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[Equipment] Any part-time mouth breathers transition from a FFM to Nasal Pillows?
#11
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
My story switching from FFM to P10 as a side sleeping mouth breather: A hard case, but problem solved. Mouth taping would be my second choice, but will do it again if I cannot do as in thread below.

http://www.apneaboard.com/forums/Thread-...of-the-P10
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#12
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
I was too slow coming back to edit my reply above.

Please note: Regarding my link above: The chin strap that is depicted in my old March 2017 thread is a thing of my past, the last strap of several I used along the way.

I've long used the cervical collar instead of a chin strap, that with far better and more comfortable results.

I do use and have been very satisfied with the mouth sealer described and pictured and did devise and do use the Resmed F10 anti-asphyxiation valve mentioned in the thread.

2SB
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#13
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
When Mizz Cracker made the transition from masks to pillows, she was encountering the problems of mouth breathing while sleeping. They will occur...but we found that when you do mouth breath, the air pressure being delivered through her nostrils, would get loud... Kinda like a discharging air hose in a cave... The noise would rouse her from her sleep, and she'd close her mouth, and the noise would subside.  She seldom has it happen these days...she's apparently, auto-trained herself in time to keep her mouth closed without the aids of chin straps etc, when sleeping.  I'd just recommend patients, time, and eventually you'll likely do the same.

Her AHI number last  night was 1.4, av'ing just over 3 with the new unit.  I'm so proud and happy for her.  But with a little more tweaking and time, I'm hoping for some zeros real soon.  

FLc
If It Weren't For 'Flashbacks', I'd Have No Memory At All
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#14
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
(03-19-2019, 01:46 AM)Hydrangea Wrote:
(03-19-2019, 12:26 AM)RayBee Wrote:  I am beat down with a nasty head cold right now, often having zero ability to breathe through my nose. And it's driving me up a wall until the next round of Sudafed kicks in. I know trying to use my FFM would be a futile effort until I beat this bug. 

I just got over a several week long chest/head something-or-other, with an ear infection thrown in for fun.  I could not breathe through my nose one tiny bit.  I still used my CPAP, with my F20, and it was great!  I cranked up my pressure just a bit, because my throat was fighting staying open as well, and it worked wonderfully.  

It's worth a try.
I tried sleeping with the machine on, but that didn't work for me. I lasted about 20 minutes. Too restless and no sleep - no fault of the machine or mask. I resolved myself to be miserable for a couple nights and then resume my quest once I beat this bug.  Big bummer for me.  In the mean time, my CPAP parts are in the ultrasonic cleaner getting squeaky clean again.
RayBee

Self-Treatment - via ApneaBoard experts. :Thanks
Self-Pay - no help from Kaiser other than my script, then a pat on the butt and out the door.  Thumbs-down-1
Self-Educated - via ApneaBoard experts and its many users.  Grouphug3
Using a 2018 MacBook Pro running Mojave.
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#15
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
(03-19-2019, 01:54 AM)Hydrangea Wrote:
(03-18-2019, 11:31 PM)Big Guy Wrote: I get air leaks at night. When I do, I simply re-adjust the mask. I'd be surprised if any mask was 100% leak free. I'm a side sleeper as well and that just complicates matters more.

That's been my experience, too.  I just wake up, readjust, go back to sleep.  But with the memory foam of the F20 AirTouch, I sleep through the night. It stays put (despite me sleeping on my side).

I mention it, just so you or others might know there could be an option/solution.

Thanks for the info. I need to work on this too. My problem is that (before treatment) I've been getting up every couple hours to urinate. And now my brain has been programmed that way. So I wake up when my brain says it's time to go, but nothing's there.  Funny.  And stupid too.  I just need to fight that unfounded urge and go back to sleep.  Maybe my brain will get reprogrammed over the next few months.  I am looking forward to trying out the memory foam AirTouch though.
RayBee

Self-Treatment - via ApneaBoard experts. :Thanks
Self-Pay - no help from Kaiser other than my script, then a pat on the butt and out the door.  Thumbs-down-1
Self-Educated - via ApneaBoard experts and its many users.  Grouphug3
Using a 2018 MacBook Pro running Mojave.
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#16
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
I would like to add another experience of transitioning from a mouth breather to being able to use an AirFit P10 successfully. 

I would also like to express some concern regarding suggestions that essentially obstruct the mouth.

About 12 years ago I realized I might have significant OSA, the clue was not the typical excessive daytime sleepiness despite adequate or even prolonged sleep—What I had been taught in my Family Practice Residency.  My presenting symptom was severe cognitive impairment that started rather abruptly and rapidly progressed to where I thought I would need to close my practice.  (I will share the clinical details in a future post but need to stay on topic)

I got assessed at Kaiser using a rather primitive apparatus that strapped to my forearm and only measured O2 and heart rate—a proxy for sympathetic tone.

I was told I had mild sleep apnea and it was up to me if I wanted to treat it.  That was the full input.  I was on my own to find a DME.  The DME set me up with a ResMed AutoSet 8 and I began to try various apparatus.  I could check out three at a time and bring them back and try others.  I think I went through at least 12-15 different designs, and finally settled on the Mirage Swift.

I was having absolutely the worst sleep I had ever had in my life for the next 3-4 months.  I would wake with the “Sahara Desert in Your Mouth Syndrome”, where you literally wondered if you’d ever get your shriveled up tongue off the roof of your mouth. But I doggedly persisted and every time the thought of throwing the Blankety Blank thing away, I would audibly repeat to myself, “You need Your brain!”  I’d put it back on and never once slept without it in the first 2-3 years. 

I don’t think I thought I was a mouth breather, because no one told me about that.  I just realized that whether using a pillows or nasal mask, the only thing directing the air flow into your lungs and not out your mouth was the soft palate which acts as a flap, separating your nasalpharangeal from your orol cavity. (It’s why you usually don’t have Coke running out your nostrils when you drink too fast.)  If I ever so slightly relaxed my soft palate, (releasing the slight vacuum holding it in place) the air would be immediately be redirected out my mouth and the ramped up postitive pressure would force the palate to stay opened.  Hence, you’d wake to the roar of a rushing wind and a totally parched mouth.

I believe over this adjustment time I gradually became less prone to this dynamic. Somehow my unconscious brain told my sleeping brain to, “Keep your bloody mouth closed!!!” And eventually I was able to better control my soft palate, sleep through the night and could try a number of nasal mask and pillow designs.

It seemed like I tried about everything out there.  One had good pillows, but lousy headgear.  Or one had good headgear but lacked a swivel or had lousy pillows. It got to when I finally requested a in house sleep study years later, when I got on Medicare, I took my custom- made contraption in with me.  I had barrowed the best elements from four different designs.  The best pillows, the best head headgear, the best vent and the best swivel. I’d even make molds so I could mold plastic or silicone parts.   The sleep tech looked at it and said, “Are you and engineer? It’s usually the engineers that do this.”

Anyway, I started my sleep study, and then was rudely awakened from deep sleep when the tech blasted me with light, jerked my head around and said you are a mouth breather, and she yanked a chin strap on.  That’s actually the first time I was informed of this.

I had simply assumed that my dry mouth was due to the occasional lapse in my soft palate staying closed.

So, I returned home thinking, OK, I am going to give this chin strap a try and see if this solves the only residual complaint that I have with using my CPAP—a dry mouth.  I tried several chin strap designs, and finally decided they were a joke.  Problem is, even if your teeth were literally wired shut, there are still enough channels behind your last molars, and between your teeth for the air to stream through and flutter out your lips.

I decided, if my dry mouth is the result of mouth breathing, then I should be able to completely offset this by doing what some have suggested in this thread: Tape my mouth completely shut. I had taken note of the tape that the sleep tech had used on me--Hypaflix. It’s kind of cool. Very thin and light weight, very flexible but very sticky. It has a fabric like texture but has a very thin plastic like layer that is impermeable to air and water. It is tenacious, but comes of without residual and is kind to your skin. I got it off Ebay.
 
[attachment=10873]
   

So, I very carefully used about a 4x2 inch strip, pursed by lips together and applied if firmly over my mouth.  It was completely airtight.  Very importantly, I peeled off some of the backing on one end and folded the tape back on itself to form a flap.

To my utter surprise, with my mouth completely closed, I woke in the morning with a dry mouth! About as dry as it was with my mouth left open.

This meant that either there are enough eddy currents in the oral cavity to still dry the mouth, or there is actually enough desiccation in the naso oropharyngeal region to dry the oral tissue out.

I can’t prove it, but I would favor the second theory.  The reason is that the nasal turbinates are convoluted bones on each side of the nasal cavity.  The are covered with mucous membranes replete with a dense plexus of blood vessels.  The result is they form an extremely efficient heat and moisture exchanger.  That’s why you can inhale very cold air and by the time it hits your airway it’s pretty much at body temperature and humidity.  If this were not so, we would probably have severe bronchospasm when the cold air hit our lungs.
   

The point is that I think this mechanism may suck the moisture right out of the surrounding tissue including the tissue of the oral cavity lying just below the turbinates.  I would have thought that the huge blood flow to the tissues of the head and face would quickly re-establish equilibrium with respect to tissue moisture, but maybe there is a lag time. Many of you have experienced marks left on for face from head gear.  There is edema or excess fluid in the tissue and the depression can persist for some time before your circulation takes up the extra interstitial fluid.

I think this same mechanism may contribute to dryness and pain in the eyes (which I will save for another thread). 

So, at this point I am resigned to having a dry mouth.  If I do mouth breath it is probably not clinically significant since my AHIs are always below 1, usually 0.5 or lower.

A FINAL WORD OF CAUTION REGARDING TAPING YOUR MOUTH OVER. 

When I tried this, I was aware of a potential, very dangerous risk—that of regurgitating with your mouth obstructed.  Coming out of a deep sleep, you would literally have micro-seconds to get that tape off before the reflexive compulsion to inhale would make you suck your vomit into your lungs.  

Aspiration pneumonia is very dangerous.  It’s not like you just inhaled some water while swimming.  You are inhaling the most acidic fluid in your body.  And it burns the heck out of your airways causing marked inflammation and a rip roaring pnuemonia.  That’s why I made the flap I mentioned earlier.  I made sure it was large and that I knew exactly where that flap was and I notified my wife (a nurse practitioner) as well when I was doing this.

Some may say, well, I am sure I would have warning if I’m going to be at risk for vomiting.  But there are a number of scenarios where you might vomit straight out of sleep. 

·      Bad case of the flu
·      Staphylococcus food poisoning, which starts abruptly with projectile vomiting
·      Gastro esophageal reflux, where your stomach contents come up your throat and can cause choking and gagging and aspiration pneumonia. As a group those with OSA are at particular risk because the vacuum formed when the airway obstructs can suck up the gastric contents.
·      Heart attacks, especially right posterior descending artery is associated with nausea and possible vomiting
·      Gastroparesis or slow stomach emptying (a condition that can be seen in people with diabetes)
·      Too Much alcohol
·      Certain medications, e.g. complex antibiotics
·      Distension of muscular organs—Gal Bladder, Bowel, Kidney Stones which can start abruptly and can be associated with severe pain and nausea.

So, I would be very cautious if you consider using this as an ongoing solution to mouth breathing.
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#17
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
I forgot to respond to a few issues you mentioned RayBee.

But I am beat down with a nasty head cold right now, often having zero ability to breathe through my nose. And it's driving me up a wall until the next round of Sudafed kicks in.

When you have swelling in the nasal mucosa, whether from allergies or a cold, the tissue becomes leaky and serum fills the interstitial tissue (tissue between the cells) causing edema.  This can partially or in some cases almost completely obstruct your nasal passages depending on your particular anatomy.  

I have this same problem with colds or allergies and I usually can overcome it by using a topical decongestant like Afrin.  One or two sprays in each nostril usually begins to vasoconstrict the leaky vessels and after 10-15 minutes, as the excess fluid gets absorbed the mucosa shrinks down.  I find that if it shrinks enough to let me start to use my P10, the positive pressure begins to squeeze out the edema and it gets easier and easier to breath.  Then usually I can sleep through the night as long as I don't stop the CPAP for too long.  

When you use Sudafed, which works systemically it is not targeting the effected tissue as directly, and it also can have other side effects such as raising blood pressure, heart rate and make you more alert and less sleepy--everything you might expect from a mild stimulant.

The other comment had to do with your urinary frequency.

My problem is that (before treatment) I've been getting up every couple hours to urinate. And now my brain has been programmed that way. So I wake up when my brain says it's time to go, but nothing's there.

When you feel you have to go, but there is nothing there it can be caused by a number of things.

The simplist would be too light of sleep.  If you remain in the lighter stages of sleep you are closer to being aroused--by a barking dog, or the sense that your bladder is full.  Once awake, you may make yourself go, because you think if your bladder is already partially full, it's just going to wake you up again soon.

Of course a major cause of lightened sleep is apnea since the events force you up out of deeper sleep toward partial or full arousal plus you get a pulse of adrenalin to boot.

Other cause of urinary frequency may be a urinary tract infection--possibly low grade so it doesn't cause more severe pain, but enough irritation to make the bladder reactive. This would be more like in women than men though.

It also could be due to prostate problems, where the partial obstruction results in incomplete emptying of the bladder so you end up feeling its full and go, but only partially empty again.
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#18
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
Mdmarmd - Have you tried upping the humidity? I had the same problem, and upping the humidity helped a lot. I go through an entire humidifier chamber every night, but have no dry mouth.
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#19
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
On the mouth breathing thing I used either a Wisp nasal or an Airfit P10 pillows mask for several years and rarely had leaks or any mouth breathing problems and regularly returned Sleepyhead readings in the 0.4 to 0.8 AHI. That was until I had a heart attack on January 6 resulting in urgent surgery only an hour later to clear the blockage and the insertion of 2 stents....after a week in hospital 3 days in ICU I was allowed home and on my 1st night using the P10 and the same settings I returned an AHI of 30+ over the 7 hours I was asleep.

This continued for several more nights before I visited my Doctor who sent me straight to see my Cpap therapist who had absolutely no doubt looking at my charts that I was now a mouth breather and would have to go onto a FFM.

She recommended the PR Dreamwear FFM and after some initial trials and tribulations I now mostly return a Sleepyhead reading of around 0.8 AHI on a good night ranging up to 3.0 on a bad night.

I also find I get better results now using my Resmed S9 Autoset set on 12 - 18 than I do if I use my PR DS 560 System One Auto which is the opposite of my results prior to the heart attack.

Can anyone explain why this is the case?
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#20
RE: Any part-time mouth breathers transition from a FFM to Nasal Pillows?
Hydrangea wrote:

Mdmarmd - Have you tried upping the humidity? I had the same problem, and upping the humidity helped a lot. I go through an entire humidifier chamber every night, but have no dry mouth.


I do use my water chamber and fill it to the very top. (I wish the capacity was 20% more, but I guess it would increase the overall size of the CPAP.)

Usually in the morning I have less than a 1/4 inch of water in the tank.  If I sleep long, it can even dry up completely.  But the catch 22 is the problem of maintaining the balance between higher humidity and avoiding rain out. I mentioned in another thread regarding the P10 and hypercapnia:

Anyway, I had had my settings around a temp of 80 and a humidity of 4 for awhile with no real problems.  But on one morning I felt a bit more dried out and the following night I increased the humidity to 6.  Well, that night I woke abruptly short of breath with all the symptoms I have come to equate with hypercapnia.  I looked at the P10 tube and there was prominent condensation—the sort where little droplets were scattered around within the tube.  Since I had a backup, I replace the whole P10 unit and went back to sleep.  Shortly, I again woke symptomatic of hypercapnia and the second P10 also had rain out.

It doesn't help that during the cold season, the incoming air is also much drier since most of the humidity has condensed out in the environment.

But even if I can approach maximum humidity in the warmer months, I still have a dry mouth. It may be that I do mouth breath or at least have some leakage through my mouth when my soft palate is displace from resting on the base of my tongue.  In my view this is not truely mouth breathing but more akin to leaking.  But maybe that is just splitting hairs.

I am just resigned to accepting that having a dry mouth is a reasonable price to pay for keeping my brain working.
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