General mouth breathing

[condition]

Hello, I am scheduled to visit my pneumonologist for renewal of my Airsense 10, after one year (mixed) CPAP therapy.
This year, I have come to various and definite conclusions, regarding how I react to CPAP therapy.
First and most important is that I cannot tolerate EPR, although it significantly lowers my AHI, it creates rhinitis. The first 2-3 weeks, until I discovered it, at the setting 3, had to take antibiotics because of rhinitis and congestion. At a later stage, around December, I begun using it again at the lowest setting, one instead of three, but even at this setting I end up seriously congested, though at a much slower rate. So, I must sleep without EPR.

I am using full face ResMed hybrid masks F30 & F40, in view of serious mouth-breathing, I sleep only on my sides, and a chin collar does not work, as not my whole chin drops, I just crack an opening in my mouth at the side and inhale from there.

My question is: during deep sleep, my mouth remains slightly open inside the hybrid mask and then suppose that I inhale from the mouth. 


Most of the breathing still happens from the mouth, Isn't this still unhealthy? Does it even play a role that the mask is full face, apart from the leaks since I do not inhale from the nose?

[ejbpesca]

I am a mouth breather during sleep who must use a FF mask.  The F40 has been my favorite out of seven.

I would prefer to breathe through my nose during sleep as I do awake, but I have found no way to prevent mouth breathing during sleep.  Not tape, collar, or chin strap will keep my mouth closed.

I have had severe dry mouth from PAP therapy for 18 years.  I also have developed irritation to the upper airway I think due to PAP therapy and mouth breathing but I cannot confirm that.

[Deborah K.]

It is healthier to breathe through your nose than through your mouth or both.  I comfortably tape my mouth and use a pillows mask or Bleep, but many prefer to go the full-face mask route, and seem quite happy with it.

[condition]

I am a mouth breather during sleep who must use a FF mask.  The F40 has been my favorite out of seven.

I would prefer to breathe through my nose during sleep as I do awake, but I have found no way to prevent mouth breathing during sleep.  Not tape, collar, or chin strap will keep my mouth closed.

I have had severe dry mouth from PAP therapy for 18 years.  I also have developed irritation to the upper airway I think due to PAP therapy and mouth breathing but I cannot confirm that.

Thank you for your feedback. I was able to use mouth tape prior to cpap therapy, and mouth tape was the reason I discovered that I have severe sleep apnea. After the use of CPAP I feel that I cannot handle the mouth tape and therefore I use FFM F30 & F40. From experience I know when my pharynx is dry, my nasal passages are next.  So I battle with dry mouth/nose every night.

Now on another main concern regarding my visit to pneumonologist for 6 months equipment renewal. I had a sleep study a year ago, which I attach herewith. It seems that I experienced mainly Central Apneas and Hypopneas. Since english is not my main language, I will try to post my concern as simply as I can:

Provided that I cannot tolerate ResMed's EPR, not even at the lowest setting, and provided that sleep study shows mostly centrals, should I request to replace my Resmed equipment from Airsense 10 to AirCurve 10 VAuto Bipap? 

My AHI score is lower with EPR enabled and even lower without humidification but I cannot tolerate both and I wake congested with EPR and dry out without humidifier, making me a very complicated case at my fifties.

[ejbpesca]

I have seen many times advice to switch to a BPAP aka BiPap, Bilevel machine that will increase exhalaltion pressure relief.  I would like to try one myself due to my flow limitations.  I have been told they do a much better job of pressure recovery for inhalation due to superior software.

I will ask for one the next time my insurance pays for a new machine.

BiPAP/Bilevel machines can be set to a wider range of therapy settings.  It will take using one and trying various settings to see how you react to its options.  Even though a BPAP will offer a type of extended EPR, the way it operates to recover from lower pressure should be a different experience than EPR on an APAP.

When I reduce my EPR my AHI goes down.  It has been explained to me that EPR is not good for some and for others, it works well.  For me, I need continuous pressure to prevent apnea events.  When EPR drops the pressure I lose quality therapy.  For others, it does not. 

I do not use humidification. It did not help with dry mouth but did help with dry nose but I find it cumbersome and more trouble than it is worth.  Others use it daily with success.

Much advice will be given on how to deal with dry mouth and nose.  I have tried them all and failed, others succeed by one or more of them.  Suggestions have been made that include:

Xymelt tablets that dissolve slowly and prevent dry mouth. (I wonder why those who use them are not concerned they may asperate one during sleep)

Chin strap to keep the mouth closed.

Tape over the mouth to keep the mouth closed.

Cervical collar to prevent the jaw from dropping and mouth opening.

These do not work for me so I have tolerated dry mouth and nose for a very long time.

[charlie*M]

Xymelt tablets that dissolve slowly and prevent dry mouth. (I wonder why those who use them are not concerned they may asperate one during sleep)

I used Xylimelts for some time before starting CPAP therapy.  One side of the lozenge is a different composition, designed to adhere to the gum or cheek tissue.  When placed correctly I found that this kept it in place and so did not worry about aspiration.  I did find I can do without Xylimelts now that I'm using CPAP successfully.

OP, I don't dispute your findings of EPR level causing rhinitis, but I cannot think of any physiological link of cause and effect.

[condition]

OP, I don't dispute your findings of EPR level causing rhinitis, but I cannot think of any physiological link of cause and effect.

When I first got into CPAP therapy, the Airsense 10 was set 6 - 14, with EPR at level 3. It felt so strange at the first night, it was like I was Exhaling into space, each exhalation was like it was taking several seconds. I believe that this is not related to sleep apnea, rather in my exhalation all day long. I have multiple spirometry tests, all similar, I attach a scan of the latest where you can see the exhale flow diagram is not continuous.  Nevertheless, in a week I was so congested with yellow phlegm, knowing that I must correct my therapy.

I have seen many times advice to switch to a BPAP aka BiPap, Bilevel machine that will increase exhalaltion pressure relief.  I would like to try one myself due to my flow limitations.  I have been told they do a much better job of pressure recovery for inhalation due to superior software.

I will ask for one the next time my insurance pays for a new machine.

BiPAP/Bilevel machines can be set to a wider range of therapy settings.  It will take using one and trying various settings to see how you react to its options.  Even though a BPAP will offer a type of extended EPR, the way it operates to recover from lower pressure should be a different experience than EPR on an APAP.

When I reduce my EPR my AHI goes down.  It has been explained to me that EPR is not good for some and for others, it works well.  For me, I need continuous pressure to prevent apnea events.  When EPR drops the pressure I lose quality therapy.  For others, it does not. 

I do not use humidification.  It did not help with dry mouth but did help with dry nose but I find it cumbersome and more trouble than it is worth.  Others use it daily with success.

Much advice will be given on how to deal with dry mouth and nose.  I have tried them all and failed, others succeed by one or more of them.  Suggestions have been made that include:

Xymelt tablets that dissolve slowly and prevent dry mouth. (I wonder why those who use them are not concerned they may asperate one during sleep)

Chin strap to keep the mouth closed.

Tape over the mouth to keep the mouth closed.

Cervical collar to prevent the jaw from dropping and mouth opening.

These do not work for me so I have tolerated dry mouth and nose for a very long time.

Thanks, regarding xylimets, I tried them before knowing my sleep disorder, as I had very dry mouth from undiscovered then, mouth breathing during sleep. I also got 2 chin straps, but they do not work as I just crack my lips open and inhale from there, my jaw does not drop. These are my averages wtih F40:
With EPR 1, no humidity/no additional heat AHI = 1-2
No EPR, no humidity/no additional heat AHI = 2-4
No EPR, Humidity level 1, no additional heat AHI = 3.5-5.5
No EPR, Humidity level 1/additional heat 22 C. AHI = 5-8

But I feel more comfortable at the latter setting, I do not have phlegm, nor need for nasal wash, moisturising creams etc

In this respect, I am thinking to request the Bilevel machine, to assist with my exhalation, lower my AHI while maintaining the most comfortable CPAP therapy. Does this make sense?

[ejbpesca]

I would keep EPR 1 for the lowest AHI on the list, and try EPR 2 to see if it goes lower, but many will say your comfort level is very important for restful sleep so a bit less AHI may not be worth EPR 2 if that setting irritates you.  The last settings on your list produce unacceptable therapy to most.  I need at least AHI <2 to feel better from therapy.  I would try to learn to tolerate more EPR if it produces better therapy.  

The decision to go BiLevel machine is something I am still researching.  I must make my case for one to get an insurance-covered prescription for it.  If I understand it correctly, once I get one and try Bi-Level settings, I can set it back to APAP-like settings if need be.

What is curious,  and please someone correct this if wrong, is that Bi-Level PAP is like an extended EPR and if it is pressure relief that irritates you, you may not take well to one, yet its pressure relief may have a different feel than an APAP's EPR. (better response and recovery time)

My concern about EPR is that that it does not maintain the pressure level I need for continuous therapy.  The pressure drop of EPR at 3 wrecked my therapy.  I have read this is the reason some use straight CPAP mode which I may end up with instead of a Bi-Level PAP machine.   

I may be very mistaken in thinking a Bi-Level machine can help me but it is worth a try if somehow its exhale pressure reduction regains inhale pressure fast enough to maintain therapy for me and it can be set to a similar setting as EPR 1 if lower pressure reductions result in higher AHI.

From what I've learned we all react differently to various settings and machine types and it is only by trying them out that will tell the story if they are the better choice.  Suggestions here are just that even though they may be presented imperatively.

[condition]

Hello thanks for keep suggesting, I do not want to go back to the EPR, as I can keep AHI lower without the use of Humidifier and heated tube, for example I post yesterday's (Friday) night sleep report without humidifier and heating aat72F. Thursday night with humidity level 1 and tube's temp around 72F, same settings same mask, greater AHI. Obviously, therapy works better without additional humidity. Bedroom's temp rarely falls below 65F anyway, my nasal passages seem to prefer dry heat. 

On another note, I had a leak for some time yesterday as the strap's left magnet detached from the mask for some time.

[NewlyDiagnosed]

Not at all an expert, but my dry mouth/mouth leaking problem was finally solved with the SomnoSeal. It's a soft silicon shield-shaped device that goes inside your mouth, outside your teeth. Even before I knew I had apnea, I had such a problem with dry mouth that I slept with 2 full glasses of water next to my bed (now I don't have to drink at all during the night). Once I started apnea therapy, I had mouth leaks. Tried taping with different kinds of tape, still somehow had leaks. The SomnoSeal completely stopped them. You're supposed to be able to use it without taping, or with only a tiny strip, but I still have to completely tape my mouth with kinethesiology tape. I also wear a cervical collar but that's for positional apnea.

It might be worth a try - very inexpensive.