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.
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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.