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Nasal prong and nasal mask fitting -- seal question. Help me save my dad!
My dad's 72 and recently started using a CPAP -- he was having some serious short term memory problems (long term was fine), and a neurology study revealed some apnea. It makes a significant amount of difference, but he hates it, and the medical supply company is of little help unfortunately. He is very lucid when he's been wearing the mask and sleeping. He is sandbagging on using the CPAP, complains about it constantly, and I have to basically convince him that he needs to be doing this for his health. Luckily, he is willing to give it a try, but he gripes about it constantly. He does know that I'm taking an interest in it, though, because I downloaded Sleepytime (thanks, by the way), and am able to pull his numbers easily.

I have a few concerns about the mask fittings, though.

His nasal masks (the normal Philips Respironics translucent mask and the ComfortGel -- the blue gel one with the tiara with the blue pads) cut the bridge of his nose and the ComfortGel gouges the very tip of his nose as well. "Large" was the largest size they had in the medical supply. I'm thinking of seeing if they can get him an XL. Anyone have any experience with this? I only hope they can exchange it. They fit him for a mask in the company, but you can't tell if it's going to gouge him unless he wears it while sleeping.

Nasal cushions don't seem to work due to the shape of his nose.

First question... should an L nasal mask be wearing a sore every night on the bridge of his nose where it touches his skin? Would an XL do the same, or do we need to invest in something like a nasal pad?

He has a pretty big nose. I was surprised that the tip of his nose was rubbing the bottom of the ribbed area on the ComfortGel.

Second question is about nasal prongs and proper fitting. Sleepyhead Dad's AHI numbers are on the whole better (by about 1 point) with nasal prongs than a nasal mask. He doesn't have the sore on his nose if he uses the prongs. The problem is, the bulbs/nipples on the prongs where the air comes out tends to not go up his nose and seal, they just sort of point into it and don't appear to form a seal between nostril and prong. You can see a small gap between his nostril and the prong. I've been staying with him to observe him (he's been on it since end of June), and tightened his mask down last night so there'd be no gap between his nose and the prong.

He complained about the straps hooking his ears and the tightness of the mask, so I wanted to ask the community if I really need to pull it that tight.

His AHI was about 3.5 last night with the tightened prongs, down from 4.6 the night before with the nasal mask. He had 0% large leaks with the nasal mask that cut his nose, and 14% with the prongs, which would account for about one hour. When I checked on him and saw the aforementioned space between the prongs and nose, I woke him up, cinched him to a full seal, and let him go back to sleep. He had the gap for about an hour, so that might account for the 14%. Or maybe not.

We're trying many things and seeing what results in the best numbers, fewest leaks, and most comfort.

I would appreciate any feedback you can offer on how to help him adjust to this. I realize that it's a bit difficult since I'm writing on his behalf, but I'm sure that if it improves his quality of life, he'll appreciate it too.

Thanks for helping me save my dad.
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Has your dad tried the Respironics Optilife nasal pillow mask? It comes with four different sizes of pillows that should accommodate everyone's nasal openings.
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After looking at the photos online, I believe that is actually the one he is using -- I referred to it as prongs, but it's the same mask and headgear.
However, they only gave him one set of the pillows at the supply company. He's on a fixed income and mostly bound by what the insurance can pay for.
I'll have to check and see what size he's currently using.

I'm a little concerned that the supply company is going to balk at doing exchanges. But they should be fitting him correctly, shouldn't they?
It's not like they've fit him and then watched him sleep.
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Hi weeabooshogun,
WELCOME! to the forum.!
It's great to hear that you are willing to help your dad with CPAP therapy and taking an interest in his care.
I know it's a challenge but at least he is trying to use the machine even though he complaines a lot about it. Just keep trying to encourage him to keep using the machine..
Hang in there for more answers to your questions and best of luck.
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I have only been at this two and half weeks myself. I have tried two different full face masks, one hybrid full face mask, and an oral (like a scuba regulator). Just last night I tried an Opus nasal pillow. Each and everyone of them did the job in terms of controlling the apnea. They all have their shortcomings and none of them stands out in the comfort arena. Most are tolerable, but for me it comes down to comfort. The oral was most uncomfortable, could not swallow and woke up with a sore mouth. So it looks like I will have long road to travel until I get what I want, if I ever do. I guess I am just trying to say that I understand your fathers gripes. Hang in there and try as many masks as you can. And try them more than once. Sometime it is just a matter of how tight the head gear is. Try a different tension each night, but starting out as light as possible and in the sleeping position. It will act differently if you adjust standing up.

Good luck to you and Dad.
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Thanks everyone for your very kind comments.

The nasal mask he's using is the TrueBlue, and that's the one that he says cuts the bridge of his nose (it does, he developed a sore) and presses against the tip (don't know about that).

He's had some luck with a nasal pillow, if we can get the right fit.

I think that my interest in this is a good encouragement for my dad to keep trying, trish6hundred. He complained today that the nasal pillows push his nostrils out, but there are some things I think he's just going to complain about regardless until he gets used to it. It's a piece of soft rubber, I doubt it's going to deform the shape of his nose.

We got him down to 2.9 AHI last night with 1% large leaks with about 8 hrs, 30 minutes of usage. That's only about five minutes of leak time, and he said he got up to go to the bathroom a few times, so maybe that's what happened. I told him I was really impressed with him. He really is a different person when he's been using it.
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Hi weeabooshogun,
If he will just keep trying them, he'll eventually get used to them. Is he complaining about irritation from the pillows?
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You dad is lucky to have someone like you to take an interest in this. It is difficult but I started 6 weeks ago and only in the past week or so (I hope) am beginning to see results. Still fighting the mask sometimes. I guess persistence is the only thing that works for all of us.

I will let others more experienced than me make any recommendations. Good Luck!!!
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I'm pretty new at this but love my Swift FX nasal pillows. Also, wondering if he is over-tightening. Sounds like maybe. Keep encouraging him. He needs a cheer-leader like you. It's all about making educated guesses about the right adjustments to make for each individual. And, ultimately it's about not giving up. Smile
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(08-28-2013, 09:53 AM)weeabooshogun Wrote: However, they only gave him one set of the pillows at the supply company. He's on a fixed income and mostly bound by what the insurance can pay for.
I'll have to check and see what size he's currently using.

I'm a little concerned that the supply company is going to balk at doing exchanges. But they should be fitting him correctly, shouldn't they?
It's not like they've fit him and then watched him sleep.

Hi weeabooshogun, welcome to the forum!

It may be that the mask came from its manufacturer with a set of pillows of various sizes. If that is the case, you should be able to ask for the rest of the pillows which came with the mask and receive them for free.

The supply company should have delivered all the pillows that came with the mask, so the patient can try the other sizes, if desired.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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