Patent Publication Number: US-2023149653-A1

Title: Nasal Interface Apparatus

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation-in-part of U.S. patent application Ser. No. 17/215,589 filed Mar. 29, 2021; which is a continuation-in-part of U.S. patent application Ser. No. 15/595,990 filed May 16, 2017, now U.S. Pat. No. 10,987,481 issued Apr. 27, 2021; and which claims the benefit of U.S. provisional application Ser. No. 62/355,493 filed on Jun. 28, 2016, the disclosure of which are incorporated by reference. 
    
    
     FIELD 
     This invention relates to the field of medicine and more particularly to a nasal interface for the delivery of gases in the treatment of sleep apnea and other respiratory problems. 
     BACKGROUND 
     Ventilation is commonly used in the treatment of respiratory conditions such as sleep apnea. On such form of ventilation is a continuous positive air pressure system often referred to as a CPAP system. Continuous positive air pressure systems typically include a mask that interfaces to a user&#39;s mouth or nasal passages, supplying air pressure from an air flow generator that is typically located in the proximity of the user. The mask directs the flow of air into the breathing passage of the user while allowing the user to exhale. 
     For the treatment of sleep apnea, the continuous positive air pressure system is worn while the user sleeps. In continuous positive air pressure system in which the mask interfaces with the user&#39;s nostrils, the nostril interface need be held in place and maintain a seal so that, as the user moves during sleep, the mask/nostril interface remains intact and sealed to provide positive airway pressure. Any break in this seal will result in less air being provided to the user and will create noise that may disturb the sleep of the user. 
     The mask/nostril interface is often referred to as pillow interfaces. An end of the pillow interfaces is inserted partially into each nostril, maintaining a, hopefully, air-tight seal. As the pillow interfaces are worn while the user sleeps, it is important that the pillow interfaces be as comfortable as possible. If the seal is not air-tight, less positive airway pressure is delivered and, the break in the seal will often create noise (e.g., hissing) that may impact the user&#39;s sleep. Further, and the pillow is inserted into the nostril, deformation of the pillow reduces airflow within the pillow and increases turbulence leading to further lowering airflow and creating additional noise from the flow of gasses. 
     Another issue with continuous positive air pressure system is the flow velocity of the positive airway pressure. In providing an adequate volume of gas (e.g., air, oxygen) for each breath the patient takes (inhalation), the continuous positive air pressure system must provide a minimum volume per time period. Tradeoffs are made between providing greater volumes by using larger orifices with lower air velocity or by using smaller orifices and increasing the velocity of the provided air. Unfortunately, when the velocity of the provided air is increased, several user issues occur including burning sensations in the user&#39;s sinuses, drying of the user&#39;s sinuses, a compromised therapeutic index, and increased noise that is undesirable when the user is trying to sleep. 
     Existing continuous positive air pressure systems have pillow interfaces that are generally round in cross-sectional area whereas the human nostril is not. These pillow interfaces cause discomfort when worn as the nasal septum is typically more sensitive to pressure and is typically relatively flat in areas of the nasal openings, in particular, the septum. Round cross-sectional shapes do not interface well with flat walls and, as an accommodation, prior pillow interfaces are typically made of a soft material that deforms and flattens when inserted. This flattening reduces the cross-sectional area of these prior nasal pillows, resulting in an acceleration of the air velocity, and therefore, the issues cited above. 
     The interface pillows of prior continuous positive air pressure systems have numerous issues, some of which are:
         a. Pressure drop within the closed system/cannula.   b. Lack of ability to deliver an adequate volume of inspired air to the patient.   c. Air velocity delivered through these pillow interfaces is often high, leading to burning sensations, drying of sinuses, etc.   d. The pillows leak when required to deliver air pressure at more than  10  centimeters of water. Such leaks cause noise.   e. The shapes of these pillow interfaces lead to discomfort at the bottom of the nostrils.   f. Head gear often needs to be adjusted tightly, leading to patient discomfort.   g. Air leaks often occur from slight movement of the head.   h. Lower levels of air deliver often lead to a decrease in blood oxygen saturation during sleep.   i. These interfaces pillows fit within the nostrils in a way that leads to a disproportionate amount of pressure being applied against the septum (center cartilage) of the nostrils, causing discomfort. The septum is the most sensitive area of the nostrils.       

     Many of the above issues relate to the shape of the prior-art interface pillows, the material of which they are made, and the resiliency of the materials. As the shape of the prior-art interface pillows is not optimal for sealing within the nostrils of a user, to compensate for such, the prior-art interface pillows are made of very soft material that is easily deformed under pressure. The prior-art interface pillows, after insertion, deform to seal as best that then can within the nostrils of the user. This deformation provides pressure on the sensitive septum of the user&#39;s nose, causing discomfort. This deformation also reduces the cross-sectional area of the air passage of each prior-art interface pillow, causing an increase in air flow velocity and noise. The increase in air flow velocity leads to dryness, a sudden burning sensation in the nostrils, and stuffiness in the sinuses. Higher air flow velocity and lower volume of incoming air is less efficient at correcting apnea and often interrupts normal breathing patterns. 
     Further, most prior interface pillow designs included turning points for the incoming air, some as much as 90 degrees, resulting in turbulence, noise, pressure drop, and a decrease in the therapeutic index of the treatment. As a result of this, more pressure is typically required to deliver the required increased flow rate which partially compensates for inadequate air volume needed for treatment. This increase in air velocity increases unwanted side effects and requires significantly more air (gas) to be delivered from, for example, an air pump or gas tank. An increase in air flow velocity is not preferred over supplying adequate air volume to the patient at lower velocity. 
     It should also be noted that with each incremental increase in driving pressure beyond 7 centimeters of water pressure, there is less and less proportionate therapeutic effect. Increases in driving pressure beyond 9 to 10 centimeters of water has little, if any, therapeutic effect using a prior-art interface pillows, and likely only exacerbate the negative effects. Most prior interface pillows will not hold pressures of more than 9 to 10 centimeters of water pressure. This has been one of the significant limitations of such pillow interfaces and only patients with mild obstructive sleep apnea typically have success with the prior interface pillows due to this limitation. 
     The prior interface pillows create a seal by applying pressure to the inner rim of the nose. The seal is tenuous. Head movement often causes a significant and annoying air leak unless the head gear is noticeably too tight. The apex of the prior interface pillows (where the air flow passes into the nostrils) is very non-structural and the inner diameter of the prior interface pillows is easily compromised when pushed into the nostrils. This often decreases the cross-sectional flow space and air volume delivered, which in turn, further increases the velocity and/or pressure drop of the air flow entering into the nostrils. The area directly beneath the prior interface pillows where they fit against the nostrils becomes narrowed or compromised when encountering pressure against the bottom of the nose created by the head gear. This creates another source of restriction to air flow resulting in a decrease in delivered air volume, pressure drops, an increase of incoming air velocity, and a reduced positive effect. 
     Based on typical adult inspiratory demand; a patient&#39;s respiratory rate, in many cases, will decrease using the prior interface pillows because less air volume is available, which will take longer to complete the inspiratory cycle. The respiratory rate has been seen to decrease from a normal 12 to 14 breaths per minute down to 9 breaths per minute. This interruption of normal respiratory rate often creates a feeling of suffocation and reduced compliance (usage) of the system. 
     If the inspiratory cycle is prolonged, the expiratory cycle is also prolonged and the lungs may not empty completely before the inspiratory cycle is initiated. An increase in driving pressure will likely be required, but the increase in driving pressure only partially compensates for the inadequate volume of air that must be delivered to maintain an adequate tidal volume and minute ventilation that feels normal to the user. The result is that the user&#39;s normal breathing patterns are disrupted, the user feels insecure, a feeling of suffocation and impending doom for some, and less likely to achieve restful sleep. The inadequate lower inspired air volume also creates the need to provide a lower cross-sectional flow space for expired air. The prior interface pillows style interface does not let the patient feel as if their expiratory cycle is normal. This is perceived as an increase in work of breathing. Adequate cross-sectional flow space for exhaled air can only be provided if there is an adequate volume of air supplied to the inspiratory cycle with very little or no resistance accompanied with a low air velocity which simulates normal inspiratory/expiratory flow rate. 
     The expiratory cycle is normally completed during deep sleep and is achieved only by the elasticity of the patient&#39;s lung. Accessory muscles are not active during restful sleep. If inspired air is not normally exhaled the patient will not feel secure and deep sleep will not come easy. The inspired air is not being normally exhaled if the patient&#39;s respiratory rate has been disrupted. 
     Further, bleed ports in prior systems direct exhaled air flow onto the patient&#39;s arms/hands. Some bleed ports are embodied into a swivel adaptor that can unintentionally misdirect exhale air flow in an unwanted direction. Constant adjustment is often needed. The patient&#39;s breathing mechanics must function as if they are not using CPAP therapy, and the CPAP therapy must correct apneic events to promote a sound, prolonged sleep, and consistent compliance to treatment. For the vast majority of patients using prior interface pillows, this requires a high volume of air delivery; significantly lower air velocity; and using significantly less pressure. 
     It is desired that the patient experiences no change in noise of air flow throughout the inspiratory/expiratory cycle. Any change in air flow noise during any part of the ventilation cycle indicates the patient&#39;s normal breathing is being interrupted. This is typically caused by an inadequate volume of inspired air and inadequate flow space for exhaled air. When a high volume of air is provided then a lower level of pressure is required to correct apneic events for the vast majority of patients. Apneic events are not sudden; they build up. If an ample/adequate volume of inspired air is supplied with a lower pressure, apneic events are prevented. If adequate inspired air volume is not available, then apneic events eventually occur during sleep and pressure will need to be increased to compensate for inadequate volume. To this end, sleep technicians often increase driving pressures as the sleep cycles progress. The increase in driving pressure is not preferred over adequate volume, often only partially compensates for an air volume deficiency, and typically increases unwanted effects. 
     Another issue with existing continuous positive air pressure systems is disposal of extra pressure, either from the air flow generator or from the user&#39;s exhalation. Many existing continuous positive air pressure systems have inadequate exit venting or exit venting that is directed toward the user&#39;s body, creating discomfort as the user exhales. 
     What is needed is a continuous positive air pressure system that provides a linear flow path form a gas input port into a nasal interface that seals against the edge of the nostrils while retaining comfort and proper air flow. 
     SUMMARY 
     In one embodiment, an integrated cannula with interface pillows is disclosed. The interface pillows are for sealing with a nostril of a user. The integrated cannula with interface pillows includes a cannula section having a gas inlet for receiving the gas from a source of gas, exhalation holes for venting exhalation gas to the atmosphere, and nubs for attaching a head strap. There are two interface pillows formed from a pliable material extend from the cannula section. Each of the interface pillows having an insertion tip that is distal from where each of the interface pillows meets the cannula section. An insertion bulge extends from each interface pillow between the insertion tip and the cannula section, limiting an insertion distance of the insertion tip. An insertion area of each interface pillow extends between the insertion bulge and the insertion tip during use, the insertion bulge is configured to seal against an outer edge of the nostril of a nose. 
     In another embodiment, integrated cannula with interface pillows is disclosed. The interface pillows seal against a nostril of a nose of user. The integrated cannula with interface pillows includes a cannula section that has a gas inlet for receiving the gas from a source of gas, exhalation holes for venting exhalation gas to the atmosphere, and nubs for attaching a head strap. There are two interface pillows formed with the cannula section and made of a pliable material. Each of the interface pillows has an insertion tip distal from the cannula section and an insertion bulge for limiting an insertion distance of the insertion tip to approximately 0.25 inches. An insertion area of each of the interface pillows extends between the insertion tip and the insertion bulge, sides of which taper inwardly towards the insertion tip at an angle, thereby a cross-sectional area of the insertion tip is smaller than a second cross-sectional area at a point where the insertion area meets the insertion bulge. The insertion bulge of each of the interface pillows seals against an outer edge of the nostril of the nose. 
     In another embodiment, a method of delivering positive airway pressure to the user is disclosed using the integrated cannula with interface pillows described above. The method includes inserting the insertion area of each of the two interface pillows into respective nostrils of the user until the insertion bulge of each of the two interface pillows interfaces with an outer edge of the respective nostrils of the user. The insertion area of each of the two interface pillows extending into the respective nostril of the user and the insertion bulge of each of the two interface pillows deform under pressure from the cannula section and seal against the edge of the respective nostrils of the user. Gas from the cannula section flow through the two interface pillows and into the user&#39;s nostrils. 
     In another embodiment, an interface pillow for insertion into a nostril of a user is disclosed. The interface pillow includes a body made of a pliable material. The body has an insertion tip and a connection interface that is distal from the insertion tip. The connection interface is for interfacing with a cannula. An insertion bulge extends from the body between the insertion tip and the connection interface. The insertion bulge limits an insertion distance of the insertion tip. An insertion area of the body extends between the insertion bulge and the insertion tip so that, when in use, the insertion bulge is configured to seal against an outer edge of the nostril of a nose. 
     In another embodiment, an interface pillow for insertion into a nostril of a user is disclosed. The interface pillow includes a body made of a pliable material. The body has an insertion tip and a connection interface that is distal from the insertion tip. The connection interface is for interfacing with a cannula. The body includes an insertion bulge that extends from the body for limiting an insertion distance of the insertion tip to approximately 0.25 inches. An insertion area of the body extends between the insertion tip and the insertion bulge. Sides of the insertion area taper inwardly towards the insertion tip at an angle, thereby a cross-sectional area of the insertion tip being smaller than a second cross-sectional area at a point where the insertion area interfaces to the insertion bulge. When in use, the insertion bulge is configured to seal against an outer edge of the nostril of a nose. 
     In another embodiment, a method of delivering positive airway pressure to the user using the above-described interface pillows is disclosed. The method includes connecting two interface pillows to the cannula that is interface to a source of air flow and inserting the insertion area of each of the two interface pillows into respective nostrils of the user until the insertion bulge of each of the two interface pillows interfaces with an outer edge of the respective nostrils of the user. After insertion, the insertion area of each of the two interface pillows extends into the respective nostril of the user (e.g., by 0.25 inches). After insertion, the insertion bulge of each of the two interface pillows deforms under pressure from the cannula and seals against the edge of the respective nostrils of the user so that air from the cannula flows through the two interface pillows and into the user&#39;s nostrils without leaking. 
     In another embodiment, a nasal airway interface apparatus is disclosed including a body section having a gas delivery connector for receiving a gas from a source of gas, two nasal interfaces, and strap connectors for attaching a head strap. Each nasal interface of the two nasal interfaces extends from the body section, has an insertion tip that has an opening that is distal from the body section, and a flattened side for sealing against a septum of a nose. Two exhalation manifolds are provided for exhausts, each of the two exhalation manifolds have a plurality of holes for expelling exhalation gases. Gas flows in a substantially linear path from the gas delivery connector, through the body section, through the two nasal interfaces and out the openings. 
     In another embodiment, a nasal airway interface apparatus is disclosed including a body section made of a soft, pliable material and having a gas delivery connector for receiving a gas from a source of gas, two nasal interfaces, and means for holding the body section. Each nasal interface of the two nasal interfaces extends from the body section, has an insertion tip that has an opening that is distal from the body section, and a flattened side for sealing against a septum of a nose. Two exhalation manifolds are attached to the body section, each made of a stiff plastic material, and each has a plurality of holes for expelling exhalation gases. Gas flowing from the gas delivery connector, through the body section, through the two nasal interfaces and out the openings flows in a substantially linear path. 
     In another embodiment, a method of delivering positive airway pressure to a user is disclosed. The method includes inserting an insertion tip of each of two nasal interfaces into a respective nostril of the user until an insertion bulge of each of the two nasal interfaces abut an outer edge of respective nostrils of the user, each of the two nasal interfaces extending into the respective nostril of the user and each of the two nasal interfaces connected to a body section such that the insertion bulge of each insertion tip seals against an edge of the respective nostrils of the user. During inhalation, gas from a gas delivery connector flows through the body section and through the two nasal interfaces and into the respective nostrils of the user, thereby providing positive airway pressure to the user. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention can be best understood by those having ordinary skill in the art by reference to the following detailed description when considered in conjunction with the accompanying drawings in which: 
         FIG.  1    illustrates a perspective view of a system of the present invention. 
         FIG.  2    illustrates a bottom plan view of a pillow interface of the present invention. 
         FIG.  3    illustrates a cross-sectional view of the pillow interface of  FIG.  2    along lines  3 - 3 . 
         FIG.  4    illustrates a perspective view of the cannula of the present invention. 
         FIG.  5    illustrates a cut-away partial view of the cannula of the present invention. 
         FIG.  6    illustrates a perspective view of the cannula of the present invention being connected to a source of air flow. 
         FIG.  7    illustrates a pillow interface of the present invention abutting against the edge of a nostril. 
         FIG.  8    illustrates a cannula with pillow interface of the present invention. 
         FIG.  9    illustrates a cannula with pillow interface of the present invention abutting against the edge of a nostril. 
         FIG.  10    illustrates a patient-interface view of a nasal interface apparatus of the present invention. 
         FIG.  11    illustrates a gas interface view of the nasal interface apparatus of the present invention. 
         FIG.  12    illustrates the gas interface side view of the nasal interface apparatus of the present invention with exhalation ports detached. 
         FIG.  13    illustrates a side view of the nasal interface apparatus of the present invention. 
         FIG.  14    illustrates a top view of the nasal interface apparatus of the present invention. 
         FIG.  15    illustrates a perspective view of the nasal interface apparatus of the present invention. 
         FIG.  16    illustrates a second perspective view of the nasal interface apparatus of the present invention. 
         FIG.  17    illustrates a cross-sectional view of the nasal interface apparatus of the present invention. 
         FIG.  18    illustrates the cross-sectional view of the nasal interface apparatus of the present invention showing air flow during inhalation. 
         FIG.  19    illustrates the cross-sectional view of the nasal interface apparatus of the present invention showing a portion of a nose interfaced thereto. 
         FIG.  20    illustrates a perspective view of the nasal interface apparatus of the present invention being worn by a user. 
         FIGS.  21  and  22    illustrate comparison data between the nasal interface apparatus of the present invention and three other popular industry breathing apparatus. 
         FIG.  23    illustrates a test system used to measuring resistance flow through a nasal interface apparatus. 
     
    
    
     DETAILED DESCRIPTION 
     Reference will now be made in detail to the presently preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings. Throughout the following detailed description, the same reference numerals refer to the same elements in all figures. 
     The present invention provides an adequate air volume, allowing for a normal inspiratory cycle and allowing normal adequate exhalation while treating, for example, sleep apneas. The high-volume delivery is provided at decreases air flow velocity, increasing lateral pressure, decreasing of the venturi effect, and increasing the effectiveness of treatment. The present invention is designed so as to not interrupt a patient&#39;s normal breathing mechanics; therefore, not interrupting a patient&#39;s normal respiratory rate and not interrupting a patient&#39;s normal inspiratory/expiratory ratio. 
     Work of breathing is greatly diminished. There is reduced turbulence or restriction during the inspiratory cycle with little or no noticeable change in noise throughout the inspiratory/expiratory cycle. The patient is able to exhale completely via the patient&#39;s elasticity of the lungs and without the use of any accessory muscles. Respiratory rate typically remains normal at 12 to 14 breaths per minute. The patient maintains normal minute ventilation throughout the night. Heart rate and oxygen saturation remain optimal throughout the night. The patient experiences normal breathing without apneic events. Once initial pressures are set during polysomnography, there is no need for increasing pressures at any time throughout the sleep cycle. These benefits result into a significant increase in compliance to the treatment (e.g., the patient continues to use the system). 
     Throughout this description, the continuous positive air pressure system is described in relationship to being used by a user, wearer, patient, etc., interchangeably. There is no limitation as to who will used the continuous positive air pressure system described here within. 
     Referring to  FIG.  1   , a perspective view of a system of the present invention is shown. The system shown in  FIG.  1    is a continuous positive air pressure system that receives air flow from a source (not shown), connected to flexible tube  60  at one end by a swivel adapter  62 . Current systems typically provide air flow to the flexible tube  60 , which is often a 22-millimeter flexible tube  60 . The present application requires a source of air flow but is in no way limited to any particular source of a gas (e.g., air, concentrated air, oxygen, etc.) and is not limited in any way to specific plumbing for delivery of such air flow. 
     A distal end of the flexible tube  60  connects to an air supply port  42  of the cannula  40 . In general, the cannula is substantially hollow. As the continuous positive air pressure system is typically worn while sleeping, the continuous positive air pressure system need be retained to the person using the continuous positive air pressure system. 
     Although there is no limitation as to how the continuous positive air pressure system is held to the user, in the embodiment shown, the cannula  40  includes tabs  50  for attaching a retainer  70 / 72 . In some embodiments, the retainer  70 / 72  includes an adjustable portion  72  for conforming to a head size of a wearer (e.g. having hook/loop material adjustments) and resilient members  70  that provide some amount of tension, holding the cannula  40  in place, and therefore, retaining the interface pillows  10  within the wearer&#39;s nostrils. For example, in some embodiments the resilient members  70  are made from medical grade silicone. The interface pillows  10  are describe in detail along with  FIGS.  2  and  3   . 
     Note that interface pillows of the prior art are typically made of a very soft and pliable material and have an overall round cross-sectional shape. When such is inserted into the nostril of a wearer, the round shape must conform to an internal shape of the user&#39;s nostrils, leading to both discomfort and impacted air passages that result in higher velocity of air flow and noise. 
     Referring to  FIGS.  2  and  3    a bottom plan view and a cross-sectional view of the interface pillows  10  is shown. The interface pillows  10  fit into and against the outer portion (entry area) of the wearer&#39;s nostrils. In general, the interface pillows  10  are made as pliable members (e.g., deform slightly under pressure) having a body that is elongated with one end for interfacing with a cannula  40  and a distal end for insertion partially into a wearer&#39;s nostril. 
     Viewing one interface pillow  10  from the bottom ( FIG.  2   ), the insertion depth, d, is defined by a side that slopes outwardly from the insertion tip  20  to a point of insertion  30 . The insertion slope is an angle, α, that in some embodiments is 10 degrees from a center axis of the interface pillow  10 . Proper insertion is limited by an insertion bulge  35  that prevents over-insertion of the interface pillows  10  into the nostrils of the wearer an provides a seal at seal points  51 / 52  (see  FIG.  7   ) against the edge of the wearer&#39;s nostril  80  and septum  82  (see  FIG.  7   ). Each interface pillow  10  has a connection interface  34  (canula end) for connecting to the cannula  40  (see  FIGS.  4 - 6   ). In some embodiments, the insertion depth if the insertion area  17 , d, is set at approximately 0.25″ for a comfortable depth extending inside the patient&#39;s nostril, e.g., an insertion distance of d. 
     The cross-sectional shape of the interface pillow  10  is formed to provide an enhanced seal of the insertion bulge  35  against the edges of the wearer&#39;s nostril  80  and septum  82  while providing maximum comfort. Note that the view from the bottom shown in  FIG.  2    is that of an interface pillow  10  that is to be worn in the left nostril, as the interface pillow  10  that is to be worn in the right nostril is flipped to match the symmetry of the wearer&#39;s nose. 
     The cross-sectional shape of the interface pillow  10  is shown having three specific nose interface areas  21 / 22 / 23 . The septum of the wearer&#39;s nose is generally flat and relatively unyielding. The septum interface area  21  has a flattened side to rest comfortably against the wearer&#39;s septum when inserted (e.g., into the left nostril). The upper interface area  23  is rounded and narrow with respect to the lower interface area  22 , as the geometry/shape of most nostrils are wider towards the mouth of the wearer than they are towards the brow of the wearer. In this, the interface area  22  next to the insertion bulge is the widest, dilating the lower region of the wearer&#39;s nostril the most, as the lower region of the wearer&#39;s nostril is also the least sensitive. 
     This shape of the insertion area  17  provides both a good seal and improved comfort. The shape of the insertion area  17  enables the interface pillows  10  to be made of a stiffer or thicker material than those of the prior art as there is no need for the insertion area  17  to deform. In such, upon insertion into the nostrils, the insertion area  17  of the interface pillows  10  generally retain their shape and, therefore, do not restrict air flow through the air channel  27 . Further, testing has shown that the shape of the insertion area  17  and insertion bulge  35  of the interface pillows  10  maintains the seal as seal points  51 / 52  even at the highest pressures expected with existing air pressure sources, typically around  20  centimeters of water pressure. 
     The insertion area of the cushion which fits against the inside of the nostrils  80 / 82  is at an angle, α, that in some embodiments is 10 degrees from a center axis of the interface pillow  10 . When the interface pillow  10  is pressed against the nostrils, the septum  82  of the nostril remains steadfast while the outside of the nostril  80  are flexible and gives way slightly, for example, 0.10 inch. 
     In  FIG.  3   , a cross section of one interface pillow  10  is shown. This illustrates shows that the insertion area  17  of the interface pillow  10  is angled at an angle of a to reduce pressure from being exerted against the septum. The insertion tip  20  is preferably rounded. Generally, the outside area of the nostril  80  will give way by, for example, 0.10 inches, while the septum  82  remains stationery. The angle of the insertion area  17  compensates for the uneven distribution of pressure against the bottom of the nostrils  80 / 82  while in use. The result is significantly greater comfort, and much greater seal capacity with much less chance of an air leak resulting in lesser efficiency and increased noise. 
     In some embodiments, the wall thicknesses vary. In some such embodiments, at the insertion area  17 , the insertion wall thickness w 3  is . 04  inches and narrows to a wall thickness w 2  of 0.03 inches at the insertion bulge  35 . These dimensions promote a forgiving feel of the pillows cushion against the bottom edge of the nostril, while maintaining an open-air channel  27  at the insertion area  17  when inserted into the nostrils. At the connection interface  34 , the thickness, w 1 , is, for example, 0.05 inches. Note that in embodiments in which the insertion bulge  35  is made of a thinner, more flexible material (wall thickness w 2 ) than the insertion area  17  (insertion wall thickness w 3 ), the insertion bulge  35  is more flexible and deforms under sealing pressure from the cannula  40  whereas the insertion area  17  is firmer and deforms less, thereby not significantly deforming within the user&#39;s nostril and, therefore, not causing turbulence and/or flapping as air flows in/out of the air channel  27 . Note that in some embodiments, the geometry of insertion bulge  35  is such that the insertion bulge  35  is closer to the insertion tip  20  at one side of the interface pillow  10  than at the distal side of the interface pillow  10 , compensating for the septum  82  extending further from the nose than the outer edges of the nostril  80  (see  FIG.  7   ). 
     Referring to  FIGS.  4  through  6   , perspective views of the cannula  40  of the present invention are shown. The cannula  40  is preferably hollow. The bleed port section  45  of the cannula  40  allows the user to exhale. The bleed port section  45  is placed in the front of the cannula body and directs exhalation air flow in a direction away from the arms/hands of a wearer, especially when the wearer is sleeping on their side. The exhaled air flow is directed at an angle, β, which is, for example, 57 degrees with respect to a lengthwise axis of the cannula  40 . The bleed port section  45  is composed of bleed holes  41 , each having an internal diameter, for example an internal diameter of 0.02″. In some embodiments, there are approximately  160  bleed holes  41 . This provides a 0.05″ square inch cross-sectional flow space per bleed hole  41  which is equivalent to a 0.25″ diameter bleed hole. This flow space for exhaled air is much greater than that of the prior art. This flow space eliminates, or greatly reduces, work of breathing. This volume of flow space for exhaled air is possible because of the high volume of incoming air made available through the open flow space within the interface pillows  10 . 
     Referring to  FIG.  7   , an interface pillow  10  of the present invention is shown attached to a canula and abutting against the edge of a nostril  80 / 82 . In  FIG.  7   , it is shown that the edges of the nostril  80 / 82  contact the insertion bulge  35 , where the insertion bulge  35  seals against the edges of the nostril  80 / 28 . The insertion bulge  35  seals against the outer edges of the nostril  80  at seal points  51  and the insertion bulge  35  seals against the septum  82  at seal points  52 . It is also shown, as in the geometry of most noses, that the septum  82  is not even with the outer edges of the nostril  80 . Therefore, the insertion bulge  35  is curved slightly downward towards the septum  82  to exert substantially similar pressure against the septum  82  as against the outer edges of the nostril  80 . 
     Referring to  FIG.  8   , a cannula with integrated pillow interface  140  of the present invention is shown. In this embodiment, the cannula  40  (cannula section) and pillows  10  are integrated/formed/molded into an integrated cannula with integrated pillow interface  140 . In this, the pillows interface is similar to or the same as the pillow  10  described above. The integrated insertion tip  120 , the integrated insertion area  117 , and integrated insertion bulge  135  are the same as the insertion tip  20 , the insertion area  17 , and insertion bulge  35  described with the pillow  10  above, only instead of having a connection interface  34 , the integrated pillow is formed as part of the cannula  40  into the cannula with integrated pillow interface  140 . The cannula with integrated pillow interface  140  includes several exhalation holes  145  (or bleed holes) for exhausting of exhalation gases from the user. Note that in some embodiments, the exhalation holes  145  are formed at an angle and aimed away from the user so that exhalation gases flow outwardly and away from the user instead of directly at the user. There are nubs  150  for connecting to a head strap  160  (see  FIG.  9   ), the head strap holding the cannula with integrated pillow interface  140  against the user&#39;s nose as will be described with  FIG.  9   . 
     In some embodiments, the air delivery connector  152  snap-connects to the air delivery tube  60 , forming a swivel connection and allowing for rotating of the air delivery tube  60  for proper positioning. 
       FIG.  9    illustrates the cannula with integrated pillow interface  140  of the present invention abutting against the edge of a nose  80 . In this view, the integrated insertion bulge  135  is shown abutting the edge of the user&#39;s nose  80 , forming a seal against the edge of the user&#39;s nose  80  (note a portion of the user&#39;s head and nose  80  are shown in dashed lines). In this view, the integrated insertion tip  120  and the integrated insertion area  117  are within the user&#39;s nose  80  and, therefore, not visible. 
     The nubs  150  are shown connected to a head strap  160  and the head strap holds the cannula with integrated pillow interface  140  against the user&#39;s nose  80 , forming the seal between the user&#39;s nose  80  and the integrated insertion bulge  135 . 
     In the embodiment shown, the air delivery connector  152  snap-connects to the air delivery tube  60 , forming a swivel connection, allowing for rotating of the air delivery tube  60  for proper positioning. 
     Referring to  FIGS.  10  through  20   , a nasal interface apparatus  1000  of the present invention is shown. In  FIG.  10   , a patient-interface view of the nasal interface apparatus  1000  of the present invention is shown. The nasal interfaces  1135  are flattened as shown in  FIG.  2    where the septum will press against the nasal interface  1135  as shown in  FIG.  2    (septum interface area  21 ), thereby providing an enhanced seal over the prior devices and increased gas volume as the prior devices were typically round and required deformation in order to create a seal. The nasal interfaces  1135  require minimal deformation and, therefore, the nasal air passages  1137  remain substantially open to allow for maximum volume of gas delivery at a given air pressure. 
     Note that the body  1040  of the nasal interface apparatus  1000  with strap connectors  1150 , as well as the nasal interfaces  1135  are anticipated to be molded together in the same molding process using a soft, pliable material such as a medical grade silicon, e.g., class IV silicone. 
     As shown in  FIGS.  11  and  12   , in the gas interface view of the nasal interface apparatus  1000 , the exhalation manifolds  1045  are visible. The air delivery connector  152  interfaces with an air deliver tube  60  (see  FIG.  20   ). The exhalation manifolds  1045  are fabricated/molded separately from the body  1040 , strap connectors  1150 , and the nasal interfaces  1135  using a different, harder material such as polycarbonate or polypropylene. 
     Cross-sectional area of the holes in the exhalation manifolds  1045  must provide sufficient total area for the user&#39;s exhalation gases to escape the integrated cannula with nasal interfaces. As the integrated cannula body  1040  with strap connectors  1150 , as well as the nasal interfaces  1135  are anticipated to be molded of a soft pliable material as described above, it is difficult to form precise-sized holes that remain open during use with such material, and it would be easy for these holes to collapse if made from the soft pliable material. Therefore, the exhalation manifolds  1045  are made of a stiffer plastic material with precise holes and the exhalation manifolds  1045  is fastened or press-fit into the body  1040 . 
     In the cross-sectional views shown in  FIGS.  17  and  18   , it is shown that the inhalation gas flow (see inhalation gas flow lines in  FIG.  18   ) is substantially linear from the gas deliver connector  152  to the nasal air passages  137 . There are no turns or corners and, therefore, minimal turbulence is created within the body  1040  and only one obstacle is present as needed for an indentation  1180  that provides space for the septum of the user&#39;s nose. 
     In  FIG.  19   , the cross-sectional view of the nasal interface apparatus  1000  is shown interfaced to a section of a nose of the user. The septum  82  fits within the indentation  1180  and the edges  80  of the user&#39;s nostril rest on the sides of the nasal interfaces  1135 , creating a seal without substantially deforming the nasal interfaces  1135 . Note that as the septum  82  is substantially flat, the inner-facing sides of the nasal interfaces  1135  are also substantially flat. 
     In  FIG.  20   , the nasal interface apparatus  1000  is shown being worn by a patient or user. Note that the elastic straps that hold the body  1040  and, hence, the nasal interfaces  1135  within the nostrils  80 / 82  are not shown for clarity and brevity reasons. 
     Referring to  FIGS.  21  and  22   , comparison data between the nasal interface apparatus  1000  and three other popular industry breathing apparatus are shown. The data presented in  FIG.  21    comes directly from an analysis done by Valley Inspired Products, document number 22007, ISO 17510:2015 Nasal Pillows Interface Evaluation, origination date Dec. 4, 2022 and updated by Revision A on Dec. 11, 2022. This report clearly shows the advantages of the above-described nasal interface apparatus  1000 . 
     The test utilized a setup for resistance flow (per the report) is shown in  FIG.  23   . 
     The graphs of  FIG.  21    and  FIG.  22    are taken directly from the test results published Dec. 11, 2022. In  FIG.  21   , measurements for resistance to flow are shown. In this, the test results show that at a flow rate of 50 liters per minute, the nasal interface apparatus  1000  described above had a resistance to flow, or pressure drop, of only 0.2 liters per minute  1202 , while the three other popular industry breathing apparatus had resistances to flow, or pressure drops, of: 1.3 liters per minute  1204 , 1.0 liters per minute  1206 , and 0.9 liters per minute  1208 . At a flow rate of 100 liters per minute, the nasal interface apparatus  1000  described above had a resistance to flow, or pressure drop, of only 0.6 liters per minute  1212 , while the three other popular industry breathing apparatus had resistances to flow, or pressure drops, of: 4.8 liters per minute  1214 , 3.7 liters per minute  1216 , and 3.4 liters per minute  1218 . 
     In FIG,  22 , measurements for exhalation flow are shown (e.g., exhalation rates). In this, the test results show that at a flow rate of 50 liters per minute, the nasal interface apparatus  1000  described above. In  FIG.  22   , the X-axis is pressure within the mask (e.g., 4 cm H 2 O, 8 cm H 2 O, etc.) and the Y-axis is exhaust flow rate (e.g., through exhaust orifices). The nasal interface apparatus  1000  as described above measured substantial increases of exhaust flow at all internal pressures as identified in extrapolated line  1220 . The measurements for the competitors  1222 / 1224 / 1226  were significantly lower than the measurements for the nasal interface apparatus  1000 . 
     The measurements reported in  FIGS.  21  and  22    clearly demonstrate the improvements provided by the nasal interface apparatus  1000  described above. Note that the product names of the competitive products, C 1 , C 2 , and C 3 , are blanked for copyright reasons. The actual report is available if needed. 
     Equivalent elements can be substituted for the ones set forth above such that they perform in substantially the same manner in substantially the same way for achieving substantially the same result. 
     It is believed that the system and method as described and many of its attendant advantages will be understood by the foregoing description. It is also believed that it will be apparent that various changes may be made in the form, construction and arrangement of the components thereof without departing from the scope and spirit of the invention or without sacrificing all of its material advantages. The form herein before described being merely exemplary and explanatory embodiment thereof. It is the intention of the following claims to encompass and include such changes.