I love the ResMed Swift FX mask. I think they should pay me for my slogan, “it’s the next best thing to sleeping naked!”. This is a really comfortable and unobtrusive mask, but it is a little tricky to fit. On top of that, there are some really stupid DME’s and even some ResMed reps who are telling people that this mask works by cramming the nasal pillows UP YOUR NOSE. I wish they would cram it up their own noses (or someplace farther south!)—that is NOT how this mask works!
I end up posting this on CPAP forums quite often, so I wanted to have one place to direct people to (except that I cannot post the link on the OSAA boards 
( ).
First, take a close look at the nasal pillows of the mask. Those are the cone-shaped parts of this mask that touch your nose, with a narrow neck at the bottom. The wide part of each nasal pillow goes against the outside of your nostrils. The narrow tip where the air opening goes just slightly into your nose, not very far at all. A properly fit nasal pillow should not really touch the septum or walls of the inside of your nostrils. The only part touching should be the wide base of the cone outside your nostrils.
Before you start trying to fit your new Swift FX, try this experiment that will help you understand how this mask works. Holding the mask in your hand, turn the machine on, and place the meaty part of your hand over the opening in the tips on the pillows. What you will see is that the nasal pillows seem to suck right onto your hand and the air pressure in the pillows holds it against your skin. The inflation of the nasal pillows provides the pressure that seals the mask. That action is what makes these pillows work, and if you understand that, then fitting this mask will be easier.
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.
Soapbox Time:
On CPAPTalk.com and the OSAA board there’s been an ongoing debate about whether or not a nasal pillow mask will enlarge your nostrils. Personally, I think it’s a bunch of bunk. The pressures the CPAP exerts against your nose are really not very high, and it’s for 1/3 or less of your day.
There is no scientific evidence to support this crazy theory, though proponents try to extrapolate other studies to support their assertions. Nostrils tend to enlarge slightly as we age anyway, so I don’t think there’s been any study to isolate CPAP nasal mask use from the normal aging process. Furthermore, nasal pillow masks can mean the difference between CPAP success and failure. I would hate to see somebody give up on CPAP because they are too afraid to try nasal pillows. There’s enough to worry about with CPAP without stressing over whether or not your nostrils are going to get bigger!
Additional Resources:
Resmed has a slide show demonstrating fitting (slightly different technique than I recommend) here: http://www.resmed.com/us/products/swift_fx/swift-fx.html?nc=patients
I am a newbie that just got a bipap on Tuesday, March 22, 2011. I wined and complained so much to my therapist at Apria about my apprehension about using every mask I had ever seen that she finally showed me the Swift FX. I can see why you are crowing about it. Its far better than that horrible nasal mask that I used at the Sleep Test Center. All the masks were horrible.
I am nonetheless waking up every 3 hours and taking everything off to give myself a break….just sitting up and shaking my head trying to feel free and taking some deep breaths on my own. I realize how important it is that I learn to accept this new way of sleeping so I will stick with it. This Swift FX will help a lot. It goes off and on so easy and the Bipap has a “ramp” that eases me into it each time.
I asked the therapist for information so that I could read my own chip on the machine but she was adamantly against it. She seemed shocked by the question.Who can give me that information?
By: Kathleen Kleinmann on March 27, 2011
at 4:39 pm
Kathleen,
First, if you haven’t already, I suggest you go to http://www.cpaptalk.com as you will find a lot of your answers there.
It may be the ramp feature that is causing you to wake up and feel you must remove the mask to breathe. The pressure on the ramp can be so low that you may feel like you are not getting enough air, or your pressures may need some adjusting to work better for you under your normal sleeping conditions rather than the artificial conditions in the sleep lab. The therapist CAN help you figure this out, but it sounds like you will have to make it HER idea or she will get snippety with you. That’s too bad!
I have a particular bias that WE should have access to our own data. Imagine if you were a diabetic and you were given a blood glucose monitor with no patient readout. If your blood sugar was out of whack, you would not know until your next doctor’s appointment. If you were not feeling good and wanted to know why so you could work with your doctor on adjusting things, you would not be able to. You’d have to wait for an appointment to get the doctor or someone to read your data and then see what’s going on. Stupid, right?
So why should it be different with XPAP? Suppose you are having leaks big enough to cause pressure problems with your biPAP, but not big enough to show up as “large leaks” on your machine’s screen. You aren’t feeling well either. I can’t tell you how many times we’ve seen this scenario on the forums. The person calls the sleep doctor who says “just keep using the machine”, only to find out months or even YEARS later that the leaks were a problem and the AHI was too high. Or suppose you are not feeling so great and the AHI is too high because the pressures aren’t correct. But you don’t see the sleep doctor for another three months (or more). Not feeling better, you give up on BiPAP–why bother if you’re feeling so badly? Or suppose the AHI is good, but you’re still feeling rotten. Numbers alone do not tell the story. Take a look at my post on data to see why (http://maskarrayed.wordpress.com/2010/06/19/the-importance-of-having-data/). My numbers looked great, I felt awful. The software revealed that the pressures were inadequate, so WITH MY THERAPIST we raised my pressures and all was well again. Having data does not supersede the professionals–it helps YOU be a member of your own health care team and work with them to acheive optimal results. Any therapist or doctor who does not understand that is either too full or his or her own cheese or afraid that you will know more than they do.
The Encore Viewer 2.0 software is LEGAL and made specifically for CPAP users. It’s available from online suppliers for about $100. Using the software you CANNOT change the pressures or do anything to harm the settings on your machine (there are other ways to make the changes, but not through the Encore Viewer software). But you can get a good picture of what is going on with your therapy, and work with your health care providers to make changes when the software shows you what the problem is. See http://maskarrayed.wordpress.com/2010/08/07/respironics-data-tutorial/ to see what kind of data it reports.
So what is your therapist afraid you’ll find out???? That your therapy isn’t optimal and needs tweaking? She should welcome that–the idea is to get the best treatment possible, not stroke her ego that she is the smartest and most wonderful person in the world. A good therapist will welcome your involvement in your own treatment, not expect you to be passive and accept whatever she deems is appropriate.
By: janknitz on March 28, 2011
at 6:19 pm
Your comments above have been most helpful to me, as a new CPAP user. I have the ResMed Swift FX for her nasel pillows system. I prefer it over the 2 full face masks that I have tried. I am a mouth breather so have to use a chin strap which I put over my mouth instead of my chin. It works great to keep my mouth closed. I often wonder what I would do if I had a bad cold with sinus congestion. I don’t now how I would wear the mask. I am now trying to adjust to a full face mask for that reason, but sure don’t want to give up my Swift FX for her mask. I have also paid attention and think that I will get a hose hanger. Thank you much for your comments.
iammrsbear
By: Patti Grizzle on April 12, 2011
at 1:27 am
It’s a great idea to get used to a FF mask before you HAVE to. That was a miserable few nights until I learned to sleep in it–when I was already feeling terrible because I was sick. Now I’m having fun because I can wear any one of several masks and sleep well, so it just depends on what I feel like wearing at the time, or, if I’ve just washed one and it’s not dry yet, I have other options.
By: janknitz on April 13, 2011
at 11:41 pm
I’ve been a user for about three years, always using nasal masks – I started with a ResMed Mirage Activa mask (the one that goes over the whole nose and seals on the face), and am now using a Swift FX. In that time I’ve had four colds with stuffy/blocked nose, but strangely this has not caused me any trouble. After putting the mask on and relaxing into sleep, although it starts off a little less easy to breathe I have found that after a few minutes my nose actually seems to clear, then I get a normal night’s sleep. If you have a cold/stuffy nose, I suggest just giving things a try as normal and seeing how it goes. So far it has worked for me.
By: dms on June 29, 2011
at 6:32 am
Thank you thank you thank you!
Thank you for taking the time to post this. I’m a new user (less than 3 months) and I’ve had WEEKS of discomfort trying to get my mask to fit correctly. I get the odd night of full rest but most nights have consisted of multiple mask adjustments (some full removals) only to wake up with a sore nose and lines on my face. I read your article, used the tips to adjust my mask and after two full nights of rest, feel like a million bucks!
By: Connie on October 28, 2011
at 4:49 pm
Thanks for all of the info. I tried this my first couple of nights with the small size the DME recommended, but had trouble getting enough air. I tried the mediums and they were better, but still didn’t work great for me at the low pressure.
When they upped my minimum pressure +2, I tried the pillows again and it worked MUCH better!
I also started the falcon sleeping position last night which doesn’t use a pillow for your head (normal pillow, not CPAP), hoping that would help keep the nasal pillows in place better.
I keep trying to get the nasal pillows to work as I find them more comfortable than the nasal mask. I’m going to try your fitting idea of turning the machine on before adjusting the strap, as well as your other suggestions.
Thank you for this helpful info!
By: Java Time on November 15, 2011
at 7:21 pm
Okay, I just read your post again. I’ve been putting the outside of the nasal pillows, inside my nasal passage. I thought this was why the DME said I needed the small instead of the medium, maybe I misunderstood him. Can’t wait to try re-fitting these tonight on the outside of my nose to see how that works!
By: Java Time on November 15, 2011
at 7:40 pm
OMG!
DMEs are really STUPID sometimes and we are at their mercy!!! They are supposed to know better.
Once you get your mask to fit well, please go back and give that DME a lesson so he/she doesn’t do this to others, too!
By: Jan on November 15, 2011
at 7:50 pm
I went back after my first 3 days, telling them I couldn’t breathe with the FX. My insurance allowed another mask (minus deductible). I brought the mask with me, but it didn’t occur to me to check if I was wearing it correctly. I thought of this as putting air in your nose, so I stuck it in my nasal passages. It was just inside my nose, but still it sounds like I’ve been wearing it all wrong. The funny thing is I still prefer it over the nasal mask, even though I was wearing it wrong. I’ll update after I try it the correct way tonight.
I’m sure a lot of people are either wearing the strap too tight for the pillows to properly inflate or sticking the outside of the nasal pillow inside their nose, like I was!
By: Java Time on November 15, 2011
at 8:09 pm
Jan,
I think I was actually doing it correctly. The wide “ring” of each nostril is just outside my nasal passages. I have only been putting the tip of the outside of the nasal pillows inside my nostrils.
I thought you were saying the tip of the outer ring was supposed to rest on the outside of the nostril.
I look at image 5 on page 2 of the Swift™ FX user guide, and I now understand what you mean and I think I have been doing it correctly.
Swift™ FX user guide:
http://www.resmed.com/us/assets/documents/product/swift_fx/user_guide/608259_swift-fx_user-guide_amer_eng.pdf
Sorry if I confused you. and thanks again for your helpful advice for us newbies struggling to learn all of this.
By: Java Time on November 15, 2011
at 8:58 pm