Reddit reviews Philips Respironics DreamWear Nasal Cushion (Medium)

A few things:

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• You have one of the best machines (Airsense 10 Autoset) on the market. You should hear almost no noise from it.
  
• Your mask (Dreamwear full face) is a great mask and also shouldn't be making much noise. There are two "exhalation ports" on that mask - near your mouth, and at the top of your head where the hose connects. Make sure neither of them are blowing air at your pillow, headboard, etc as that will cause noise.
  
• Check your machine settings. Is auto-ramp on? CPAP will be louder at higher pressures, so lower pressure during ramp as you fall asleep will help keep noise down. Also, you may want to increase the minimum pressure (even during ramp) to 6 or 7 - many of us find we feel like we aren't getting enough air to breathe at a pressure of 4.
  
• Try running a fan or noise generator for background noise if you're still bothered
  
• Mask fit is very personal - even the "best" mask on the market may be terrible for you. Try a few out. You can find masks online pretty easily, often without a prescription and for much less than a DME would charge. Here's a Nuance Pro nasal pillow mask on Amazon for $40.
  
• Note that you can use most of your existing mask with a nasal cushion or pillows - the Dreamwear system is very interchangeable. You will need the different headgear and the cushion or pillow (note both come in Small, Medium, or Large - try Medium if you're unsure). Maybe this will work better for you, and the cost is minimal compared to another mask.
  
• You mentioned you're worried about paying for the machine if you don't meet compliance criteria. You mentioned the DME would charge $8000. That's nuts. You can have your doctor give you your prescription (they are legally required if you ask) and buy it from one of the online vendors for about $850. Just return the machine and buy your own if that becomes a problem.
  
• You mentioned your sinuses are messed up - definitely speak to an ENT specialist if you feel this is hurting your ability to use CPAP.
  
• Blood ox at 70% is very dangerous. Keep it up, it gets easier. Good luck!

I mean technically a nasal pillow. The Phillips Size Medium. Rn it's around $12 but I've have seen it drop to below $5 a couple of times

https://www.amazon.com/dp/B01CLE3DRY/ref=cm_sw_r_fm_apa_i_rE2BDbTRWR15G

Not sure which Dreamwear nasal insert you are using, but there's two -- one that goes inside your nose a little and another that sits at your nasal openings but doesn't go inside. I'm guessing that the latter would be less likely to cause you irritation.

If neither work for you, then my suggestion would be a nasal mask that could go completely over your nose all together and might avoid touching any irritating areas, such as this N20 mask.

Like everyone else says, the mask is probably too tight.

You may also want to get the large size frame. The mask normally ships with the medium frame, and it seemed to fit me fine, but I had the same problem you did. In fact the first couple months after I bough the dreamwear I only used it two or three times because it irritated my nose so bad. I finally broke down and got the large frame, and immediately noticed a massive improvement. It wasn't dramatically more comfortable at night, but in the morning my nose felt much better.

Also /u/wrong_assumption recommends the version without the nasal pillows. I used that version up until about a month ago, and I always liked it and it is slightly more comfortable. That said, I switched to the pillow version and won't go back. I had way more problems with leaks without the pillows, and it was noisy enough to wake me up way too often. Since I switched to the pillows, my sleep has noticeably improved. You may not have the same problem, but I would recommend trying the large frame before trying the non-pillow version.

BTW, if you do want to try the version without the pillows, you don't need to replace the whole mask. Just get the non-pillow nosepiece.