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New to CPAP. Mouth taping causes multiple rapid OA events
#1
New to CPAP. Mouth taping causes multiple rapid OA events
Hi all. I'm very new at this, having been on CPAP for just over a week now. I did an at-home test, was diagnosed with severe OSA at 30.5 AHI. Received the machine shortly thereafter and here I am. The only changes I've made thus far are changing my pressure from 4-20 to 8-14 (please do correct me if this seems wrong) and changing the EPR level to 3.

I would say things are going relatively well with the full face mask I'm using (Evora Full, after switching from the AirFit F20 which was not for me). But I'd like to switch to a nasal or nasal pillows mask for more comfort and less leaks. Problem is, I'm a mouth-breather after falling asleep.

So I tested mouth taping (using micropore tape) for two nights this week. This went mostly fine -- except that on both nights, I experienced a period of multiple OA events happening in quick succession. The first night, it happened shortly after falling asleep. The second night, it happened shortly before waking up. I'm almost certain I was on my back and "mouth puffing" during these times. Generally I prefer falling asleep on my side, but I'll end up on my back sooner or later.

I'm attaching standard screenshots of both nights as well as zoomed in view of one of these event phases.

Is there a way to prevent this from happening? The most obvious way would be to ditch the mouth tape, of course. But I'd love to keep my big mouth shut so I can try a different type of mask!

Many thanks in advance for the help.


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#2
RE: New to CPAP. Mouth taping causes multiple rapid OA events
Welcome! I'm a little skeptical that these clusters are caused by mouth-taping. Take a look at this:

http://www.apneaboard.com/wiki/index.php...onal_Apnea

So chin-tucking, especially while you're on your back is one hypothesis. If you use several pillows, or a high pillow, try switching to a fairly low and firm pillow to see whether that helps.

Just being on your back might also play a role. Did your sleep study show results broken out by sleep position?

Third, when we wake up or fall asleep we may experience events as part of the transition from the one state to the other. Often they are central events, but they can be obstructive too. In the zoomed-in view, I don't think you were really asleep during that spate of events.

The changes you made to your settings look sensible to me; good job. May I ask: what are the long breaks in therapy during the night?

Is the "mouth-puffing" your cheeks filling up with air? If so, by training your tongue to stay in the proper position, you can put an end to that. It took me a week or so of practicing during the day, and after that, this became my standard tongue position both day and night. It stopped the chipmunk cheeks for me. Here's my little spiel on the subject:

Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.
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#3
RE: New to CPAP. Mouth taping causes multiple rapid OA events
Thank you Dormeo!

The only reason that I think the mouth-taping is a culprit is that, out of 9 days of CPAP, the only times I ever experienced this were the two nights when my mouth was taped. Maybe it's caused by a combination of position AND mouth-taping? I do use two pillows. It's gonna be hard to break that habit, but I'll try using just one. Do you think a chin strap (instead of or combined with the tape) would help?

My sleep study showed an AHI of 81.4 on my back, 32.6 right side, 19.1 left side.

The long breaks are unfortunately just an aspect of adjusting to the therapy. That's me waking up, not being able to sleep, doing something else for a while, then going back to sleep. I do always wear the mask when sleeping, though.

Yes, the mouth-puffing is definitely cheeks filling up with air, primarily on exhale. I realized it on night 2 because I was sort of half-awake and noticed it a couple times. I will try your advice -- really appreciate it.
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#4
RE: New to CPAP. Mouth taping causes multiple rapid OA events
I have a suggestion.  Wear a soft cervical collar to keep your mandible stable.
Also, I've tried lots of different mouth tapes and found them leaky and prone to loosening, especially if you have facial hair.  Now I'm switching to a one inch wide strip of Shurtape duct tape.  It stays put and isn't permeable.  Yes, you have to go slow in removing it in the morning, but anyone who doesn't have 15 extra seconds for that needs some reorganizing of their schedule in my opinion.
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#5
RE: New to CPAP. Mouth taping causes multiple rapid OA events
(12-26-2022, 01:58 PM)bluegrey Wrote: Thank you Dormeo!

The only reason that I think the mouth-taping is a culprit is that, out of 9 days of CPAP, the only times I ever experienced this were the two nights when my mouth was taped. ...

Maybe I can help to orient you to this properly: You taped for a reason.  Why did you tape....to get better sleep?  If you respond with yes, then maybe that's what the tape is accomplishing for you...better sleep.  Except, because you have now changed a parameter of your sleep, from poor-ish to a lot better, you have begun to sleep 'differently'.  Your better sleep means you spend more time in a relaxed position, maybe supine, maybe now with more relaxed neck and with resultant chin tucking, and now the real reason for your mild apnea reveals itself: when you start to sleep well, or just 'better', you sag more, your head tucks toward your chest more, and you begin to close off your trachea. This is what systems engineers would call 'unintended consequences'.  Big Grin

If you have decided to tape, it's for a good reason, but now the different sleep has resulted in what may be the culprit all along becoming manifest, and that is the positional apneas.  They tend to cluster.  A soft foam cervical collar is often all that is needed to put paid to that problem.
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