Questions about mouth breathing and sleep apnea

[remstarcpap]

Questions about mouth breathing and sleep apnea

I'm curious about mouth breathing and sleep apnea. Here are my questions:

1. How do you know if you are mouth breathing? Do the numbers recorded by a data collecting CPAP give you any information about mouth breathing? Or is it just subjective signs such as dry mouth in the morning, or feeling tired in spite of posting good numbers on your CPAP machine?

2. What is the effect of mouth breathing on apnea?

3. If you discover or suspect that you are mouth breathing, what are the options to prevent it?

Obviously a full face mask would prevent mouth breathing from having an effect on apnea. Is this a good option?

Do chin straps prevent mouth breathing? If so what are the recommended chin straps?

I've also seen people write about taping their mouths. Is this a good idea? If so how do you do it, and what type of tape? Is it safe?

Thanks for any feedback you can give me.

[Gerald]

I counted roughly (9) questions in your post......and I urge you to work on the answers to them by doing a little research.

Click the "lightbulb" at the top of the page.....and read everything. Search for key words that'll answer your questions....using the search feature under the logo in the upper left of this page.

Read all you can....as fast as you can....your health depends on it.

Forum members will be happy to answer your questions....one or two at a time.

Gerald

[Julie]

Hi, you can know if a sleeping partner mentions it, or if you wake up all the time with a very dry mouth, or even if your own snores awaken you. The effect on apnea is not really the point (except as another hint that you might have apnea), but it's the effect on you that matters in that if you wear a nasal mask, all the good air is lost out of your mouth instead on going down your airway. The best option usually is a FF mask, but some people have trouble finding the right one, so try taping instead, which usually works very well, but is not always acceptable as a long term choice for some. Others do use chin straps, but many find they're at least somewhat ineffective. There are a (very) few cool people who somehow train themselves (and their tongues) to keep their mouths closed, or to at least block the cpap air from escaping (the tongue thing) even while sleeping, but I don't personally consider that an option for myself.

[GeneS]

Questions about mouth breathing and sleep apnea

I'm curious about mouth breathing and sleep apnea. Here are my questions:

1. How do you know if you are mouth breathing? Do the numbers recorded by a data collecting CPAP give you any information about mouth breathing? Or is it just subjective signs such as dry mouth in the morning, or feeling tired in spite of posting good numbers on your CPAP machine?

2. What is the effect of mouth breathing on apnea?

I hope this is more helpful than confusing. I am not a Doctor but this is how I think of it.

When you breath thru your mouth your cpap is not treating your apnea. CPAP treats apnea by maintaining a continuous positive airway pressure(CPAP) great enough to keep your airway open. I know there are more factors involved but to me this is the basic idea of how it works.

Mouth Breathing-- Atmospheric air pressure is defined as zero (0). When you inhale your lungs expand and lowers your lung and airway pressure below atmospheric pressure or negative. Air flows to your lungs. When you exhale your lungs contract and raises your lung pressure above atmospheric pressure or positive. Air flows out of your mouth to the atmosphere. Your airway pressure could vary from say -5 cm to +5 cm. For the most part air flows from higher pressure areas to lower pressure areas. Watch the weather forecast on TV for an example. People with sleep apnea have trouble at low or negative pressures.

CPAP Breathing-- The air in your CPAP mask is your new atmosphere. If your setting is 10 cm. Your atmospheric pressure is 10 cm. Your lungs and airway start at 10 cm pressure. When you inhale your lungs expand and your airway pressure drops below your atmosphere to say 5 cm. Air flows from your mask thru your airway to your lungs. When you exhale your lungs contract and raises your lung and airway pressure above your atmosphere to say 15 cm so air flows from your lungs to your cpap mask. Your airway pressure could vary from say +5 to +15 cm pressure (Always Positive). Your CPAP Machine maintains your atmosphere. If 5 cm is enough pressure to keep your airway open while breathing the CPAP is treating your apnea. If not you need to increase your CPAP or Atmospheric pressure to a pressure that keeps your airway open.

Mixed Breathing-- You can be breathing with your cpap and doing fine +5 to +15 cm then you open your mouth and breath in. Air would not flow from outside your mouth to your lungs unless your airway pressure dropped to negative. Your airway pressure would then vary from say -5 to +5 cm. You could then have an apnea while wearing your CPAP even if it is set at the correct pressure. The pressure jumps and drops between mouth and cpap breathing can also disturb sleep.

Mouth Leaking-- I consider mouth leaking as when you inhale from your CPAP Atmosphere and when you exhale air is diverted from your mask and goes out thru your mouth. Since the air outside your mouth is 0 cm instead of 10 it does not take as high a pressure to exhale so your airway pressure drops but remains positive. This could cause an apnea also.

10 cm of air pressure is the pressure at the bottom of a column of water 10 cm high so it is small compared to actual atmospheric pressure which is over 1000 cm if I figured it right.
3. If you discover or suspect that you are mouth breathing, what are the options to prevent it?

Obviously a full face mask would prevent mouth breathing from having an effect on apnea. Is this a good option?

I bought a few a new years back and they were to flimsy and I could not get them to seal. The ones today are much better and would likely work but I am not going to change anything as long as what I am doing now is working. In theory they eliminate all the mouth breathing problems.

Do chin straps prevent mouth breathing? If so what are the recommended chin straps?

I use a wide chin strap which helps me. I do not remember the name now. The narrow straps do not seem to help me much. I use a chin strap, a snorban device, and I tape. It seems extreme but it is working well for me now.

I've also seen people write about taping their mouths. Is this a good idea? If so how do you do it, and what type of tape? Is it safe?

I learned about taping on this forum. It has made a lot of difference in my treatment. I use Nexcare 1" Flexible Clear Tape from Walgreens. I use two strips overlapped slightly and fold back one end to make removal easier and quicker. I was a little nervous at first but have never had a problem using Tape but I adopt pretty fast since I have been on CPAP about 24-25 years and have tried a lot of things.


Thanks for any feedback you can give me.

[ozij]

Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance
Am. J. Respir. Crit. Care Med., Vol 154, No. 1, Jul 1996, 182-186.
GN Richards, PA Cistulli, RG Ungar, M Berthon-Jones and CE Sullivan

The last 2 authors are anmong the inventors of cpap.

Effect of mouth leak on effectiveness of nasal bilevel ventilatoryassistance and sleep architecture
Eur Respir J 1999; 14: 1251±1257
H. Teschler*, J. Stampa*, R. Ragette*, N. Konietzko*, M. Berthon-Jones**

ABSTRACT: Mouth leak is common during nasal ventilatory assistance, but its
effects on ventilatory support and on sleep architecture are unknown. The acute effect
of sealing the mouth on sleep architecture and transcutaneous carbon dioxide tension
(Ptc,CO2) was tested in 9 patients (7 hypercapnic) on longterm nasal bilevel ventilation
with symptomatic mouth leak.
Patients slept with nasal bilevel ventilation at their usual settings on two nights in
random order. On one night, the mouth was taped closed. Leak was measured with a
pneumotachograph.
Median leak fell from 0.35‹0.07 (mean‹SEM) L.s-1 untaped to 0.06‹0.03 L.s-1 taped.
Ptc,CO2 fell in 8/9, including all hypercapnic patients. Across all patients, the mean
Ptc,CO2 fell by 1.02‹0.28 kPa (7.7‹2.1 mmHg) with taping (p=0.007). Arousal index fell
in every patient. Mean arousal index fell from 35.0‹3.0 to 13.9‹1.2.h-1 (p<0.0001), and
rapid eye movement (REM) sleep increased from 12.9‹1.5% to 21.1‹1.8% sleep time
(p=0.0016). Slow wave sleep changed inconsistently, from a mean of 13.1‹1.6% to
19.5‹2.2% of sleep (p=0.09). Sleep latency and efficiency were unchanged. In four
healthy volunteers ventilator-induced awake hypopharyngeal pressure swing during
timed bilevel ventilation fell by 35‹5%.L-1.s-1 of voluntary mouth leak (p<0.0001).
Mouth leak reduces effective nasal bilevel ventilatory support, increases transcutaneous
carbon dioxide tension, and disrupts sleep architecture.

My emphasis....
From the above:

In the only study to date to directly measure the effect of
mouth leaks on effectiveness of ventilatory support, CARREY
et al. [6] investigated the effect of voluntary mouth
opening on diaphragm electromyogram (EMG) activity
during awake nasal intermittent positive pressure ventilation
in 5 subjects. With the mouth closed, diaphragm
EMG dropped to 15% of unassisted control, but with the
mouth open, returned to 98% of unassisted control, implying
complete loss of ventilatory support

[bdp522]

1. You can tell if, someone else see it, your data shows high leak(mine showed lots of hills and valleys on the charts), dry mouth, sore throat, still feeling tired, a high snore rate could also mean mouth breathing/leaking.
2. cpap needs to be a closed circuit to work. If the air leaks out you lose the pressure needed to hold the airway open.
3. Options are FF mask, tape your mouth shut(some prefer polident strips to seal the lips), chin strap(which doesn't work for everyone.
FF masks work but are harder to get a good seal on. They are the best idea if you feel taping is not for you.
Chin straps may help keep the jaw from dropping, but they still allow air to escape from the lips(think motor boat) and may push the jaw back causing more blockage.

How I tape;
viewtopic.php?t=9653
been doing this for years, works for me. I do put a light coat of milk of magnesia on the skin surrounding my mouth first. It helps the tape come off without taking any skin with it.

Brenda

[remstarcpap]

Thanks so much for all the feedback. So if I understand correctly, the only indicator of mouth breathing from my data would be spiky leak data? Otherwise my AHI might be low? Sounds like dry mouth and feeling tired is the only way to tell if I am mouth breathing.

I guess I could try taping for a night or two and see if I feel dramatically better in the am. Is that a long enough time to tell? I'd rather not tape if I don't have to.

If I wanted to try a full face mask, is there a consensus on the one that sucks the least?

BTW, I did search for answers, and the replies here were much more helpful. Thanks all!

[jules]

If you have either encore program, post your daily charts and get feedback on the information provided there. You want to post the ones like this one not a summary one as people tend to not comment on the summary ones as they don't offer anything to comment on.

[bdp522]

Leak data doesn't have to be spiky, just high. If you mouth breathe you probably don't do it non stop. when you mouth closed the leak is low when opened it's high.
Taping for a night or two would give you a good idea of if it works for you.
If I had to use a FF mask (or when I do) It's the Hybrid. I have also used the ultra mirage FF and it works fine for me.
And, Feel free to ask all the questions you want. Most of us don't mind answering the same questions over and over, we just want to help.

Brenda