Tooth sensitivity, mask pressure on top lip and mask fit

[openheartmama]

I am almost 4 weeks and as many masks into my CPAP treatment. A couple weeks ago, I began to notice severe cold sensitivity in my front top and bottom teeth. A trip to the dentist confirmed nothing was wrong with my teeth, making the likely culprit masks, all of which, so far, give a slight upward tug to my top lip and leave me with a slightly tingly--not asleep just like something is different--sensation in the morning. My dentist said my bite had signs of being pulled out of alignment, and the fact that I have a slightly tethered frenulum on my top lip probably doesn't help.
I have addressed the issue of not wearing my masks too tightly. I have them on tightly enough for a good seal but not so much that they pop off with high pressure. My first were the dream wear nasal pillows and then the airfit p10.
After consulting with the respiratory therapist via telemed, I have tried out the Airfit N20 which I got with the memory foam. After two nights off of CPAP while waiting for this mask to arrive, I again had tooth sensitivity and tingling after wearing the nasal mask for the first time. Though I slept relatively well, I took the mask off at 3:30 when I woke up with an awareness of my top lip and teeth. It seems there's something about my facial anatomy that makes pressure on the top of my mouth problematic.
Here's my question: what masks do others recommend that won't put pressure on or pull at my top lip, since that is causing painful side effects? Is there a nasal mask option that might fit the bill? As a side sleeper, I've been trying to avoid going to a full face mask. Has anyone else had similar issues? Of so, what solutions did you identify?
Thanks!

[Pugsy]

Look at the mask I use. Link in my equipment profile.
No headgear straps at all to put any pressure anywhere on the teeth. Use a hose management system to keep the hose routed upwards so it never even touches the skin of the upper lip.
Videos at the Bleep website.

[openheartmama]

Thanks @Pugsy. Will take a look.
Have you heard of any sensitivities to the adhesive used for the attachment site?

[WakingKnowledge]

My father is a dentist, so I have hear quite a few things over the years. Read this: https://www.michigantmjandsleep.com/tmj ... 0symptoms.

This is the important part: "Sometimes, people are urged to try CPAP instead of an oral appliance to avoid potential jaw or bite problems, but CPAP can also contribute to TMJ.

Studies have shown that prolonged use of CPAP masks can cause significant bite changes by compressing the face. The CPAP mask can also push the jaw backward. The airway may be held open by air pressure, but the jaw itself is being further displaced, contributing to jaw pain and other TMJ symptoms. And many CPAP systems have their own mouthpiece, which must be properly fitted to avoid jaw joint problems.

And, of course, even if CPAP doesn’t cause bite problems, it may not help them, either, and it may prevent you from wearing a bite splint to treat your TMJ.

When you are considering sleep apnea treatment, you need to consider the impact it may have on your bite and the health of your temporomandibular joints.

How Is Tooth Sensitivity Caused By TMJ Disoders?

Since TMDs are centered around the temporomandibular joint, you might not think that a TMD would be the cause of tooth pain. In reality, temporomandibular joint disorders can cause serious and chronic tooth pain and sensitivity.

TMDs frequently result in misaligned chewing, bruxism (teeth grinding), and problems with the mastication muscles, all of which can cause or contribute to tooth pain.

https://www.tmjtexas.com/tmj-tooth-pain ... th%20pain.

[Pugsy]

Have you heard of any sensitivities to the adhesive used for the attachment site?

No...haven't heard of any but if you are known sensitive to some tapes and question it and want to try it.
It is a product made by 3M that is hypoallergenic. I do have a small sheet of just the tape and I can cut off a couple of strips and I would be happy to mail them to you so you can see if you have a problem with the adhesive or not.
Just send me a PM with your name and address and I will drop them in the mail to you.

I have sent strips out in the past and no one has reported back to me that they had a problem with the adhesive strips.

[openheartmama]

Thanks @wakingknowlwdge!

[chunkyfrog]

If you have never tried a cloth mask, I suggest the Sleepweaver Elan.
Properly fit, it feels like the next thing to nothing at all.

[openheartmama]

Thanks chunky frog!

[khauser]

I will second the use of the Bleep interface. I don't have known allergies to adhesives, but there are several adhesives I can't use for long periods without developing some level of irritation. I don't have ANY issues with the dreamport adhesives ... no discomfort and no marks.

For me, the adhesives alone don't work well. I have rather oily skin, and even right after washing and prepping with alcohol they will tend to adhere poorly and leak. But there is a product recommended to me by the inventor of the dreamports that makes them adhere very well, and I still get no issues.

I'm very happy with them. For the 5 minute investment of time to put them on at night (and it's really more like 2 minutes), I get a great no-leak seal with almost NOTHING touching my face.
Of course, everyone is different, just wanted to relate my experience.

Also, if your pressures are high you may have issues with the fabric masks ... at least I did. I could never get them to seal at all. I had high hopes at the time...

[openheartmama]

KHauser, thanks for the additional recommendation on the Bleep mask!
I think I will try them out. Have you found a way around the high monthly cost? Also, what was the extra product that was recommended?

[Pugsy]

As far as the monthly cost. Insurance should pay for the ports just like insurance pays for nasal pillow replacement.
Now if someone has a high deductible insurance...obviously a problem.

Insurance (even Medicare) usually allows 2 nasal pillows per month...and one box of ports for 2 weeks is covered under the same HCPCS billing code at 1 nasal pillow.

Obviously the daily port cost is the biggest issue and the second biggest issue is getting the DMEs to supply the product and bill insurance. I know I got all sorts of flack from my DME when I wanted them to supply it and bill my Medicare.

There are some online Bleep DME suppliers who will bill insurance.

As to which avenue works out best for you....assuming you try the Bleep and wish to continue using it....will depend on what kind of insurance you have and what your co pay would be. You have to do the math but there are ways to keep the cost down with bulk purchases of the ports.

[khauser]

KHauser, thanks for the additional recommendation on the Bleep mask!
I think I will try them out. Have you found a way around the high monthly cost? Also, what was the extra product that was recommended?

This will be a long one ... answering this concisely is not my strong suit.

If you mean is there a way to reuse them, the answer is no. Once you take them off the adhesive is very spent and stretched. You'll never get a good seal.
On Amazon and CPAP.COM I've been able to find them for about $24/box which is $48 a month. Not cheap, certainly, but for me well worth it. That is an issue only you can answer.

I do hope the price comes down with time. My understanding is that they were even more expensive and HAVE come down. Bleep is still a small company in its relative infancy, but after talking to CEO/Inventor Stuart Heatherington I felt very encouraged that they will grow (just to be clear, my only "investment" comes in the form of buying their products). All I get from recommending them is the belief that I am exposing another person to their comfort and hopefully increasing the user base so the price can come down further.

The company (and I think that means Stuart in this case) really helped in getting me through my initial difficulties, which were the oily skin issues. He reminds me of the forum in the sense that as long as you continue to work on it he'll bend over backwards to help you get there.

So as I said, I have some unique skin issues. Stuart has spent time in the clinical environment and was able to help me quite a bit. Pugsy here was also a huge help. Pugsy identified the soap I was using as containing essential oils, which isn't particularly useful in reducing the oily situation. So one of the first changes I made was using another soap I already had for a different issue when washing my face as night. That's Cetaphil skin cleanser (https://www.amazon.com/Cetaphil-Gentle- ... 148&sr=8-8).

To promote adhesion, I also use a skin prep instead of the Bleep preps or alcohol. I use https://www.amazon.com/Skin-Prep-Protec ... 3639671b2d, which Stuart recommended.

For me, that helps a lot, but after 6 hours or so it would develop a leak and the adhesive fails. Once that happens your choices are to get up and re-apply (new) dream ports, apply some extra adhesive (most people end up trimming the dream port adhesives), or switching to a different mask for the remainder of the sleep. I did that since I could do it without getting up. But if that's where I was today I wouldn't see it as the dream solution I do. The final part of the equation is Hypafix tape: https://www.amazon.com/gp/product/B0009 ... UTF8&psc=1, which was also recommended by Stuart. I use this to seal the edges of the dreamports, basically one thin strip across the bottom just under the nose, one slightly thicker strip across the top, and two thicker strips up either side. The goal for me is to add extra seal across each edge. I also use a small 'triangle' of cut off adhesive in the space between the nostrils on the upper side. I am still on my first roll of tape, maybe halfway through. I use so little each night. There are 50 preps in a box, so they last a little less than 2 months. The cost is definitely in the dream ports.

Seems like a lot of work, but like I said I'm down to a couple of minutes a night. It happens fast once you get used to it. In the morning it comes off as a unit almost every time. Very fast, and no pain unless I manage to grab a hair on my moustache. (Ouch!) Oh yeah, for us bearded guys this is a fantastic solution! Not your issue though!

I haven't had a real leak in months now. On the weekend I might sleep as much as 9 or 10 hours (lazy bum!) without issue.

Oh! One other recommendation is hose management. Stuart has a video showing the combination of https://www.amazon.com/gp/product/B01IW ... UTF8&psc=1 and https://www.amazon.com/gp/product/B00N6 ... UTF8&psc=1. What this does is get the hose away from your face. It's touchless! That's what makes it SO comfortable!

I hope this helps, and please let me know if you have other questions!
-Kevin

[openheartmama]

That;s good to know. Since I am still in the process of figuring out mask stuff, I have been paying out of pocket to try new masks (I only got one replacement via my DME for trial). Once I figure it out, I will contact the DME. Thanks for all the feedback!

[Deborah K.]

I use and like the Bleep too. I switched to a new DME because my old one would not order it for me. The new DME is Aeroflow. They are online, so I have never met them except via phone and emails, but everything has gone well. In fact I expect my new shipment in a day or so. I have good insurance, and my Bleep items are fully covered. There is a little learning curve in using this system, but it is well worth it. They have NO effect on your teeth or lips. My former nasal mask was quite good, but I don't miss the straps or the pressure on my nose and teeth.

Whatever you do I hope you have great success!

[openheartmama]

Deborah K:. I am learning about the DMEs. It is good to know that I can choose my own. I think a lot of the online suppliers seem more flexible. I've ordered a Bleep to try out and will find out if my current team covers it shiuld it work for me! I also have pretty good insurance, so I'll have to see how it works out!