Advice please - mouth open

[chunkyfrog]

Back to the original topic:
---chin up strips (look it up--they sell them)
---home-made brandy keg (section of pool noodle + bandanna, etc)
---poli grip strips (it works pretty well, but can get messy)

[Julie]

He's not in the US, so some of those might not be available.

[ChicagoGranny]

https://www.amazon.com.au/

- anything you want

[rice]

I have a Resmed chin strap but by itself, it has not fixed the problem.

For the record, I do not breath through my mouth normally. Even at night. The issue is that with the CPAP set at twelve, during the night my mouth opens (due to the pressure?) and the air from the CPAP rushes out. Just to reiterate, apnoea is not the biggest concern, its low oxygen saturation when I sleep, but a pressure of twelve is meant to fix it.

Last night I used the tape for the first time, with good and terrible results. The good was that the machine reported 20 out of 20 for mask fit for the first time. The terrible was the quality of sleep which was simply terrible. Hardly slept at all.

[Julie]

Does your machine have a feature that gives relief oh exhalation? What setting is it on?

[rice]

Does your machine have a feature that gives relief oh exhalation? What setting is it on?

Its a Resmed Airsense 10 Autoset, so it does have that feature. However, its not enabled.

[Julie]

Well why not try it at a low setting to see if it helps.

[rice]

The saga continues.

To summarise. I went to the sleep Dr with two issues. Apnoea and low blood oxygen saturation. After a sleep study he suggested a CPAP trial (on auto.) During the four week trial I had no problems, and it fixed the Apnoea. However my oxygen saturation level was low. The specialist ordered a second sleep study and determined that the oxygenation issue would be fixed with a constant pressure of 18. I tried the new setting for almost four weeks. The stats were basically okay. AHI was fine but on some nights there was mask leakage.

I enabled the exhale pressure relief, and increased the relief number over a few nights, I also used tape to keep my mouth closed. The Oscar stats then looked very good.

As the treatment progressed over the month, I started feeling worse and worse. More and more tired, then dopey, depressed, my blood pressure increased significantly, and I felt generally unwell. I saw my GP who told me to stop using the CPAP and see the sleep Dr as soon as I could. After stopping for a few days the depression has lifted and I am feeling better, although I think I am still catching up on my sleep.

The appointment has been made, but I have some questions that I would to research before I see the Dr.

1. The Resmed 10 Auto CPAP has an ERP feature, however I have no idea how much pressure is used when that is enabled. Anyone know?
2. How/why is the bi-pressure so much better than the BiPAP machine?
3. Anyone know how much exhale pressure difference there is between the two systems?
4. What else do I need to know.
5. What should I be asking the Dr.

I know I am asking a lot but this saga has been going on for months. I am getting frustrated at the lack of progress and don't feel like I have a good handle on the situation.

[Pugsy]

1. The Resmed 10 Auto CPAP has an ERP feature, however I have no idea how much pressure is used when that is enabled. Anyone know?

Depends on what setting how much of a drop you get during exhale.
EPR allows for a per cm drop per setting during exhale. Setting of 1 is a 1 cm drop during exhale from inhale....setting of 2 is a 2 cm drop and the setting of 3 is a 3 cm drop.
Example....EPR set to 2 and pressure is set to 15 cm.....during inhale you have 15 cm and exhale is 13 cm...2 cm drop.

2. How/why is the bi-pressure so much better than the BiPAP machine?

Don't understand the question. When you use any exhale relief then a bilevel pressure situation is created.
Bilevel just means 2 distinct pressures...one for inhale and one for exhale.

3. Anyone know how much exhale pressure difference there is between the two systems?

Bilevel machines as opposed to cpap/apap machines will offer more than a 3 cm drop during exhale.
cpap/apap machine with exhale relief are limited in the amount of drop they can give.
A bilevel machine has a higher difference between inhale and exhale available.

When you enable any exhale relief the pressure drops during exhale and for some people that drop allows for the airway tissues to collapse because the pressure is lowered to a point that the airway is no longer stented open. It is of course probably more comfortable to have that difference but for some people they have to make a slight adjustment upwards to keep the pressure at a point where the airway is still held open....so they have to start a bit higher if they use exhale relief.
Not everyone will need to make that adjustment but some people might. It all depends on if using exhale relief drops the pressure enough or to the point the airway isn't held open well enough.

[ChicagoGranny]

The saga continues.

You don't mention anywhere what your AHI and leak level are when using CPAP. Do you look at the machine display each morning to view this data for the night?

[ElusiveSleep]

I have a Resmed chin strap but by itself, it has not fixed the problem.

For the record, I do not breath through my mouth normally. Even at night. The issue is that with the CPAP set at twelve, during the night my mouth opens (due to the pressure?) and the air from the CPAP rushes out. Just to reiterate, apnoea is not the biggest concern, its low oxygen saturation when I sleep, but a pressure of twelve is meant to fix it.

Last night I used the tape for the first time, with good and terrible results. The good was that the machine reported 20 out of 20 for mask fit for the first time. The terrible was the quality of sleep which was simply terrible. Hardly slept at all.

Mouth breathing is the greatest challenge I having encountered since I started CPAP 18 months ago. My best means to prevent it is the soft cervical collar (suggested by folks on this forum). Chin straps were an utter failure.

I have tried mouth taping on several occasions, but found that my AHI values would be increased (vs. the collar) despite limited mouth leaks. My take is that nasal congestion occurs during sleep, and the air from the machine needs to escape from somewhere so my mouth acts as an "escape valve" (which can occur with the cervical collar but not the tape).

I have noticed that the leak patterns on OSCAR are cyclical. My hypothesis is that these are periods of sleep on my back which increases the likelihood of my draw dropping open. Just bought a special foam block that straps to the chest and forces side sleeping. Will try first time tonight to see if it helps decrease the mouth leaks.

[jimbud]

I have tried mouth taping on several occasions, but found that my AHI values would be increased (vs. the collar) despite limited mouth leaks. My take is that nasal congestion occurs during sleep, and the air from the machine needs to escape from somewhere so my mouth acts as an "escape valve" (which can occur with the cervical collar but not the tape).

Your supposition is flawed.

No leak with mouth taped:
The machine is able to recognize/record your apnea events.

Leaks with with collar:
Depending on amount of/duration of large leaks the machine can not recognize/record all of your apnea events.

It is possible/probable that your actual AHI is the same under both conditions.

Post some charts under each condition for us to see. (on another thread of your own)

JPB

[rice]

EPR allows for a per cm drop per setting during exhale.
Example....EPR set to 2 and pressure is set to 15 cm.....during inhale you have 15 cm and exhale is 13 cm...2 cm drop.

Bilevel machines as opposed to cpap/apap machines will offer more than a 3 cm drop during exhale.
cpap/apap machine with exhale relief are limited in the amount of drop they can give.
A bilevel machine has a higher difference between inhale and exhale available.

When you enable any exhale relief the pressure drops during exhale and for some people that drop allows for the airway tissues to collapse because the pressure is lowered to a point that the airway is no longer stented open. It is of course probably more comfortable to have that difference but for some people they have to make a slight adjustment upwards to keep the pressure at a point where the airway is still held open....so they have to start a bit higher if they use exhale relief.
Not everyone will need to make that adjustment but some people might. It all depends on if using exhale relief drops the pressure enough or to the point the airway isn't held open well enough.

Thanks Pugsy, makes a lot of sense and I now have a much better understanding of the finer details.

You don't mention anywhere what your AHI and leak level are when using CPAP. Do you look at the machine display each morning to view this data for the night?

The machine's display showed everything was fine, almost always.

Oscar results were obviously more detailed. It shows:-
AHI averaged 0.52 over the 4week period and 0.31 over the last week
Leak Rate averaged 8.74 over the 4 week period
95% Leak Rate was 37.2 over the four week period and 27.6 in the last week (when using chin strap and tape.)
% of time above the Leak Rate threshold was 15.5% over the four week period and 6.18% during the last week (tape and chin strap)

[lwood30097]

Not sure what you are using - but have you tried a full face mask? If your mouth opens, you still get air.

I tried all the remedies for keeping my mouth shut and none worked. Chin strap kept it closed - but air escaped from my lips making a unique "raspberry" noise.

Went to full face mask and no problems. They also work great if you have any sinus or nasal congestion.