Respironics Dreamwisp PAP mask small bridge accessory inquiry for appropriate therapeutic use.

Client Scenario

A new patient came to us with a new prescription for PAP therapy with a diagnosis of mild sleep apnea, with an AHI of 12.

The recommended prescription listed a specified setting of 5 to 10cmH20, Aflex, no automatic settings and in ready-to-use condition straight out of the carry case.

After an initial phone consultation, the patient agreed to trial a PAP unit with several popular trial masks, one of which included the Respironics DreamWisp.

Key Concerns

The Respironics DreamWisp arrived as a Fit pack (w/all sizes inside mask package), whereby the client read the directions completely and examined the relevant instructional video accompanying her Trial Start Package.

Upon her review, an explicit instruction from the Respironics DreamWisp literature called for the user to fit the small bridge between the ends of the mask frame along with the assemblyof the small cushion, if the small cushion was necessary.

However, her preference was to use the medium cushion with the medium frame for a series of nights.

She mentioned a concern about the small bridge and small cushion option, which would become a discussion later in her therapy. We encouraged her to start therapy and address specific needs along the way, to which she agreed.

Solution Flow and Answers

She fit herself following the viewing of a fitting video. She successfully fitted the Dream wispmedium cushion and medium frame with medium bridge adapter to get started.

After practicing with her trial PAP and DreamWisp mask for two nights, the underside of her nose suffered some undesirable pressure and skin irritation, to which a follow-up call took place.

Our discussion disclosed a few alternatives, including the original concern of utilizing the small bridge with the small cushion.She decided, with our advice, to solve this issue in steps.

She began using the included headgear, medium frame, and medium bridge with a small cushion, instead of the medium size.


Another follow-up call occurred two days later. She reported that the included headgear, medium frame, and medium bridge with a small cushion had not aggravated the base of her nostrils.

But she specifically addressed the use of the small bridge with her small nasal cushion for potentially added comfort. She repeated how her concern emanated from the enclosed instructions requiring the assembly of these two pieces. She inquired why this articulated assembly was compulsory instructions, and I addressed this concern with a call to the manufacturer.

After consulting the Respironics representative, the practice of utilizing the small bridge on the DreamWisp frame was necessary if the right and left portions of the mask frame (on her cheeks) travelled toward her nose.

Using the small bridge accessory might pull the right and left portions of the frame back toward her ears, away from her eyes, and balance the mask.

But the position of the frame was not the issue for this patient.

Therefore, she proceeded using the DreamWisp mask with medium frame and medium bridge and small cushion. The reason for this choice was because the pressure underneath her nostrils was no longer an issue and because it properly balanced the mask on her head.

At the time of this writing, this patientcontinues with the DreamWisp with a small cushion and medium frame and medium bridge.

She has also been experiencing substantial increases in sleep time and overall satisfaction.

Case Update

Upon checking her sleep report, her usage increased from five to ten minutes at a time to seven and a half hours. Her AHI average was 3.1, with an acceptable leak, and measurably low incidents of arousals.

All the preceding has been her nightly experience after verifying the details about the fitting of the DreamWisp frame, bridge and cushion combination and all without nasal irritation and nostril discomfort.

The small bridge accessory remains an option for the client.


Currently, the patient is appreciating the DreamWisp fitting changes proposed by consistent phone consultation and is acclimating steadily to her prescribed PAP therapy. The status of her PAP usage is still in the trial stage, which now reveals an even lower AHI, longer sleep time and improved mask comfort.

Ontario Sleep Care

Ontario Sleep Care aims to assure optimum PAP therapy to all patients by maintaining ongoing support and help. Our client-focused program uses email, phone, and remote options to advance the success of prescribed PAP therapy. Call us today for full support in your journey for better sleep. Please use 289-459-1087 for help.

Summarized by
Bill Bistak, B Sc.
Clinical Specialist
Ontario Sleep Care