Problem with CPAP. Please help.

[chazz]

I have been on CPAP for a couple of months and am using the Aura Twilight NP nasal interface with the Resmed S8 Auto Vantage. With this system I am getting reasonably good results for a limited time period:
Pressure: 11
Leak rates: .3-.4 l/s
AHI: 4-7
HI: 1-2

My problem is that after a few hours on CPAP (usually 3 to 5 hours) I find that on inspiration my mouth fills with air, and sometimes my cheeks pouch out. This is not from mouth breathing but a diversion of air from my nostrils to my lungs. If I am using tape over my mouth I have no choice but to swallow this air. Without tape I can expel the air between my lips. But in either case, once this begins, the problem will not go away and I have to abort using the CPAP. If I try to continue, this keeps recurring and keeps me awake until I finally have to give up.

Any help or advice would be greatly appreciated.

Chazz

[rested gal]

Chazzz, try putting a soft homemade strap of some kind horizontally around your head, across your cheeks. To keep them pushed in. That will lessen the amount of air that can fill your mouth. Less air in your mouth, less chance of feeling like you need to swallow it.

Actually you don't have to swallow the air. When your cheeks balloon out, just suck your cheeks inward to force some of the collected air backward (it's gotta go backward...can't go forward through the tape) and then work the remainder backward with your tongue. Go through the first motions of "swallowing" without actually swallowing -- the motion of pressing your tongue up against the roof of your mouth just before you'd swallow.

If you get the air moved back far enough with cheeks flattened and the middle and back of tongue pressing upward to squeeze the air on backward, the air will be caught in the stream that you are breathing in through your nose and get whisked on down the right way. Stop just short of swallowing.

All bets are off as to what happens when you are asleep, though. That's why you might want to add an extra strap for keeping the cheeks flat. Worn like a sweatband that has slipped way down.

A lotta gear, I know.

[JimW]

Looks like you're using your machine as a straight CPAP. Check out the possibility of using this in autopap mode, as long as it's not medically contraindicated. (Might check with your physician regarding this, assuming you're under a physician's care for OSA.) The overall lower pressures generated in auto mode would likely result in less air moving into your mouth cavity.

[Wulfman]

Looks like you're using your machine as a straight CPAP. Check out the possibility of using this in autopap mode, as long as it's not medically contraindicated. (Might check with your physician regarding this, assuming you're under a physician's care for OSA.) The overall lower pressures generated in auto mode would likely result in less air moving into your mouth cavity.

Maybe chazz likes EPR, which wouldn't be available in "Auto" mode.

Den

[chazz]

Rested Gal, JimW, and Wulfman thank you very much for your replies.

I am using the Resmed 8 in the autopap mode, not as a straight CPAP. The pressures, as read daily on the LCD, are all in a very narrow range: 11.0 to 11.6. After trying the straight CPAP for a few nights, I did not feel the the EPR was necessary for me.

I am going to try the techniques suggested by Rested Gal to avoid swallowing air. The straps did keep my cheeks from pouching out. But the main problem is that this keeps me awake. And once it starts, it does not go away.

Is there a name given to this phenomenon? It seems to be the opposite of mouth breathing, or is this, in fact, what mouth breathing is?

Might I be better off with the hybrid mask? Would using the straight CPAP set at a pressure lower than 11 in order to alleviate this problem be advisable?

Finally, how do I get a new posted message to have an N at the lower right hand corner of the icon?

Thanks, again.

Chazz

[blarg]

The pressures, as read daily on the LCD, are all in a very narrow range: 11.0 to 11.6.

What are your minimum and maximum pressures set to? It looks like they could be set at 11 and 12 respectively, which of course would mean not much variation in pressure over the night. You might not need 11 as a minimum pressure, and you might even do better with a lower minimum pressure as it may help with the air-in-mouth problem you're having trouble with. I wouldn't go changing it yet, but what's it set at?

[roster]

chazz,

For eight months I was using nasal pillows and trying chin straps and mouth taping. I cycled all night long: puffed cheeks/swallow air/puffed cheeks/swallow air. I felt miserable.

I had a long discussion with the sleep doctor and we both believe I was having several hundred arousals (awakenings without becoming aware) per night. I switched to a full face mask (Hybrid!!!!) and got rid of the problem. I am sleeping and feeling much better!

When I first started with the Hybrid, the back of my cheeks would still puff out where the mask was not covering them. Horrible thought, but I actually trained myself over a few weeks time to leave my mouth open all night so the pressure was balanced and the cheek puffing stopped.

Based on my experience, I encourage you to try the Hybrid.

Good luck and let us know how you are progressing,

rooster

[chazz]

blarg:

Thanks, your point is an excellent one so I checked my settings for autopap. The pressures are from 6 to 15, so that is not the problem.

rooster:

Your descriptions sounds just like my situation. I am going to order a Hybrid ASAP. Thanks

chazz

[rested gal]

Is there a name given to this phenomenon? It seems to be the opposite of mouth breathing, or is this, in fact, what mouth breathing is?

As for the ballooning cheeks, I'd call it simply "cpap air detouring into the mouth." With tape keeping it from escaping out the front of the mouth, some on the message boards call it a "blowfish" effect. LOL! Without tape over the mouth or a DIY device to dam the air from escaping out the front of the mouth (or a FF mask to contain the open mouth air) it would be called "mouth air leaks".

Swallowing air is aerophagia. It sounds like you have to deliberately swallow it, and aerophagia is usually thought of as inadvertently swallowing air, or air getting pushed down past the esophageal sphincter.

Any sleep disruption is a sleep disruption. What bothers some people might not bother another person. What matters is that you find a way to get more uninterrupted sleep, so if a FF mask turns out to work comfortably and effectively for you, that's certainly worth trying.

[GoofyUT]

You might want to seek some more advice about the Hybrid from ResMed S8 Vantage users. I for one, believe that the Hybrid is essentially incompatible with the S8 Vantage operating in AutoSet mode. That mask's considerable bias or exhaust rate exceeds the algorithm's upper limit of .40L/s for proper operation of the auto-titration algorithm, in my opinion. I'm told that the Hybrid's manufacturer is aware of this and is working on a release of a Gen. II Hybrid, with more moderate exhaust to allow compartibility with the ResMed S8 Vantage.

I know that I tried the Hybrid for some hours and could not get it to work effectively with my S8 Vantage because of the considerable exhaust, despite the variety of mask settings that I tried in the ResMed's mask-setting menu. Others here have reported the same frustrations. So, BE CAREFUL before ordering your Hybrid, and do seek the opinion of other S8 Vantage users here who have experience attempting to use the Hybrid with this particular APAP.

BTW, I am NOT aware of any FDA-issued warnings or restrictions on the use of the Hybrid with the S8 Vantage, nor any from the manufacturer. So, my views expressed here are simply my opinion and impressions.

Nonetheless, BE CAREFUL!

Chuck

[-SWS]

Swallowing air is aerophagia. It sounds like you have to deliberately swallow it, and aerophagia is usually thought of as inadvertently swallowing air, or air getting pushed down past the esophageal sphincter.

Interesting topic. The coordinated swallowing of air (either with or without CPAP) and the inadvertent passage of CPAP pressurized air (past an inactive or passive LES and into the stomach) are both actually aerophagia. With only 10 cm pressure, and a GERD-aggravated LES, I can sometimes very distinctly feel pressurized air slowly breeching past my own passive LES and into my stomach.

It feels like a verrrrry slow, soft, and continuous belch in reverse. True. .

[rested gal]

I can sometimes very distinctly feel pressurized air slowly breeching past my own passive LES and into my stomach.

It feels like a verrrrry slow, soft, and continuous belch in reverse. True.

I know that feeling! Gives me a sinking ( ) feeling to notice it happening.

[Snoredog]

I'm afraid you may have to eventually resort to a Full Face mask if tape is not working, with a full face mask it doesn't matter and you won't have the puffy cheeks as the pressure will be equal, the real problem is when you are in REM, you have no control over that puffy cheeks and/or mouth breathing.

A full face mask for me forces me to breathe through my nose for some reason, I always recall my mouth being closed. I've gone back to using a nasal mask in the Soyala over the course I've used that mask my machine has only alarmed 1 time due to mouth breathing.