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Fisher & Paykel Pilairo CPAP mask: road test

For many Australians, CPAP is a nightly necessity, but it's far from elegant. We test Fisher & Paykels new one-size-fits-all nasal pillow Pilairo, and compare it with a standard nasal mask.

For as many as one in five Australians, the use of continuous positive airway pressure (CPAP) treatment for sleep apnoea is now a part of their nightly routine. Where ever they plan to lay their heads, their CPAP machines will be with them. But this treatment is far from elegant.

Even hummingbirds suffer from the torments of sleep apnoea. (Credit: Fisher & Paykel)

I should know; I've been using CPAP treatment for over five years now and have tested several CPAP machines and masks in this time. My first machine was very much like a small, beige vacuum cleaner that blew air, rather than sucking (though, trust me, it sucked). Since then, the machines I have owned have become smaller, quieter and more comfortable, as a result. The masks, on the other hand, haven't — until now.

The Pilairo is a new nasal pillow CPAP mask, differing from most masks by sealing inside the nostril, rather than around the nose. Nasal pillows aren't actually new in concept, but to my knowledge, earlier designs were only really suitable for people with mild sleep apnoea and lower pressure treatment. Fisher & Paykel rate the Pilairo for use with pressure of up to 20cmH20, or the same as any of the half and full face masks on the market.

Also interesting is its one-size-fits-all headband. Every other mask I've encountered uses Velcro to customise sizing and ensure a good seal. The Pilairo doesn't rely on contact with the user's face to create a seal, though, so the headband is really used only to hold it in place. Instead, the nasal pillows inflate once air is applied, and a seal is formed just inside the nostril.

Road test

Over the last month, I've tested the Pilairo by using it alongside the ResMed Activa mask I currently own. The Activa covers my nose while I sleep and has a forehead support band with elasticised Velcro, which creates two bands behind my head. The first thing I noticed about the Pilairo is how light it is. This is noticeable both in my hands and also, more importantly, on my face.

It is truly refreshing not to have to make any adjustments when I put it on. The headgear fits well, it's neither tight or loose-feeling. The pillows fit neatly in my nostrils and fill comfortably with air, with my CPAP machine switched on.

This mask is a bit noisier than the ResMed mask I'm used to, though. Its exhalation valve runs across the top of the pipe that clips into the CPAP tubing, and the hiss that comes when I breath in and out is noticeably louder and sharper than I usually hear when using the Activa. This pipe rotates in a full-circle, so it's easy to guide the cool air that comes out, away from the back of the person who shares my bed.

To make a comparison, I've worn the Pilairo for two nights, then the ResMed for two nights, back and forth for the month. As with most new CPAP machines, mine collects nightly usage data, then produces reports on how well I've slept and how effective the treatment has been. Below is a comparison of two nights in the trial month.

This graph shows fluctuations in pressure when using the Pilairo (top) and the ResMed Activa LT (bottom). (Credit: CBSi)

These graphs represent pressure (measured as centimetres of water) and it shows fluctuations in pressure, produced by the CPAP machine when it detects that the user requires more air. The most common reason the machine will increase the pressure is to counteract a mask leak; where the mask shifts on the face, creating a gap and lowering the effectiveness of the treatment.

What I noticed, after looking at these graphs, was that the nightly fluctuations while using the Pilairo were impressively low. For the most part, this suggests that the mask created a solid seal and maintained it, despite my tossing and turning through the night. Less breaks in the seal mean less interruptions in sleep, and a better result all around.

On the mornings after using the Pilairo, I did feel like my treatment had improved, however subtly. My Resmed mask still works well, but I definitely felt that the Pilairo mornings felt better, though, I can't say how much of this was the mask and how much was the placebo effect of trying something new and exciting. At any rate, if you're in the market for a new mask, it'd be worth your while asking your CPAP clinician whether they have one you can trial, the next time you pop in for a check-up.