Chin Straps, lip straps and a collapsing tongue.

[mhorowit]

I'd like to clarify my understanding of something if you please.
I'm trying the OptiLife Nasal pillows and like the comfort; unfortunately I'm getting large leaks to which I attribute my tongue falling back and air going out my mouth. So for the cost of a headband and a little sewing, I built a 'lip strap' (mentioned elsewhere on the forum) and it does hold my lips closed. However, when my tongue falls back the pressure begins to rise and the lip strap fails. This morning, just as waking when I was still very relaxed, I tried an experiment. Optilife was still on. I allowed my tounge to assume it's normal position in my lower jaw and air blew out my mouth. Clamped my teeth and the air continued, clamped my lips and the air continued. It was only when I moved my tongue to right behind my upper teeth and allowed the tongue to flatten against the roof of my mouth that the air redirected to my windpipe. YMMV, but I'm thinking this is what Rooster ment when he disparaged chin straps. They shut the mouth, but the mouth isn't the problem (for some people, i.e. me).

Elsewhere we hear that we can teach ourselves to position our tongues for better air flow.
Hold that thought for a moment.

General wisdom seem to be "shut the high leak rate alarm off", but what if you left it ON, so that when you got an alarm, that would remind you to reposition your tongue; Pavlov's dogs. Now, I haven't tried this yet, but there is no medical risk involve, so I'll try it; maybe not tonight, but certainly this weekend.

Does anyone see a flaw in this logic?

Yes, I know FFM is the ultimate solution, but this OptiLife is really comfortable and I'm not really keen on using tape.

Thoughts? - Mike

[kebsa]

it makes sense to me, classical conditioning (pavlovs dog's) is very powerful. I had found the same thing about the position of the tongue and i have read posts from some one else that mentioned this (i think it was rested gal) i have been a mouth breather for as long as i can remember- i have always had sinus congestion and hayfever that only partially resolved with anti histimines of cortisone nasal spray. For me thankfully the chin strip has corrected the position of my tongue but it took trying a couple (they tend to pull in quite different directions) i eventually did some minor surgery to the chinstrap and that has worked for me - the interesting thing is that i am gradually adapting to nose breathing. For me i think the most imprtant thing was dealing with the sinus congestion - for as long as i can remember the family doctor has said that it is not possible to get rid ofall the congestion as australia has such a high rate of asthma and allergies and i just accepted that. i finally tried one of the saline washout kits ( i think some of ou guys call them nettipots) and for the first time in years i can breathe properly through my nose! now sleeping with my mouth closed seems to be becoming automatic- i am not game to ditch the chinstrap entirely! My onlycomplaint is that i saw my reflection in the mirror with all the gear on and i looked like hannibal lecters sister!! not a great look!

[LinkC]

General wisdom seem to be "shut the high leak rate alarm off", but what if you left it ON,

In MY case.....divorce!

[rested gal]

mhorowit, it's worth trying... your Pavlovian trial.

What you discovered about position of the tongue (not just the jaw being held up with a chinstrap) is key to whether a person is going to have mouth leaks or not when sleeping. The geometry of the inside of the mouth has a lot to do with whether the tongue can maintain a leakproof seal during the complete relaxation of sleep...even with jaw prevented from dropping much.

Keeping the jaw from dropping down a lot can be all it takes for some people. For others (me!) air will gush out when the tongue loses a seal, even if the teeth are clenched tight.

Maybe you'll be able to train yourself to keep the tongue where it does its best sealing. I never could. But I never tried your alarm idea. Good luck!

Here's an old, old post on another board, from a long time ago before cpaptalk got started, when I thought I had it licked (no pun intended... ) but didn't.

August 31 2004 - Mouth leak training wheels
http://www.talkaboutsleep.com/message-b ... php?t=3604

A description of the "nexcare" mouth dam mentioned in that thread is here:

June 09 2004 - Air leak solution, maybe? - nexcare dam
http://www.talkaboutsleep.com/message-b ... 2052#22052

Hope you'll have success, mhorowit, but if not, you might want to think about fashioning yourself a "DIY" (do it yourself) thingie, to help keep the tongue in a sealing position:

December 01 2004 - mouth leak solution, cheap DIY oral appliance
http://www.talkaboutsleep.com/message-b ... php?t=4750

[OCNorsk]

My machine says the alarm is on, but I've never heard it. How high would it have to be for the alarm to sound? What does it sound like?

[tattooyu]

I don't know about Respironics machines, but the ResMed Autoset II clinical manual says:

Leak Alert — Enables or disables the Leak Alert feature; when enabled, leaks > 0.7 L/s for > 20s result in an audible alert and a high leak message in the LCD.
Note: when Leak Alert is enabled, SmartStart/Stop is automatically disabled.

Your therapy could definitely get compromised well before you hit that mark, but in my first weeks of therapy, I defintiley would have set it off. I had leaks up to 1.3 L/s! On most nights, my leak rate is 0.1 or below.

[SharkBait]

My leak rate alarm went off last night for the first time...

I immediately got up and fixed myself a sandwich (weak Pavlov wisecrack...)...

Seriously, my mask had gotten knocked loose (I'm thinking I tried to roll over onto my stomach). It just barely woke me up and had you not posted this, I doubt I would have remembered...

[DreamStalker]

I think the key to training yourself not to mouth leak has more to do with the soft palate tissue in the roof of your mouth. There is actually some muscle tissue in your soft palate and exercising it will help firm it up to seal the sinus cavity from the mouth cavity.

When I first started, I thought planting my tongue up on the roof of my mouth behind my front teeth (like sucking on a hard lemon drop candy) was what was helping me to keep a good seal. The act of doing that actually contracts the muscles in your soft palate. With a little Googly internet search I learned that singers exercise the muscle tissue of their soft palate and that the occasional reference to didgeridoo playing as a cure for apnea (which it is not) also strengthens that soft palate tissue (which may still be a good thing or at least fun).

Furthermore, as I began learning and doing regular nasal saline irrigation, I discovered that I could control the flow of water in my sinus cavity (sealing or not sealing from mouth cavity) by how I contracted the muscles in my soft palate. In addition, I learned I could talk with my nasal pillow mask on and under pressure (with a Neil Young nasal tone but I still cannot sing worth a darn). I can open my mouth and relax my tongue (or place it any where in my mouth or even stick out of my mouth) while wearing my Swift LT and not leak any air out of my mouth simply by controlling the shape of my soft palate. And all of this is possible because of the firm muscle tissue in my soft palate.

I have no problems with mouth leaks unless the pressure exceeds about 11.5 to 12 cm but I’m sure that threshold is different for everyone. So lucky me, my optimal treatment pressure is just under my soft palate’s threshold so I don’t have a need to tape, glue, staple, or stitch my lips together each night in order to use a nasal pillow mask.

As for chinstraps, they generally do not work unless you use a very low pressure but in that case you can probably also just exercise your soft palate and do without the chinstrap altogether. At higher pressures, a chinstrap may hold your jaw in place but the air may and usually does just escape out from between your teeth and/or lips. What a good (one that does not stretch much or at all like PapCap) chinstrap does work well with is a full face or Hybrid type mask. Since it keeps your jaw in place, you are less likely to lose the seal from around the mouth area.

[rested gal]

a chinstrap may hold your jaw in place but the air may and usually does just escape out from between your teeth and/or lips. What a good (one that does not stretch much or at all like PapCap) chinstrap does work well with is a full face or Hybrid type mask. Since it keeps your jaw in place, you are less likely to lose the seal from around the mouth area.

Good hint, DreamStalker, for FF mask users who have a lot of leaks during the night. Could be that their jaw is dropping down enough to change the contour of the face around the mouth...just as you say...breaking the seal.

[araminta]

What the heck is a "lip strap"?

[anotherRandy]

Yes, I know FFM is the ultimate solution, but this OptiLife is really comfortable and I'm not really keen on using tape.

Thoughts? - Mike

I'm using tape and Polident strips. My leak rate? 0.00

[rested gal]

What the heck is a "lip strap"?

As far as I know, there's no commercial "lip strap" just in and of itself. Some chin straps are designed, so that they might have an area that would push upward on the lower lip some, helping to prevent air from puffing out between the lips. Or, some people devise their own way to push the lower lip up more, like Snork1's solution:

The infamous bra strap:
viewtopic.php?p=19854#p19854

(humming a childish chant again... )

[araminta]

So RG,
I'm trying to picture what kind of material would be under the lower lip. Just the stretchy bra strap material?
Sounds like it's worth a try to help the blowfish thing I sometimes do ...
Thanks.

[rested gal]

araminta, if by "blowfish" you mean mouth filling with air and cheeks puffing out like a chipmunk - like when the mouth is taped shut - I don't think a lipstrap would remedy that. The only thing I've used to prevent puffed out, airfilled cheeks is a sort of chin strap (can be soft and homemade) running vertically up along the sides of the face or horizontally around the head. A strap of some kind alongside the cheeks to keep them flattened will not stop CPAP air from entering the mouth from the back of throat, but will at least keep to a minimum the amount of air entering the the mouth from the back...simply by virtue of preventing the cheeks from ballooning outward as much as they could with nothing keeping them flat.

Yes, the shoulder strap of a bra is what snork1 used for a lip strap since just a regular chin strap wasn't enough to stop his mouth air leaks. However, a lip strap won't keep CPAP air from filling the mouth from rushing in from the back of the mouth. The lip strap was simply to try to stop mouth air leaks and mouth breathing with a little additional "dam" (the lower lip pushed up.) A lip strap would help only if a person needed just that little bit of extra "seal" of closed lips. For a diehard mouth breather that has CPAP air easily gushing out the mouth even when wearing a chin strap, it's worth trying to fashion a lip strap of some kind to see if just the slight extra "damming" provided by keeping the lower lip raised might work. Chin strap + lip strap still isn't enough for me. Thus, I use tape.

[rested gal]

Additional discussion about fashioning a lipstrap is in mhorowit's other topic:

'Lip' strap/Mask?
viewtopic.php?t=40944