Review: Resmed Airfit N30

I bought the newly introduced Resmed Airfit N30 from Lofta because they offered a 30 day money-back guarantee, and because they had a decent discount.

The new nasal-cushion style of mask fits very differently from my tried-and-true Swift FX nasal pillow. Rather than having nacelles that fit into your nose, these are effectively a block of soft silicone material with two cut-outs where your nostrils are. The effect is very comfortable, with no abrasion whatsoever.

The problem with these is that they work great for one night, and then by the second night the wear from the first night means that the cut-outs will loosen up and no longer give great therapy. By the third night, the cushion is completely worthless. If this doesn't happen to you (I might be particularly tough on masks), then these are worth a shot.

Not recommended.

Review: Resmed N30i Mask

I've been using the ResMed Swift FX nasal pillow for the last 7 years without a complaint. It's cheap, easy to work, and I can buy parts off Amazon at a low price, eliminating the need to go through DME providers or insurance. The ResMed N30i, however, came with a 30 day money back guarantee, and promised a whole new level of comfort nusing a new "nasal cradle" system, so I decided to give it a shot.

The kit comes with 3 different cradle sizes, and a card that you stick under your nose in front of a mirror to figure out which size you should use. It's important to use this or your nasal cradle will leak. The mask itself is very comfortable, and in fact, quite a bit more comfortable than my old Swift FX in normal conditions. There's nothing shoved into your nostrils, and you don't have to tighten it so tight because the design is such that however you choose to move in bed, you won't jiggle it loose. It was so comfortable that I thought I was going to give up the Swift FX for sure.

Then I caught a 'flu from one of my kids. That's when the cradle-style didn't work out. With the Swift FX, because the pillows are shoved into your nostril, you have a complete flow of air shoving through the gigatons of mucus being generated  by your nose during a night's sleep, and is in fact, the only way I can sleep through a 'flu (and sleep, as you all know, is very important to recovery from infections).  The N30i by contrast, just started leaking, and leaking huge amounts, so much so that I woke up and switch masks before sleeping.

It's clear that even if I could use the N30i in superior comfort during "normal times", I'd still have to keep an alternate mask around for 'flu time (or other times when my nose decides for no reason whatsoever to generate gigatons of mucus), and that's not practical for what looks likely to be a high allergy season spring.

I sent back the N30i. I think it could be a great improvement for those of you who have good noses. Mine, however, need the abuse the Swift FX provides.

Review: HDM QTube In-line CPAP Muffler

My biggest issue with the HDM Z1 CPAP machine is that it's loud and noisy. If you don't have a humidifier (HME) attached to it, sound vibrates all the way down the tube and conducts through your skin into your ears, making sleep pretty much impossible unless you ride all day. (Granted, that's my usual use case when traveling with the Z1!) Even with the HME, however, it's still not that quiet, so when I saw (and someone on my blog comments recommended) that the Qtube In-line CPAP Muffler was available, I tried it.

One problem that I'd hoped the Qtube solved was that the HME is a consumable item. The HME should be replaced every 7 days. In practice, I've found that every 10 days is OK. Unfortunately, the Qtube is not maintenance free. The internal foam baffling needs to be replaced every 2 weeks. That means even if it did outperform the HME as a noise muffler, you'd still have to carry replacement foam baffling on a 3 week tour.

Unfortunately, the Qtube does not outperform the basic HME. I tried it in 3 configurations: Qtube alone, Qtube inline with HME with HME connected to the machine, and Qtube inline with HME with the Qtube connected to the machine. None of these configuration changes made any difference in sound, though with the Qtube inline with the HME I noticed a significant latency in the back-off whenever I breathed out.

Worse, the Qtube is heavy! You could carry 2 HME for less weight than the Qtube, which meant that for a 3 week tour of the alps, I did exactly that and left the Qtube behind.

All in all, disappointing, and I won't recommend it. Use the weight budget on carrying the HME instead.

Review: HDM Z1 CPAP

Two weeks before my 2014 Tour of the Alps, my doctor told me about the HDM Z1. Now, I've been very happy with my ResMed S9. It's quiet, durable, and works well for sailing. However, even with the portable 30W power supply the entire package weighed 40oz, discounting the hose and the CPAP mask. For a cycle tour with big mountains, this was not ideal, and the HDM Z1 at half the weight of the ResMed S9 was very appealing.

There are a few issues with this machine compared with the S9:

• It is much louder. After comparing this machine with the S9, Arturo found that the S9 was almost silent in comparison. Subjectively, I rate the difference between the machines at 5dB. The HDM Z1 was so loud my wife refused to let me test it. One interesting thing is that adding the HME to the tube makes the machine quieter, which indicates that the increased noise isn't just due to the louder air pump, but also to do with the resonant frequency of the output into the hose.
• For at home use, there's no elegantly integrated humidifier like the S9. Instead, you buy a Fisher & Paykel humidifier, or you use a HME. HMEs are consumables, and each one is good for only 7 days, which at $6/pop is significant over the usual 2 year depreciation period of a CPAP machine. Since you'll almost certainly need to travel with HMEs, the HMEs add some bulk but not significant weight to the final package.
• The ResMed S9 is an auto-PAP, adjusting pressure according to how much you need to avoid apnea events. The Z1, however, is a fixed pressure CPAP, so you only get to set one setting, and live with it for the entire trip. My 95% pressure was 9, so that's what I used. I initially didn't think there was much difference for me, but at the end of the trip, I switched back to the S9 and immediately felt more refreshed after a night's sleep, indicating that the auto PAP algorithm on the ResMed is more effective and provides better sleep.
• There are reports as to the robustness of the machine, with some users reporting failure after 4 weeks of use. HDM offers a 2 year warranty, but that's of no use to you while you're traveling if your machine fails! My trip was only 3 weeks, so I decided it was worth the risk.

Was this enough to offset the 20oz difference between the ResMed and the HDM Z1? No, so if you've been hankering to an independent bicycle tour and the weight/bulk of carrying a CPAP was putting you off, stop reading and just buy it now.

The machine itself is interesting. it comes with the machine, which weighs in at 10oz, and a power supply, which also weighs in at 10oz. I was wondering why the power supply hadn't gone in for more weight reduction, but that's probably because the machine is rated for higher pressure than I use, and so the power supply has to handle that, rather than my relatively low pressure rating. It comes with an adapter for use with the standard CPAP hose. The adapter basically splits the hose so the pressure measuring system can be separated from the output of the pump. You could just leave the adapter in place all the time, but I wouldn't recommend it while traveling, since the tongue of the adapter is in a particularly highly leveraged place, which would cause it to break off.

The machine comes with a micro-SD slot, but I didn't have time to buy a micro SD card to put in the machine, so did not test the software or get details about my apnea events while using the machine. Given that the primary symptom of my apnea is incredibly loud snoring and my roommates did not kill me while I slept, however, I think we can safely say that the machine works.

You can buy a Powershell battery for the Z1, which is basically an integrated battery for camping and other off-the-grid uses. The battery is also incredibly light at 200g, with the downside being that you can only charge the battery with Powershell, so you can't charge multiple batteries at once, for instance. Since the Tour of the Alps is a hotel-based credit card tour, I opted out of buying one and did not test it.

The biggest feature of the machine, however, is the weight and size. It's truly remarkable, and done (as far as I can see) without exotic materials like carbon fiber, titanium, or magnesium, which means that there's ample room for even lighter, more premium versions. The cost of the machine is around $600, which is affordable and much cheaper than a planet ticket to Europe these days. The cost/weight reduction ratio is much better than the typical weight reduction measures on bicycles, so this represents an exceedingly good deal for cycle tourists who carry their own baggage.

All in all, I'm very impressed, and would highly recommend this product.

Long Term Review: Resmed Swift FX Nasal Pillow System

I just replaced the nasal pillow on my Resmed Swift FX Nasal Pillow system due to wear, so I'm guessing that it's time for a long term review. I'd always used full-face masks before, but they had several problems: first, they were heavy and bulky. Secondly, they leaked. Finally, they were costly to replace and maintain. For a while, discount retailers on the internet would get them to me for a relatively cheap price, but the manufacturers recently clamped down on them so they're now very pricey.

I thought I wasn't a good candidate for a nasal pillow system because my brothers were all mouth breathers, and so I thought I was one as well. I took a loaner from SleepQuest, along with a chin strap so I could tie my mouth shut if it stayed open at night. (Yes crack all the jokes you want about my wife wanting me to use it during the day) After two days, however, I stopped using the chin strap as it would slip off at night. The nasal pillow would cause a nasty backflow through my mouth if my mouth slipped open, so obviously I wasn't a mouth-breather, since I would have woken up the minute my chin strap slipped off!

There was an initial adjustment period. Basically, my nostrils would get sore from the pillows in my nose. I guess despite the name, they're not particularly soft or comfortable, at least at the beginning. I would swap between my full-face mask and the nasal pillow every 2-3 days to give my nostrils a rest. I used vaseline as well on my nostrils so as to lubricate the pillows and not chafe my nostrils.

Then during the Hawaii trip I basically went cold-turkey and used only the nasal pillows. They worked great. Basically, my nose has gotten use to the pillows now and I can use them all the time with no problems. I was told that the pillows would last about 6 weeks or so, but in practice I got 3 months out of each pillow set. Replacements are about $21 each on Amazon, so there's no reason not to replacement whenever you notice wear. (Basically, my wear indicator was that the inside silicone wears larger and larger)

The best thing about the pillows is that they don't leak, and they feel very comfortable. On a secondary basis, the pillows are also much lighter than the full face mask and easier to pack, making future tours of the alps potentially easier on my body.

Highly recommended.