleep apnea problem is back again: https://myapnea.org/forum/puzzled-by-results-of-first-night-cpap-use

No matter what settings I tried last night I got AHI of between 10 and 20 with 95% of the apneas central. I felt like I couldn't get enough air at the lower pressure settings so increased the minimum pressure to 8 with EPR of 3. This felt the best but also had the highest AHI of around 20. For reference, my sleep study had AHI of 6.7 so I was a lot worse using the mask!

The input from this forum has been of far more help than I have gotten from Kaiser. I really appreciate the replies/suggestions.

Good one from a few days ago:

Bad one last night (only a small portion of the night as I kept trying different settings, but all settings tried were bad)

Flags on:

Zoomed in:

Zoomed in More:

I think you are right. I tried minimum pressure of 6 without EPR and then minimum pressure of 7 without EPR. Here is a short section when it was set at 7 (only tested for 9 minutes) in which I had AHI of 0. Unfortunately, I couldn't see that this section was zero until I went into sleepyhead today as it appears that the Airsense 10 only shows average for the whole night to that point. I am going to try minimum pressure of 6 or 7 tonite with EPR off.

PS Thanks again for all of your help.

Here is a graph of a 20 minute "nap" I tried to take just now. Toward the end I was drifting off to sleep. Minimum pressure set to 6, Maximum pressure set to 11, EPR off, ramp time off. Note that the pressure gradually drifted up to around 9. AHI of zero (but I wasn't quite asleep so not a particularly good test). I am a bit surprised the pressure went that high while I was not quite asleep.

I ended up trying different minimum and maximum pressures (I wasn't sleeping very well any way) last night. Setting minimum of 7 and maximum to 8 seemed to work for a while, then got a bunch of central apneas such that the whole section had AHI of 11.89:

I got disgusted and changed from APAP to CPAP with a set pressure of 7. Over a period of an hour and 40 minutes (last sleep section of the night) I got AHI of 0.61 with one central apnea and nothing else. There was a bit more flow limitation, but no hypopneas. Looks like CPAP 7 will be my setting for the whole night tonite.