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Mouth breathing
#1
Mouth breathing
I have been using a CPAP machine for over 10 years.  In the last year or so I have woke with an extremely dry mouth from mouth breathing. My remedy so far is to cover my mouth with tape before I go to sleep.  It is not a very satisfying solution.  Do you have any helpful solutions?

Thanks,

Larry
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#2
RE: Mouth breathing
Traditional fixes include a 1. Chin Strap, 2. Full Face Mask, or 3. an ergonomic pillow.
non-traditional fixes include 1. taping (Definitely the most controversial) and IMHO the newest and likely the best, 2. the cervical collar.  The best fit is one that is looser than it's traditional use


From the "Mask Primer"

Mouth Breathing
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 occured 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. 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.



Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
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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#3
RE: Mouth breathing
Fred
Thank you for a very helpful response.  You mentioned several options that I will definitely try to reduce dry mouth.
Thanks again.
Larry
Post Reply Post Reply
#4
RE: Mouth breathing
(07-08-2017, 04:51 PM)bonjour Wrote: Traditional fixes include a 1. Chin Strap, 2. Full Face Mask, or 3. an ergonomic pillow.
non-traditional fixes include 1. taping (Definitely the most controversial) and IMHO the newest and likely the best, 2. the cervical collar.  The best fit is one that is looser than it's traditional use


From the "Mask Primer"

Mouth Breathing
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 occured 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. 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.



Fred

Thanks, very helpful.  Any tricks to measuring and getting a good fit from an online order?
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#5
RE: Mouth breathing
There are many manufacture fit guides/templates towards the end of the Mask Primer, but masks must still be tried on.  The manufactures have videos of fitting masks, they offer good tips.  and then there is the mask primer with a lot of good info on fitting masks.  

Mask Primer[edit]
Getting the right mask is one of the hardest parts of PAP therapy. This article is intended to help guide you through your choice of a mask.
First, all masks can and do handle all pressures associated with PAP therapy machines, this is from 3 to 20 (CPAP) or 25 (BiLevel/BiPAP) cmH2O.
Second, each of us has a different facial structure. This means that what works for me may or may not work for you, and what works for you may or may not work for me. You have to TRY the masks to see what works for you.
Third, You will have to try masks to see what works for you.

I’m going to call out 1 particular online vendor for 2 reasons. First they list masks by popularity within the mask type. This means that you can assume that the more popular masks work for more people. The second is that they offer “return insurance”, some free, some low cost, so that you can return a mask that does not work for you. That Vendor is Supplier #1
Your DME is an excellent resource to try different masks. Use them for this purpose. Make an appointment for a mask fitting, under pressure, and preferably lying down in sleeping position.. If you are using a DME it is their job to help you use your PAP system for effective therapy. If the mask doesn’t fit or is extremely uncomfortable they are not doing their job.
A Mask Trial Strategy[edit]
First, even a mouth breather may be able to use ANY style of mask, even the simplest, most unobtrusive, Nasal Pillow. See the Mouth Breathing section to see what to do.
Try masks from the most unobtrusive to the biggest bulkiest of masks. This would typically be starting with Nasal Pillows, Nasal Mask, Hybrid Masks, then finally the Full Face Mask. The smaller masks that you start with leave you with less mask on your face and more visibility.
Finally, as I have said before, you have to try masks on, under pressure, and preferably lying down in sleeping position.

Mask Types[edit]
Nasal Pillows
Nasal pillows rest under the nose covering the nasal openings and sealing against them. This mask style is among the least intrusive of all masks. Typically they easily seal and have very low mask leak rates. The main disadvantage of this style is with the light touch if you are a very active sleeper the headgear can shift and cause a mask leak. Generally these masks are for non-mouth breathers. There are ways (chin strap, cervical collar, tape) which may eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from bulky to minimal, and they will fit differently. The only way to tell what works for you is to try them.
Size matters. Try the different sizes, I have trouble with the small and the medium here, the large works for me. This may differ depending on brands
Some users do not like anything touching their nose. I’d try a pillow to see if this is an issue for you. Don’t assume.

Nasal Prongs
Nasal Prongs are similar to Nasal Pillows except for the fact that they actually sit inside your nose and expand slightly to seal. Nasal Pillows have mostly replaced Nasal Prongs in the marketplace. This mask style is among the least intrusive of all masks. Typically they easily seal and have very low mask leak rates. The main disadvantage of this style is with the light touch if you are a very active sleeper the headgear can shift and cause a mask leak. Generally these masks are for non-mouth breathers. There are ways (chin strap, cervical collar, tape) which may eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try them.
Size matters. Try the different sizes, I have trouble with the small and the medium here, the large works for me. This may differ depending on brands
Some users do not like anything in their nose. I’d try a prong to see if this is an issue for you. Don’t assume.

Nasal Mask
These masks cover the nose from the upper lip to the bridge of the nose. The volume of these goes from minimum, just barely covering the nose with minimal volume otherwise to considerably bigger. Most have a hard mask mount up to the forehead, but a few do not. These tend to have mask leaks a bit larger than the Nasal Pillows or Nasal Prongs. This is because they have more area to seal and more force trying to push the mask off your face at any given pressure. With this type of mask it is important to try them because of the difference facial structures. You have to find what works for you. Again these are mostly for non-mouth breathers. There are ways (chin strap, cervical collar, tape) which may eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands

Hybrid Masks
Hybrid masks are mix between a Full Face Mask, for the mouth, and Nasal Pillows for the nose, all incorporated into one mask. These masks are growing in popularity because there is NOTHING on the bridge of the nose and nothing blocking vision. The mask does not extend above the bottom of the nose. Like the FFM below this style mask is primarily for mouth breathers.
Like all masks, Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands

Full Face Mask (FFM)
The primary purpose of the Full Face Mask is to eliminate the need to correct for mouth breathing. The FFM covers the nose in a manner similar to a Nasal Mask but the lower seal is below the lips so it surrounds the entire mouth and nose. This is the traditional method of solving mouth breathing. These masks are bigger than most other masks and because of their size have more area to seal and more force trying to push the mask off your face. Generally the bigger the mask the greater the potential for leaks.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands
One specific FFM I will call out is the Amara View. I’m not saying that this mask is better than any other mask. This mask seals differently than other full face masks so it is one to try if you are having trouble finding one that fits and works for you.
OK, one more. The “Total” Face Mask. This mask covers the entire face including the eyes and is occasionally used when other choices are not working.

Specialty Masks

These are masks that have a unique feature that may allow application in different situations. This is not a statement that these masks are better or worse than any other masks that may or may not be specifically called out. As with any masks they must be tried on.

  • Cloth Masks -- cloth instead of traditional silicone or plastic for those that have an issue with silicone or plastic contacting their skin.
    • SleepWeaver Cloth Masks by Circadiance (various)
    • Wisp Nasal Mask by Philips Respironics has an optional fabric frame

  • Mirage Activa by ResMed -- A nasal mask with a conventional modern seal (good) that is held in place by a flexible silicone bellows which in turn is mounted on a conventional hard plastic mount. This allows a very light amount of pressure because of the bellows (pictures coming later).
  • Oral Mask by Fisher & Paykel -- Absolutely no contact with the nose.
and there is even more info in the Mask Primer
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
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.
Post Reply Post Reply
#6
RE: Mouth breathing
I had the same problem mouth breathing as you do.  I tried a variety of things, however the thing that worked for me was taping.  I also practiced the tongue suck method as per Bonjour's post.  I found that the taping reinforced the tongue suck method, I find it similar to closing your mouth and trying to suck through a straw.  Once you have negative pressure just don't release the sucking.  After several weeks of taping and practice, i found that i did not need to tape any more.  I always had some concern about taping my lips and you will find it controversial in this forum, but hey, it worked for me.  Good luck!!

PS: if you have a lot of saliva in your mouth, the tongue suck method is not working for you.
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#7
RE: Mouth breathing
Fantastic info. Thanks.
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#8
RE: Mouth breathing
Hi lashlock,
WELCOME! to the forum.!
Good luck to you with CPAP therapy.
trish6hundred
Post Reply Post Reply
#9
RE: Mouth breathing
(07-09-2017, 09:20 AM)bonjour Wrote: There are many manufacture fit guides/templates towards the end of the Mask Primer, but masks must still be tried on.  The manufactures have videos of fitting masks, they offer good tips.  and then there is the mask primer with a lot of good info on fitting masks.  

Mask Primer[edit]
Getting the right mask is one of the hardest parts of PAP therapy. This article is intended to help guide you through your choice of a mask.
First, all masks can and do handle all pressures associated with PAP therapy machines, this is from 3 to 20 (CPAP) or 25 (BiLevel/BiPAP) cmH2O.
Second, each of us has a different facial structure. This means that what works for me may or may not work for you, and what works for you may or may not work for me. You have to TRY the masks to see what works for you.
Third, You will have to try masks to see what works for you.

I’m going to call out 1 particular online vendor for 2 reasons. First they list masks by popularity within the mask type. This means that you can assume that the more popular masks work for more people. The second is that they offer “return insurance”, some free, some low cost, so that you can return a mask that does not work for you. That Vendor is [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #1
Your DME is an excellent resource to try different masks. Use them for this purpose. Make an appointment for a mask fitting, under pressure, and preferably lying down in sleeping position.. If you are using a DME it is their job to help you use your PAP system for effective therapy. If the mask doesn’t fit or is extremely uncomfortable they are not doing their job.
A Mask Trial Strategy[edit]
First, even a mouth breather may be able to use ANY style of mask, even the simplest, most unobtrusive, Nasal Pillow. See the Mouth Breathing section to see what to do.
Try masks from the most unobtrusive to the biggest bulkiest of masks. This would typically be starting with Nasal Pillows, Nasal Mask, Hybrid Masks, then finally the Full Face Mask. The smaller masks that you start with leave you with less mask on your face and more visibility.
Finally, as I have said before, you have to try masks on, under pressure, and preferably lying down in sleeping position.

Mask Types[edit]
Nasal Pillows
Nasal pillows rest under the nose covering the nasal openings and sealing against them. This mask style is among the least intrusive of all masks. Typically they easily seal and have very low mask leak rates. The main disadvantage of this style is with the light touch if you are a very active sleeper the headgear can shift and cause a mask leak. Generally these masks are for non-mouth breathers. There are ways (chin strap, cervical collar, tape) which may eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from bulky to minimal, and they will fit differently. The only way to tell what works for you is to try them.
Size matters. Try the different sizes, I have trouble with the small and the medium here, the large works for me. This may differ depending on brands
Some users do not like anything touching their nose. I’d try a pillow to see if this is an issue for you. Don’t assume.

Nasal Prongs
Nasal Prongs are similar to Nasal Pillows except for the fact that they actually sit inside your nose and expand slightly to seal. Nasal Pillows have mostly replaced Nasal Prongs in the marketplace. This mask style is among the least intrusive of all masks. Typically they easily seal and have very low mask leak rates. The main disadvantage of this style is with the light touch if you are a very active sleeper the headgear can shift and cause a mask leak. Generally these masks are for non-mouth breathers. There are ways (chin strap, cervical collar, tape) which may eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try them.
Size matters. Try the different sizes, I have trouble with the small and the medium here, the large works for me. This may differ depending on brands
Some users do not like anything in their nose. I’d try a prong to see if this is an issue for you. Don’t assume.

Nasal Mask
These masks cover the nose from the upper lip to the bridge of the nose. The volume of these goes from minimum, just barely covering the nose with minimal volume otherwise to considerably bigger. Most have a hard mask mount up to the forehead, but a few do not. These tend to have mask leaks a bit larger than the Nasal Pillows or Nasal Prongs. This is because they have more area to seal and more force trying to push the mask off your face at any given pressure. With this type of mask it is important to try them because of the difference facial structures. You have to find what works for you. Again these are mostly for non-mouth breathers. There are ways (chin strap, cervical collar, tape) which may eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands

Hybrid Masks
Hybrid masks are mix between a Full Face Mask, for the mouth, and Nasal Pillows for the nose, all incorporated into one mask. These masks are growing in popularity because there is NOTHING on the bridge of the nose and nothing blocking vision. The mask does not extend above the bottom of the nose. Like the FFM below this style mask is primarily for mouth breathers.
Like all masks, Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands

Full Face Mask (FFM)
The primary purpose of the Full Face Mask is to eliminate the need to correct for mouth breathing. The FFM covers the nose in a manner similar to a Nasal Mask but the lower seal is below the lips so it surrounds the entire mouth and nose. This is the traditional method of solving mouth breathing. These masks are bigger than most other masks and because of their size have more area to seal and more force trying to push the mask off your face. Generally the bigger the mask the greater the potential for leaks.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands
One specific FFM I will call out is the Amara View. I’m not saying that this mask is better than any other mask. This mask seals differently than other full face masks so it is one to try if you are having trouble finding one that fits and works for you.
OK, one more. The “Total” Face Mask. This mask covers the entire face including the eyes and is occasionally used when other choices are not working.

Specialty Masks

These are masks that have a unique feature that may allow application in different situations. This is not a statement that these masks are better or worse than any other masks that may or may not be specifically called out. As with any masks they must be tried on.
  • Cloth Masks -- cloth instead of traditional silicone or plastic for those that have an issue with silicone or plastic contacting their skin.
    • SleepWeaver Cloth Masks by Circadiance (various)
    • Wisp Nasal Mask by Philips Respironics has an optional fabric frame
  • Mirage Activa by ResMed -- A nasal mask with a conventional modern seal (good) that is held in place by a flexible silicone bellows which in turn is mounted on a conventional hard plastic mount. This allows a very light amount of pressure because of the bellows (pictures coming later).
  • Oral Mask by Fisher & Paykel -- Absolutely no contact with the nose.
and there is even more info in the Mask Primer

Sorry, I was unclear.  I was speaking of measuring for a cervical collar.
Post Reply Post Reply
#10
RE: Mouth breathing
edfreeman,

Sleeprider wrote a very good description of correct cervical collar sizing for CPAP use.

Sleeprider Wrote: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".


I hope this will help.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Beginner's Guide to Sleepyhead and OSCAR
Apnea Helpful Tips

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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