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Chin tuck or chin "collapse"?
#1
Chin tuck or chin "collapse"?
(Continuation of my previous thread Altitude, dehydration, and centrals - but changing focus a bit. Mods: please move it back under if it should be in the same thread. BTW, a big thanks to all who contributed to that topic. I passed the info along to my PCP, who apparently has a different patient who has been fighting unresolved CPAP issues long-enough that she has been considering moving out of region to lower elevations. Hopefully this helps her as well, or at least motivates her to come to the forum.)

TL;DR version: does the cluster on the attached screenshots look like it's due to chin tuck or due to chin "collapse" caused by the full face mask pressing the jaw into the airway?

Longer version: after playing with the max pressure to balance between mouth leak arousals and apnea events, I determined that there was no "good lower pressure" for me that really made much difference in how I felt the next morning. I then just set the max back up to 18, and am now trying to address the leaks directly. (Many of these are definitely mouth leaks, with a couple of recent nights having me waking up with a dry, open mouth.) Increasing the humidity has helped some, but really hasn't fully solved the problem.

With all of the periodic breathing and related centrals pretty-much addressed now, and no longer masking other issues, I wondered if giving the AirTouch F20 another chance will help me better deal with the mouth leaks. The attached screenshots are the result of the first night back on the F20, same chin strap and pressure settings as before with the P10.

The leaks are almost completely gone (yay), but at the cost of double the AHIs and increased aerophagia - neither of which were helped by an event cluster and related spike in pressure. Looking at how the obstructions don't seem to be impacted by even close-to-max pressure on the machine, this seems to me that this might be a positional issue. However, I wonder if this is due to chin tuck or due to the jaw collapsing into the airway. (I recall that the AirTouch F20 is supposed to be worn more tightly than the AirFit F20 in order to seal properly.)

Thoughts? I'm trying to avoid buying yet another SCC unless I need to continue down that path.

       
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#2
RE: Chin tuck or chin "collapse"?
I think we have a habit of calling positional apnea what it is without much regard for its cause, so your question whether this is mask related or chin tucking is good food for thought. If the mask pulls the jaw back it will increase potential for airway restriction. A soft cervical collar or chinstrap like the one offered by Supplier #37 would likely help. The mechanism of obstruction is basically the same, and forward pressure on the jaw from a SCC or upward pull from a well designed jaw strap can help overcome that rearward pull by a mask or the wrong style of chinstrap. Maybe check into the Knightsbridge double chin strap?
Sleeprider
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