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First Post - Be Gentle
#1
Hi Folks,

This is my first post (even though I have been lurking for some time) so please be gentle. I should apologise up front for my lack of brevity in this posting, but I need to get my story across. Now, where do I start?

I have been using CPAP for about 3 months now with very mixed results. My unaided overall AHI was 32.8 while in supine 67.6. Later my titration night indicated a pressure of 8 cm. Overall the diagnosis was “severe obstructive sleep apnoea with mild hypoxaemia”.

Since I am a mouth breather I elected to buy a Full Face mask (Resmed F10) even though the titration was done using a Nasal Pillow. The other reason for choosing a FF mask was that my nose was quite sore after the night with the NP. I also purchased a PR Remstar Pro C-Flex+ with the Humidifier (a constant pressure machine).

My provider set up the machine to the recommended 8 cm and off I went expecting ‘perfect’ results. That was the 9 March and a resulting AHI of 12.3, well sort of ok for a first night I thought, it can only get better. But the following night AHI was 33.2 and for the next four weeks or so varied between 20 and 30, not good I thought. So I upped the pressure to 9 cm and for the next week my AHIs hovered between 11 and 20. I’m on to something here I though so again I upped the pressure to 10 cm but little changed.

After telling my equipment supplier about all of this I received a friendly ‘rap over the knuckles’ for changing the pressure without reference to anyone. They then advised me to up the pressure to 12 cm which brought the AHI to between 6 and 12.

My equipment supplier then suggested I should try an auto machine to see if we could ascertain the right pressure. The PR Auto machine was setup for 6-16 cm but I soon found that the FF mask leaked uncontrollably at the higher pressures. On advice I reduced the pressure to 4-14 cm, but the leaking remained. During this time my AHIs were all over the place from 5 to 25.

I have had a feeling about the FF mask for some time so I asked my equipment supplier if I could borrow a Resmed P10. Having also noticed the friendly banter between P10 users and Pilairo users on this board I asked if I could also try a Pilairo. As happens they didn’t have a P10 available but its predecessor, but they did have a Pilairo. They were kind enough to loan me both NPs.

So last night I tried out the Pilairo with the pressure at 12 cm. I couldn’t believe it this morning when after about 8 hours sleep I looked at the screen to see an AHI of 1.6. Checking with SleepyHead there was only one obstructive event for the whole evening. I am sure however that this low AHI is a result of my mouth breathing. So now at long last to my questions.

1) At one stage I awoke with a very dry mouth, this seems to indicate to me that I was mouth breathing during the night. I notice with SleepyHead that the Flow Rate for about 10 minutes prior to waking is quite asymmetrical unlike the ‘normal’ roughly symmetrical wave shape. Is this an indication of mouth breathing?

2) I have been given a chin strap to help with mouth breathing but it seems to be somewhat elastic so how tight should that strap be?

3) I am experiencing a lot of difference between using a FF mask and a NP and the transition is quite difficult particularly the placement of the tongue - move the back of my tongue and the air flows out of my mouth regardless of the chin strap. I guess this is normal?

4) I woke this morning with one of my nostrils sore from the NP even though I used a moisturiser before putting the mask on. Will this nasal aggravation reduce over time as I become used to the device?

Well that’s about all the questions for now, all help appreciated with thanks.
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#2
Welcome!

I use lanolin to help my raw nose.
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#3
If the titration portion of the study was properly performed, and you slept in REM on your back, that 8cm should be a 'cover all' pressure for you. Upping the pressure more likely will result in higher AHI and leaks, and would not be the way to go, IMHO. Try the Pilaro at straight 8cm in spite of your comment that 12cm resulted in a very good AHI. Be sure that leaks are minimal.

There should be a separate report on the study from a SLEEP DOCTOR commenting on the sleep study findings with the fixed pressure he or she recommends. This is in addition to the sleep study. You might want to obtain a copy of the report written by the sleep doctor. The separate report is apparently required to be made.

In any event, you should not need to exceed that 8cm using straight CPAP. If using Auto, and you do not have 02 issues below 8cm, 6-10cm might be a good starting setting.

It appears that your issues relate more to your mask and control of leaks/efficient use of the mask.

In the meantime, it would indeed be of benefit if you posted the titration table and technologist's comments here.

It would also help if you posted your xPAP graphs via SleepyHead if your machine is compatible with that program.
Mine isn't, but the software data program using the SD card is quite adequate for my purposes.



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#4
Onclover, in answer to #2 of your queries, I initially didn't have a problem with mouth breathing with a nasal mask but after a while (2 months) found my mouth relaxing and just opening, letting out pressure. I bought at chin strap but it seemed unwieldy so tried tape and have found it very workable. I am using 3M Micropore surgical tape (aka Gentle Paper) and it works very well as it easily peels off in the morning but seals things during the night.
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#5
Welcome Dafod!

Trying to understand... do you mean you are actually taping your mouth shut?

(06-17-2015, 05:12 AM)Dafod Wrote: Onclover, in answer to #2 of your queries, I initially didn't have a problem with mouth breathing with a nasal mask but after a while (2 months) found my mouth relaxing and just opening, letting out pressure. I bought at chin strap but it seemed unwieldy so tried tape and have found it very workable. I am using 3M Micropore surgical tape (aka Gentle Paper) and it works very well as it easily peels off in the morning but seals things during the night.

-Ailu
Reformed CPAP Outlaw
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#6
Hi onclover,
WELCOME! to the forum.!
Get some HPA Lanolin cream to help with your soar nose. Just take a cotton swav and put a very little bit into your nostriles and that should help.
You can find HPA Lanolin in most stores in the baby isle.
Hang in there for more suggestions and answers to your questions and much success to you with your CPAP therapy.
trish6hundred
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#7
(06-17-2015, 05:12 AM)Dafod Wrote: Onclover, in answer to #2 of your queries, I initially didn't have a problem with mouth breathing with a nasal mask but after a while (2 months) found my mouth relaxing and just opening, letting out pressure. I bought at chin strap but it seemed unwieldy so tried tape and have found it very workable. I am using 3M Micropore surgical tape (aka Gentle Paper) and it works very well as it easily peels off in the morning but seals things during the night.

I've been taping my mouth shut for months (people have been suggesting that I do so since childhood Oh-jeez ).

Thanks for the tip re the surgical tape as I've been using Gorilla Tape and painter's tape to this point. Those tapes work pretty well but I am concerned about health effects- whether these concerns are founded in anything but speculation I do not know.

Have you been using the 1" or 2" tape? I am actually looking for a tape that is not particularly breathable.. Suggestions?



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#8
for the mouth breathing, master the tongue suck technique:
trick is to put your tongue up on the roof of your mouth and and suck it slightly to make a light vacuum. For me, it was easy to train myself to do that because I am normally a nose breather (at least awake) and the cyclone of air jetting out my mouth when I open it while sleeping tends to wake me. I have mastered the tongue suck technique well enough that a couple of times I have awakened with my mouth open, but seal intact.
ix-nay on the ape-tay!

for the sore nares, clean the pillows well, daily. If I do that mine never get sore, but they sure do, if not! I hate the feeling on lanolin on there.... ymmv!

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#9
Ailu,
yes, taping the mouth shut. Not sure of the width but you should just try and see what works. I have two widths - 3/4 inch and 1 inch. I find 3/4 works fine. Both come off easily.
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#10
First, I do NOT recommend taping your mouth shut. there are better chin straps out there that may give you better results. I had trouble for a few years with a FFM and they just kept changing the cushion size and kept telling me there were very little choices out there for masks (I now know that there are multiple FFM out there as well as nasal masks and nasal pillows).

Eventually I got some help from a sleep center manager who came to the sleep center with a lot of masks and I tried the ones I was interested in with the machine at the sleep center. I choose the wisp nasal mask that covers your nose rather than fits inside your nostrils. They also gave me a great chin strap.

That was over a year ago and I still use the Respironics Wisp nasal mask but no longer need the chin strap.

Maybe you can try the wisp and see if you get better results.

FFM are notorious for leaking but they work well for some people. I was not one of those people. What works well for some will not work well for others. YMMV

Hope this helps you.
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