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144 days... and I seem to starting to mouth breathe
#1
Hello,
I've been on APAP for 144 days now and seem to have started to get a habit of mouth breathing (I've been having issues being woken up with air rushing out my mouth, or a dry mouth), despite my efforts to keep my tongue shoved up against the roof of my mouth. Not sure what has caused the gradual trend.

Mask: Airfit P10 pillows, changed every month and a half
Climate: full auto (tried higher humidity but couldn't avoid rainout)
My sinuses are normally a bit stuffy (I've got a wickedly deviated septum to the point my nose is crooked), but the humidity of the machine seems to clear it up.

I've been using a Respironics chin strap for a few days now and it seems to help if I have it tight enough.

The DME said a FFM would be the next step if the chin strap doesn't fully help. I'm curious if perhaps a regular nasal mask vs the pillows would be a reasonable next step? Just wondering if the directed jets of air up my nose are perhaps drying things out more than perhaps a nasal mask would? Anyone have any thoughts or experience along these lines?

Here's my leak rates over time. It seems the 95% leak rate has slowly been climbing up since the start of therapy:

My 95% leak rate over the past couple weeks has been around 12.


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#2
When you awake with the mouth leak, cycle the on/off button. This will record a break in the timeline, registering when it occurred. View that day's data in SH and look for the break and then look at the pressure up to that point. I've found that up to a certain pressure I don't have any problems, but just .2cm above the magic number and I start mouth breathing.

Good luck!
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#3
(09-13-2015, 06:36 PM)sgearhart Wrote: When you awake with the mouth leak, cycle the on/off button. This will record a break in the timeline, registering when it occurred. View that day's data in SH and look for the break and then look at the pressure up to that point. I've found that up to a certain pressure I don't have any problems, but just .2cm above the magic number and I start mouth breathing.

Good luck!

That is a good idea. Now that I dream again I sometime wonder if I am just dreaming I'm mouth breathing. Hah. But using a break to record these is events makes sense. I'll give it a try.

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#4
Another idea to avoid dry mouth :

If you want to try and avoid rainout by using higher humidity try wrapping your tube - a snugglehose (available on-line) works for me.
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#5
(09-13-2015, 07:11 PM)sonicboom Wrote: Another idea to avoid dry mouth :

If you want to try and avoid rainout by using higher humidity try wrapping your tube - a snugglehose (available on-line) works for me.

So even with the climateline tubong you found the hose cover makes a difference in condensation? I would have thought the heated hose would have been enough.
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#6
Hi SleepyDude,
I no longer have condensation using a snuggle hose over my heated tube. I've been on CPAP for almost a year now, and had a hard time with mouth breathing at first, but have learned to control that. In the beginning, I used a chin strap, but once I mastered the tongue to roof of mouth trick, I stopped using the chin strap. Smile

I also have to change my nasal pillows every 2 to 3 weeks. If I try to stretch it any longer, they get soft and don't keep their seal as well. That's when I find myself mouth breathing because I'm feeling like I'm not able to get enough air through pillows that get soft.

Waking up with dry mouth from mouth breathing is pretty nasty. I use Biotene mouth rinse which helps.

I like sgearhart's suggestion on turning machine off and back on so that you can check to see what pressure you were at when mouth breathing occured.

Good luck in resolving this issue. What works for one may not work for you.

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#7
OpalRose, interesting. I guess having the hose insulated can only help prevent condensation. The snugglehose is so inexpensive its worth a shot. The idea of the hose beig softer is appealing too.

Interesting. I suppose a new nasal pillow is a simple thing to try so I should probably try that right away.

Thanks

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#8
(09-13-2015, 05:55 PM)SleepyDude Wrote: The DME said a FFM would be the next step if the chin strap doesn't fully help. I'm curious if perhaps a regular nasal mask vs the pillows would be a reasonable next step? Just wondering if the directed jets of air up my nose are perhaps drying things out more than perhaps a nasal mask would? Anyone have any thoughts or experience along these lines?

hi SleepyDude,

great ideas above to try and address the mouth breathing. Hope that solves it.

If it does not, then nasal mask is not a useful next step because it doesn't cover the mouth. In order to prevent mouth leaks you will need a mask that covers nose and mouth. The FFM is the next step. If that doesn't work there is a Total Face Mask (TFM) option. In my short five months in therapy I have not known of anyone who uses a TFM but I and lots of other mouth breathers have done well with the FFM.

Also, regarding chin straps... Retired Guy once advised in a post that the chin strap is more about gentle pressure to hold the right position rather than tightness to clamp the mouth shut. He suggested a too tight chin strap could cause you to wake up with a headache because of jaw muscle tension and potentially cause other problems. The idea of the chin strap he said is to keep your jaw from relaxing and dropping out of place as you fall asleep, and a gentle support in the right place is all it takes.

Don't know how that might play into your recent chin strap strategy, but it suggests to over tighten may be counter productive. Maybe there is something in that idea to work with in order to regain the success you once had with the chin strap.

I am a mouth breather who had limited success controlling air leaks until I added a chin strap. That has worked so well for me that I just set aside my Simplus FFM to give the P-10 a try and see if I can use the nasal pillows which was not an option for me coming out of the titration study.

After two nights I am loving the P-10, although I had not considered how often they have to be replaced (what is the normal recommended replacement inerval for these?).

My 90% pressure has dropped four points from 15.x down to 11.x and sleep is more comfortable. No more waking up during the night to wiggle my chin or nose or tug on the mask in order to close little leaks that spring up as I moved around. Uninterrupted sleep is sweet sleep and more is better. Smile So I have become a new fan of the P-10.

Having come from FFM to pillows, I would try some things before I would go back. But if you have to go to FFM it's not the end of the world. I tried the F-10 and had better luck with the F&P Simplus. The Simplus has lots of silicon air cushion to mold itself to your facial structure. That worked better for me, but you may have to play with different FFMs to find the right one. Hope you don't have to go there because the nasal pillows are such a lighter weight solution.

Saldus Miegas
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#9
The edema of soft tissue in our breathing apparatus goes down after successful xPAP therapy over 3-6 months. That may reduce your pressure needs (there is a paper in pubmed on this explaining how a 2nd titration after a few months of Cpap shows a lower required pressure).

My theory on mouth opening is that if the pressure applied is just a bit More than the critical pressure to keep the airway open, it blows open the mouth gate. In my case, I can even open my mouth while breathing nasally thru my P10 pillows and no air escapes thru the mouth.

You can try to correlate if the leak is happening at a higher pressure (and maybe that threshold has changed over time ). You may want to tighten your top end of the range a bit (if AHI permits) and evaluate.

And you can never leave the P10 cult once you join. Resistance is futile!! Smile
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#10
(09-13-2015, 11:25 PM)SaldusMiegas Wrote:
(09-13-2015, 05:55 PM)SleepyDude Wrote: The DME said a FFM would be the next step if the chin strap doesn't fully help. I'm curious if perhaps a regular nasal mask vs the pillows would be a reasonable next step? Just wondering if the directed jets of air up my nose are perhaps drying things out more than perhaps a nasal mask would? Anyone have any thoughts or experience along these lines?

hi SleepyDude,

great ideas above to try and address the mouth breathing. Hope that solves it.

If it does not, then nasal mask is not a useful next step because it doesn't cover the mouth. In order to prevent mouth leaks you will need a mask that covers nose and mouth. The FFM is the next step. If that doesn't work there is a Total Face Mask (TFM) option. In my short five months in therapy I have not known of anyone who uses a TFM but I and lots of other mouth breathers have done well with the FFM.

Also, regarding chin straps... Retired Guy once advised in a post that the chin strap is more about gentle pressure to hold the right position rather than tightness to clamp the mouth shut. He suggested a too tight chin strap could cause you to wake up with a headache because of jaw muscle tension and potentially cause other problems. The idea of the chin strap he said is to keep your jaw from relaxing and dropping out of place as you fall asleep, and a gentle support in the right place is all it takes.

Don't know how that might play into your recent chin strap strategy, but it suggests to over tighten may be counter productive. Maybe there is something in that idea to work with in order to regain the success you once had with the chin strap.

I am a mouth breather who had limited success controlling air leaks until I added a chin strap. That has worked so well for me that I just set aside my Simplus FFM to give the P-10 a try and see if I can use the nasal pillows which was not an option for me coming out of the titration study.

After two nights I am loving the P-10, although I had not considered how often they have to be replaced (what is the normal recommended replacement inerval for these?).

My 90% pressure has dropped four points from 15.x down to 11.x and sleep is more comfortable. No more waking up during the night to wiggle my chin or nose or tug on the mask in order to close little leaks that spring up as I moved around. Uninterrupted sleep is sweet sleep and more is better. Smile So I have become a new fan of the P-10.

Having come from FFM to pillows, I would try some things before I would go back. But if you have to go to FFM it's not the end of the world. I tried the F-10 and had better luck with the F&P Simplus. The Simplus has lots of silicon air cushion to mold itself to your facial structure. That worked better for me, but you may have to play with different FFMs to find the right one. Hope you don't have to go there because the nasal pillows are such a lighter weight solution.

Saldus Miegas

Well, I did try leaving the strap a bit looser than I had initially and I think it reduced the number of times I had mouth leaks. I'll have to really play with the position and tightness though. I find there is a fine line between it working perfectly (first half of last night before the cast on my foot woke me up I had 0 leaks; second half I had 3 x 1/2 hour leaks).

I would really like to keep with the pillows if possible. I do like how simple they are and how they seem to be pretty immune to leaking themselves. But if I have to go FFM in the end, I'll go FFM. Smile
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