New Exercise to Reduce Mouth Leakage

Raj · Post by **Raj** » Mon Dec 22, 2008 1:18 pm

I've delayed posting this because although my results have been quite promising so far, they've also been inconsistent and I wanted to be reasonably sure that no other factor was responsible for my successful nights.

Not wanting to tape my mouth and finding that Poligrip doesn't work for me, I've been doing a series of mouth, throat, and tongue exercises that seem to improve my AHI and help me maintain a sealed mouth against xPAP pressure. It occurred to me that if such a seal depends on my ability to generate and hold a partial vacuum in my mouth, an exercise specifically designed to strengthen the muscles responsible for creating that vacuum might be valuable. In other words, and I hate to put it this way, I needed to find a way to increase my ability to suck. Sad but true.

Having recognized a possible need for this kind of exercise, a means of accomplishing it became obvious. I bought a water bottle from Whole Foods ($4.50 and supposedly BPA free if you can trust a label) with a screw-type valve that can be adjusted to allow a full flow or a limited flow of liquid. Here's how I've been using it: I fill it, open the valve just enough so that it takes considerable pressure to suck the liquid out (without quite turning my head inside-out) and spend some time each day sipping. Over the course of a week since starting this, I've had several nights with a reported leak rate from my Swift LT of 0.00, which I've never achieved before. Also several nights with satisfactorally low leakage.

If you care to try this, I'd suggest you avoid the potential for damage by exerting somewhat less than the maximum force your mouth, tongue, and diaphragm is capable of, and being careful not to apply a very strong force for too long.

RipVW · Post by **RipVW** » Mon Dec 22, 2008 3:24 pm

How cool that is! Finally got my leaks and open mouth under control, but I'll bet this will work for others as well!

Racurl · Post by **Racurl** » Mon Dec 22, 2008 3:34 pm

I was trying to figure out just what an acceptable "Leak Rate" would be. New to CPAP and have the sort of machine that records data. It mentions that I have a leak rate of 19.8 l/m. Since I am short of my first trip back to the Doc to give him the "Smart Card" so he can tell me if I will live or die, I really have no idea if that amount of leakage is good or bad.

High Pressure has been 9.8 cmH2O and I use a Swift LT mask.

rested gal · Post by **rested gal** » Mon Dec 22, 2008 4:23 pm

Racurl, it would help if you could tell us what machine you have...the full name of the machine, as written across the top of the machine.

However, since you said you're seeing a leak rate reported as l/m it sounds like you have a Respironics machine. Respironics reports leak rate in l/m (liters per minute), whereas the ResMed machines (the brand Raj is using) reports in l/s (liters per second.)

Also, it sounds like the Respironics machine you have is an M series model, since you're able to see results in the machine's window. Or...do you have the Encore Viewer software, perhaps?

Anyway, if your machine is a Respironics, that leak rate of 19.8 l/m (per minute) is extremely low!!!

A leak rate of 19.8 would be an ENORMOUS leak with a ResMed machine...in l/s (per second.) But it's an beautifully low leak (in l/m... per minute) with a Respironics machine. Sounds like you've got leaks very well under control.

sepool · Post by **sepool** » Mon Dec 22, 2008 4:27 pm

I use a Swift LT as well - here (from the user manual) is the expected leak rates for various pressures:

Pressure
(cm H2O)
Flow
(L/min)
4 20
8 28
12 33
16 38
20 42

So indeed it looks like you are doing well. I don't know what your average pressure is, and also the Respironics measures flow in 7 lpm steps.

Racurl · Post by **Racurl** » Mon Dec 22, 2008 4:45 pm

Wow! Quick response. Thank you both. That is why I was asking the question.....Raj has a "leak rate" of .04 and I am sitting at 19.8!!!!! I sort of thought that I was WAY out of whack!

My machine is, indeed, a Respironics M with AFlex. The AHI level has been decreasing steadily to about 5.4 at this time. I think that this is pretty good considering that my sleep study had me at a AHI of 106 and oxygen desaturization to 72%! For now, however, it will take a bit of getting used to for this to become "normal". It is kind of like sticking a garden hose up your nose, hooking the other end up to a Toro Leaf Blower and then pretending that this is a "normal" way to go to sleep!

My doctor told me, however, that with the numbers that I presented, I should NOT considering doing nothing! Day 14 is better than Day 1. Keep the threads going, I have learned MUCH about "Rainout", masks, and all of the other items that you folks present here.

plr66 · Post by **plr66** » Mon Dec 22, 2008 5:53 pm

rested gal wrote:Racurl, it would help if you could tell us what machine you have...Anyway, if your machine is a Respironics, that leak rate of 19.8 l/m (per minute) is extremely low!!!

I was about to respond to Racurl with a question about how it was possible in this universe to obtain that low a leak rate. But it occurs to me that this begs the question of whether the expected leak rate has been cut down by a third because the exhalation vent might be blocked. Which is not good at all.
....Not to be a wet blanket......
Just wondering.
And I'm also thinking that it would be good for Racurl to start a new thread on this issue, since we seem to be hijacking another important and intriguing post which is unrelated.

RosemaryB · Post by **RosemaryB** » Mon Dec 22, 2008 6:34 pm

Raj, that's a great idea. I looked at the Facercise book from my library a while back with the same thing in mind. However, the exercises were too complicated and time consuming (they are supposed to take the place of a facelift) for me to do them. Hard to figure out from the book. I like your simple method much better plus I could do it at work because I drink water all day at work .

alexcue · Post by **alexcue** » Tue Dec 23, 2008 11:57 am

rested gal wrote:Racurl, it would help if you could tell us what machine you have...the full name of the machine, as written across the top of the machine.

However, since you said you're seeing a leak rate reported as l/m it sounds like you have a Respironics machine. Respironics reports leak rate in l/m (liters per minute), whereas the ResMed machines (the brand Raj is using) reports in l/s (liters per second.)

Also, it sounds like the Respironics machine you have is an M series model, since you're able to see results in the machine's window. Or...do you have the Encore Viewer software, perhaps?

Anyway, if your machine is a Respironics, that leak rate of 19.8 l/m (per minute) is extremely low!!!

A leak rate of 19.8 would be an ENORMOUS leak with a ResMed machine...in l/s (per second.) But it's an beautifully low leak (in l/m... per minute) with a Respironics machine. Sounds like you've got leaks very well under control.

Wow, thanks so much for explaining the differences between machines. I'm really new myself to this, and i didn't know the differences between manufacturers and how they report leakage and i thought my leak rate was horrible till i read your post. Thanks!

grandmajoy · Post by **grandmajoy** » Tue Dec 23, 2008 12:16 pm

Raj, thanks for posting your idea. I'm still having a little problem with mouth leaking. I can't wait to try this. I have no luck with taping and the chin strap drives me crazy. Sorry, you FF people; I just don't think I could wear one.

roster · Post by **roster** » Tue Dec 23, 2008 12:36 pm

grandmajoy wrote:Raj, thanks for posting your idea. I'm still having a little problem with mouth leaking. I can't wait to try this. I have no luck with taping and the chin strap drives me crazy. Sorry, you FF people; I just don't think I could wear one.

As a former nasal mask/nasal pillow/chin strap/take/mouth leaker, I feel sorry for those who resist using a FF mask.

My Hybrid FF mask is more comfortable, secure and effective than everything else I tried.

GrandmaJoy, Just judging from your Username, I bet you make Christmas fun for some lucky people.

Captain_Midnight · Post by **Captain_Midnight** » Tue Dec 23, 2008 12:58 pm

Raj --

That's an interesting experiment, and I hope it's successful.

I suspect that for those of us with apnea related to throat architecture, (for example, an unusually formed hyoid suspension), exercises might be of a modest benefit. For the past few years, I've been doing a few of the ones on this site a few days per week http://www.smile-on.com/articles/articl ... cle_id=521 . I can't tell for sure if it helps, but I seem to notice a slight inverse association between the exercises and AHI, but it's difficult to tell. (It does no harm, however. )

I usually don't mention this, because we get posters who (understandably) would like to forgo xPAP and do some magical exercises, and that is not likely for anyone.

That said, it it entirely possible that conscientious tongue and mouth exercises might improve xPAP results by improving muscular support around the breathing passages and making mouth closure more secure (and leaks less of an issue).

Good luck with exercising, I hope you are onto something.

goose · Post by **goose** » Tue Dec 23, 2008 1:24 pm

Hey Raj,
Thanks for posting that method. It sure sounds like it could work for a lot of folks!!!
I taught myself to not mouth breathe over a year ago -- I think this method would have been a bit easier, but hey, whatever works. I just consciously kept my mouth shut and my tongue planted on the roof of my mouth and over time it just stayed there and still does.

Leak rate can be affected by masks as well....in the paperwork that comes with your mask will be an expected leak rate by pressure. There is always a leak in a mask due to the exhaust function.....
Example is my headrest at 12cm (my 90% pressure) has a leak rate of about 27 or 28 (if I recall correctly). My 90% leak rate is about 32 so I feel that I'm in the ballpark. I chased leaks for about 6 months experimenting with all kinds of ways to see if I was mouth leaking etc.....turns out I don't mouth leak and all my masks are within "specs" as far as leak rates......

If mouth leaking is a problem and there are issues with correcting (tape, polident, chinstrap or.....), rooster is absolutely right -- try that FF mask. They work!!!! I have issues with FF masks due to facial hair, but have also found I don't need one with the exception of 3-5 nights a year where my allergies clog my nose.....then I just hassle through a leaky FF mask (HC431).....

Thanks again for the method -- great idea.
take care
cheers
goose

Raj · Post by **Raj** » Tue Dec 23, 2008 3:51 pm

I appreciate the appreciation and hope this turns out to be helpful for those, like myself, who need better, um, oral leakage control but have problems with FFMs. I'm finding -- not much a surprise -- that if I tire the relevant muscles excessively, the exercise becomes counterproductive.

BTW, RipVW, you've got some great gifs (the GIF that keeps on GIFFING?) and I like the way they're always relevant to the subject. And I thank you humbly for your restraint in not using a baby-bottle gif, which must've been a sore temptation.

grandmajoy · Post by **grandmajoy** » Tue Dec 23, 2008 7:56 pm

Rooster - actually I have thought about using a Hybrid or Liberty. What is the biggest difference between them? I haven't gotten around to checking out how often I can get a new mask from my insurance - I'm too busy trying to help my family have fun

I have five grown sons, four daughters-in-law and three grandchildren ( 3 yrs, 2yrs & 1 month, and 2 on the way!). I love being with my family. I'm so proud of them all, and we truly have fun when we're together, not just holidays. I am really blessed to have such a wonderful family; the sleep apnea is just a minor problem along the way.

Thanks for everyone's help. I've learned a lot from this forum - much more than my "medical" advisors.

Joy

New Exercise to Reduce Mouth Leakage

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