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please help, large leckages, how to solve this
#11
RE: please help, large leckages, how to solve this
The designed purpose of cervical collar is to support the cervical vertebrae which is not what we are trying to accomplish.  We want to "remind" the jaw that it wants to be closed.

From the Mask Primer
Mouth Breathing[edit]
Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With SleepyHead look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In SleepyHead right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, not overnight, but it works for some.
Cervical Collar. A "soft" Cervical Collar. This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occured when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues. You are looking for a comfortable fit 2-inches larger than the circumference of your neck and just tall enough to support the jaw when your head falls out of alignment (measure your neck from collarbone to jaw and subtract 1". It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, the Ultimate Chinstrap, Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose being to maintain a proper head and neck alignment while allowing for the mask maintaing the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks / mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth, when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask. Many users use a product called Biotene to get relief from this symptom.
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#12
RE: please help, large leckages, how to solve this
Other than comfort I see no issues with a trial of your fitted cervical collar. The success we have seen is with a looser fit.
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#13
RE: please help, large leckages, how to solve this
Thank you very much, bonjour.
Yes, it is true, my cervical collar is not comfortable. Maybe I should give another try to a smaller one...(not so high), because generally it would help...I tried this already
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#14
RE: please help, large leckages, how to solve this
i cutted my soft collar down to a better, looser size (was 9cm high before, now 7 cm) and shall try this tonight and shall report then.

Also i made myself a headband with a small elastic part of rubberband on it and shall try this to cover my lips. (get little pressure to the lips) I do not think, that my problem is mouth breathing or chin dropping, it is - because of the pressure - sometimes air is coming - bubbels, streams, flutters - through my lips...I found this tipp also in the forum...

So hopefully, one or both of this works for me...
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#15
RE: please help, large leckages, how to solve this
You are going the right direction with the cervical collar. Tightening it too much around the neck can cause problems as well.

I found a stretchy hair band works well to control lip leaks. The ones I use are about 5 cm wide, although wider would be better if you can find one. The headband needs to be as smooth and soft as possible to keep lip irritation down.
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#16
RE: please help, large leckages, how to solve this
I tried the "cutted" smaller collar tonight, and yes, my feeling in the morning was much better... The AHI increased a little bit, but the large leckages where reduced, but still some... will try the headband next..
https://imgur.com/a/JFIQw
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#17
RE: please help, large leckages, how to solve this
Do you have a mask that also covers your mouth available? You may need one when you have a cold anyways. It would be interesting to see what pressure for the AHI and left hand stats bar you get. I assumes you would have the median 500ml tidal volume. It also gives you a base of knowing when you have the mouth breathing sorted.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#18
RE: please help, large leckages, how to solve this
Christian, your results last night look pretty good with the improved cut-down collar. Rather than add a hair band, I'd like to suggest using EPR to try to resolve some hypopnea. You are using 11-15 pressure without EPR and had no obstructive apnea or centrals. Adding some exhale pressure relief may improve on those results. Your leaks are not so bad, and rather than add more crap around your face, I suggest staying on this course and seeing how leaks go for a couple days. I would just keep the same pressure and collar, and add in EPR at 2. If that goes well, a trial at EPR 3 may follow.

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Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#19
RE: please help, large leckages, how to solve this
I had today simular results than yesterday. (only collar, nothing changed)

@ajack: yes, I have a full-face mask (amara view) i tried it a few times but not working for me really. And I got the simplus this morning, so I have to try the simplus in next days. My tidal med is low, about 400 mbar, does not depend which mask I use (+/- 10%),

@sleeprider: I shall try my new Simplus mask in next days, depending what results I get, I work afterwards with the collar and adjusting EPR as you recommended. I already tried EPR in all avialable levels. I do not really understand, why EPR (which lowers my minimal pressure by 1,2,or 3mbar, i.e. from 11mbar to 10 or 9 or 8) should resolve the hypopnea? Could you please explain this?

Thank you all for your inputs. Thanks
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#20
RE: please help, large leckages, how to solve this
If you use EPR it would allow you to raise the pressure up without the discomfort of a higher pressure. Example would be to raise the minimum pressure by 2cm and also use 2 on the EPR. That allows you to maintain a lower pressure for OA's while increasing the higher pressure for hypopnea's. Sort of a mini BPAP.
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Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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