Newbe with Chipmunk Cheeks

[Apnea Infant]

Sandyelle

My overnight sleep study titrated to 20cm H2O and woke me up violently at the hospital. Apparently although my AHI was low to moderate when I was at REM sleep everything collapsed and hence 20cmH2O. A further 2 weeks home titration resulted in advice of 16.8cm H2O.

The initial month of 16.8 with the FFM resulted in severe aerophagia and nightly chipmunk cheeks. I would wake up feeling like my face was in a wind tunnel. I felt the high pressure came whoosing out of my open mouth, not escaping fast enough and would lodge in my chipmunk cheeks. If my sleep was not so fragmented with severe exhaustion I would have found it all so funny.

So I am with Opal Rose in saying that mouth breathing with the FFM is not the way to go. In fact it was only with slowly learning to keep my mouth closed so all pressurised air was channeled to my airways that my therapy started to succeed. With that, I looked to lowering pressure slowly as an aide to perhaps more comfort and also reducing leaks. OK, so the neck collar worked for me and I learned to stick my tongue to the roof of my mouth. I do that as I fall asleep. At times I do still wake up to find my tongue down but in the main, it has worked.

Chins straps have worked for others and also filled sock rolls have been suggested too as aides to keep mouth shut. For me the neck collar also serves to align my head/neck to keep airway open.

Do give your self time to get over the effects of the operation before making conclusions on PAP.

[robermax]

Sandyeelle
I have nasal masks for about 20 years and recently decided to try full face mask.  I did notice billowing of cheeks on the first few tries with FFM.  If I consciously tried to breathe through my nose this seemed to quickly resolve and now it is a non issue.
Hope this helps


Bob

[babag1]

Airsense 10 and pillows. Chipmunk cheeks reduced using silk tape across the lips to keep air from leaking out of lips. Changed the ramp time on the machine from off to 30 minutes. If I have the slightest leak, the pressure elevates and those puff of air torments me inside my mouth. The pressure stays high and annoying. Turned the machine off and back on last night and it starts the ramp of 30 minutes to let me go back to sleep. 

Once that pressure gets so high from the slightest lip leak, it stays that high and it won't reduce. This is the reason I turned the machine off and back on. 

A better idea would for me to change to a full mask. I've tried it and I hated them. The pillows to me are like sleeping before I had apnea. 

Note: My pressure settings top is 11 and I can't imagine the rush of air in the mouth with a higher pressure. All my results are right on the mark.
 

Love my silk tape.

[Sandyelle]

Thanks for all the help and comments.  I am still hanging in there trying to find the right mix for me.  

My doctor lowered my pressure to 10/14 from 10/18 yesterday.  He thinks I need the higher pressure,  but since the mouth leaks are causing me sleepless nights, a lower pressure may be better for me.  My tongue does not naturally rest at the top of my mouth, however I am practicing this.    

I've tried several chin straps but with a full face mask (Amara View and Airfit 10)  the chin strap causes a leak where the mask and strap touch.  I did better last night wearing the chin strap over the mask.  Cervical collar caused neck pain, but I think I will try the toddler sized travel pillow.  I even went to see an ENT.  He said that my pallet is too long and discussed surgery, which I am not interested in- sleep doctor agreed - he said that this is something they used to try years ago that did not work. 

My doctor suggested I try another mask.  He suggested the Quatro FX.  Not sure this is much different from the Arifit 10.  He was not in favor of a nasal or pillow mask.  

Taping seems to be the only solution that has provided any success.  It's really hard to tell what is working best because I switch masks/straps/tape during the night, trying to get better rest.  

There are a couple of masks that look like they have build in chin rests.  Has anyone tried them?  Or have other suggestions?  
Aspen Full Face 
Forma Full Face 

Part of my sleeping problem is because I had surgery for a torn rotator cuff on 10/11 and I still have pain when sleeping, however my shoulder recovery is going well.  

I'm hoping the lower pressure and using tape works a little better.  Thanks again for everyone's input.

[babag1]

If you try Silk tape. Durapor 2" is what I have from Amazon. 
You rip a piece wide enough+ for your mouth then fold each end under just a little in case you have to sneeze or get sick then you can rip it off fast. Removing it slowly is the ticket for the next morning. 

Don't make a mistake and try paper tape. That was my mistake as it is still harsh to the lips. 

[Sandyelle]

Hello everyone.  I wanted to give an update and see if you have more suggestions for me.  Everyone on this site has been wonderful.  I think that I may have given up on CPAP with you your advice.  


Help please.   I posted when I frist started with CPAP that I had chimpmunk cheeks and I have been struggling to resolve my breathing with an open mouth issue.  I'm not sure a full face mask is the correct mask for me.  If I open my mouth slightly, it's like the flood gates are open and the air keep pouring in until my mouth is wide open with the pressure increasing.  

I have a f/u appt tomorrow with my doctor.  On my last visit he suggestetd I try a 3rd full face mask, FX Quatro.  I have both the Amara View and F20 masks.  Neither works well for me.  I'm m not sure the FX will be much different.  My doctor did not feel that I could use a nasal/pillow due to my pressure level.  His last suggestion was to lower the pressure  from 18 to 14 to see if I could adjust to the treatment.  

I need suggestions.  Years ago a dentist I met on a fishing trip told me that my tongue was not properly positioned and that I had a tongue thrust.  

I have tried chin straps, tapping and a cervical  collar - which does not work for me right now as I recently had shoulder surgery and the collar causes pain..  My best option has been taping. Does anyone use an inexpensive mouth guard?  That is the one thing I have not tried.  Or any other suggestions.  

Since I am taping my mouth closed, why do I need a full face mask?  Contrary to what I thought,  I can't sleep with my mouth open with a full face mask.  The pressure increases and my mouth opens wider and wider.  So there appears to be no reason to sue one.  

I am posting my recently sleepyhead data with taping.  Please let me know what you suggest.    What should I discuss with my doctor.  

[babag1]

My husband tried taping with his full face mask. His pressure is also high too like yours. It worked better than a chin strap for him. He didn't have to use the chin strap then either. His problem was that his jaw always dropped lower than the mask. He did that for some time and now he wears a baseball cap with bill cut off and velcro non-stretching tape around his chin and over the cap. You can see this idea by a doctor on YouTube. Taping videos are on YouTube also.
It is odd looking for sure. I am lucky that my pressure hight is set at only 11.

[Sandyelle]

I ordered the  Durapor take and had the best night so far. I only woke up once.  I hope that at some point I can wean off the tape and lean to keep my mouth close.

[Sandyelle]

Still Struggling:  
I am 3 months into  my CPAP journey.  I am still trying to figure this out.  My main problem is that
I am a mouth breather.  I have a full face masks, F20 and Armaview.  I change them back and forth.  I have several
chin straps but have the most succes with tape 
First question:  Is there any point in having a full face mask? I still need a chin strap or tape to keep my mouth closed
so my pressure does not increase. Would  a nasal mask would be more comfortable? 

My doctor had suggested lowering my pressure to 14, however the treatment might not be as effective.  My doctor did not want to see me again for 4 months. 

Since I was always at 14,  I increased the pressure back to 18 but 18 was "blowing me away".  I lowered the pressure last night to 16, and I sleep a little better. 

I have an appt with my DME on Friday.  Should I get a nasal mask and use tape?  I need to do something consistently.  
I've been sleeping on my shoulder since my rotator cuff surgery 10/11 but I think I am ready to try side sleeping again. 
Do I need a special pillow.  

I seem to be all over the place with no idea or plan...  Help please. 

[Sleeprider]

Sandy, your charts would be more informative if you moved the flow limits upward and replaced the mask pressure chart. I suspect that you have a considerable amount of flow limitation, and that would be helpful to see. Your obstructive events appear to be clustered, and many members have benefitted from the use of a soft cervical collar to help with upper airway restriction, flow limitation, and obstruction. You certainly do not need higher pressure that the 16 cm max you are using here, and your current EPR setting does not seem to be a problem.

I think a lot of issues could resolve with a soft cervical collar, which may encourage your mouth to stay shut by providing gentle pressure on the back of the jaw, while at the same time maintaining a better airway alignment. Your leak rate is quite good, so your mask is working just fine. I think a nasal mask or pillows might be a problem since you do tend to have your mouth drop open or you breath through the mouth. That is a disqualifier for nasal therapy if you can't break the habit, and I am personally not a big fan of taping.