Puffy Cheeks

[walt48]

I am new to the forum and read posts concerning puffy cheeks.

I have been using a CPAP for about 15 years.  I have no medical training whatsoever.  Since I breathe through both my nose and mouth at night, I use a full face mask.  I also get ‘puffy cheeks’ when using the CPAP and full face mask correctly. 

My understanding is that the difference in air pressure between the inside and outside of my cheeks causes them to puff out.  When the full face mask and CPAP machine are on, the pressure in my lungs, throat, mouth, and sinus cavity is higher than the outside air pressure (i.e. the CPAP machine/pump is increasing the air pressure). 

My ribs keep my lungs from puffing out; the cartilage in my throat keeps my neck from expanding; my cheek bones and upper jaw bones keep my sinuses from expanding; the rigidity of the full face mask keeps it from expanding (if it were made of balloon-like latex material it would puff out).  My cheeks, however, expand out without a ridged structure to support it.

I can move my ‘soft palate’ 1/ so that it block air from the lungs and at the same time seal my lips closed; that will prevent air pressure in my mouth.  However, if I open my soft palate my cheeks will puff out regardless of whether my lips are open or not, and vice versa. 
1/ during swallowing, the soft palate is pulled up, causing it to press against the posterior pharyngeal wall. When elevated in this way, it completely blocks and separates the nasal cavity and nasal portion of the pharynx from the mouth and the oral part of the pharynx.

As a consequence of the puffy cheeks and dry mouth, I was treated several times for an infected parotid gland (one type of salivary gland).  The gland got ‘clogged’ when the saliva dried up and blocked it.  I was treated by antibiotics and I was told that if the infection spread to my brain, it could be fatal. 

I found the ‘Respironics Fit Life Total Face Mask’ prevented my puffy cheeks.  I understand this is because the air pressure on the outside of the user’s cheeks is the same as the pressure inside their cheeks.  However, for unrelated reasons, that mask didn’t work well for me. 

I have been using the ‘Respironics Amara View’ full face mask for about five years.  To prevent my cheeks from puffing out, I insert a foam wedge between the lower mask straps and my cheeks to “push” against the outside of my cheeks. I have used this technique successfully for about 10 years or so.  I purchase “Heel Cushions” (Comfort Foot is the brand name) from my local pharmacy (in the section with foot products) that are intended to be slipped into the back of a shoe.  The cushions come with the thick side of the wedge rounded to fit under one’s heel.  I put that thick side towards the center of my face (i.e. towards my front teeth) under my cheek bone, and the thin part near/under my ear.  Obviously the straps need to be adjusted to accommodate the cushions.  The only problem I have had is that maybe once a year, one will slip out overnight.  I have had no reoccurrence of the parotid gland infections.

I also use ‘Orahealth XyliMelts Discs’ to aid with dry mouth.  They may also have had a positive impact of the infections.

[Sleeprider]

Interesting solution to a problem a lot of people share Walt. I have always used a nasal interface, and so the pressure rarely reaches my mouth. The Total Face Mask should mitigate your problem, but it seems like a very invasive mask. For someone that needs this solution, it is a lifesaver. Why didn't it work out? This is the first time I have heard of using foam wedges between the mask straps and cheeks to control the differential pressure. I wonder if a soft cervical collar might help by keeping the jaw closed.

[walt48]

Good point.  I don’t know why your cheeks wouldn’t ‘puff out’ when using a nasal mask if your lips are closed and soft palate (or tongue) is open.  I guess if the pressure is relatively low, there may not be enough air pressure difference make your cheeps puff out. 

I had no claustrophobia issue with the Total Face Mask, but the gasket leaks were insurmountable.  This was one of the masks I tried at the very start of my CPAP use ~15 years ago.  I assumed that the more gasket there is, the more opportunity there is for leaks.  I don’t recall how often the gasket gets replaced.  I buy supplementary cushions for my Respironics Amara View mask I use, so I change the cushions every week to keep the gasket silicon “tacky.”  Maybe I should give the Total Face mask another try.  I am now aware that washing the gasket with dishwashing detergent ‘renews’ some of the silicon’s tackiness.
 
A soft cervical collar works for me to keep my jaw closed, although the first tries were unsuccessful.  All of the soft collars I found (save one) are 3” to 4” wide - not wide enough to span from my chin to my collar bone.  Also, to work even a little, I would have to make them so tight (to keep my chin from sliding down between my throat and the collar) that it put pressure on my Adam’s apple and I would wake up coughing.
 
Then I tried an adjustable, rigid, open frame collar.  It definitely have kept my mouth closed, but was so bulky and uncomfortable, I couldn’t even get to sleep.
 
After some research I found a collar (the only one I found) that is 5” wide.  It works for me.  It is a Medline Serpentine-Style Cervical Collar "ORT 13300 L."  Because it is 5 inches wide, it is pretty effective at keeping my chin closed at night.  I bought it from MedLine over the phone (less than $6 plus delivery), but it should be available at local suppliers. 
 
Although the ORT 13300 L works fine for me, my lips are still able to open, so I still get a little dry mouth.  I did tape my lips for a year or so, with varying success.  I discontinued using the surgical tape primarily because the tape caused sealing problems with the mask’s silicon gasket.