Correlation between sleepiness and mouth leak?

[BigMoose13]

Hey friends-

I'm getting conflicting info on how important mouth leak really is. One the one hand, my doc (who is engaged and on top of things) dismisses mouth leak almost entirely as long as my events are 5.0 or below. When I began in July 2018, I didn't struggle with mouth leak and my events were 0.2-0.5. Now I'm getting a fair amount of mouth leak (25-35 L/min) and my events have risen, but only to about 0.8-1.2. My doc maintains I'm still getting effective therapy even with the mouth leak, while the web (always a trusted resource haha) tells me otherwise.

That said, I feel like my daytime fatigue is climbing again. I usually don't wake up feeling rested (I was never an overnight success story, but did have some improvement with the daytime fatigue). I also feel like I need to nap again in the afternoons now, which is a backslide.

I've tried a FF mask but had horrible seal because of my facial hair. I've also done some pretty wild combinations of airplane pillows under my chin, chin straps and hair bands to keep my mouth closed. While those work to keep my mouth closed, what they don't help is the root problem of when I relax and sleep, my tongue falls back into my throat slightly opening the airway between my mouth and nose--hence the leak.

So my questions are this:

1- Is there correlation between effectiveness of therapy/sleepiness and mouth leak?
2- Are there effective dental devices anyone here has used to keep the mouth closed/tongue in place? I know they've gotten mixed to largely negative reviews from what I've read here.

I have also checked to see if there's any other medical reason for the fatigue at my docs request, and testosterone/thyroid function normally, so the culprit may be the mouth leak.

As always, any/all advice welcome. Thank you!

[Okie bipap]

Depending on how much your mouth leaks, the effects can be detrimental to your treatment. If the leak is bad enough, your machine cannot properly identify your events. When I tried nasal pillows or nasal masks, I had the same problem you do. As soon as I fall asleep, my tongue drops down and I start losing air which also creates an extremely dry mouth for me. After trying several times, I have decided to stay with a full face mask. Rather than fight the facial hair problem, I shaved the beard I had for over thirty years. It felt a little strange at first, but now I don't miss the beard and I have gotten used to no having it. Of course, if I could ever learn to use a nasal mask or nasal pillows, I would seriously consider regrowing the beard, again.

[kteague]

A few suggestions to help with mouths leaks...
- Train your tongue to stay suctioned to the roof of your mouth. My jaw can relax yet still maintain a seal.
- Avoid back sleeping unless medically necessary.
- When side sleeping, hang at the edge of the pillow making it collapse a bit and with the front of your face tilted downward, gravity will make
your tongue fall forward instead of into the throat.
- Use a firm flat pillow. A fluffy pillow can allow the head to be at an angle with the chin lower than the forehead, a recipe for gravity to allow the
jaw to go slack. On a flat pillow your jaw may relax but will not fall. It used to be my habit to sleep with my shoulder on the edge of the pillow,
which compressed the pillow putting my jaw in a position to drop. Had to break that habit.

While our machines are designed at accomodate some leakage, I prefer avoidance if possible. I remember waking many times each night by the air escaping my mouth. Sometimes it was in puffs, sometimes rushing, and sometimes full fledged mouth breathing. Even when not fully wakened by it, seems reasonable to think it could be disrupting sleep stages and thereby causing tiredness even if the machine was able to keep up.

[BigMoose13]

Thanks to you both. More info is always more helpful than less! I'm a back sleeper--of course, and am reticent to shave the beard. But in a week I may be freshly shaven and sleeping on my side lol. Thx again!

[Pugsy]

Unless your leaks (for whatever reason) are well above 35 L/min for prolonged periods of time your therapy is unlikely to suffer.
Above 35 L/min it might start getting iffy in terms of recording and responding...Actually probably 40 L/min but I like to use 35 as a more conservative line in the sand.

You will need to use available software...don't go basing on the leak number showing up on the LCD screen because that number is what we call a 95% number and all it means you were at OR below that number for 95% of the night. It is not an overall average and it is not where you spent 95% of the night at.
It's easily skewed to the high side by relatively brief periods of larger leak. Often makes it look like leaks are worse than they are.

I have a good example in this thread
viewtopic.php?f=1&t=108724&p=1036669&hi ... t#p1036669

Now any leak that wakes up up (no matter if teeny tiny or deep into large leak territory) is unwanted but more from the disturbing sleep aspect than a therapy aspect.

[palerider]

Hey friends-

I'm getting conflicting info on how important mouth leak really is. One the one hand, my doc (who is engaged and on top of things) dismisses mouth leak almost entirely as long as my events are 5.0 or below. When I began in July 2018, I didn't struggle with mouth leak and my events were 0.2-0.5. Now I'm getting a fair amount of mouth leak (25-35 L/min) and my events have risen, but only to about 0.8-1.2. My doc maintains I'm still getting effective therapy even with the mouth leak, while the web (always a trusted resource haha) tells me otherwise.

That said, I feel like my daytime fatigue is climbing again. I usually don't wake up feeling rested

Your doc's casual dismissal of everything if your AHI is under 5 isn't really "on top of things", 5, while "medically good enough" is a pretty crap AHI.

More evidence that it's not adequate treatment is in the last line quoted up there.

25-35lpm is a *lot* of leak to all be coming out of your mouth, you should be waking up with a mouth dry as a desert. Is that what's happening?

[zonker]

Thanks to you both. More info is always more helpful than less! I'm a back sleeper--of course, and am reticent to shave the beard. But in a week I may be freshly shaven and sleeping on my side lol. Thx again!

before you shave that beard-

viewtopic/p1089718/viewtopic.php?f=1&t= ... s#p1086296

i'm a full bearded fella, i use the p10 and the method outlined in the link works for me. i do just a wee bit of modification on it as it takes a bit more to keep my big yap shut.

i also use a foam cervical collar.

once i started on this, my ahi reduced by a full point and i no longer have trouble with mouth breathing or leaks.

good luck!

[jwoceanside]

I also have a low AHI or Events and high Mouth Leaks. Been on a CPAP for 63 days. No interruptions

Over that time my Events have ranged between 1-3

Over the same time my Leaks have ranged between 30-35

I've replaced my Nasal Mask and Tubing believing it was a leak problem. Still the same results.

How does one know that it's not an Open Mouth issue. I've tried Chin Strap and Mouth bandage. Same results

I'm seeing my doctor in a few weeks. See if I should try a Full Face Mask

Any thoughts

Thanks

[dreamingofdreaming]

My mouth falls open when I sleep too. I have had luck with a chin strap.