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Better to breath through mouth or nose with FFM?
#1
I'm new to the PAP adventure and have been working through tensions between myself, the machine, the mask and my sleep physician since commencing six weeks ago.

Before expanding on my question, here is a brief history to date:
* Diagnosed with sleep apnea with AHI of 12 (AHI of 29/hr supine) and minimum sleep SaO2 of 87%. Given the AHIs reported on this board by others, I thought this is going to be a cinch to get from 12 to something under 5!
* After a few trials of nasal pillows and nasal masks, the best result for mask leaks and acceptable comfort was F&P Eson 2 nasal mask.
* Because of mouth leaks I tried chin restraints, trying to do the 'seal with tongue' trick, and finally Micropore tape across the mouth.
* The Eson 2 and Micropore tape gave what I think is a reasonable leak rate and reduced AHI to 2.23. All events were hypopnea. Pressure range was 7 to 12. Experience to date is that machine pressure runs up from the minimum set pressure to the maximum set pressure as soon as I'm asleep and mostly sticks close to the maximum until I wake up. With this combination there is potential for improvement with adjustments to leaks and pressure.
* I'm not too keen on a taped mouth on a permanent basis (friends would probably suggest full-time permanent would be a good idea). Sounds like it could end badly if something goes wrong, let alone the discomfort of greeting every day by ripping tape off my mouth. My next brilliant idea was to use a FFM and try to train myself to keep my big trap shut and if that worked to move back to a nasal mask. In the meantime the therapy would be working with the FFM.
* Several FFM trials later I have a PR Amara View mask which is comfortable and provides a good seal allowing me to sleep on the back and both sides with few leak problems as I move about. AHI increased when I started trialing FFMs. I have tried and am continuing to try different pressure ranges. To this novice the indicators were that the pressure range should be increased, but with a pressure range of 13.6 to 16, AHI was 12.29 (worse than my sleep study result). So far the best result has been AHI of 6.07 with a pressure range of 10 - 12. This is a work in progress.

Back to my question. I think it is well established that for general health reasons, breathing through the nose (particularly inhaling) is the preferred option. However, I don't know if this applies to sleep apnea and treatment with PAP to achieve a desirable AHI. During the day I breath mostly through my nose, but obviously from nasal mask experience I mouth breathe at times. I don't know for how long and when. I seem to spend periods of time where events are few and periods when events are high. I thought the pattern may be related to 'mouth open' and 'mouth closed' periods, but it could also be changes of sleeping position or other factors. The pattern can be seen in my charts from last night. There was no sleep during the second segment of the chart.

[Image: 6laJKLwl.png]

I am wondering if anyone has been able to ascertain whether keeping the mouth closed or open with a FFM gives the better result. Also, are there any distinguishing features of the SleepyHead charts that indicate mouth open or closed or at least when there has been a transition?

Thanks in advance for your wisdom.
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#2
I think if you can, it is generally considered better to breathe through your nose.

However, when connected to CPAP there is an extra consideration. If CPAP is via the nose only and your mouth is open, air enters the nose and can then vent out through your mouth, making you uncomfortable and decreasing the effective pressure within your airway. That is, it is a large leak, and will affect your therapy.

With a full face mask, the pressure is equalised, so it really doesn't matter from a therapy point of view if your mouth is opened or closed.

I am in the same situation as you. I use and Amara View. I try to breathe through my nose as much as possible. As soon as I fall asleep, my mouth opens. With the full face mask this doesn't really matter, except sometimes my bottom lip will drop out of the maskSad

I am consistently getting AHI results below 1.0, and I feel fine.
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#3
Sharp board member said you can not fix mouth breather with chin strap.
They were just spot on.

I got waterboarded feeling (with full mask). Issue was that pressure
was too weak. Uped pressure 12 to 13.8

So go right to full mask. You may have to up pressure.

Don't even try to use nasal mask. You will get used to mask.
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#4
It is obvious that you need to increase your pressure settings. The lower pressure of 4 cm H2O is a poor starting point since it can make you feel starved for air initially. I suggest raising the lower pressure to 6 cm H2O and the upper to 9 cm H2O for a starting point. If you are then still over 5 AHI, start working up on both setting equally until you start getting below 5 AHI readings. You may eventually need more than 9 cm H2O but it isn't wise to make such a large change all at once. That can be upsetting and make acclimation more difficult. Allow a few days between incremental changes before judging the results.

Dude
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#5
I have used a FFM for ten years. I have a deviated nasal septum and it doesn't take much for me to be unable to breathe through my nose.
When I can breathe through my nose it is better for me because my mouth doesn't dry out as much. It sometimes does dry out even though I use the heated humidifier.
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#6
(09-30-2016, 08:12 AM)surferdude2 Wrote: It is obvious that you need to increase your pressure settings. The lower pressure of 4 cm H2O is a poor starting point since it can make you feel starved for air initially. I suggest raising the lower pressure to 6 cm H2O and the upper to 9 cm H2O for a starting point. If you are then still over 5 AHI, start working up on both setting equally until you start getting below 5 AHI readings. You may eventually need more than 9 cm H2O but it isn't wise to make such a large change all at once. That can be upsetting and make acclimation more difficult. Allow a few days between incremental changes before judging the results.

Dude

Good call, but with the machine in auto mode, she looks like the pressure is fixed at 8.0. I would suggest a maximum pressure closer to 12 and see where the machine wants to go. If EPR is needed for comfort, that would be okay too, but definitely needs higher minimum and maximum pressures.
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#7
(09-30-2016, 07:07 AM)jxyzobrien Wrote: Sharp board member said you can not fix mouth breather with chin strap.
They were just spot on.

Chin strap with P10 nasal pillows works great for me.

I used F10 and Simplus FFMs and still suffered leaks when my mouth fell open. So I got a chin strap with the FFM and voila the leaks disappeared on the first night.

This worked so well, that about a week later, I wondered about trying the chin strap with nasal pillows. Sure enough, no leaks, and a much more comfortable experience.

I can only speak for myself, YMMV. But I believe that if you tame the leaks using a chin strap with FFM, then it's definitely worth it to buy a nasal pillow with return insurance (that's what I did) and see if it works. Nothing to lose, much to gain.

Saldus Miegas
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