Odd blockage of exhalation with P10

After weeks of sleepless troubleshooting& experimentation, I finally found a setup that works with excellent results: Airsense 10 with pressure relief on(setting6-14 mm, average pressure use 11.2) & airfit P10 with REMZzzs liner. Went from 26 events per hour to 1.8. However, at roughly 5 am(but not every night and with no discernible pattern), I am awakened by an intermittent inability to nasally exhale. Vents appear open(cleaned regularly with soft brush & I change the airsense 10 filter every 2weeks). It feels as though the nasal pillow cones are collapsing & since I find a couple of small water droplets in cones in the morning, I wonder if it is a surface tension effect. ( I prevent rainout using climate tubing with padacheek cover, tubular gauze on P10 tubing for insulation, adjusted humidity manually, and airsense 10 is below head level ) It is fine before I fall asleep. Neither the DME RT supervisors nor sleep MD know why. Anyone else have this problem, and has anyone found an explanation/ solution?

This isn’t a solution but a possible line of inquiry. At that hour, you are likely to be experiencing REM Sleep during which you may need much higher pressures.

Check your sleep study. If done in a lab, that number may be broken out separately. (My overall AHI was 19, but during REM it was 83.)

If you are experiencing apneas during REM due to the higher pressure needs, what would happen to the nasal pillows? Could the vacuum effect of an apnea make them collapse? I use a nasal mask, personally, and not the pillows, because they always felt too claustrophobic, but people who use them may have some other ideas….

I use the same machine and mask, and have not really had those issues. About the only basic thing I see different in your setup is that I put my humidity control on Auto. That should be the default setting. I find it works well and I have never had rainout other than once when I moved the machine perhaps a bit roughly when it was full of water. That certainly caused some gurgling and water carryover. I had to get up and dump the water out of the hose!

I have had something similar to what you describe was when I was first using this P10 mask and used a nose cushion that was too small and went too far into my nostrils. I find you get the most comfort and best function when using the biggest nose pillow size that still seals. Also, excessive tension in the headgear may be causing the nose cones to go too far in, causing them to collapse.

What is your EPR set at? The lowest exhale pressure will be when it is set at 3 cm.

Another thing you can do is download OSCAR. With OSCAR you can see what is happening during the night in breath by breath detail. It requires a PC or Mac and a SD card reader. If you need help using it or interpreting the results just post, ideally with a screenshot of the Daily Report of a night. You can zoom in on the areas of concern to see the real detail.

Hope that helps some,

Thanks for your thoughtful replies. I am waiting for delivery of a SD card reader and will see if OSCAR can help me figure this out. At first, I tried the extrasmall P10 pillow “for her”, which eroded my nasal septum. I have been using a small P10 pillow, since I tried the medium 2 months ago and lasted only 8 minutes with a medium with REMZzzs before my nose hurt and had to switch back to a small. I had previously used the automatic climate setting, but had turned the humidity down a notch in the hope that there might be less condensate in the cones — literally only 2 droplets. Never true rainout. But maybe enough surface tension to stick. Weirdly, when an exhalation blockage woke me up several mornings, I was able to break through with first a short inhalation followed by a forced exhalation. But it recurred intermittently while I was awake— so I don’t think this is a REM apneic-inducedvacuum effect. The RT had me switch to a Nuance— and it was even worse— an inhale- exhale could not blow through it. So I went back to the P10 …It’s only occurred 15 out of 63 nights used.all things considered , it’s been much less of a problem than the 6 other masks(2sizes of DreamWear, Airfit 30, Airtouch F30, F20, Brevida,Nuance) I’ve tried. But it’s got everyone baffled. I’ll post if I come up with something. & appreciate any other thoughts anyone might have.

Thanks, Sierra. I do have an old one and will try that. (It happened one time last night at 1:30 am and again one time at 2:05 am. ) The reason I use the nasal pillow REMZzzzs is that I developed pustules in my nose from the silicone( despite having washed the area with soap and water immediately before using the pillows and again each morning. ) I tried a full face mask for the next night to spare the area and ended up with a macerated nose and massive leakage to show for it. I had to skip CPAP for three days while I treated it and it healed enough to resume with the liner. I figured it was a sensitivity to the silicone. Yeah, I’ve had a tough time of it but am gutsy and stuck with it, with creative troubleshooting, as you can tell from my first post—using religiously for 7-8 hours every night from day 1 (even when miserable and sleepless to the amazement of my sleep doc) except for that hiatus of healing time until I finally found something that worked. I was an obligate mouth breather all my life , so went for full face first. Epic fail ( leakage unless straps tight enough to cause headaches, TMJ pain and pressure on carotids from straps) . Then tried nasal with chin strap, but woke up with swollen tonsils ( no joke). Went through 3 cervical collars before found solution with Releaf collar. Motivated because apnea diagnosis was prompted by 2 episodes of a fib, which has not recurred since started CPAP— and blood pressure normalized as well. What a journey.

My experience with the smaller pillows was the same as yours. The medium didn’t leak, though, just hurt the nostrils laterally. When I had the pustules, I scrubbed with soap and water, used Mupirocin ointment ( to cover nasal flora) and 1% hydrocortisone. Since using the REMZzzzs , I have minimal imprinting and if I do feel a little chafing (rarely), I use Lansinoh in the morning and wash it off in the evening before using the pillows.

I wonder if the mask might not be the real problem because if you experiment with the muscles in the back of the mouth and throat when breathing at just the right airflow against the machine you can get a door slamming effect that is not caused by the mask.

I used the Nuance for years and really liked it but ended up having to make adaptations to it and eventually abandoning it altogether.

Growing Noses

Size Matters

Replacement of CPAP Supplies

Sierra,I tried trimming the p10 cones on an old pillow I had saved, and unfortunately, the pillow wasn’t useable because the peak of the cone was what anchored the REMZzzzs liner in place. So I went back to my newer untrimmed one. Oh, well, it was worth a try. As luck would have it , no obstructions last night. It’s totally unpredictable. I have kept a detailed “lab book” and found no correlation of any kind. But recently, I’ve noticed it does seem related to whether I lie flatter rather than more inclined ( I sleep in a recliner). We’ll have to see if OSCAR sheds any light on this. Any idea how sneezes impact apnea-flagging? Had an isolated run of 5 sneezes and am curious how that may have impacted results. Have also noticed that there is poor linear correlation between the events per hour on the air sense 10 display and the total AHI trend. Also weird ( and no credible explanation from the MD, RT or RESMED) why there is*absolutely* no correlation between the air leak recorded on the air sense 10 and the MyAir app…, even accounting for average leak and 95%ile leak. Even as analyzed by a mathematician in the family. Machine always reads either 14 or 16 liters/ min and app records anywhere from 0-25.2 L /min. [I suspect the machine is in error, but it has been otherwise OK and I don’t want to rock the boat …2 weeks into CPAP, my first machine was clearly defective — controls did not work properly— and after the exchange , the data was lost from the first machine. But the DME twice contacted me twice, in August and yesterday that “I hadn’t used any CPAP “ because they didn’t seem to realize I was on the new machine….and had to reload the data. ] so I basically ignore the leakage data unless I feel a leak…Always something…

I may try just clipping a vertical slit in the cones and see if that helps… would possibly enlarge opening without really changing contour.

Used P10 small pillows last night with one small vertical slit cut into the end of each double cone, not changing the overall contour— a “relaxing incision”, if you will. At 5:30 am, I woke up with two very momentary blockages which instantly blew through with exhalation. As we say in the medical literature, “this is a small sample and further study is warranted”….but I am hopeful that I found a solution.

Yeah, I already tried that one. Dreamwear. Didn’t work. Had massive leakage unless straps compressed carotids. The snip was very small— maybe 1 mm or 2 at the most at the very tip. Didn’t affect cone structural integrity. Got great numbers—1.9 events / hour and 8.4 L/ min leakage.

Correction— that wasn't the carotid compressive one. Gave me headaches

There was also a resmed one. Also didn’t work

Just checked —The oval one is a philips dream station

Slits solved blockage problem -as long as I don’t lean too far back in recliner— guess is gravitational effect sleeping on my back. My guess is that side sleeping in bed would also not be a problem. Sierra, I just downloaded OSCAR and find the huge panoply of settings daunting. Do I just leave the default settings, or are there some I should change ?

Thanks,Sierra. I hadn’t even accessed the SD card yet when I was confronted with several tabs worth of settings. Will sit down and keep notes for questions.

OK. So I’ve imported all my data in ( an embarrassment of riches ). One problem I haven’t been able to figure out is that I configured OSCAR For Pacific time, my computer is set for Pacific time, but the data set seems to be coming out in Eastern time. Clearly, I can compensate by subtracting 3 hours, but when I’m trying to correlate times of cone collapse with events, it’s kind of annoying. Any ideas what I need to do to fix this?

Ummm…not about daylight savings time — is time zone issue…

Sierra, If it the air sense 10 that is set to eastern time, should I just change the OSCAR setting to eastern time to compensate. Or will that mess up the data.

Really odd: looking back, on the daily wave traces page, on some days the x axis lists military times ( not pacific) and on other days, today included, the x axis is labeled as actual time on the machine ( from t= 0 :00 to 9:01 hours). I had recorded on paper the actual time I started (PST) and when I turned off the machine to see how I could correlate events. What’s so weird is that I didn’t change anything in the settings and in fact I can’t see where one enters preferences for how the the X axis for time is labeled. Anyone know?