Leaks and Dry mouth

[MTEng]

To preface things here I am a 6-month newbie dedicated to the treatment (>60 AHI w/o), the treatment works but I am looking to improve.
I have an S9 Autoset Elite with pressure auto set to 8-15. I initially started out with the Mirage FX Nasal mask but soon found out I was a mouth breather. Kind of new I was a mouth breather before treatment as before CPAP I would have my uvula so dry it would swell and I would choke on it. Not fun. I was hoping getting on CPAP would resolve the mouth breathing. Clearly since I still woke up with a dry mouth the nasal mask was not cutting it. So I talked to the doc and she switched me to a full face mask, the Quatro FX med size full face mask this works somewhat better but still not the perfect solution. My mouth still opens up enough that I get leaks into the corners of my mouth-->dry mouth-->wake up-->not happy . I am sure many of you know the routine.

Checking in Sleepy Head the pattern is clear. I have leaks up to 60L/min which I can see last for a while and then I wake up -->bathroom-->water-->back to bed. My PEAK AHI is 11 or 12 but my average is about 2. Not a bad average but I would like to bring the peak down and eliminate the dry mouth.

Recently I have gone back to the Nasal Mask and a chin strap in an attempt to improve my situation. While nasal mask/chin strap combo does seem to reduce the mouth breathing. The comfort of the chin strap sucks. I have been using the Respironics Premium Chin Strap. The name of the chin strap sounds nice, however the strap around the back of my head is generally uncomfortable. The chin strap also does not apply the pressure evenly across my chin, tends to dig in no matter what I do to adjust the chin strap.

I don't know if I should try a different full face mask maybe the large, or if there is a comfortable chinstrap soultion out there?

Another solution to my problem may be to improve my ability to breath through my nose. I breath all day fine however it is always the case that I slow down for the evening I get somewhat congestited and when I go to bed I can feel that one passage will be blocked and I have to flip drain repeat. Any nasal hints might help as well.

[LSAT]

Take a good look at the PapCap
http://www.pur-sleep.com/content/?id=44

[Tino2You]

Hi MTEng,

A few things to try. These have worked for me but as we like to say....your mileage may vary!

I found out that I needed humidity to keep my sinuses clear. Sounded counter productive when someone told me at first because when it is hazy, hot and humid in the summer, my sinuses shut down on me. BUT....with CPAP, the moisture keeps everything clear. Initially, I had to shoot some saline up my nose before bed to "wash away the days crud" but now I can usually skip that step.

The second thing I did was to buy a Ruby Adjustable Chin Strap. It has Velcro tabs at the back and top and allows you to "adjust" the fit to your head. After a while, I could loosen up the strap AND keep my big trap shut

Lastly, I was told of a technique where you place the tip of your tongue behind your upper front teeth. This closes your throat so air does not puff out your cheeks. After a while (3 months?) I found my sleeping brain would leave the tongue there and that was when I started relaxing the chin strap. Two weeks ago, I forgot my strap but have been maintaining good therapy.

Well those are my tips and tricks....let us know how you progress.

Cheers,
-tino

[Conrad]

Hi MTEng,

A few things to try. These have worked for me but as we like to say....your mileage may vary!

snip...

Lastly, I was told of a technique where you place the tip of your tongue behind your upper front teeth. This closes your throat so air does not puff out your cheeks. After a while (3 months?) I found my sleeping brain would leave the tongue there and that was when I started relaxing the chin strap. Two weeks ago, I forgot my strap but have been maintaining good therapy.

Cheers,
-tino

I"ve never read about that tip of the tongue trick but I seemed to have stumbled upon it on my own and it works great for me. It's an automatic thing now.

[MTEng]

Here in Montana humidifier is a requirement not an option. We had 4% humidity for a while this summer, did not help the fires near my house. I have my humidifier set to 5 any higher and I ended up with water in the tube. I will give the saline up the nose before bed a shot. I figure if I can breath clearly through my nose at night. I will be less likely to mouth breath.

I will give that other chin strap a shot. The one I am using the Respironics Premium Chin Strap is not restful to have on.

The tongue behind the teeth thing I will have to see about.

I do think I am on a better path though with the nasal mask and a chinstrap since my big mouth opens too wide much for the full face mask.

[Julie]

Why don't you try a room humidifier - the stand alone kind?

[Tino2You]

One other thing to try is a heated hose. I have mine set to 78 degrees and allow the s9 to set the humidity. When I had a cold a couple of weeks ago, I bumped it up to 81 and allowed more moisture.

-tino

[chunkyfrog]

Are there still fires in your area?
If so, I would filter the bedroom air--HEPA is the best, but any clean filter has got to make a difference.
You don't have to see or smell smoke for it to hurt you.

[MTEng]

No fires now, a few inches of snow and 19F mornings take care of that.

[jencat824]

If you still have problems with dry mouth, ask your Dr for an RX for Evoxac, a prescription drug for dry mouth. I have severe dry mouth during the day, and take this drug. I don't take at night because since I am sleeping, my mouth stays closed (probably closed since I am so busy grinding my teeth). The Evoxac works well for dry mouth for me and also for a friend I know who had a similar problem, it helped her too.
Good luck,
Jen

[shaunas]

A post late last week talked about a double mouth guard that works for them. You can order for 3.99 but shipping is more. Check that out. looks good to me. I'm going to try that before the chin strap.m

[teachcsg]

Some of my patients have reported good succes with Biotene...over the counter for dry mouth..may want to give it a try. They used the spray. The Ruby chintstrap does seem to work well..stays in place better throughout the night. I have had some complains of it being a bit "warm" since it covers a large portion of the head. Good luck

[archangle]

I make a chin strap from a 3 inch non-adhesive Ace bandage. 3 times around the head, secured with safety pins.

It's cheap to try, and I find it comfortable. It needs replacement fairly often.

[Cindy Lou Who]

Welcome MTEng to the forum. Glad you found it.
People talk about using blue Painter's tape to keep their leak rates manageable. Have used the narrower cloth tape from local drug store. It works fine. But sometimes had to deal with loose tape and drool... damp pillow case, etc. I taped for a month and stopped. My body remembered to keep the mouth and lips shut for about a week.... then the leak numbers crept back up over time.
My RT was horrified that I even considered taping. Taping has risks. I certainly would not tape my mouth shut when feeling sick. If you feel you may choke and inhale saliva.... don't try it!
If you try it, turn a corner (or both ends) back on itself so you have something to easily grab to pull the tape off. You can search the forum to see other comments about taping.
I like the idea of a double mouth guard and will check that out. Currently hubby and I both use the "boil and bite" sports mouth guards found in Wall-mart. One of those and a chin strap help me reduce leaks.
On the last visit with my sleep Dr. we talked about hybrid face masks.
I may give up and try something like this: https://www.cpap.com/cpap-masks/hybrid-cpap-mask.php. It may only work if the part covering the mouth will go under the chin.
Let us know what works for you! Lots of people have leak issues. For some it takes trying a lot of things and combinations of things until they fine a comfortable solution. You've got a great attitude towards this, so you'll succeed.
Best wishes,
Cindy

[MTEng]

I have sort of looked at the hybrid masks I just wonder how well the nasal Pillows seat.