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Mouth tape causing OSA ?
#1
Mouth tape causing OSA ?
Thanks to all the contributors on this forum that are helping me understand the ins and outs of PAP therapy and where to go from here.

(I don’t want to open a new thread on this subject if this has already been covered elsewhere, if so please advise…)

At my titration study, I discussed the annoying mouth leaks with my Respiratory Physician (Pulmonologist), even though  was using chin straps. He mentioned that some people do use mouth tape successfully. I expressed some concern about taping up the mouth, but he did not seem overly worried and felt it would be worth trying.

I attach 2 charts below on the night of Feb 19th that I tried some mouth tape, for comment and opinion.
(Down under we just call it Micropore tape but it is the same as 3M Corp's NexCare "Water Resistant")

I was using the Resmed N30 nasal cradle at that time and in session 1 and session 3 I had a Super de luxe “chin strap” with OK results.

Session 1: I awoke around 01:40 feeling grim and with masses of mouth leaks. However no apneas.
Session 2: So I donned the mouth tape: Over the next 90 minutes or so there was almost no leak, but flow limitations increased, pressure increased to around 15.9 !!, I experienced 6 apneas and was promptly aroused at around 03:47 with painful ears. So: mouth tape off (ow, painful) and back to the chin strap after that for the rest of the night.

Overall night not too bad: AHI = 1.34
Session 1 = 0.51
Session 2 (mouth tape) = 4.67 with maximal flow limitation near the end. Never been so high since then.
Session 3 = 0.88

I am keen to ditch the neck collars, Alice bands over the mouth etc and feel I want to try the mouth tape again.

Before I do, I wondered if anyone had any insight as to what caused the increase OSA with the mouth tape?

[attachment=22051]
[attachment=22052]
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#2
RE: Mouth tape causing OSA ?
I have not looked at your charts, but I could guess that you are tucking your chin into your chest, the air can't get down and pressure increases giving you sore ears and even eyes! Try a neck brace cushion to keep your head from going forward. If you have a chin strap you can then still use it or drop it and rely on the neck cushion to keep your mouth closed, though I found I still had to use the chin strap. There is only so much you can do to stop are escaping out your mouth as it will come out between your lips. Personally I don't bother much with leaks these days, I just let the machine increase the flow, but that leads to a bigger leak It is a viscous circle. Mouth taping will work, but be careful what tape you use as it does cross the lips.
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.


Every journey, however large or small starts with the first step.

Sleep-well
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#3
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RE: Mouth tape causing OSA ?
Thank you Sleep2Snore, that is a great insight. Since I currently use a Neck Collar I assumed I had also used one back then.
But... going back to my records I see I only starting using a Neck Collar after 2nd March! So that makes perfect sense. I had not added to my records which pillow I was using at that time, that is yet another variable to factor in.

That gives me some confidence to give this another go. Just not keen on ripping the micropore off every morning so will find a better alternative.

I might go back and review my data and compare them pre-collar and post-collar usage, that might be interesting.

I do appreciate your input.
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#4
RE: Mouth tape causing OSA ?
Actually your flow limitation graph looks less busy during the second session, the one with the tape. It's tempting to try to generalize from the data you've posted, but I'd advise resisting the temptation. It's just not enough to go on.

You might want to try Somnifix. It is more expensive than what you are using, but it is gentle on the skin, not painful to remove, and does the job.

For me, even when my lower jaw is kept in place by a collar, my lips want to part if I don't tape them. So tape has been part of my routine for many months now. I did invest in a little circuit alarm that I've plugged into an outlet on the same circuit as the machine, to make sure I wake up and remove the mask and tape if the power goes off. I can't imagine I'd actually suffocate in my sleep, but this adds a layer of safety.
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#5
RE: Mouth tape causing OSA ?
Something to note that regardless how you solved general leaks is that when leaks are lowered, the accuracy of the CPAP device is likely better. One may see low events but have a certain level of leaks versus having addressed leaks which are signified as lower yet events have gone up. It's not necessarily that events are going up, it is possible the machine could not flag them with the prior higher leak rate. I myself would say that would be so especially if these are mouth leaks, because that could be an open circuit.

The way I see it if you have mask leaks, there's still some attempt at controlling leaks, it's just less efficient than optimal. With a mouth leak, it's far less likely for any control to exist. Once that seal begins to break open, it soon blows open. Think of a dam holding a lake. Get a small hole in that dam. Unchecked, soon the dam is broken and the lake is gone. A mouth leak exists when the mouth has opened and the tongue seal has been broken. I am aware some can open and close the mouth seal, demonstrating better control of that seal.

Bottom line is I think you're looking at leaks and events incorrectly. The tape is not causing events, it's allowing the machine to accurately flag events that were hidden before the tape sealed the circuit.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Mouth tape causing OSA ?
(04-18-2020, 11:21 AM)Dormeo Wrote: Actually your flow limitation graph looks less busy during the second session, the one with the tape.  It's tempting to try to generalize from the data you've posted, but I'd advise resisting the temptation.  It's just not enough to go on.

You might want to try Somnifix.  It is more expensive than what you are using, but it is gentle on the skin, not painful to remove, and does the job.

For me, even when my lower jaw is kept in place by a collar, my lips want to part if I don't tape them.  So tape has been part of my routine for many months now.  I did invest in a little circuit alarm that I've plugged into an outlet on the same circuit as the machine, to make sure I wake up and remove the mask and tape if the power goes off.  I can't imagine I'd actually suffocate in my sleep, but this adds a layer of safety.

Thank you.

Hmm, yes, I "think I saw that" but did not recognize what it meant.
I accept this is only a small data set, and now that I have more confidence to combine tape with a neck collar, I will look to extend that.

Would it be reasonable to suggest then, that with large mouth leaks the the airway splinting is compromised?
That with mouth tape in place there is better splinting of the airway and hence less FLs? and therefore better therapy?
If that turns out to be the case, I may be able to lower the pressures I need.

As it happens I do have Somnifix, but have not been game to take this experiment further, for reasons that put me on PAP therapy in the first place. Slowly slowly catchee monkey, one step at a time.

I too can control the lower jaw with chin straps and collars, but not what happens inside the mouth nor my lips while sleeping or dreaming!

I might pluck up the courage to try the Somnifix with neck collar over the next few days and hope to provide further feedback.
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#7
RE: Mouth tape causing OSA ?
(04-18-2020, 11:36 AM)SarcasticDave94 Wrote: Something to note that regardless how you solved general leaks is that when leaks are lowered, the accuracy of the CPAP device is likely better. One may see low events but have a certain level of leaks versus having addressed leaks which are signified as lower yet events have gone up. It's not necessarily that events are going up, it is possible the machine could not flag them with the prior higher leak rate. I myself would say that would be so especially if these are mouth leaks, because that could be an open circuit.

The way I see it if you have mask leaks, there's still some attempt at controlling leaks, it's just less efficient than optimal. With a mouth leak, it's far less likely for any control to exist. Once that seal begins to break open, it soon blows open. Think of a dam holding a lake. Get a small hole in that dam. Unchecked, soon the dam is broken and the lake is gone. A mouth leak exists when the mouth has opened and the tongue seal has been broken. I am aware some can open and close the mouth seal, demonstrating better control of that seal.

Bottom line is I think you're looking at leaks and events incorrectly. The tape is not causing events, it's allowing the machine to accurately flag events that were hidden before the tape sealed the circuit.

Dave, appreciate your valuable insight, much appreciated: that is why my primary focus at this early stage (2 - 3 months into PAP) is to control/minimize leaks so that:

a) the PAP machine can work to the best of its ability and give me more reliable data.
That will allow me to make better decisions about pressures needed, the need for EPR etc

b) the labial symphony stops disrupting my sleep!

You said:
"The tape is not causing events, it's allowing the machine to accurately flag events that were hidden before the tape sealed the circuit."
Wow that is a scary comment: this implies that with large leaks I may have many more events than flagged...

Thankfully I don't see this every night, note the night of the 17th attached below, with Neck Collar, headbands over the mouth to contain/reduce the noise from mouth leaks.
Low leak levels, but no OSA, stable pO2 levels, and low flow limitations.
So I take heart from that, but would prefer to see this most nights.

[attachment=22080]

By using EPR = 2 I am seeing more rounded inspiratory flow pattern, even at lower pressures, which is satisfying.
It also feels easier to breathe out against.
[attachment=22081]

The quest for the Holy Grail, or something close continues...
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#8
RE: Mouth tape causing OSA ?
To put your mind at ease, unless your leak rate is consistently above the leak redline of 24 L/min on the ResMed, the machine is capable of dealing with events.

That chart is pretty good. Under 1.0 AHI is excellent, large leaks are below 5%. Best to ya.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Mouth tape causing OSA ?
(04-18-2020, 08:41 AM)SevereApnea Wrote: I might go back and review my data and compare them pre-collar and post-collar usage, that might be interesting.

Just to close the loop, I thought I would post this just for follow up:

Looking at my data comparing
1. Nasal Mask and Chin Strap versus
2. Nasal Mask and Neck Collar.

Not entirely controlled for all variables, but this was the most notable difference between groups.
Group 1 had mostly EPR 3
Group 2 had 50% EPR Off.

Anyway the interesting thing is 95% Flow Limits were the same.

AHI was better in group 1, likely due to more frequent use of EPR 3.
Peak EPAP and 95% EPAP was lower within group 2 with the Collar, which hints that this may be beneficial.

Data from the last 2 columns I extracted from Oscar charts directly:

a. Av Epap with OSA: On days that I did have OSA, I looked at the pressures when the OSA started: the average of these was lower in group 1 (chin strap and EPR3)

b. Av Epap with No OSA: on those days when I had no OSA, I looked at the  average 95% EPAP, again these seem lower in group 1 with chin strap.


This all suggests that while I pursue the neck collar route, I will consider increasing EPR from 2 at the moment to 3.


[attachment=22116]
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#10
RE: Mouth tape causing OSA ?
What happens if you sort on EPR 3/0??
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