different kind of chin strap

[palerider]

so what it is that you folks feel like I am trying to sell to you in Nebraska? Canada?

slick big city dentist sig:
Armen Mirzayan DDS
Los Angeles, CA
90017
Esthetic Dentistry Dental Group
http://www.estheticdentistry.something

[avi123]

Armen, instead of using chinstraps what about taping the lips to keep the mouth closed?

[Jay Aitchsee]

folks, these chin straps are a terrible idea
the whole reason people snore and/or have apnea is that when they fall asleep, their jaw muscles relax, and the lower jaw settles into the airway, constricting it. If you apply a chin strap in this manner, you are actually making things worse for your self. Your lower jaw should "stick out", not forced back into the airway.

As the one who suggested this idea, let me say that I agree with you that chin straps in general are not very effective because they do not prevent airflow from the mouth and, as you say, they tend to push the jaw back, possibly exacerbating the conditions which contribute to apnea.

My suggestion is not a "chin strap". It is a mouth covering to be used in lieu of tape to slow expiratory mouth breathing and to reduce the tendency for complications from that. The tension of the band is slight and the force is shared by the upper and lower jaw so there is not nearly the tendency to push the lower jaw backward as with a conventional chin strap. Again, it is proposed that this be used in lieu of tape, a rather extreme measure with its own drawbacks.

Did you read the accompanying post?

Here's an item I suggest rather than tape. It's a stretch headband made from a thin, soft cotton like material similar to that of a T shirt. It is double thickness (a tube), but still thin. The material is stretch and inside at one edge there is a narrow elastic band. It doesn't unravel when cut. It is about 2.5 inches wide and fits nicely between the nose and chin. I think it would fit most without being too tight or loose. Wear it just like a headband only pulled down over the mouth and ears. I cut holes for my ears. It does not interfere with a P10 or Dreamwear nasal mask. When it is worn with the internal band down, it tends to keep the bottom lip closed. It is porous so that chipmunk cheeks are less likely to form, but at the same time, it restricts the flow and reduces mouth leaks considerably. It also softens the noise of mouth leaks and discourages mouth inhalation. I've worn it for about two months and it has reduced my average nasal mask leaks (mouth) from an average of about 12L/m to about 5 rarely exceeding the large leak mark. I've see them sold at various places including grocery and drug stores. They cost about $5 for a set of five and are washable. One set should easily last a year. Here's some at Amazon.

[ArmenDDS]

Armen, instead of using chinstraps what about taping the lips to keep the mouth closed?

i have never worn a CPAP machine. I have done HST's to find out my AHI which is under 3. I snore when I have the occasional social drink which drives my wife crazy.
anyway, to be very clear, I am not here to bash on cpap at all. the question i have for you is how do you exhale? is exhaling important? would taping your mouth shut help or hinder exhaling?

the whole point of the cpap machine is to keep the airway open with positive pressure
if you do anything to hinder airflow, you will only constrict the airway, thus requiring even more pressure to overcome that
the only other way to keep the airway open it to move the tongue forward. you do that by moving the jaw forward, as the base of the tongue is attached to the lower jaw.
this doesn't even address the exhaling question

[ArmenDDS]

folks, these chin straps are a terrible idea
the whole reason people snore and/or have apnea is that when they fall asleep, their jaw muscles relax, and the lower jaw settles into the airway, constricting it. If you apply a chin strap in this manner, you are actually making things worse for your self. Your lower jaw should "stick out", not forced back into the airway.

As the one who suggested this idea, let me say that I agree with you that chin straps in general are not very effective because they do not prevent airflow from the mouth and, as you say, they tend to push the jaw back, possibly exacerbating the conditions which contribute to apnea.

My suggestion is not a "chin strap". It is a mouth covering to be used in lieu of tape to slow expiratory mouth breathing and to reduce the tendency for complications from that. The tension of the band is slight and the force is shared by the upper and lower jaw so there is not nearly the tendency to push the lower jaw backward as with a conventional chin strap. Again, it is proposed that this be used in lieu of tape, a rather extreme measure with its own drawbacks.

Did you read the accompanying post?

Here's an item I suggest rather than tape. It's a stretch headband made from a thin, soft cotton like material similar to that of a T shirt. It is double thickness (a tube), but still thin. The material is stretch and inside at one edge there is a narrow elastic band. It doesn't unravel when cut. It is about 2.5 inches wide and fits nicely between the nose and chin. I think it would fit most without being too tight or loose. Wear it just like a headband only pulled down over the mouth and ears. I cut holes for my ears. It does not interfere with a P10 or Dreamwear nasal mask. When it is worn with the internal band down, it tends to keep the bottom lip closed. It is porous so that chipmunk cheeks are less likely to form, but at the same time, it restricts the flow and reduces mouth leaks considerably. It also softens the noise of mouth leaks and discourages mouth inhalation. I've worn it for about two months and it has reduced my average nasal mask leaks (mouth) from an average of about 12L/m to about 5 rarely exceeding the large leak mark. I've see them sold at various places including grocery and drug stores. They cost about $5 for a set of five and are washable. One set should easily last a year. Here's some at Amazon.

thanks for that.
no i didn't read the whole thing. I tend not to take advise for my health by people on the internet.
just kidding.

Let me phrase this another way. Why do some people favor a bipap vs a cpap?
is it ok to use the word bipap on this forum or should i go look for a bipaptalk.com site?

[Julie]

Maybe if you stopped being such a smartass people might be more welcoming! That was completely unnecessary!

Bipap is for people who need a very high pressure setting and many people here use it.

[Jay Aitchsee]

Doc, we're talking here about a failure of the velopharyngeal sphincter to prevent pressuized air from escaping through the mouth, as illustrated in the diagram.

And further here:

...

Next, think about how the air flows through the respiratory system. Normal flow is in and out through the nasal passage. Although sometimes, it is normal to breath in through the nose and out through the mouth, but we'll leave that for now. Abnormal breathing would be in through the mouth and out either through the nose or the mouth. This would only be "normal" usually under conditions of heavy exertion. Some people suffer abnormality of the nasal passage which requires inhalation through the mouth.

Inhaling through the mouth is what I call mouth breathing. Mouth breathing is likely to cause dry mouth.

...Now sometimes, the velopharyngeal structure doesn't separate the nasal passage from the oral cavity well enough and pressurized air finds its way past it into the mouth and out the lips, from the "back door", so to speak, because the pressure in the nasal passage from CPAP is higher than the atmospheric pressure at the lips. This isn't really mouth breathing, its really more like mouth leaking. Mouth leaking is what most people who try a nasal mouth suffer, although it often called mouth breathing. It's not really breathing at all, it's leaking and if it's bad enough it can cause dry mouth, and a loss of therapy. Many people find it disturbing because it feels funny and is often noisy. There are some who claim to have "taught" the velopharyngeal structure to seal properly by holding the tongue in a certain position. I think that might be possible, or it just learns on its own. My mouth leaks have improved since I started a nasal mask a year or so ago.

I think what you are experiencing is mouth leaking. Tape will stop it because once past the seal the air has no where to go. Personally, I prefer the cloth over tape because it more comfortable and it slows the leak enough for me not to be noisy or cause dry mouth. However, tape (and the cloth) will still allow air into the oral cavity and that in itself could contribute to dry mouth, though it's probably not as likely.

Full face masks will prevent loss of therapy from mouth breathing and will prevent mouth leaks by applying equal pressure to the nose and mouth, but a full face mask will not necessarily prevent dry mouth.

Chin straps may discourage mouth breathing but won't necessarily prevent mouth leaks and dry mouth...

BTW, a full face mask probably pushes the jaw back as much or more than a conventional chin strap and I am sure more than the cloth covering I suggested.

[Jay Aitchsee]

no i didn't read the whole thing. I tend not to take advise for my health by people on the internet.

Why are you here?

[palerider]

is it ok to use the word bipap on this forum or should i go look for a bipaptalk.com site?

har har.
it's more appropriate to say "bilevel" since "bipap" is a registered trademark of respironics.

like calling all copiers "xerox machines".

[ArmenDDS]

Maybe if you stopped being such a smartass people might be more welcoming! That was completely unnecessary!

Bipap is for people who need a very high pressure setting and many people here use it.

it was a joke.

we're onto something here. Julie, do you agree with me that most people use a Bipap so they have an opportunity to exhale against the positive air pressure?
if you do, do you think that there may be a correlation between those that use it were likely the ones who used a cpap that somehow strapped their lower jaw back, forcing an increase in the positive pressure to combat that constriction?

either i am an idiot or a genius for saving a lot of people on the internet today
unless there is something systematically wrong with you, like chronic obstructive pulmonary disease, it really should not be that difficult to get into your lungs.
strapping your lower jaw to your skull is about the last thing you should do. it constricts the airway and you enter into a viscous cycle of trying to breath in vs breath out

NOTE: I AM NOT A MEDICAL DOCTOR AND I ADVISE YOU NOT TO TAKE MY ADVICE FROM READING IT HERE. DO NOT ALTER THE ROUTINE PRESCRIBED TO YOU BY YOUR SLEEP PHYSICIAN UNTIL YOU TALK TO HIM OR HER. YOU HAVE MANY ALTERNATIVES SOLUTIONS THAT MAY NOT ANCHOR YOUR LOWER JAW INTO YOUR AIRWAY WITH YOUR CPAP MACHINE

[palerider]

no i didn't read the whole thing. I tend not to take advise for my health by people on the internet.

Why are you here?

to promote dental devices for mild and moderate OSA sufferers?

[ArmenDDS]

no i didn't read the whole thing. I tend not to take advise for my health by people on the internet.

Why are you here?

at first i came on here to sell my dental appliance to all of you as a solution to your troubles with cpap for really incredibly high fees
but now I am here to learn and get as much information as possible so that I can understand my patients and what they are talking about

[ArmenDDS]

is it ok to use the word bipap on this forum or should i go look for a bipaptalk.com site?

har har.
it's more appropriate to say "bilevel" since "bipap" is a registered trademark of respironics.

like calling all copiers "xerox machines".

of course, but bileveltalk.com does not sound as cool as bipaptalk.com!

[Jay Aitchsee]

but now I am here to learn and get as much information as possible so that I can understand my patients and what they are talking about

Try the therapy for a few nights and study the mechanics of it.

[ArmenDDS]

Doc, we're talking here about a failure of the velopharyngeal sphincter to prevent pressuized air from escaping through the mouth, as illustrated in the diagram.

And further here:

...

Next, think about how the air flows through the respiratory system. Normal flow is in and out through the nasal passage. Although sometimes, it is normal to breath in through the nose and out through the mouth, but we'll leave that for now. Abnormal breathing would be in through the mouth and out either through the nose or the mouth. This would only be "normal" usually under conditions of heavy exertion. Some people suffer abnormality of the nasal passage which requires inhalation through the mouth.

Inhaling through the mouth is what I call mouth breathing. Mouth breathing is likely to cause dry mouth.

...Now sometimes, the velopharyngeal structure doesn't separate the nasal passage from the oral cavity well enough and pressurized air finds its way past it into the mouth and out the lips, from the "back door", so to speak, because the pressure in the nasal passage from CPAP is higher than the atmospheric pressure at the lips. This isn't really mouth breathing, its really more like mouth leaking. Mouth leaking is what most people who try a nasal mouth suffer, although it often called mouth breathing. It's not really breathing at all, it's leaking and if it's bad enough it can cause dry mouth, and a loss of therapy. Many people find it disturbing because it feels funny and is often noisy. There are some who claim to have "taught" the velopharyngeal structure to seal properly by holding the tongue in a certain position. I think that might be possible, or it just learns on its own. My mouth leaks have improved since I started a nasal mask a year or so ago.

I think what you are experiencing is mouth leaking. Tape will stop it because once past the seal the air has no where to go. Personally, I prefer the cloth over tape because it more comfortable and it slows the leak enough for me not to be noisy or cause dry mouth. However, tape (and the cloth) will still allow air into the oral cavity and that in itself could contribute to dry mouth, though it's probably not as likely.

Full face masks will prevent loss of therapy from mouth breathing and will prevent mouth leaks by applying equal pressure to the nose and mouth, but a full face mask will not necessarily prevent dry mouth.

Chin straps may discourage mouth breathing but won't necessarily prevent mouth leaks and dry mouth...

BTW, a full face mask probably pushes the jaw back as much or more than a conventional chin strap and I am sure more than the cloth covering I suggested.

Jay I understand what you are saying and agree that all of the different straps are likely worse than your cloth covering.
what I am saying is here is that there is a very good chance that the remedy with straps is possibly mimicking the cause of apnea, causing even greater trouble

who here has a cpap machine that does not use a full face mask or straps to the lower jaw?
there are so many other options right on cpap.com
any try this
https://www.cpap.com/productpage/tiara- ... -mask.html
or this
https://www.cpap.com/productpage/resmed ... dgear.html


again, please don't go changing therapy in any way without talking to your sleep physician