Mouth Tape or Increase Pressure?

[jabberwock]

I would appreciate advice on what I should do to avoid dying in my sleep tonight

A little background first. I was first diagnosed three years ago with severe (37) sleep apnea, titrated to a pressure of 7, given a basic RemStar Plus and a Simplicity mask and sent on my way. Not surprisingly, I abandoned therapy after about four months out of sheer frustration.

I went back for a retitration study in December 06 and the pressure level was changed to 6. Coming to the realization a month ago that I was becoming increasingly sleep-deprived, I gave in, went and had my machine adjusted, borrowed a new mask from the DME and FOUND THIS FORUM!

After trying several masks, I finally purchased an Activa and slept with it on quite comfortably for the first time last night. EXCEPT for waking at one point in the night on my back (usually a stomach sleeper), with my heart racing, gasping for air. One of my kids just told me it sounded like I was having an asthma attack (I don't have asthma)! Sounds like an apnea to me?

What I don't know is whether it was because I was breathing through my mouth and losing treatment, or the pressure was not sufficient to stop the apnea because I was sleeping on my back.

When I went in to have my machine reset to 6, I asked to see a copy of what the sleep doc has sent to them. I was stunned, to say the least. When I went for the retitration in December, I had not used cpap for close to two years, and the tech even told me that I barely slept (I knew that!)
The info the sleep doc sent indicated that I had an RDI of 37/hr, and RDI in REM of 4/hr. (I would be surprised if I had more than 10 minutes REM sleep).

It also states that I used my own mask (I did not; I used one of the clinic's masks); that adaptation was "excellent" (I lay awake most of the night), that sleep onset was "fast - 15-30 minutes" (it takes me an hour to fall asleep most nights, without a bunch of wires and electrodes attached to me); and that patient quailty of sleep was "improved" (?) and that patient feedback regarding cpap was "positive" (??)

I don't know who they wrote that report about, but I swear it wasn't me! So now I am really questioning the pressure setting of 6. I'm truly afraid they simply picked a number out of the air! Thanks to this forum, I have asked my sleep doc's office for a copy of my full study, but they are stalling me. I will keep after them

I don't know if I mouth breathe because I have no sleep partner to ask. I'm sorry for the long post, but I am afraid of having another episode like I had last night, and even more afraid of taping my mouth in case the problem is insufficient pressure to start with. Is it possible that I would suffocate?

If I am over-reacting, please tell me so. Should I tape my mouth tonight in case the problem is mouth-breathing, or should I try setting the pressure higher (with the help of my friends on the forum ?

Bonnie

[Guest]

Get a full face mask and then you don't have to worry about whether or not you mouth breathe. Until then you can try making your own chin strap or taping your mouth. If you have concerns about the 6 then try it at 10 a couple of nights. Six is like nothing from my perspective.

[Jaggles]

6 seems awfully low to me but as you know jab, I am a novice at this myself. I would sure consider upping it to 7-8 to start and would not tape yet. I have, on occasion, done a little open mouth stuff and it sounds weird. But give it more than 1 night before doing anything major.

[blarg]

There's no way to tell what's going on without going back in for another study on your cpap, or having a data recording machine. Yes, you could just get a full face mask, but I have a very hard time sleeping with those at all, and it's not cheap to just be getting masks willy nilly.

So, basically, we need to see what's going on. Any chance of that happening?

[RosemaryB]

One thing you should do is to get a copy of your COMPLETE sleep study and titration studies. Get the old ones and the new ones. This means all the graphs and charts, not just what the doctor's report says. YOu have a right to these, by law.

I found some flaws in the doctor's write up of my study this way. Perhaps sleep doctors are asleep when they do these write-ups.

It would help for you to have a data capable machine so you can see what's going on if you are going to try and set your pressure. It would also allow you to see whether there are leaks or not. It makes life much simpler if you want to see what's going on and compensate for a low quality sleep study.

My titration study was low quality. My pressure was set at 5. With a data capable machine (I got an autopap) I have been tweaking my pressure and have gotten my AHI down so it is no longer classifiable as OSA. Looking at the results, it's clear that without the equipment I have, I could not have done so and would still, technically have OSA.

[jabberwock]

Thanks for the replies.

Blarg, I can't have another sleep study/titration until December (insurance allows only one per year). My insurance won't pay for another xpap for another 18 months. I am keeping my eye on ebay and craigslist for a data compliant machine that I can afford.

I was thinking of buying a FF mask anyway to use when I have a cold.

Out of curiosity Rosemary, what pressure are you using now? (i.e. increase from 5)

[JohnMudie]

......
waking at one point in the night on my back (usually a stomach sleeper), with my heart racing, gasping for air.
.....

I can't tell if you are using C-Flex , but just in case you might be, I want to tell you I found myself breathing rapidly once and figured out it was due to a phenomenon call "Breath Stacking" which is discussed in

http://sleepapnea.wikia.com/wiki/C-Flex

Welcome aboard. Keep on trying. I did and it got better.

John M

[jabberwock]

No C-flex John, but thanks for the thought. Interesting article on breath stacking.

Bonnie

[GeneS]

When you breath in thru your mouth your airway pressure is negative (below atmospheric) or air would not flow from your mouth to your lungs. Since c pap is continuous positive airway pressure it has no beneficial effect when breathing in through your mouth no matter what pressure it is set at. You need to eliminate mouth breathing before you can determine the correct pressure. Naturally a new test would be best but I would not wait for a long time for one. I would try to figure it out myself like you are doing. I would probably add a few centimeters of pressure and get a good wide tight chin strap to start. If you seem to get thru the night better and have confidence that the pressure is enough to eliminate most apneas I would then put a strip of 1" wide or so tape across my mouth along with the chin strap. One end should be folded over and easy to grab if you need to remove it quick. If it is still completely sealed in the morning you are probably not mouth breathing. If the seal is broken you need to tape better as described in this forum or use a full face mask. Once you can sleep thru most of the night and feel comfortable sealing your mouth you can tweak the pressure up or down based on how you sleep and how you feel during the day. Trying to tweak the pressure when you are mouth breathing is difficult if not impossible.

Someone else may have a better idea but the important thing is to try something and get treatment working.

GeneS

[oldgearhead]

If you are having trouble inhaling with you mouth closed or taped, then
raise the pressure a bit to 8 or 9. It's unlikely pressures that low will be
a problem. However, a pressure of 6 has three problems, in my experience:
1) Inhalation is difficult
2) The check valves on several full-face masks may "chatter" at 6 cm/HO.
3) Insufficent flow through for C2O flushout.

I have one or two of these problems with pressures lower than 8.

Remember, curling irons are more dangerous than CPAP machines..

[jabberwock]

A big thank you to everyone who has offered advice/suggestions... you guys are awsome!

After considering everything, and until I can get my hands on a machine that gives me some data to work with, I am going to try mouth taping and increasing the pressure a little, maybe 8 to start.

One more question; if the pressure at 6 is not high enough to keep the airway open and/or provide sufficient C2O flushout, is it possible that I am trying to breathe through my mouth to get more air?

Bonnie

[GeneS]

When the pressure is not high enough you probably have an apnea and cannot get enough air so you have an arrousal and then your airway opens and you get air and start to sleep until you have another apnea and start over again. When your airway closes you probably try to get air wherever you can mouth or nose. If your mouth is taped you will need to get it from your nose which should be better because it is at a higher pressure and should open the airway quicker. I recommended raising the pressure some before taping to reduce the chance of apneas while your mouth is blocked which can be uncomfortable especially if you are not used to it.

GeneS


GeneS