Exhaling thru mouth when air pressure increases

[sleepychar]

Last night was night no. 7 for me... I am still needing a nap (or two) during the day... I am using the P10 nasal pillow mask... Both yesterday and today I woke up with a very dry mouth and throat... Humidity level set to 7 on the AirSense for Her... I have been waking up approx 3 times/night for bathroom trips... Last night, one of those times, I very definitely found myself exhaling through my mouth when I awoke at about 3:30 a.m. I am not breathing through my mouth EXCEPT when the air pressure increases... so last night, when it occurred to me to look at the pressure, it was 10... this was after I was awake for a few minutes and breathing so that may or may not have been the highest pressure, but at 10, I was definitely exhaling through my mouth... I could actually feel the air filling up my mouth... so I'm wondering if that exhaling through my mouth is kind of defeating the goal of getting a good night's sleep... I'm wondering if I'm possibly having an apnea event, which without the machine would have disturbed my sleep anyway, but now I am waking up due to the increased air pressure... I haven't attempted a SleepyHead report yet - maybe it's time... I'm going to call the RT at the DME suppliers today and let him know what's happening and how I'm feeling... he seemed more informed than some of the DME people that I have read about here... But, meanwhile, any suggestions?

[Pugsy]

Your software reports will tell you if you are doing enough mouth leaking (during exhale or whatever) to harm the therapy effectiveness.
When using nasal pillows the tongue has to keep the back of the oral cavity closed so that air going up the nose doesn't try to exit prematurely through the mouth. This is where tongue placement is critical to keeping that door closed. Easy to do while awake but once we go to sleep the tongue gets lazy and it drops down and opens the back door and air will enter the mouth...usually if lips are closed this creates what we call chipmunk cheeks and while we can force the air back it's hard to do and usually the chipmunk cheek effect eventually has to find a release with the air exiting the mouth.

Part of this tongue placement trick is just habit that will eventually become second nature. I can do a big yawn..open my mouth wide and stick out my tongue at you and even talk without the air entering the mouth from the airway. It took quite a bit of time to get to this point though. I can't tell you how I do it...just that I can do it and I am not the only one.

Not all mouth breathing/leaking equals massive leaking to the point of negatively affecting therapy.
Some time ago I happened to wake up and I was gently mouth breathing. No massive rush of air out my mouth ...no loud noise...just very gently breathing in and out through my mouth. Since it was my normal wake up time I decided to just continue breathing that way so that I could see exactly how much extra leak would show up on the leak graph. I think I did the experiment for about 15 or 20 minutes.
Below is the report and I circled in red the known awake time where I was for sure mouth breathing...but very gently. As you can see there wasn't a massive leak at all and in fact it barely registered as a leak.
So not all mouth breathing equals massive pressure loss....people need to evaluate the leak graph to see just how bad the leaking is before deciding just how they want to try to fix something.

[sleepychar]

I'm not worried about the leak in and of itself. Leak is still only 11L/min, which I know you advised not worrying about. What I am concerned about is that I am waking up. I don't know if it is the increased air pressure that is waking me up or the apnea... and that I am still very tired during the day... My OSA is in the mild category according to my sleep study... but still there were apnea episodes lasting as long as 110 seconds... and I think those were disruping my sleep which is why I started the CPAP therapy. Maybe I just need to be patient until I stop feeling sleepy during the day but if there is something going on that I could do something about, then I would like to do it. My own theory is that I am not waking up just to go to the bathroom but I'm waking up due to the sleep apnea and then noticing that I have to go to the bathroom... I could be wrong about that though...

[Pugsy]

Anything that wakes us up is unwanted.
If you feel that it is when you hit 10 that the problem is worse then maybe you could try limiting the range to 9 and see if it helps prevent those wake ups without allowing too many apnea events to happen.
So maybe a teeny tiny range in apap mode would better suit your needs...at least for right now until your body and brain gets adjusted to all this stuff.

I think it took me about 2 months just to quit multiple wake ups from my brain poking me to say "hey, dude, do you know you have an alien stuck on your face" because I wasn't having any leaks or comfort issues...just wake up to feel the mask.

You could limit the max to say 9 and see what happens.

[Jay Aitchsee]

Hi, Char
Without seeing the reports it's hard to know exactly what's going on. One thing you don't want to do is worry and obsess over things that occur while you are trying to sleep. Leaks that continue to wake you, if they do, are a problem, but from what you say, they are probably not affecting the machine's ability to prevent your apneas. As Pugsy mentioned, you may want to decrease your pressure, but without the a report to judge by, it will be hard to determine the true effect. Your humidity setting is pretty high (7), sometimes higher humidity settings actually contribute to mouth breathing by causing the nose to become congested. You may want to turn it down or off. Many of us just let the air blow over the water without any heat (humidity off) to obtain just a bit of added humidity.
Waking in the night may be due to mouth leaks, or it may be (as Pugsy mentioned) just an unfamiliar situation, or it may be just normal wakes. You are only 7 days in. As I mentioned in another thread, your immediate goal is to become comfortable with the treatment. Obsession, worry and the expectation of immediate results will get in the way of that.

[sleepychar]

Thank you both. I will see if I can get more feedback from the DME's RT - he can look at more detailed reports from Resmed - if he has time... All I get to see are the MyAir report and the LED display on the machine and that is not very much information. I have put off learning more about SleepyHead just because of what you said - I don't want to make these early days more complicated than they need to be. I increased the humidity because my nose, mouth and throat were so dry and the increased humidity seems to help that somewhat. It is much better than before although yesterday morning my mouth and throat were pretty dry again. I don't seem to have any trouble breathing through my nose although, even without the CPAP, I do have some mild allergies (mild for the most part, that is) that cause nasal congestion but not to the point of not being able to breathe through my nose. I don't think I'm mouth breathing except when the air pressure increases and then it is more exhaling than inhaling through my mouth. I know I have to be patient and just get used to things - patience isn't one of my stronger assets though but I'll keep working on it... I am much more comfortable with the mask now that I have increased to the medium pillow size from the extra small.

By the way - separate question - I can't get the smiley faces to display in my messages. Do you have any tips about that?

[Jay Aitchsee]

By the way - separate question - I can't get the smiley faces to display in my messages. Do you have any tips about that?

Sign on. Go to control panel (upper left), Board Preferences, Edit Posting Defaults, Select Enable Smilies by Default.

[ChicagoGranny]

I don't think I'm mouth breathing except when the air pressure increases

It's not always easy to separate the causes from the effects. It could well be that the machine senses difficulty in the airway and raises the pressure.

About the same time, your mouth might open reflexively in an attempt to get the breathing going. Or, the lips might be forced open by the additional pressure. If your jaw actually opens, I would guess the former is the case.

I increased the humidity because my nose, mouth and throat were so dry

CPAP humidifiers are good at delivering moisture to keep the nasal passages from drying. They are of little help when air is passing through the mouth.

You are being encouraged to stick with a nasal interface in hopes that you will be able to adapt, and the mouthbreathing will cease. If you get to the point of failure, don't forget the default position is to use a FFM.

[sleepychar]

Chicagogranny, thanks for your supportive comments. I know a FFM is an option but I am hoping, hoping, hoping to be able to make the nasal pillow mask work. I talked to the RT at my DME suppliers a little while ago. He tentatively suggested a chin strap as a next step trial but - and I appreciate this very much - he is going to pull a report generated by my CPAP machine and review that before he makes any definite suggestions. Intuitively, and this could be far off the actual mark, I think there was an apnea even and when the machine sensed that and increased the air pressure, I wasn't breathing at that instant and so the air went into my mouth. At some point in there I woke up. I haven't explored people's success rate with chin straps yet... I so want the nasal pillow mask to work out... but I also want the treatment to be effective or else why bother at all...

[ChicagoGranny]

I haven't explored people's success rate with chin straps yet

The success rate seems to be low. Personally, I tried two of the best chin straps. They were not effective, and they interfere with the mask headgear, not to mention they were more mussing of my hair.

Instead of chin straps, I have been using a firm foam spinal collar every night for at least five years. It holds the jaw up, keeps the neck in the optimum position for airway patency and does not interfere with the mask headgear. It also does not pull your lower jaw backwards making the airway narrower, as many chin straps do. If air wants to push through your lips, a spinal collar will not stop it, but neither will a chinstrap.

If you ever want to try one, it is a very inexpensive trial.

I like the DMI Universal Firm Foam Cervical Collars -
http://www.walmart.com/search/?query=DM ... %20Collars

The firm works better and lasts longer than the soft. There seems to be no loss in comfort with the firm over the soft.

The cells in the foam break down over time. One lasts me about four months.

Typically the 3-inch width fits a smaller person, and the 3.5-inch or 4.0-inch fits a larger person. Some may need to change the size up or down on the second order. The larger size you can wear, the more support to keep the jaw from dropping.

Walmart ships free to your closest store for customer pickup.

[sleepychar]

Thanks for that information. I was kind of afraid that was what I would find out about the chin strap. Just from what I experienced last night, I think air was pushing through my lips because the air was going into my mouth and had no place to go. Even when I started taking deep breaths through my nose at one point, the air pushed through my mouth a little bit. I had to breathe, or at least it felt like I had to breathe very, very deep breaths to prevent the air going into my mouth. I don't think my jaw is falling open and I am not mouth breathing in general. But will see what the RT says and how I do over the nights to come before rushing into any decision. I am especially going to take a little more time before switching to a FFM. If I have to go that route, I have to have convinced myself that I have no other choice...

[avi123]

sleepychar, try a chin-strap together with your nasal mask and it will solve all your mouth leaks. Guarantee! Leave a small gap between your teeth and lips:

http://www.cpaphelpdesk.com/cpap-chin-strap.html

[Goofproof]

[quote="avi123" Guarantee! Leave a small gap between your teeth and lips:

http://www.cpaphelpdesk.com/cpap-chin-strap.html

[/quote]

I would say that's correct, leaving a gap should insure leaking! Jim

[palerider]

sleepychar, try a chin-strap together with your nasal mask and it will solve all your mouth leaks. Guarantee! Leave a small gap between your teeth and lips:

sleepychar, please remember that avi is best ignored... and teeth aren't air tight, so chinstraps don't stop mouth leaks, as you found out.

[Dr. CEK]

I am a new CPAP user who is a mouth breather. I use the nasal pillows. A chin strap didn't even help me. So I invented a device that I have been using for a couple of months now that stops air leakage through the mouth; without the uncomfortable shin strap. It works so well for me, that I have patent pending for it. I thought I would join public forum for CPAP users to see if there were others with the same problem who might be interested in field testing my device.