CPAP does not seem to help - Dry mouth

[scooter133]

Okay, so the put me on CPAP 2 years or so ago. AHI was in the 40s. Been using it 95% of the past 2 years. I read about how many of you are all seeing the benefits of this 'great' device. Some after a few weeks, some after several month. I though 2 years should be enough. I'm still tired all the time. Does not seem like I see much benefit.

When I switched to the FFM from the nasal my headaches went away, so that is a plus. I'm a jaw clencher (not a grinder) so the morning headaches are from nighttime clenching. With the FFM I position the bottom of the mask on my lower lip and it opens up my mouth. Okay, yeah, not optimal' but I don't clench and I don't wake with a headache.

My issue is that some times I wake with a mouth that is so dry it hurts. I have the PR system one with regular humidifier tank full and set to 5. Live in northern California, humidity is not too high. House is kept cool (not AC, but we don't use heat) temps in house get into low 60's

If I wear a mouth guard that is 1/4" or more thick I also don't wake with headache and still feel the same. I'd rather not abandon the CPAP, but the morning dry mouth is killing me.

Any suggestions?

Thanks!

[zoocrewphoto]

I don't have a solution for the dry mouth, but wondered if you have been checking data to see how successful your treatment is.

Most doctors seem to care only about compliance, so if the settings aren't optimal, they won't notice it.

[library lady]

Dry mouth is something I've finally pretty much conquered after 3 months on cpap. It drove me nuts initially, I woke up with cottonmouth halfway through the night and again in the morning. What I did was, I went to Target and found a double-walled mug with a straw and a cover. Every night I filled it halfway with water and set it on a small stool about three steps from my bed. If I needed water in the night, I pulled the connector elbow off my ff mask and took in some water. For me, the connecor is actually right in line with my mouth so it is really easy to get to the straw without taking the mask off. My backup mask, the connector is not in line with my mouth, so I have the disposable straws to use with that one. I can bend those, and it's a bit awkward to get a drink but it does the trick. Lately, I'm not getting up for water in the middle of night; I don't seem to notice the dry mouth anymore. For a while I was just taking a sip on my way back from the bathroom, but now I don't even have water ready.

[Pugsy]

The default humidity delivery system for the model 550 is for the "new humidification system" which utilizes sensors and the ambient room humidity to control moisture delivery. It typically uses less water. The should be another humidity delivery mode available to you in the clinical setup menu which is called "Classic Mode"...it will deliver more humidity at the same setting. Chance of rain out increase though.

So you might try switching over to Classic mode to see if it helps.
I doubt that it will help enough but worth a try as it won't hurt anything to try it except to increase chance of rain out and should that develop there are ways to eliminate it.

Some people just have dry mouth...yes, commonly thought that it relates to mouth breathing but some people get dry mouth even when they tape their lips shut and tape is intact in the AM...so they can't be mouth breathing.
There are multiple reasons for dry mouth and mouth breathing is just one of them.
Using a full face mask doesn't guarantee no dry mouth. It will at least eliminate loss of pressure therapy if mouth breathing is occurring since it maintains a seal and pressure including the mouth so the pressurized air doesn't go out into the room air.

Humidifiers can't always add enough moisture (even with a full face mask) to relieve the dry mouth caused by whatever it is caused by. The oral cavity is just too large to be able to rehydrate well with the moisture available from the humidifier (even at max setting).
It doesn't always take a lot of mouth breathing (like doing it all night) like a person might think to dry out the mouth. I have had it happen to me and from the looks of the leak graph I maybe was mouth breathing 10 minutes and my mouth was horribly dry.

Mouth breathing/opening/leaking is just one cause of dry mouth. Meds and/or other general health conditions can also cause it or make it worse.

If your dry mouth is intermittent...maybe some mouth breathing is going on and more on some nights than others
Using a full face mask doesn't guarantee that the humidified air going into the mouth is humidified enough to make up for the drying effect. It works for some people but not others. We get dry mouth complaints all the time from full face mask users and they have already set humidifier for maximum moisture delivery.
Remember...some people get dry mouth even with mouth taped shut so they aren't mouth breathing. It happens.

Biotene products specifically designed to help with dry mouth may offer some relief. Keeping yourself well hydrated during the day and evening will offer some relief. Keeping a glass of water at the bed...is sometimes necessary.
Unfortunately there is no single one miracle fix for dry mouth no matter what the cause. The best we can do sometimes is just minimize it the best we can with whatever works.

[Sigrid]

Dry mouth is not the same as thirst, and water doesn't help dry mouth other than momentarily relieves the discomfort. Lack of saliva is the problem. Go to the drug store and buy these: Biotene dry mouth mouthwash, Biotene Oral Balance dry mouth moisturizing gel, Biotene moisturizing mouth spray, Act Dry Mouth lozenges with Xylitol. Use the mouthwash during the day and before bed. Before putting on your mask, apply a dab of the gel on the inside of your cheek and smooth it around with your tongue (do not swallow although it won't hurt you if you do). Some people find the lozenges (you stick it to the inside of your mouth) work better than the gel, but you need to experiment. Keep the mouth spray at your bedside--it is easy to grab and spray the inside of your mouth if you awaken in the middle of the night (it works upside down and sideways so you don't even have to raise up from the pillow). The goal is to replicate the feel of saliva, not only to quench thirst (that's what water does). Good luck!

[Intercostaldrama]

Scooter133 you have my sympathy. After two years you should be free of such discomfort. In my experience this always involves open mouth. With my soft Dreamweaver mask which does not cover the mouth, this is always a problem if the jaw strap is not effective, and it rarely is. The air enters your nose and exits your mouth. Almost nothing goes into the lungs. DRY mouth and blistering headache. I notice that the Quattro FX I now use has a different over the head set of straps to those shown on this site. Instead of going around the head it goes very much over the top with side bracing coming up from the lower mask. Properly adjusted with symmetrical distribution of the pad pressures this full face mask does a far better job than the soft Dreamweaver. It also keeps the mouth closed by the pressure on the lower pads. Just take care that if your mouth opens with this one that you may get the same dry mouth effect but it's much easier to fix by readjusting the pad pressure using the adjusting straps and of course even if your mouth does open, the air will still be entering the lungs. Just make sure that if you get the Quattro FX, that it has the skull cap strap orientation. Good luck. Reg.

[Janknitz]

When I switched to the FFM from the nasal my headaches went away, so that is a plus. I'm a jaw clencher (not a grinder) so the morning headaches are from nighttime clenching. With the FFM I position the bottom of the mask on my lower lip and it opens up my mouth. Okay, yeah, not optimal' but I don't clench and I don't wake with a headache.

Scooter, in my observations on this forum, dry mouth that doesn't occur at other times of the day is almost always caused by mouth breathing. You are purposefully propping open your mouth with the mask, so that fits. It's a sure bet that you are mouth breathing.

There is hope. When you were a kid, do you remember playing around in the swimming pool, having conversations under water? You were able to open your mouth without the water flooding into your lungs, by tightening up the throat to seal off the mouth from the rest of the respiratory system. In effect we can do that, too, on CPAP, and still open our mouths.

The key is the TONGUE position (though in the swimming pool we did it a different way). If you seal the tongue to the roof of your mouth, you can close off the nasopharynx from the mouth so air will not escape through your mouth. You can try it now--put your tongue up there, just behind your front teeth, pinch your nose shut and try to breathe without moving your tongue from that spot. You shouldn't be able to move air in or out. Some people have anatomical defects, or have had surgical alterations (in an attempt to treat apnea) which prevent them from sealing it off, but most people can do this.

So the trick is to learn to keep the tongue in that position all night. At first I didn't believe it could be done, but I learned that if I practice ALL day, it became habit and carried over at nighttime. Your tongue should be in that spot all day, unless you are talking or eating. Put a loose rubber band around your wrist, and every time you notice the rubber band, check the position of your tongue. It may take a few days.

Secondly, you need to check your leak rates. The way you position your mask sounds like leak city to me. Lips move a lot in sleep, and I would guess that you must leak often. So your therapy may be suboptimal at best, which would explain why you don't feel much better. I would suggest either a bite guard or asking your dentist to make you a simple bite block, then using a better fitting mask.

Finally, hydrating well during the day MAY help a little. That means drinking a lot of water throughout the day, tapering off in the evening so you don't have to get up to go to the bathroom. If your tissues have plenty of hydration, they are less likely to dry out from the air flow.

[Nozzelnut]

I'm FFM user and usually a mouth breather too. I'm trying to change the mouth breathing. (Got my tonsils out Monday and a great side effect has been that my nose is more clear throughout the day and night.)

One thing I've noticed about my dry mouth is when I'm clenching at night it's worse. I think when you lock up your muscles with the clenching, it doesn't allow you salivary glands to work well and produce saliva. If I had a squishy kind of mouthguard that would let the jaw muscles work some; that might help produce saliva. Not sure if that would help or hurt the clenching though...

I've been using Biotene and it seems to help for about 2 hours; so it only helps somewhat.

[squid13]

I've been using Biotene and it seems to help for about 2 hours; so it only helps somewhat.

They've took the enzymes out of Biotene, that's why it doesn't last. I use the house brand at Walgreens which has enzymes and it works, so does the house brand at CVS.