Mouth dryness NOT from mouth-breathing

[mcs2015]

It appears this can be a real problem for those of us using nasal masks.

I'm using a DreamWear nasal mask and recently changed from APAP to CPAP and at higher pressure.

So, my AHI has improved substantially and am feeling better with less palpitations/PVCs, etc.

But the sudden mouth dryness which was never a problem before is interrupting my sleep. And it's NOT from mouth-breathing. How do I know this? I've tried a chinstrap and mount tape and I still woke with dry mouth. This is the only source I could find that makes sense:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359345/

"...dry mouth also occurs when the mouth is closed with a chin strap, taping, adhesive, or bandages to force breathing through the nose. If the absence of saliva is not caused by the flow of air through the mouth, then what is the cause of dry mouth?
Saliva is produced by the activity of salivary glands, which send secretions into the oral cavity through ducts at a determined pressure. If the pressure in the oral cavity is higher than that of the secretion pressure at the duct outlet, the flow of saliva is blocked."

"Because the pressure of CPAP devices in the oral cavity or in the nasopharynx that is in communication with the oral cavity typically ranges from 6 to 14 cmH2O, it is likely that this high pressure is impeding the flow of saliva."

"With oronasal masks there is nothing that can be done to reestablish a normal flow of saliva, even with saliva secretory stimulants, because the increase in pressure comes from the mouth. With nasal devices, the only remedy for decreasing the pressure against the outlets of the salivary ducts is to close the opening between the oral cavity and pharynx, where there is increased pressure. The isthmus faucium can be closed by contracting the base of the tongue against the pillars and opening the mouth, so that the oral cavity regains normal atmospheric pressure. Decreased oral pressure can also be achieved with suction in the closed mouth. However, these treatments require that the patient be awake, and thus would interrupt the patient's sleep. One might try (although it is often found insufficient) heated humidification to soothe the discomfort caused by dry mouth, but this is not an option when using a nasal mask. The only solution that remains is consumption of sips of water at intervals during the night, but this is counter to the purpose of CPAP therapy—to provide patients with undisturbed sleep."

That being the case, oral solutions to hydrate the mouth, etc. are useless.

I also CANNOT tolerate a full-face mask, even the new ones are garbage - at least for me.

Has ANYONE come up with a solution to this conundrum???

[kteague]

Thanks for sharing that. It explains for me why since I trained my tongue to stay suctioned to the roof of my mouth I have less dry mouth. That was a lengthy process, but I was persistent. Used to have to peel my inner lips from my gums from dry mouth. If one can train their tongue to stay suction sealed to the roof of their mouth and at the same time prevent jaw drop so as not to disturb the seal, that's the only thing I've found that helps with my dry mouth. A flat pillow helps me as it makes gravity not work against me. Chin can't drop if it's level. At the same time it helps keep the tongue out of the throat. I've found my seal can withstand a relaxed jaw, just not a widely dropped one.

[rcobourn]

Have you tried Biotene? It's a spray that acts a lubricant in your mouth. ACT also makes such a product.

This is obviously only my experience, but if you gradually increase your pressure over a few days or weeks instead of all at once, you may be able to acclimate better. Maybe in the situation you are in, back off the pressure enough to alleviate the problem in conjunction with the spray, then work up. My dryness was caused in part by medication, so I can't be sure my improvement wasn't as much acclimation to the meds as it was to the pressure, so your milage may vary.

[Pugsy]

I can talk, open my mouth and stick out my tongue and blow raspberries, or even yawn big....all while wearing a nasal mask with the cpap on and not have air enter my mouth. It's a reflex somehow that I do. I am not alone. Others report it but apparently I do it when I am asleep as well.

I wish I could explain how I do it but I can't. It's just something I noticed about 6 months into therapy while trying to talk and I realized I could talk normally and didn't get the tornado out the mouth anymore. Then I played around with yawning and even sticking my tongue out with mouth wide open....still no air enters the mouth from the back of the airway.
There's something that gets shut off or closed between the nasopharynx part of the airway and the oral cavity. It closes off when we blow up a balloon and air doesn't go out our nose. Even if I could explain it...there's no guarantee that a person would do it when they are asleep. But I have never had chipmunk cheeks or anything like that. That reflex keeps the back door closed and while the tongue can play a part...obviously if I can blow raspberries with my mouth wide open and tongue out...the tongue doesn't play a part to that action.

If I could explain how I do it and market it...I could buy a new truck.

Otherwise...all I can offer is it can be done....using a full face mask won't necessarily fix dry mouth anyway...and maybe try adding a higher humidity setting and see if it helps or not.

[mcs2015]

Have you tried Biotene? It's a spray that acts a lubricant in your mouth. ACT also makes such a product.

This is obviously only my experience, but if you gradually increase your pressure over a few days or weeks instead of all at once, you may be able to acclimate better. Maybe in the situation you are in, back off the pressure enough to alleviate the problem in conjunction with the spray, then work up. My dryness was caused in part by medication, so I can't be sure my improvement wasn't as much acclimation to the meds as it was to the pressure, so your milage may vary.

I can try the Biotene but since the problem is dryness from inside the mouth and not mouth breathing, I don't know how well it will work. Acclimation to raising the pressure in increments over time may do the trick. I backed down to 8 for now and did better last night. Thanks.

[ChicagoGranny]

Biotene spray

In my experience, dry mouth sprays and rinses provide relief for five minutes or less.

I've used gels for years, and they work all night for me. Users need to develop a technique for applying them. When my mask is ready to be put on for the night, I place two small dabs of gel in the gum at the front of the mouth. One dab goes in the upper gum and one in the lower. The dabs need to be small lest they sipon out. I have been doing this nightly for years.

I have been using GC Dry Mouth the last several years. I just noticed that the Xylimelts company now has Xyligel, and I will try that at some point.

Zonker should be along soon to tell you about his success with Xylimelts.

[ChicagoGranny]

Zonker should be along soon to tell you about his success with Xylimelts.

zonker

Get over here, Zonker!

[zonker]

Zonker should be along soon to tell you about his success with Xylimelts.

zonker

Get over here, Zonker!

user says-

That being the case, oral solutions to hydrate the mouth, etc. are useless.

who am i to argue?

[ChicagoGranny]

user says-

That being the case, oral solutions to hydrate the mouth, etc. are useless.

who am i to argue?

By "oral solutions", I took it he meant "liquids" like mouth rinses and sprays.

But, whatever.

[zonker]

user says-

That being the case, oral solutions to hydrate the mouth, etc. are useless.

who am i to argue?

By "oral solutions", I took it he meant "liquids" like mouth rinses and sprays.

But, whatever.

OH! you know, i should really learn to read a post before commenting on it.


to the op:

yeah, xylimelts have been a god send for me. it's a wee lozenge that sits between cheek and tooth it stays in place with a slightly tacky side towards the tooth. slowly melts overnight promoting saliva production.

drinking water has no effect on it's properties.

good stuff. either at amazon or at the local drugstore. have seen them at rite aid and cvs.

good luck!

[rcobourn]

I originally came across Biotene when my eldest son lost a salivary gland to a blockage and had it removed. So that's definitely dryness coming from inside the mouth. They also have a gum but that is not useful for sleeping.

[ChicagoGranny]

Biotene

There are 7 products (https://www.biotene.com/dry-mouth-products/) with this tradename. It might be helpful to specify which one you are recommending.

[rcobourn]

Biotene

There are 7 products (https://www.biotene.com/dry-mouth-products/) with this tradename. It might be helpful to specify which one you are recommending.

It's all the same thing in different forms.

[ChicagoGranny]

It's all the same thing in different forms.

Good grief. The ingredients lists on all 7 are different, and the difference in physical form makes a huge difference in what the products are used for.

[rcobourn]

It's all the same thing in different forms.

Good grief. The ingredients lists on all 7 are different, and the difference in physical form makes a huge difference in what the products are used for.

Somehow I think you'll survive this terribly confusing situation.