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Is AHI related to mask leak?
#1
Is AHI related to mask leak?
Ok, this is probably not a scientific theory but my observation is that on the days I use mouth taping, my AHI is always higher compared to the days I am not using taping. Of course, it is isn't a controlled trial where all variables are kept constant and I don't have a large sample size yet, however I have a few theories why it might be the case.

The upper airway, to my understanding, has 2 locations where the diameter can be constricted. The first one is the soft palate and the second one is the tongue. The soft palate and the tongue muscles can relax during sleep and obstruct the nasopharynx and the oropharynx respectively. The nasopharyngeal constriction can be prevented by the EPAP of the device, by keeping it open using air. I am not sure if the air is strong enough to prevent the tongue from falling back but I think it would be harder and less effective. 

When you don't use mouth taping, the mouth will open eccasionally and you'll end up leaking air, depending on the position of the tongue. If you are leaking air, it means the high pressure air won't be going to your lungs, as it is diverted from the oropharynx. One effect this can have would be less central events, as the oxygen content will not be as high as it would be if all of the high pressure air went directly to the lung. Also, the nasopharyngeal constriction will still be resolved, because the air will be passing by the soft palate. The problem here would be with the constriction due to the tongue, but I am not sure how effective the EPAP is for pushing the tongue. 

With mouth taping, you might increase air pressure inside your mouth, and this can push the soft palate up, or even the tongue back, so the constrictions could become more severe.

Do you think those theories have any merit??
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#2
RE: Is AHI related to mask leak?
Not sure.
I've proven empirically for myself that mouth leaks cause centrals for me. A prolonged mouth leak will eventually result in me taking an unconscious deep breath while resealing my mouth, what follows is normally one or more centrals as I drift back to sleep.
Mouth tape fixes that issue for me. My AHI averages around 0.3 when I get it right, and 2 (mostly centrals) when I forget the tape.

What I've found in this game is that there are no universal theories, every theory depends on the person. It's also why I don't believe that DME's etc. are much good at helping beyond the basic level of CPAP therapy. I'll bet everyone on this forum will have theories that contradict each other, because we are all individuals.
Once leaks, appropriate therapy mode and rough pressures levels have been established it's down to fine tuning that only the person themselves can do.
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#3
RE: Is AHI related to mask leak?
Machine event records become increasingly unreliable with higher leaks. This varies somewhat between brands and types of machines and the result can be either an increase or decrease in events. Because we cannot rely on results or event what type of event is being recorded, we will always try to resolve leaks as much as possible and may reserve judgement on what the machine is telling us. Leaks can also be an indication of movement or thrashing in bed which is a significant cause of false events.
Sleeprider
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#4
RE: Is AHI related to mask leak?
I do tape, and have a low setting of 8/5.6 with EPR of 2 cm.  Apart from the rush of air out of my mouth if I don't tape, and the resultant eventual arousals, I would have to say I don't get higher numbers of events, flow restrictions, hypopneas, or the like due to the tape.  IOW, it's far, far, worse for me if I don't tape, and I don't get the sense that taping is the least of evils...for me.  About the worst that happens is the chipmunk look, which to be truthful does occasionally cause me to arouse as I fall asleep, but most often it does not. 

We learn to adapt, and we find things that work for us.  I lie on my back until I get that first drift off and arousal, at which I turn onto my side and don't even get the chipmunk effect.  When I sleep on my side, I bring my hands up under my chin or around my neck nearby, curled tightly at the wrists so the forearms will fit comfortably under my chin, and that helps to keep my mouth closed despite the slack and in spite of the tape.  Weird, but that's all I know with my own experience.  

Now, if only I could get a steady 7 hours of sleep, and not the 5.5-6.5 hrs that I get so reliably.  Sad
Serial Tapist
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#5
RE: Is AHI related to mask leak?
Without taping I get a high leak rate--usually around 3o or higher--with my P10. I also get a low ahi reading, under 1. When I use am Airfit F30 I get a very low leak rate--and a higher ahi (still low though; 2.5 or so.)

someone here suggested the high leak rate was throwing my ahi report out of whack. I think that's true. I don't trust it. However...I often feel as good in the morning when I use the p10 as when I use the F30. Go figure.

I've tip toe-d through the tulips into taping. The 'gentle' paper tape I bought isn't gentle at all. If I can find a soft tape I may take up taping. I can get bags under my eyes from the F30; never from the P10.
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#6
RE: Is AHI related to mask leak?
My first night, 'cuz I didn't know any better, was awful.  Next night, I tried sports wrapping tape.  That worked to a limited extent, but at least I could fall asleep.  I next went looking in a pharmacy and found 3M Corp NexCare white 'water resistant' tape in a large white plastic spool.  The spool nests in a decaled white plastic cylinder to fit.  The tape is about 2.4 cm wide, easily torn, easily applied, and if you take the extra step of firmly pressing it into place with finger tips, and I do mean firmly, it will hold well.  It comes off very easily, but first make a small folded-over tab of the tape at one end...helps a lot, especially if you're in a hurry.

Also, they're once-on-wonders.  The tape is not designed to be removed for a cough, a belch, or a glass of water, and then restored into position.  Once you remove it, reach for another piece.  Again, stiff finger jabs to get it firmly attached across its surface.  

Make sure at least 5mm extend past the corners of your mouth, or you'll leak or get moisture leakage and it'll release.

Some tapes out there will rip your lips off.  Be very careful.  The caramel coloured stuff with a fibrous look is lethal.
Serial Tapist
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#7
RE: Is AHI related to mask leak?
Hegel, the mouth leaks are a tough issue, but sometimes are resolved with a little encouragement to the jaw to resolve. I have never taped, but I think my first step would be something like the Knightsbridge chin strap Supplier #37. Looks pretty comfortable and might be enough to keep your mouth in the correct position. What have you tried so far? Probably worth mentioning, I hear air hissing from my wife's mouth every night and yet she sleeps well and has no problems with the therapy.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Is AHI related to mask leak?
(06-18-2020, 04:01 PM)mesenteria Wrote: My first night, 'cuz I didn't know any better, was awful.  Next night, I tried sports wrapping tape.  That worked to a limited extent, but at least I could fall asleep.  I next went looking in a pharmacy and found 3M Corp NexCare white 'water resistant' tape in a large white plastic spool.  The spool nests in a decaled white plastic cylinder to fit.  The tape is about 2.4 cm wide, easily torn, easily applied, and if you take the extra step of firmly pressing it into place with finger tips, and I do mean firmly, it will hold well.  It comes off very easily, but first make a small folded-over tab of the tape at one end...helps a lot, especially if you're in a hurry.

Also, they're once-on-wonders.  The tape is not designed to be removed for a cough, a belch, or a glass of water, and then restored into position.  Once you remove it, reach for another piece.  Again, stiff finger jabs to get it firmly attached across its surface.  

Make sure at least 5mm extend past the corners of your mouth, or you'll leak or get moisture leakage and it'll release.

Some tapes out there will rip your lips off.  Be very careful.  The caramel coloured stuff with a fibrous look is lethal.

I recently found Simply Breathe tape and it is amazing Commercial link removed.  Google Simply Breathe or visit their web site.

Strong all night adhesion and zero residue or pain when removing. They’re super impressive!







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#9
RE: Is AHI related to mask leak?
Well, I am not using a tape since I converted to full face mask, but when I need to use the nasal cradle my actual choice is the 3M Micropure.It is 2 inches (around 5 cm) wide and comes in 10 yard rolls (around 9 meters). I've bought a six pack for 11.5 USD from Amazon and that amount should probably last for 18 months, if used every night. It is very strong, so I had no problems with it staying in place. There are some reviews that talk about it being harder to remove but I did find it quite easy to remove and it doesn't leave any residue (none that I can taste at least).
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