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Question About Mouth Breathers
#1
I'm curious if anyone knows how it's clinically determined whether a person is a mouth breather. Here's what I mean. As mentioned in another thread I'm helping a family member who has severe apnea (oxygen levels in the 70s, near constant apneas easily observable when sleeping) with a machine as he waits to get tested.

I've now been able to observe him sleeping and he routinely gasps for air out of his mouth. But what I also noticed is it always seems to be in response to an apnea event. IOW he'll be nose breathing, stops breathing, and then gasps out of his mouth.

So last night he slept with a machine for the first time, using a nasal pillow mask, and did amazingly well. I walked into the room to watch him a few times and it is the first time I've ever seen him sleeping peacefully and breathing completely normally. I only watched for a few minutes, but I didn't observe a single mouth breathing episode and when I analyzed the results in sleepyhead in the morning, AHI as well as leaks looked good, which I believe would have looked otherwise if he was mouth breathing.

So this made me wonder - how do they clinically determine that a person is a mouth breather, and therefore needs a full face mask, when the only reason the person may be mouth breathing is because of apnea? I suppose they should be able to tell during the titration study, but I'm curious how often a titration study doesn't happen and a person just gets given a full face mask when they might not need one? Which in turn would I think, result in more treatment failures, since some people have a hard time tolerating a full face mask.

Thanks

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#2
I think you are confusing mouth breathing with desperately gasping for air which is what your family member was doing. Mouth breathing is regular, peaceful breathing through your mouth. It would get diagnosed by observing it, confirmed by the leak rate and flow wave forms.

You make full-face masks sound like uncomfortable, unpleasant things. I quite like mine. The main downside is a potential to leak more due to the larger seal.
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#3
Hi Dreams of Green,
I'm glad to hear your family member is doing well with CPAP therapy. He is very fortunate to have you looking out for him.
Hang in there for more answers to your question.
trish6hundred
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#4
Hi Dreams of Green. You bring up an interesting point! When I had my sleep labs (initial undiagnosed, then titration) the sleep lab technicians each had 5-6 patients they were responsible for. Between them going into patients rooms to adjust stuff, or disconnect things so they can visit the washroom, making patient notes on files etc etc it makes me wonder how long they have available per patient to observe whether or not someone is a mouth breather. I'm guessing it is more pertinent to watch a patient during titration rather than the initial diagnosis sleep lab where one might 'gasp' mouth breath.
I guess in a less economically strapped world, it would be more prudent to have a sleep tech with only a couple of patients, but that's never going to happen - at least not up here.
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#5
(09-04-2016, 02:11 AM)chill Wrote: I think you are confusing mouth breathing with desperately gasping for air which is what your family member was doing.
No I explicitly explained that I'm not confusing that, and one of the things I'm wondering is how often the observing person does. Hopefully not since they are trained, but I still wonder.

I also wonder since many people don't do titration studies, are people just being giving full face masks to play it safe?

Quote:You make full-face masks sound like uncomfortable, unpleasant things. I quite like mine. The main downside is a potential to leak more due to the larger seal.
I don't mean to suggest that, but I do suspect that as an overall percentage most people would choose a non full face mask (if they can), and be more likely to tolerate it.
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#6
(09-04-2016, 02:11 AM)chill Wrote: It would get diagnosed by observing it, confirmed by the leak rate and flow wave forms.

Thank you, this is the part I was wondering about. I would be curious to see the clinical standard for how it's diagnosed.

And since many people seem to be diagnosed without a titration study, and insurance companies now routinely refuse to pay for in-clinic tests for people who don't meet certain criteria, how is it determined for that group of people?
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#7
Dreams, I hope I'm not missing something here in your question, but I don't understand the need for or importance of a "clinically" determined label of mouth-breather. I've been one all my life since childhood, long before it was found that I had apnea as a late middle aged adult. I've known all along that I tend to breathe through my mouth as much as or more than through my nose. Go figure why.
Thinking back to my two sleep studies to date, the mask type I should use was never determined for me; it was try any you'd like to try. I believe there were FFMs and nasal masks shown to me at the sleep lab on the morning following my first sleep study. I don't recall any pulmonologist I've seen since I began CPAP telling me or even suggesting to me that I need to use a certain style mask, and mask type is not on any of my CPAP scripts. Again, forgive if I'm missing something important here.
David
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#8
(09-05-2016, 02:03 PM)Dawei Wrote: Dreams, I hope I'm not missing something here in your question, but I don't understand the need for or importance of a "clinically" determined label of mouth-breather.

Above all, intellectual curiosity. Sometimes I become curious about something and want to gain a deeper understanding of it, just for the sheer pleasure of understanding it.
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#9
(09-04-2016, 01:41 AM)Dreams of Green Wrote: I only watched for a few minutes, but I didn't observe a single mouth breathing episode and when I analyzed the results in sleepyhead in the morning, AHI as well as leaks looked good, which I believe would have looked otherwise if he was mouth breathing.

When you say leaks "looked good" does that include a look at the leak rate graph to see if it remains horizontal for the entire night? If there are significant rises and falls it could indicate mouth-leaking.

Quote:So this made me wonder - how do they clinically determine that a person is a mouth breather, and therefore needs a full face mask,

A mouth-breather is someone who typically breathes through the mouth when awake, because the nasal passages are blocked or obstructed. Even for a lot of these people, a nasal mask will help clear the nasal passages and allow them to breathe through their nose.

Mouth-leaking on the other hand, occurs when a nasal mask is applied and the pressurized CPAP air escapes through the mouth, ruining the therapy.
Sleepster
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#10
(09-05-2016, 03:25 PM)Sleepster Wrote: When you say leaks "looked good" does that include a look at the leak rate graph to see if it remains horizontal for the entire night? If there are significant rises and falls it could indicate mouth-leaking

This is from the first night. Comments welcome.

To my eyes it looked like the mask probably came loose a few times (which is very easy with the Dreamwear) but otherwise he seemed to be within acceptable parameters, though there is improvement to be had.

I've got two other nasal masks for him to try too but first wanted to have him try the one he found the most comfortable and not have him jumping all around when he's just starting.

[Image: HfKa0L7.jpg]


Thanks
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