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Yet another newbie with questions (getting used to CPAP, mouth leakage, etc).
#1
Hi, Apnea Board Forum. This is my first post, and I apologize in advance for its long-windedness. I've done some reading of several threads (and also the wiki article about mask selection). Last night was my 4th night on CPAP, and I have yet to get a decent night's sleep while on it, so I assume it's gonna take some time getting used it before it really starts helping me. I hear that some people take to it right away and get good sleep from night one, and others take a while before they start getting the benefits. Well, I guess I'm the latter. Which were you?

My diagnosed AHI was 56.85, pressure is 9. Using ResMed AirSense 10 and nasal pillows. Events per hour while on the machine has been under 5, so that's a good thing, I guess. (HOWEVER - that number is misleading because it doesn't take into account all of the time I spend lying there AWAKE while on the machine). 

I like the nasal pillow mask so far. It's comforable, and I get a good seal. My default sleeping position is on my back, and when I first lay down and put the mask on, I am comfortable and fall asleep quickly. As long as I stay back, my mouth stays closed, and I breath easily and stay asleep.

But at some point during the night, I find myself shifting onto my side (I'm not sure why). Once I'm on my side, that's when my jaw opens, and the sensation of mouth leakage wakes me up. After that, it takes hours for me to fall back asleep. Miserable. After so long of lying there awake, I eventually turn the machine off and go out to the living room sofa. For whatever reason, doing that helps me to relax. And once I get sleepy again, I shuffle back to bed and get back on the machine. And on a bad night, this cycle occurs twice.

My reports show that I remove my mask anywhere from 5 to 8 times per night. Some of these mask removals come when I'm lying there awake and need to get up to use the toilet. (By the way, an email response from ResMed support said that the machine only detects mask removals when the machine is turned ON. That's weird because every time I remove my mask, I turn off the machine first).

So, I guess my questions are these: 1) how to prevent mouth leakage while on my side - is it about mask selection? I hope not, because I like the nasal pillows. Could an oral appliance be the answer? 2) What might be causing me to want to rollover onto my side in the first place? 3) Any tips for helping fall back asleep once you're lying in bed on the cpap awake?

(By the way, I thought it was normal and natural for most humans to sleep with their mouths open. However, during my follow-up appointment, I learned that, in general, our mouths open because our brain is trying to fight the obstruction and pull in more air. During the study, the tech instructed me to try and keep my mouth closed, which, to my utter amazement, I was able to do. Mouth leakage wasn't an issue night of the study as a I stayed on my back the whole time).

Any insight will be duly appreciated.
N
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#2
Welcome to the forum,

On masks,
Trial fit your mask when you go to bed both on your side, and on your back.
Reread the Mask Primer (In my Signature), especially the sections on Mouth Breathing, and Mask Leak Prevention.
Recently added is the section How to achieve the perfect mask fit - GUARANTEED! This is about establishing a non-leaking fit.

I am frequently a mouthbreather and I use a P10 as my everyday mask, My personal solution to mouthbreathing is to tape my lips.

Solutions here never work for everyone so please try multiple different approaches.

Fred
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#3
Welcome to the forum.

You may find that a chin strap will help keep your mouth closed and prevent mouth breathing.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#4
Welcome to the forum, Nicholas!
You may want to try either a chin strap or a soft cervical collar.  It seems that the cervical collar is a popular choice and works well.

You can buy one almost anywhere.  Amazon is a good place to look.  They sell many different sizes.  Just measure your neck and add a couple inches so it isn't tight around your neck.
It should be loose and comfortable. Also measure the area from your chin to neck.  They sell collars starting from 2" in height and up.

The collar will keep your jaw/mouth from dropping open.

In the meantime, start practicing the tongue seal technique:

Place your tongue to the roof of mouth, with tip of tongue behind your front teeth.  Then suck upwards.  This places your tongue in a natural position and creates a seal at back of throat so that no air can escape.

This takes some time to master, but worth it.  This technique may not stop your jaw from dropping open, but will stop the air from escaping.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#5
Hi Nicholas,
WELCOME! to the forum.!
I know CPAP therapy can take some getting used to, but I want to encourage you to stick with, it will get better over time.
Good luck to you on your CPAP journey.
Hang in there for more responses to your post.
trish6hundred
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#6
Welcome!

I took to it right away,  I was desperate for sleep.  If I have been told I needed to sleep with a dog turd in my mouth, I would have been happy to comply.  Happily, a mask and hose is all that is needed.


Quote:Events per hour while on the machine has been under 5, so that's a good thing, I guess. (HOWEVER - that number is misleading because it doesn't take into account all of the time I spend lying there AWAKE while on the machine). 

Maybe not how you think.  The machine does not know if you are sleeping or awake, so it assumes asleep.  So it does count the time you are awake.  And awake breathing can closely mimic sleep disordered breathing.  Your AHI when you sleep a full night might be well below 5.

An oral appliance is probably not the answer.  If you absolutely can not tolerate CPAP then an oral appliance is better than nothing.

I have no tips for helping fall back asleep once you're lying in bed on the cpap awake.  I don't get back to sleep easily when woken.  You could try a sleeping pill or Melatonin for the short term.  It takes time for your body and brain and lungs to adjust to this.  It is a process.  Allow it time.  I will guess a minimum of a year to fully acclimatize to it and feel the benefits.  Which is not to say that early days can't be good.  But you will find that your sleep patterns, day time wakefulness, comfort, etc, will change over the year.  This is normal.

I will respectfully disagree with OpalRose.  For me, the cervical collar should be as tight as is comfortable.  If it is at all loose, I have problems.  We are all different.  I may be more different than most.  Grin
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#7
(04-26-2017, 12:02 AM)chill Wrote: I will respectfully disagree with OpalRose.  For me, the cervical collar should be as tight as is comfortable.  If it is at all loose, I have problems.  We are all different.  I may be more different than most.  Grin


Hi chill.... No, I'm more different than most.   Wink

Please let me rephrase......The term loose could be interpreted differently.  I should have been more precise with my statement.  

This is what happened to me.  I measured my neck circumference, then ordered a collar that exact size.
Needless to say, I felt like I was choking, as there wasn't any room to even inset a finger.  

You should be able to insert two fingers between collar and skin.  Anything too tight is not necessarily better, but at the same time, we don't want to be able to twirl it around our necks like hula hoops.   Too-funny
That would be too loose.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#8
Chill and Rose, I never appreciated how commonly these soft cervical collars could resolve problems with sleep apnea. I just wanted to comment that we're seeing this become much more common on the forum since we started recognizing the benefits of these simple devices and the circumstances they seem to perform better than pressure increases. If you go back just one-year on the forum we almost never mentioned the collars as an important tool.
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#9
(04-26-2017, 12:02 AM)chill Wrote: The machine does not know if you are sleeping or awake, so it assumes asleep.  So it does count the time you are awake. 
^^^ Yeah, that's what I figured.


Quote:And awake breathing can closely mimic sleep disordered breathing.
^^^ That I wouldn't have guessed. Now you've got me curious what my fully-awake AHI is.

To all who have responded so far: thanks for your thoughtful and knowledgeable replies!
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#10
(04-25-2017, 09:23 PM)OpalRose Wrote: In the meantime, start practicing the tongue seal technique:

Place your tongue to the roof of mouth, with tip of tongue behind your front teeth.  Then suck upwards.  This places your tongue in a natural position and creates a seal at back of throat so that no air can escape.

This takes some time to master, but worth it.  This technique may not stop your jaw from dropping open, but will stop the air from escaping.

Thanks, OpalRose. I've actually already experienced this and know what you're saying. I've come to realize that part of getting used to CPAP treatment is learning what sensations are normal, natural, and to be expected vs. things that are problematic. I can't tell the difference just yet. You're right, though: when my mouth opens, I only need to stick my tongue to the roof, and the it stops the air from escaping. However, the feeling of using my tongue as a seal while my lips remain open is an still an awkward one. I didn't know whether that was ok or not; but now I do and am willing to try it more. But that tongue seal "motion" is a voluntary one, no? I never knew it was physiologically possible to actively adopt sleep "techniques." Put another way, it seems counter-intuitive to me that we have voluntary control over anything our bodies do while we're sleeping. Come to think of it, I suppose t's sorta akin to a child learning how not to wet the bed, no?
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