Teenagers, small faces and compliance

Cat'smom · Post by **Cat'smom** » Thu Jul 19, 2012 9:01 pm

Hey all,
I've got a 16 year old daughter, with a wee little face, recently diagnosed with OSA. We started with a ResMed nasal mask, and despite leaks frustrating the heck out of her, and too much pressure on her nose, she was handling it all right. Then this weekend we were visiting family and sharing a room, and I noticed her breathing through her mouth. Despite me repositioning her, and gently waking her up and reminding her to breathe through her nose, this continued for about an hour. First thing Monday AM I call the DME and we both agree she needs a full face mask ASAP. Got her fitted with one that same day, another ResMed. Despite her feeling like the leaks are better compared to the nasal, she's having a bear of a time dealing with it, and according to the data I'm looking at out of the machine, her breathing looks worse.
I guess mostly I just needed to vent (thanks for bearing with me) but I think I've got a few questions.
The night I observed her breathing through her mouth - the data from her machine didn't show anything unusual for that time period or the rest of the night. (On the nasal her AHI ran from .7 to 3.8, down from 16 in the sleep study.) If she was breathing through her mouth shouldn't there be something adverse showing up in the data? She was starting to feel better, and said her throat wasn't sore. If her AHI is down to something reasonable does it really matter if she breathes through her mouth sometimes?
Thanks for listening,
Heather

chunkyfrog · Post by **chunkyfrog** » Thu Jul 19, 2012 9:12 pm

Mouth breathing equals NO THERAPY.
It's about as bad as not wearing the mask at all.

Pugsy · Post by **Pugsy** » Thu Jul 19, 2012 9:16 pm

Cat'smom wrote: If she was breathing through her mouth shouldn't there be something adverse showing up in the data? She was starting to feel better, and said her throat wasn't sore. If her AHI is down to something reasonable does it really matter if she breathes through her mouth sometimes?

The leak line data is what you need to look at and not the AHI when mouth breathing is suspect.
If leaks are excessive for prolonged periods of time the machine may not be able to accurately report events.

I know for a fact that I sometimes do a bit of breathing with my mouth open but when I look at the leak reports I just don't see anything of great excitement. Maybe a little spike or two that lasts maybe 5 minutes and then only rarely.
I don't sweat small little short lived leaks even if they reach large leak territory as long as they are brief and don't wake me up.

Mouth breathing can equal no therapy but it is not a given that the whole night was wasted. It all depends on how much and how long. Gotta look at the leak line to know for sure. Can't rely on the numbers with this one.
30 minutes of massive mouth breathing and huge leak out of 8 hours with minimal to none leaks for the other 7 1/2 hours is far from the end of the world and negating the entire night's therapy.

Wonderbeastlett · Post by **Wonderbeastlett** » Thu Jul 19, 2012 9:26 pm

Reading this post has me concerned now because I wear a full face mask and am an avid mouth breather! Does breathing through your mouth with a full face mask not work? I am very compliant and use my mask all night and with naps. Should i be concerned that im not treating my OSA?

Pugsy · Post by **Pugsy** » Thu Jul 19, 2012 9:34 pm

Wonderbeastlett wrote:Reading this post has me concerned now because I wear a full face mask and am an avid mouth breather! Does breathing through your mouth with a full face mask not work? I am very compliant and use my mask all night and with naps. Should i be concerned that im not treating my OSA?

No, no. You are fine. Full face mask users maintain their seal around the mouth so that therapy pressure that exits the mouth is still curtailed and within the mask so no loss of pressure occurs.
Those of use that have the mouth uncovered can have loss of pressure when the mouth is open because the air exits the mouth and goes out into the room air.
Avid mouth breathers should use a full face mask if they can't/won't use a nasal interface with some way to keep mouth shut and the mouth breathing is excessive enough to impact therapy pressure.

chunkyfrog · Post by **chunkyfrog** » Thu Jul 19, 2012 9:36 pm

As long as your mouth is not opening beyond the confines of the mask, you are good.
I woke up with my mouth trying to escape the silkgel full face; the nicest mask I ever had to return.

Cat'smom · Post by **Cat'smom** » Sat Jul 21, 2012 7:28 pm

Thanks for all the helpful comments, everybody.
She's had a couple of more rotten nights with the full mask. We even tried mask liners and they didn't help. She had to take it off in the middle of the night last night because she couldn't deal with all the leaks.

Pugsy, the leak line actually looks worse with the full than it does with the nasal.

With the reasoning that 3/4 of a night of therapy (with nasal and mouth breathing) is better than 1/4 night (with the full with tossing and turning and finally taking it off) I'm having her go back to the nasal tonight. Then on Monday, we're going on a concerted effort to try a bunch of masks until we can find one that actually fits her. The ones we've tried so far really are too big for her. Also, they've all been ResMeds, and I don't think their floating seal is a good choice for her, be queen no matter what I tell her, her reactions to leaks in the middle of the night is to tighten everything down, and that just makes it worse.

Thanks again everybody -if there's any women out there with small faces who've found a particular mask that worked for them, I'd love to know about it.
Heather

Julie · Post by **Julie** » Sat Jul 21, 2012 7:52 pm

Hi - there are women who have been in the same boat and I found these that come in petite:-

http://www.cpapxchange.com/amara-cpap-b ... -face.html

http://www.devilbisshealthcare.com/prod ... e-masks/v2

Guest · Post by **Guest** » Sat Jul 21, 2012 8:45 pm

Some of the smallest nasal masks:

Fisher & Paykel Zest, Petite
Respironics Comfortgel nasal, petite
Resmed Mirage Micro, Small
Resmed Mirage FX for her, small

Wonderbeastlett · Post by **Wonderbeastlett** » Sat Jul 21, 2012 9:05 pm

I have a Mirage Quattro in extra small and I still get leaks. I don't know how she would feel about the mirage Quattro because it has a forehead rest.

What I actually wanted to add was a hang in there! She's probably feeling all sorts of emotions right now and as a mother you're feeling them to. High school is tough enough as it is! All of us are here to help and listen when venting is needed because all of us have been there!

SleepingUgly · Post by **SleepingUgly** » Sat Jul 21, 2012 9:33 pm

I had an 8-year-old on CPAP, so here's my advice... Try the Resmed Micro in a size Kids, which is a size small mask with a size small headgear. You can also try a size Small, which is a size small mask with a regular size headgear. Add a chinstrap, such as the Ruby adjustable one to keep her mouth shut:

https://www.cpap.com/productpage/cardin ... strap.html

Another option is to use nasal pillows, which there will be less leaks from. However, if you see any signs or complaints about sore nostrils, switch to another mask immediately until it's gone. We had a scenario where it looked like we'd done permanent damage to my son's nostril shape with what was pretty minor irritation.

Myolin · Post by **Myolin** » Sun Jul 22, 2012 6:53 am

Hello, I understand the difficulty, I am a mouth breather too and an active sleeper I tried all kind of maskes.

Last year they let me try a extra small Mirage quattro and since my AHI average is 0,7. I am compliant but often I took it out after 4 hours.

Last week I tried the Mirage quattro FX, it is just a week but I get 3 nights at 00 and at 0,2 for all the week. I kept it all night long because it was less big, with no headrest and lighter.

I still open my mouth and snore with the full face mask but the most important is that the therapy is working.

I would also suggest the Hybrid that is fine too but less efficient for me.
The chinstras is also a solution but I didnt like it.

Good luck

gertrude · Post by **gertrude** » Sun Jul 22, 2012 7:13 am

No one has mentioned it yet, but lots of folks use nasal pillows and control their mouth breathing with a chin strap rather than using a face mask. That might be worth a try if you haven't yet experimented with it.

Cat'smom · Post by **Cat'smom** » Mon Jul 23, 2012 8:53 am

Thanks for all the great suggestions.
I just got done ordering the Amara full (petite), the Mirage Micro nasal in a kid's size, for nose pillows we're trying the Bella, and a nasal gel (all with return insurance, of course.) Thank goodness for all the selection on-line, our DME doesn't seem to have anything that fits her.
Thanks again for all the support, I'll let you know how it goes.
Heather

Tino2You · Post by **Tino2You** » Mon Jul 23, 2012 9:01 am

chunkyfrog wrote:...the nicest mask I ever had to return.

Great Quote Froggy! I love it!
-tino

Teenagers, small faces and compliance

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