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Mouth Leak and Breathing During Rem Sleep
#1
Mouth Leak and Breathing During Rem Sleep
Hi,

I have now been on APAP for ~ 6 weeks. The APAP has been helping with my fatigue/tiredness and it helped me get through a ridiculous work load prior to Christmas (77 hours one week, 60 the following week) which I don't believe I would have been able to accomplish without it but I still don't feel like I am getting good sleep and wake up multiple times. I have also been diagnosed with nonallergic rhinitis causing enlarged turbinates and I have a high mallampati score (saw this in another thread, mine would be 3.5-4) which I assume are part of if not the cause of my SDB. 

I was originally diagnosed with an AHI of 16 consisting almost entirely of hypopneas and SPO2 that fell to 75% with 43 minutes spent below 88%. In my sleep study there were two periods of extended desaturation that occurred later in the morning and I believe they correlated with REM sleep. 

While on APAP I have been tracking my results with OSCAR and I have noticed that my breathing rate increases significantly during what I am sure is REM (like 1.5-2 times as fast) and gets very uneven/rough looking, my flow limitations increase significantly and I often have leaks which I believe are usually from my mouth (I know this as it often wakes me up). I assume this leaking is either due to relaxation of muscles during REM or my body trying to breath through my mouth due to increased nasal restriction. 

Attached are two images from last night. The first is an overview from last night and the second one is zoomed in on the large leak showing the increased respiration which nearly doubles at some points, I know that large leaks do affect the data but in comparing to other nights it hasn't been skewed too much and gets the point across). I have a few thoughts about this but am curious to get some of your thoughts first (if this is normal or abnormal, what to do about it etc).

   

   

My sleep study for those interested

   
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#2
RE: Mouth Leak and Breathing During Rem Sleep
Personally I think your charts look good. As for not feeling well it took me almost 2 1/2 months to feel better. If you keep at it and control your leaks as best you can you’ll be feeling better soon
Download OSCAR <——— Click
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#3
RE: Mouth Leak and Breathing During Rem Sleep
15 months now, and I'm still waiting the the ship to pull into port.  Eat-popcorn
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#4
RE: Mouth Leak and Breathing During Rem Sleep
As you can see over my treatment time my leaks have been increasing. I believe this is because I am getting more rem sleep now(have been noticing these periods more in data which supports this thought). My usage was pretty poor due to how busy I was pre Christmas and it also seemed like my body was so used to being tired that it wouldn't let me sleep as much as I wanted to. I know that hasn't helped the transition and thankfully things should be a lot slower in the new year so I can try to get some more consistent sleep. You guys might be right that it is just a waiting game as my body keeps adapting. 

The funny thing is that it is tough for me to cause a leak when awake, I can open mouth wide open, stick out tongue etc. Makes me wonder if it is my body trying to mouth breathe that creates the leak. I usually wake up a few times a night due to these leaks and I know that they are messing up my sleep now so I need to try and stop them to see if that helps sleep quality. Trying mouth tape then maybe a full face mask seems like all I can try. 

I believe the recent increase in AHI was due to a cold I have been fighting. Almost all of my centrals appear to be post arousal, sometimes after obvious obstructive issues, sometimes after what just seems like a big inhale like this one (8 of 9 from last nights data were this type, only other one was a sleep transition central early in the night).

   

   
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#5
RE: Mouth Leak and Breathing During Rem Sleep
There are ways to fix mouth leak. A chin strap is one, also a soft cervical collar. The collar will also help with flow limitations. Or you could tape your mouth shut. 

Those are the options to stop mouth leak. If all those options fail you may need a full face mask. 

All those options failed for me so now I use a full face. The trick is finding a full face that works for your facial structure. I use the ResMed AirFit F30. It works great for me since it gives me an open field of view just like a nasal or pillow mask while still covering my mouth so I can easily read or watch tv before falling asleep
Download OSCAR <——— Click
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#6
RE: Mouth Leak and Breathing During Rem Sleep
Still unsure, is that fast ragged breathing during rem sleep normal?

Here is a more zoomed in version from a section last night. To me this just doesn't seem normal but maybe rem breathing is just that strange?

   

More examples of what appear to be post arousal CA's.

   

And a number of other what appear to be arousals with no CA.

   

These kinds of events (ragged rem, post arousal CA's and what appear to be numerous other arousals) have me wondering about UARS which I have done a fair bit of reading on. I wanted to get a VAuto but therapist wouldn't sell me one as they incorrectly believed that all bilevels including the VAuto have backup rate... I am still considering buying one used if the larger PS may help. My AHI has been good since the first day of treatment at only 6 cm pressure (was 0.5 the first night), I feel like increasing the pressure up to 8 made an improvement (probably because of increased EPR) and felt like 10 did too but am considering trying 8 again. 

I only have two other ideas. 1) It really is going to take months to adapt to APAP and for these events to stop happening. 2) Although I believe a fair share of these arousals to be caused by breathing many of them may not be. I recorded myself sleep prior to started treatment and had numerous obvious arousals almost always following a leg/arm twitch. I believe a twitch prior to arousal is normal in SDB(from a few PSG videos I watched) but I know they could also be the cause of arousal. I was hoping to feel like the APAP treatment was well under control before making another video to see if the twitches were still happening but I don't feel like that has happened yet. Unfortunately I have been unable to get the doctors or sleep therapist to do an in clinic study so am stuck with PSG data.

Video of twitches pre treatment if interested.

https://youtu.be/7of3kcFadss

Anyways that is more of the thoughts I have had and I am curious what others may think.
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#7
RE: Mouth Leak and Breathing During Rem Sleep
posted in error, pls delete.
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#8
RE: Mouth Leak and Breathing During Rem Sleep
My suggestion would be to try a soft cervical collar and give it a few nights. That will let us see if if smoothes out your breathing by getting rid of flow limited breathing that doesn’t register as a flow limitation. I’ve had to do the same or I would be restless while I slept so I ended up with a ton of post arousal CA’s and feel awful the next day. 

Give that a try because there isn’t a machine in the world that can treat positional breathing issues
Download OSCAR <——— Click
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#9
RE: Mouth Leak and Breathing During Rem Sleep
Finally found a good answer regarding the rough looking rem sleep, it is normal.

https://youtu.be/gR6o5XT3O6I?t=697

Earlier in this video he comments on how it is normal to also have some arousals and post arousal centrals. Good seeing his explanation on how it can be hard to tell if the arousal is actually due to breathing or if the breathing is due to spontaneous arousal as you can't really tell without EEG data.
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