Need Help with Nasal Pillow Comfort

I am a dentist working in dental sleep medicine. One of my patients needs to use CPAP very badly, but is currently having tissue sensitivity and chaffing under his nasal pillows. I know about CPAP Moisture Therapy Cream and using the pillows off and on to toughen the skin of the nares. Do any other fixes come to mind out there? Any help greatly appreciated. a.b.luisi,d.m.d.

Thanks for joining us here! Do you and your colleagues get questions about CPAP frequently? Do you notice issues with the interface and initiate the conversation or does the patient?

You can search on CPAP liners to find some options. Some CPAP users have sensitivities to the materials used so changing brands or type of pillows might help. Some pillow users rotate between a mask and pillows. The CPAP provider sees many many patients and might be a good source of information for you. Do you think dentists in sleep medicine have enough resources available to them?

Thank you for the reply. It was helpful. Yes, sleep dentists do get questions about CPAP. Many times, potential oral appliance patients are thinking about transitioning off CPAP or have proven to be CPAP intolerant. I always take the time to ask patients about what their experience with CPAP has been like and what problems, if any, have occurred. The answers will often give me insight into the level of motivation of the patient. For instance, if a patient has tried very, very hard to adapt to CPAP, but ultimately failed, that would indicate to me that he or she will also be diligent about adapting to the oral appliance and will probably succeed because it is much easier to do. Many other patient CPAP observations will also transfer to the OA experience. Personally, I have taken the time to understand CPAP both technically and emotionally. I think that patients would expect a sleep dentist to be conversant with it. However, I do believe that at least some sleep dentists do not have an adequate understanding of CPAP. Do I think dentists in sleep medicine have enough resources available to them? I think that they absolutely do not have enough resources available to them. You are not really supported by the medical community. Regular general dentists are totally indifferent to what you do. Educational opportunities are very limited. Much progress remains to be made. a.b.luisi,d.m.d.

Hello Dr. Luisi. Apart from what you mention you have have already done, and the great tips by "MakeSleepAPriority!", some things that might help (and some/many of these may already have been tried) include:

1. Treatment of any coexisting nasal congestion/ rhinits
2. Ensure that the patient has a heated humidifier, and is adjusting the settings for optimum comfort.
3. Using a different product to clean the mask (possible allergy to the current product).
4. Minimize air leak: consider lower pressure or APAP or BPAP, if appropriate.
5. Washing/ cleaning the face before putting on the mask at night and after taking off the mask in the morning (especially with oily skin and sores/bumps on/around the contact area).
6. Prevent nose 'trauma' as by exposure to the cold weather (like the one ravaging the East Coast nowadays)
7. Soaking the pillows in warm soapy water before use (albeit at a risk of reduced mask life). Best regards!

Dear Rohit, Thank you for those great tips. I have been extremely pleased with the response to my question. Isn't it amazing how effective the collective intelligence on these forums can be. a.b.luisi,d.m.d.