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Mouth stuck shut - tissues in mouth glued together after an hour of cpap
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zonk Offline

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Post: #11
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
(04-18-2013 06:48 AM)SaviAtHome Wrote:  Has anyone out there had a similar experience? If you have, how did you deal with it?

A good night tonight to all ...
Not exactly similar issue but inside of my lips where they rest together used get sticky with nasal mask (you,re using full face mask) probably due to mouth leaks. Resolve by itself with better mask fit and chinstrap to minimize mouth leaks

Vaseline during the day helps and drinking plenty of water during the day to keep well hydrated
04-18-2013 10:36 PM
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Shastzi Offline

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Machine: ResMed S9 Autoset
Mask Type: Full face mask
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CPAP Pressure: 15cm-20cm H2O (auto)
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Post: #12
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
I see you are in Canada. Sounds like low humidity and cold weather. (Yes I know, Capt. Obvious. Big Grin )

You are going to need a humidifier with "long range tanks" and a separate heated hose.

You mentioned that you were running out of water before wake up time. This is significant since
it only takes 10-15 minutes tops to totally dry out your mouth and throat once you are out of water.
I have experienced this first hand!

H5i is a good humidifier but it is too light duty for what you need. It only holds about 400ml if water so it runs out fast
when you turn it up to max. So...
You will need to do what I have done.

I picked up the HC150 Fisher & Paykel. It is a hideous atrocity that just happens to work well!
If you shop around you can find it for about $140.

It comes with cheap disposable tanks so you may want to get the $40 " dish washer safe" tank later.
Then you need an 18" section of hose to connect it to the CPAP.

This thing will generate lots of humidity for you when set at 2.75 on the dial so you are going to have rainout
like crazy. (until you fix that issue like I did...see below)

Last of all you get the Hybernite rainout control system, (separate heated hose!)
Shop around some more and you can pick up the whole thing for $49. (a bargain!)

The HC150 can be loaded up with 600ml of water in a pinch and that can last you another 2-3 hours longer before it will run out.
After 8 hrs I usually have about 1/4" of water left in the bottom so this is good.
No more dry mouth & throat.

Success!

Down side: There is more stuff to keep clean but you can't have everything, right?

Now, go forth and conquer!

=^.^=

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
04-19-2013 09:31 AM
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archangle Offline
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Machine: ResMed S9 AutoSet
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Post: #13
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
We need to know which model PRS1 machine you have. It should say something like REMstar xxxx near the display.

Is there a particular reason you are using a full face mask?

Even with the full face mask, mouth breathing drys your mouth out. Try using a chinstrap. You can make one from a 3 inch non-adhesive ACE bandage.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
04-22-2013 11:48 PM
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imfletch Offline

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Location: Pensacola, FL

Post: #14
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
Hmmm, water tank runs out, lips stuck together and mouth dry as the Sahara.

Sure sounds like your mouth is coming open to me. If you are exhausted, this could be happening and you could just be sleeping right through it.

If you are using a full face mask, what are your leak numbers?

Have you taken a look at your graphs? Do you see high leaks, events and/or snoring all happening at the same time?

Have you tried a chin strap?

When I began, I used to keep a glass of water with a straw by my bed because I would awaken with super dry mouth. One time I awoke to note my mouth was slightly open and the pressurized air was flying out my mouth...of course taking all my moisture with it.

Some people have real trouble with Full Face masks - when they ratchet them down enough to stop leaks, they begin creating pressure sores.

In my humble opinion, I'd first consider leaks and mouth breathing. I can't speak for you, of course, but I know if "I" had the problem you describe, it would be an open mouth causing the woes.
04-23-2013 11:33 AM
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matthew1943 Offline

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Post: #15
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
(04-18-2013 06:48 AM)SaviAtHome Wrote:  ]I have not been on cpap for very long, only a week or so. Pressure is currently at 12, and I have a medieval torture device also known as a face mask with a forehead stabilizer. I have been diligent and followed the rules but, after the first couple of days, I have found that after about an hour on the machine, my mouth is stuck - in effect, glued shut and there are dry bits of crystalline material in various places, not to mention a chemical odour when I finally get my mouth open. My mouth is so stuck together that I cannot activate my salivary glands (which I usually am able to do) and I have to pour water over my lips in order to get some to seep through so that I can begin to get my mouth open and re-hydrate. I have to do this several times during the night. (My cpap device has a heated hose and a water reservoir - Philips Respironics system one remstar ....).

I thought about this and decided that it could be a combination of pressure and a heavy mask, so last night I did the unthinkable. I changed my pressure - first to 11 for a couple of hours, which was no better; then to 8 which worked just fine for the mouth problem (mouth was fine this morning, a bit dry but nothing else) [/font]but of course, both obstructive and open airway apnea figures went through the ceiling overnight. I don't breath with an open mouth, this is not "dryness" in the usual sense. It is something else. It is difficult to describe it to someone who hasn't experienced it (such as the "clinician" who sells the equipment because the clinician has never tried cpap ... a whole other story there).

Has anyone out there had a similar experience? If you have, how did you deal with it?

A good night tonight to all ...

These are my experiences:
With tests on myself, I noticed that if I use a nasal pillow or nasal mask of whatever kind, I develop mouth breathing whenever the pressure goes above 6cm H₂O. This often causes a dry mouth which is a certain telltale. I was trying to establish why I did not feel as well as I expected, i.e. was not getting the full benefit of the CPAP when using a nasal pillow of some kind. I found that the natural resistance of my mouth tissues and lips having relaxed during sleep, can handle a delivery pressure of around 5cm H₂O before starting to leak, realizing that to exhale against a constant delivery pressure of 5cm H₂O coming into the lungs would require a return pressure of more than 7cm H₂O to push the delivery air back. Thus when these two anti-pressures totaling 12cm H₂O reach the back of my throat, it becomes natural to rather escape sideways through my mouth, if possible, than to continue along the inside of the nose to the outside of my nostrils. In my case, when I increase the delivery pressure to 6cm H₂O, the return pressure will probably have to increase to 8 or 9cm H₂O, totaling 14cm H₂O, and my natural resistance in my mouth is too low to resist and mouth breathing commences.
My guess is that most users may develop some kind of mouth breathing (leakage) depending on the pressure setting. ( Imagine if you had a delivery pressure of 10cm H₂O – with a return pressure of at least 12cm H₂O – a total of 22cm H₂O!). The CPAP machines, without exception, obviously only record a leakage (over and above the normal air escape through the mask vents) and it usually tends to be described as 'mask leakage'. This through-the-mouth escape of air into the surrounding atmosphere will cause a drop in the pressure in the airways, and all machines will respond with an increase in air volume delivery at a higher pressure to compensate – probably now exaggerating the air escape through the mouth! Not even mentioning that the higher air volume at a higher pressure is being forced through your nose – heaven forbid you have one nostril blocked! This differs markedly from a mask leakage, where the pressure in the airways remain relatively the same as the leakage is now still in the delivery system before it enters the body. To this mask leakage the machines will also respond the same, but the increased pressure and volume is not transferred to your airways but escapes through the mask leakage.
CPAP Auto, C-Flex technology and Bi-PAP machines address this high expiration pressure necessary to exhale by sensing the start of expiration and then dropping the delivery pressure by 20 – 30% so as to make exhaling (expiration) a little easier. They do succeed in making breathing easier, especially if you should need a high delivery pressure. But it becomes more difficult for these machines to predict the start of expiration when a major leak is present. No machine as yet has the capability to differentiate the position of an unintentional leak as opposed to the intentional leak provided by the vents in the mask. Therefore, even with these more expensive machines, the problem of mouth 'leaks' or mouth breathing is still present.
This drop in pressure and delivery during mouth breathing cancels most of the advantages of 'Continuous Positive Airway Pressure' (CPAP) and that appears to be the cause of my experience of not getting the expected benefits of the CPAP. The moment I switched to a full face mask or a Hybrid mask delivering positive air through my nose and covering my mouth, the problem disappeared and I have never felt better at waking in the morning. Mouth leakage now does not occur, as the pressure inside the airways, throat and mouth is the same as outside of the mouth inside the mask.
There is some discomfort and some skin side-effects as well as possible dangers ascribed to taping your mouth with paper tape or similar to prevent mouth breathing. Wearing a chin strap gives conflicting results, as most of them either slip off during sleep or may pull the lower jaw backwards, increasing the chances of apnee episodes. Various snoring devices to pull the lower jaw forward and/or seal the mouth and pull the tongue forward is not only uncomfortable, but has not been assessed as successful in preventing mouth breathing during CPAP usage.
I do realize and agree about the common reasons for not liking a full face mask, i.e. feeling hot, claustrophobic, condensation in the mask, pressure on the bridge of the nose, visible pressure marks the next morning, cannot speak to your partner, and the feeling of something big and heavy sealing you off from the outside world. But I imagine you have two choices if you want to make this CPAP experience really successful: get used to a full face mask (use a preferably bigger mask rather than smaller) – it takes easily a month, but the result is 1,000 times worth it, or try a hybrid mask where the mask does not cover the nose, no claustrophobia, and it uses nasal pillows combined with covering your mouth. It does feel a lot more comfortable with the same end result.
Therefore it appears that it is a fallacy to believe a technician or professional can really tell you how you actually feel in the morning when you wake – and he/she cannot give you a better idea of what works and what not than yourself. Trust your own feelings and intuition and take responsibility for improving your own wellbeing by responding and demanding from them the correct equipment needed as determined by your personal experience. You should also be able to adjust the delivery pressure of your machine yourself to control your own health care delivery if you so choose.
04-23-2013 10:52 PM
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Shastzi Offline

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Machine: ResMed S9 Autoset
Mask Type: Full face mask
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Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

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Post: #16
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
If you can't keep your mouth shut with a chin strap, (I usually found mine on the pillow or floor the next morning)
just go to the full face to total face and learn the maintenance to prevent leaks.
If you get the typical sore nose, use bandaids till the skin gets tougher.
I am trying the total face mask now and it leaks a little more but the APAP compensates.
I was having detrimental pressure effects behind my eyeballs, making them swell up by morning. Very irritating.
So far the total mask keeps the air pressure equal in front and behind the eyes. This is much better though the mask is bigger,
clunky and feels stuffy, I can work around that.
OA's & CA's are completely gone so far. Only an occasional hypopnea or two. Pressure is staying below 17.2. This is quite good!
The mask has a lot more dead space and every night I put it on and go "Bleah. This is stuffy as hell!" then I conk right out and wake up either in the morning or because one of the cats barfed up a furball.

Things are getting better!

Smile

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
04-24-2013 08:43 AM
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SaviAtHome Offline

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Location: Canada

Post: #17
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
(04-23-2013 10:52 PM)matthew1943 Wrote:  These are my experiences:
With tests on myself, I noticed that if I use a nasal pillow or nasal mask of whatever kind, I develop mouth breathing whenever the pressure goes above 6cm H₂O. This often causes a dry mouth which is a certain telltale. I was trying to establish why I did not feel as well as I expected, i.e. was not getting the full benefit of the CPAP when using a nasal pillow of some kind. I found that the natural resistance of my mouth tissues and lips having relaxed during sleep, can handle a delivery pressure of around 5cm H₂O before starting to leak, realizing that to exhale against a constant delivery pressure of 5cm H₂O coming into the lungs would require a return pressure of more than 7cm H₂O to push the delivery air back. Thus when these two anti-pressures totaling 12cm H₂O reach the back of my throat, it becomes natural to rather escape sideways through my mouth, if possible, than to continue along the inside of the nose to the outside of my nostrils. In my case, when I increase the delivery pressure to 6cm H₂O, the return pressure will probably have to increase to 8 or 9cm H₂O, totaling 14cm H₂O, and my natural resistance in my mouth is too low to resist and mouth breathing commences.
My guess is that most users may develop some kind of mouth breathing (leakage) depending on the pressure setting. ( Imagine if you had a delivery pressure of 10cm H₂O – with a return pressure of at least 12cm H₂O – a total of 22cm H₂O!). The CPAP machines, without exception, obviously only record a leakage (over and above the normal air escape through the mask vents) and it usually tends to be described as 'mask leakage'. This through-the-mouth escape of air into the surrounding atmosphere will cause a drop in the pressure in the airways, and all machines will respond with an increase in air volume delivery at a higher pressure to compensate – probably now exaggerating the air escape through the mouth! Not even mentioning that the higher air volume at a higher pressure is being forced through your nose – heaven forbid you have one nostril blocked! This differs markedly from a mask leakage, where the pressure in the airways remain relatively the same as the leakage is now still in the delivery system before it enters the body. To this mask leakage the machines will also respond the same, but the increased pressure and volume is not transferred to your airways but escapes through the mask leakage.
CPAP Auto, C-Flex technology and Bi-PAP machines address this high expiration pressure necessary to exhale by sensing the start of expiration and then dropping the delivery pressure by 20 – 30% so as to make exhaling (expiration) a little easier. They do succeed in making breathing easier, especially if you should need a high delivery pressure. But it becomes more difficult for these machines to predict the start of expiration when a major leak is present. No machine as yet has the capability to differentiate the position of an unintentional leak as opposed to the intentional leak provided by the vents in the mask. Therefore, even with these more expensive machines, the problem of mouth 'leaks' or mouth breathing is still present.
This drop in pressure and delivery during mouth breathing cancels most of the advantages of 'Continuous Positive Airway Pressure' (CPAP) and that appears to be the cause of my experience of not getting the expected benefits of the CPAP. The moment I switched to a full face mask or a Hybrid mask delivering positive air through my nose and covering my mouth, the problem disappeared and I have never felt better at waking in the morning. Mouth leakage now does not occur, as the pressure inside the airways, throat and mouth is the same as outside of the mouth inside the mask.
There is some discomfort and some skin side-effects as well as possible dangers ascribed to taping your mouth with paper tape or similar to prevent mouth breathing. Wearing a chin strap gives conflicting results, as most of them either slip off during sleep or may pull the lower jaw backwards, increasing the chances of apnee episodes. Various snoring devices to pull the lower jaw forward and/or seal the mouth and pull the tongue forward is not only uncomfortable, but has not been assessed as successful in preventing mouth breathing during CPAP usage.
I do realize and agree about the common reasons for not liking a full face mask, i.e. feeling hot, claustrophobic, condensation in the mask, pressure on the bridge of the nose, visible pressure marks the next morning, cannot speak to your partner, and the feeling of something big and heavy sealing you off from the outside world. But I imagine you have two choices if you want to make this CPAP experience really successful: get used to a full face mask (use a preferably bigger mask rather than smaller) – it takes easily a month, but the result is 1,000 times worth it, or try a hybrid mask where the mask does not cover the nose, no claustrophobia, and it uses nasal pillows combined with covering your mouth. It does feel a lot more comfortable with the same end result.
Therefore it appears that it is a fallacy to believe a technician or professional can really tell you how you actually feel in the morning when you wake – and he/she cannot give you a better idea of what works and what not than yourself. Trust your own feelings and intuition and take responsibility for improving your own wellbeing by responding and demanding from them the correct equipment needed as determined by your personal experience. You should also be able to adjust the delivery pressure of your machine yourself to control your own health care delivery if you so choose.

Thank you - your description re: leakages appears to describe my case very well. Mouth leak indeed! Chin strap slips as you say. I've tried the nasal "pillow" but it will take more analysis so, I have changed masks to a mask that covers nose and mouth but without the forehead stabilizer. Not much help with the AHI which is still extremely high, but it is more comfortable. (we have to be able to sleep without waking numerous times to adjust the mask!) Settings have been changed to A-Flex, 10 - 18. A good AHI appears to be elusive; you will see my other post about the statistical analysis of event duration.

By the way, my "clinician" has not shown me a hybrid mask. I rather thought that such a thing should exist - could you please provide a reference?

04-26-2013 10:08 AM
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imfletch Offline

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Post: #18
RE: Mouth stuck shut - tissues in mouth glued together after an hour of cpap
The Mirage Liberty by ResMed is an excellent hybrid mask.
You can find it at ResMed or [commercial DME link removed]




Howdy, Fletch... sorry but per our rules, commercial DME links are not allowed on Apnea Board. As a suggestion, you could say, "You can find it as ResMed or Supplier #1 on the Supplier List". thanks. - SuperSleeper, Admin.



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To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.
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04-29-2013 03:38 PM
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