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Mouth Breathing w/Nose Pillows waking me up
#1
I use the ResMed AirFit P10s and am having an issue with my mouth breathing. I’m only 2 weeks into therapy so very new.

Before APAP, I was mouth breathing A LOT. Bad sinuses combined with apnea, and I basically would wake up with a nasty dry tongue all the time. Now with the APAP I’m finding myself continuing to mouth breath throughout the night. This causes a “leaf blower” effect where air shoots through my nasal canal and out of my mouth with a good amount of force. This wakes me up frequently (some nights I'm being awakened repeatedly & worse than my pre-APAP days). I’ve tried tried a soft cervical collar (uncomfortable and I still find a way to breath out of my mouth) and a chin strap (same as the collar).

Out of the 2 weeks of therapy, I've probably had about 4 really good nights where I woke up feeling awesome. The rest have been a struggle with frequent arousal due to mouth breathing. My AHI looks good - between 1-3, but the machine isn't capturing the many times I'm waking up from the mouth breathing. For instance last night it looks like I had one wake up with two four hour sleep sessions, but in reality, during that 2nd chunk of sleep, I woke up 5-7 times due to mouth breathing.

How long should I give it before I try switching to a full face mask? I'm looking at the AirFit F20. Has anyone else had such trouble w/mouth breathing that they'd moved to the full face mask and found it to be much better for them?

Has anyone heard of this supplier? Seems like a good deal. Commercial link removed.  Instead search "bonanza" web site for ResMed AirFit F20 Full Face Mask.





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#2
Some people who use full face masks still report dry mouth and eventually realize that they're still mouth breathing.  Mouth breathing doesn't go away except in some cases where the person uses a cervical collar or a chin strap.  In my particular case, I opted for taping my mouth when I was advised of the various options, and I happen to have adjusted well.  No anxiety, only one episode where I awakened to find my nostrils were both swollen shut and I had to tear off the tape.  Honestly, it was no big deal, certainly not enough to trigger my AFib.

You can use lozenges to stimulate saliva production, but they only work for a short period, long enough to fall asleep and for a while after until mouth breathing defeats them anew.  I'll defer to others to describe which ones and how they use them.

Bottom line, if you mouth breathe, a different mask won't make much of a difference in all likelihood, a chin strap or cervical collar has higher efficacy (subject to the individual's own experience), and if all else fails, perhaps taping will work well enough that your therapy becomes more beneficial and pleasant.  Oh, and the occasional use of lozenges might also help a lot.  You'll still awaken though when you realize you need one.
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#3
I use the Airfit 20 and I’m a mouth breather. It works fine for me. I use humidity level 5 and don’t get dried out. My nose is always clogged at bedtime, by morning I’m breathing thru both.
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#4
(10-09-2018, 05:57 PM)mesenteria Wrote: Some people who use full face masks still report dry mouth and eventually realize that they're still mouth breathing.  Mouth breathing doesn't go away except in some cases where the person uses a cervical collar or a chin strap.  In my particular case, I opted for taping my mouth when I was advised of the various options, and I happen to have adjusted well.  No anxiety, only one episode where I awakened to find my nostrils were both swollen shut and I had to tear off the tape.  Honestly, it was not big deal, certainly not enough to trigger my AFib.

You can use lozenges to stimulate saliva production, but they only work for a short period, long enough to fall asleep and for a while after until mouth breathing defeats them anew.  I'll defer to others to describe which ones and how they use them.

Bottom line, if you mouth breathe, a different mask won't make much of a difference in all likelihood, a chin strap or cervical collar has higher efficacy (subject to the individual's own experience), and if all else fails, perhaps taping will work well enough that your therapy becomes more beneficial and pleasant.  Oh, and the occasional use of lozenges might also help a lot.  You'll still awaken though when you realize you need one.

I think I'm waking up due to the "leaf blowing" effect of having air shoot out my mouth from my nasal cavity. My thinking was that this effect would be much less with a FFM. I could be wrong though - I have no idea how a FFM works vs. the nose pillows (just like I had no idea that air would shoot out my mouth when I first tried to talk w/nose pillows on).
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#5
(10-09-2018, 06:16 PM)isuckatsleeping Wrote: I think I'm waking up due to the "leaf blowing" effect of having air shoot out my mouth from my nasal cavity. My thinking was that this effect would be much less with a FFM. I could be wrong though - I have no idea how a FFM works vs. the nose pillows (just like I had no idea that air would shoot out my mouth when I first tried to talk w/nose pillows on).

With FFM the pressure is equalized at both nose and mouth, so there will be no "leaf blowing" effect.
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#6
Mouth Breathing[edit]
Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With SleepyHead look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In SleepyHead right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.

Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, not overnight, but it works for some.
Cervical Collar. A "soft" Cervical Collar. This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occurred when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues.
  • Fit: You are looking for a comfortable fit 2-inches larger than the circumference of your neck and just tall enough to support the jaw when your head falls out of alignment (measure your neck from collarbone to jaw and subtract 1".
It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, the Ultimate Chinstrap, Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose being to maintain a proper head and neck alignment while allowing for the mask maintaing the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks / mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth, when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask.
  • Many users use a product called Biotene to get relief from this symptom.

That said (from the Mask Primer) I had a major issue with mouth breathing, especially with my CPAP pressure of 19 cmH2O.  I too had a tornado exiting my mouth. I solved it over several months utilizing the tongue trick supplemented with the controversial technique of mouth taping.  I also failed with 2 different chin straps (this was before the use of cervical collars.   I can also talk extremely well while on CPAP utilizing the tongue trick relaxing it just enough to make sound.  When I had a tornado exiting the only way I would stop it was to turn off the machine then restart.
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download SleepyHead
Organize Charts
Attaching Charts

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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#7
With the FFM it’s easy. Nose, mouth or both at the same time  it’s like sticking your head out a moving car. Face full of air. Just breathe.
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#8
A good chin strap makes all the difference, but even then I still get a dry mouth due to air escaping through the lips, it does not take much. Once the mouth dries you might find it even harder to stop leaks through the mouth. I keep a small bottle of water beside my bed so I can take a sip of water without stopping the machine.
The bottle has a pop up top so I just pull the top, take a sip, then push the top in again. The water needs to be replaced every couple of nights and in hot weather every day. But it does help wetting the mouth if you wake up with it dry, it will help you get a seal again for a while. The chin straps that have a single strap over the head are a waste of time, they stretch, slip and are not up to the job. Look on Ebay for ones that go round the Bach of the head and up in front of the ears. Look at the quality of the picture as a guide. These are sometimes sold as anti-snore head gear. You can get then in a fetching pink for the ladies.
A word of caution, but one, if it is good, buy more as some are poor copies.
If you like them to be tight to keep the chin/mouth closed they will almost all need reinforced at the seam at the chin, but when this is done they will stop the mouth from opening, but you will still get air escaping through the lips, so keep that bottle of water handy.
>^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^<
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.

I am just a long term user of c.p.a.p. and therefore I have some experience in using these machines and equipment.

However, I am NOT an expert, so advice given should be taken as given in good faith only and NOT medical advice.

Every journey, however large or small starts with the first step.   Coffee
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#9
I stopped mouth breathing when I had my nose done, turbinates and septoplasty.
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#10
Thanks all for such a comprehensive guide to mouth breathing. I wore the chin strap yesterday and the difference was insane. I still woke up 1-2 times with air in my mouth but it was nothing like the previous night. I also ordered the F20 so I’ll give the FFM a try when it arrives.

Pretty good night of sleep last night all things considered. My 85 pound dog who shares the bed woke me up stepping on me, Waking me up from a 6 hr sleep session (unheard of before APAP). I think he’ll have to sleep in the dog bed going forward. Can’t sacrifice my sleep anymore.
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