Data to tell if I'm breathing out of my mouth?

[Mariposa13]

I have been using my cpap machine for about a year now and I was typically using my nasal pillow mask (Philips Respironics nuance pro) with good success. I often experience congestion and sometimes use a full face mask (F&P Simplus). I became concerned that I was opening my mouth when using the nasal pillows and therefore not getting the full therapy, so I switched to using the full face mask full time. Recently, my lips have become incredibly dry from using the full face mask. I think the constant air blowing on them is actually causing the skin to breakdown. I also find it less comfortable than the nasal pillows. I'd like to try and switch back to the nasal pillows, but I've become incredibly worried that I won't be able to tell if I am opening my mouth at night and letting air escape or just breathing "over" the machine.

I am trying to find out if there is setting on my machine (REMstar Auto A-Flex by Philips Respironics) within the "info" screen that can tell me if I am breathing through my mouth at night. Would the machine register that as a large leak? Would my AHIs be affected? The techs at my sleep clinic haven't been able to offer much support in this area. Any advice you guys could offer would be SO appreciated.

[palerider]

I am trying to find out if there is setting on my machine (REMstar Auto A-Flex by Philips Respironics) within the "info" screen that can tell me if I am breathing through my mouth at night. Would the machine register that as a large leak? Would my AHIs be affected? The techs at my sleep clinic haven't been able to offer much support in this area. Any advice you guys could offer would be SO appreciated.

in order:
no,
maybe,
maybe,
typical.

Over to you, Jay.

[palerider]

in case Jay's busy:
viewtopic/p1086296/Flow-Examples-of-Mou ... l#p1085906

[Jay Aitchsee]

Review the thread in PR's post above.

I take it you don't have or can't use software (SleepyHead or Encore) with your machine? Software would be helpful in determining whether or not you were experiencing mouth leaks and if your therapy was being degraded.

I think you should switch back and see: How you feel; If leaks increase (according to the machine); if AHI increases; if you have dry mouth; if your are awakened by air escaping from your mouth. Any of these things could indicate mouth leaks.

Mouth leaks could degrade therapy - if they are large enough. But I think most people are disturbed by the leaks before the therapy is degraded. If you switch back and your AHI and leaks remain satisfactory and you feel OK (still rested and not disturbed), I wouldn't worry about some mouth leakage, even if you do see a small increase in the leak rate. As long as you stay mostly out of the Large Leak territory your therapy probably is not being degraded.

You said you had success in the past with nasal pillows. No reason to think you wouldn't enjoy the same success again.

[Pugsy]

Mouth breathing may or may not show up as much of a leak.
Not all mouth breathing equals the entire night's therapy going down the toilet.
Your machine can compensate for a good bit of leak (no matter what the cause is) and if you don't spend much time in large leak territory (and assuming any leaks don't wake you up) then your therapy effectiveness won't really be impacted all that much and then only during the time in large leak territory.

Example...if you only spend 15 minutes in large leak territory then only the 15 minutes could be questionable in term of effectiveness. 15 minutes out of 7 or 8 hours of sleep isn't the end of the world.
Now if you spent half the night in large leak territory then obviously that is a different story.

Use the available software to evaluate just how much time was spent in large leak territory and how deep you went.

If you didn't spend any time in large leak territory (your machine will flag large leaks if you have them) then if you are mouth breathing it isn't enough to cause any problems.

I don't go into minute detail examining the flow rate to try to figure out if I am mouth breathing or not.
I just evaluate the time spent in large leak (no matter what the cause) and draw my conclusions from that.
If I don't have much time in large leak I don't even give it a second glance.

I only worry about fixing leaks if they
1....wake me up often
2....if I spend much time in large leak territory

I don't worry about short lived spikes into large leak territory...no matter what the cause.

[Jay Aitchsee]

I don't go into minute detail examining the flow rate to try to figure out if I am mouth breathing or not.

But it could be helpful. The sample below contains two sets of flow waves from the same night taken during periods of over threshold high leak as indicated by the shade. The expiratory portion of the top set has the rapid rise and relatively flat run typical of a mouth leak. The bottom sample does not.
Since the over threshold leak is present with or without mouth leaks, I can assume it to be a mask leak and my pillows or headgear need attention.

[Pugsy]

But it could be helpful.

I know it could be Jay... but I just don't have enough time or energy or inclination to start putting all that under the microscope.
So I will leave that sort of stuff to you all if that's okay.
Part of my problem that caused me to "burn out" here at the forum last January was I was trying so hard to help that I just over did it trying to be all things for all people and let crap get to me.

I am not going to get into the "analyzing flow rate to look for minute changes that could mean mouth breathing" business.
I have enough on my plate as it is.

Please note that I am not saying that what you say doesn't have merit...I am just saying that I, personally, am not going down that road under the microscope for leaks. It's just more work than I want to do and I don't have an urgent need to do it.
I might spend 10 minutes over 24 L/min out of 7 hours and maybe I might spend 3 minutes of that 10 minutes over 30 L/min....I just don't feel the need to pick the air flow apart to try to figure out exactly where the leak is coming from in such short periods of large leak. What would I learn...that yeah, I was mouth breathing??? I already figured that out but it was for such a short period of time that I really don't plan to try to fix it anyway...so I really don't care to know exactly what caused it.

Do I mouth breath sometimes...yeah most likely I do but ever since I did my awake mouth breathing leak test and saw first hand that not all mouth breathing means massive leaks I just decided that I wasn't going to worry about large leaks unless it
1..woke me up
2..were consistently prolonged night after night.
That's my criteria and that's what I will share with newbies. If they (or you all who dig this stuff) want to dig deeper and put flow rate leak stuff under the microscope then they are free to do so but I, myself, won't be going there.

Now if someone shares leak reports and it looks like they fall into my number #2 category (consistently prolonged night after night) then we go digging deeper and I would most likely defer to you since flow rate evaluation at this level is simply not something that I am all that comfortable with.
Remember ...I am a lazy sot and why do I need to learn all this when I have you here to do the work for me.

[Jay Aitchsee]

I know it could be Jay... but I just don't have enough time or energy or inclination to start putting all that under the microscope
...

Pugsy, I think we are on the same page here. I didn't tell the OP (or you) anything had to be put under a microscope. In fact, my first response to the OP was essentially the same advice that you later gave, but perhaps not as well stated:

I think you should switch back and see: How you feel; If leaks increase (according to the machine); if AHI increases; if you have dry mouth; if your are awakened by air escaping from your mouth. Any of these things could indicate mouth leaks.

Mouth leaks could degrade therapy - if they are large enough. But I think most people are disturbed by the leaks before the therapy is degraded. If you switch back and your AHI and leaks remain satisfactory and you feel OK (still rested and not disturbed), I wouldn't worry about some mouth leakage, even if you do see a small increase in the leak rate. As long as you stay mostly out of the Large Leak territory, your therapy probably is not being degraded. [emphasis added]

You said you had success in the past with nasal pillows. No reason to think you wouldn't enjoy the same success again.

All I've tried to do is provide a little insight in case someone wants to look a little deeper into their therapy when the question is, "Data to tell if I'm breathing out of my mouth?"

[lanco]

Pugsy-did you post anything on your awake mouth breathing leak test? I would be interested in hearing about that. Thanks

[Pugsy]

Pugsy-did you post anything on your awake mouth breathing leak test? I would be interested in hearing about that. Thanks

Yeah I did a long time ago.
The short version is one morning I woke up at my usual wake up time and I was breathing through my mouth. It was an ever so gentle mouth breathing without a tornado exiting my mouth. Since it was time to get up anyway I decided it would be a good time to see what mouth breathing looked like on the leak graph so I kept it up for about 15 or 20 minutes and then turned the machine off. Since I knew for sure I was awake and mouth breathing I figured it would be good to have a "known" for sure mouth breathing leak to look at.
Imagine my surprise when I saw the leak graph and if I hadn't known that I was mouth breathing you wouldn't have ever thought that the leak seen was mouth breathing.

Everyone assumes that all mouth breathing causes this big exodus of air out the mouth and while sometimes it can end up like a jet engine...it doesn't always happen that way.
Below is the screen shot for the known awake mouth breathing and I circled the time that I was awake at the end of the night and I was for sure mouth breathing. Everyone wants to tell people to "get a full face mask because you are losing all your therapy pressure" without ever even looking at a leak graph to see exactly just how bad the leak really is. Yeah, I had dry mouth with this one but it sure is well within the machine's ability to compensate for this tiny bit of leak. I prefer to at least look at the leak graph first before telling someone that they are losing all their therapy pressure and just have to make the change to a full face mask or they are doomed to hell.

The known awake mouth breathing time is right at the end of the session and I circled it. The big leaks earlier in the night..I have no idea what they were from because I slept right through them.

[Jay Aitchsee]

Pugsy-did you post anything on your awake mouth breathing leak test? I would be interested in hearing about that. Thanks

And just to confirm Pugsy's response to your question - that mouth leaks don't necessarily mean high leak rates. Here is a waveform from the mouth breathing thread, viewtopic/p1086296/Flow-Examples-of-Mou ... l#p1085906.
From 23:44:50 until 23:45:20 exhalation is totally by mouth. The corresponding leak rate looks to be about 8 max, well below the ResMed redline of 24.

[Mariposa13]

Wow, I can't thank all of you enough for the information here. To be honest, I'm still trying to figure out what everything means (especially terms that seem to be related to the software.) My main goal is to get the best therapy I can, so if looking at data might help that, I'm all for it. But if I can't figure it out without that, all the better! I don't typically "feel" a big difference during the day so using that doesn't always help. I'm going to try and download the sleepyhead software and see if that can tell me anything. I hope I can post more questions here related to that as I come across things. Thank you all again and I totally understand anyone who doesn't feel like they can help out. We are all living busy lives and just trying to get some sleep

[Mariposa13]

Hi everyone. I actually got the software to download and am looking at my data. Holy cow. What is this? I mean really, what am I looking at? I'm going to put in some screen shots. All I know is, this is terrifying. I can't tell if this is normal or if I'm basically dying at night. My flow rate doesn't seem to look like any of the examples. Is that me or do I need to click some button? It says I have 0 large leaks, but then the graph doesn't seem to agree. Ah! Can anyone help me out with some basics? Assume I know nothing.

[palerider]

Hi everyone. I actually got the software to download and am looking at my data. Holy cow. What is this? I mean really, what am I looking at?

see that first post up there in the announcements section on the front page ofr the forum? read that thread.

I'm going to put in some screen shots.

before posting any more, please read and follow this:
https://sleep.tnet.com/resources/sleepyhead/shorganize

[Pugsy]

Read the SleepyHead tutorial thread. It explains the leak data along with some other stuff.

Your leak graph isn't bad at all. Large leak territory is will above 70 L/min for your machine at your pressures.
Even at the highest leak you are well below large leak territory.
The leak line will vary normally as the pressure varies....all explained in the tutorial.

If you are mouth breathing...it sure isn't very much and it's well within the machine's ability to compensate for any leaks.

Take some time to read up on the tutorial as well as how to post the images and what format.