Nasal mask & mouth open

Duke · Post by **Duke** » Fri Oct 19, 2007 7:14 pm

Now I'm using Comfort Gel nasal mask and was wandering if I'll be able to use this mask even if my mouth does fall open a little ? I was told the mask wouldn't be effective if my mouth was open, but the pressure of the machine seems to keep my mouth closed with pressure at (11).

Was wandering if any one else had machine give same effect of pressure keeping mouth closed? Thanks for any input.

Duke

bdp522 · Post by **bdp522** » Fri Oct 19, 2007 7:28 pm

Some seem to have trained their mouths to stay shut. I haven't been able to in over a year. I tape my mouth shut every night. It's the only sure way for me to keep my mouth shut while using a nasal mask.

Brenda

jennmary · Post by **jennmary** » Sat Oct 20, 2007 1:40 am

I was a mouth breather befor CPAP. It stopped on its own once I started wearing the full face mask. I just switched to the swift yesterday....so far the leak rate terrific and I am certian my mouth was closed all night. So lets hope I can keep it up. Also I have a pressure of 14....when I open my mouth with the swift on it is loud and almost painfull. So I think I would likely wake up if my mouth did open.

But you are correct....if you are opening your mouth even a little your therapy will not be effective. Some have had luck with taping...you could try that.

Snoredog · Post by **Snoredog** » Sat Oct 20, 2007 2:01 am

use the leak detection circuit contained in your machine to determine mouth breathing.

It should report leak either by the star rating system ***** or by displaying actual leak in Liters per second L/s. Note to convert that for comparison with the mask flow chart that came with your machine you will have to multiply the reading from the machine by 60. Most masks display that information in Liters per Minute L/m.

If you are using a ComfortGel (Respironics mask) with a Resmed machine you should select "Std" or Standard mask type on the machine.

Then look up your ComfortGel mask for 11 cm pressure and find the intentional leak rate of the mask at that pressure. When you observe LCD data X 60, you would subtract the intentional leak rate from leak reported, that tells you the actual leak.

If you were mouth breathing the machine would be showing a very high maximum leak rate and the avg. leak rate would also be high.

You can always try taping your mouth should that happen. Having your lips part doesn't always mean you will mouth breathe. That nasal airway seal is maintained by the soft palate and the base of the tongue, so how well you maintain that seal determines how far you can open your mouth before it is broken and the cpap seal lost.

You can check it while awake, get a hand-held mirror and a flash light, put on the mask, turn on the machine so air is flowing, put your tongue into the hard palate then part the lips, the CPAP pressure should be maintaining that seal, you can continue to part your lips while maintaining that seal. I can open my mouth and maintain that seal.

However, if you had your tonsils out as a kid or had other surgery such as a UPPP to that anatomy you may not be able to maintain that seal at all, you are then pretty much forced to use a Full Face mask.

rested gal · Post by **rested gal** » Sat Oct 20, 2007 4:36 am

Snoredog wrote:Having your lips part doesn't always mean you will mouth breathe. That nasal airway seal is maintained by the soft palate and the base of the tongue, so how well you maintain that seal determines how far you can open your mouth before it is broken and the cpap seal lost.

I agree with Snoredog on that. Depending on the geometry of the inside of each individual's mouth, some can not only have the lips parted, but can have their mouth literally hanging open and not leak cpap air at all.

As he said, it's all about whether the tongue can stay in a position (during the muscle relaxation of sleep) that can keep cpap air from detouring into the mouth from behind.

Duke wrote:the pressure of the machine seems to keep my mouth closed

Check your leak rate, as Snoredog described. If the leak rate looks nice and low, then the tongue is doing its job no matter how much your mouth might open during the night.

If the leak rate for your resmed machine is not exceeding .4 liters per second, you're doing fine. If it's more than that, then you've got too much leaking going on, but you have to be your own detective to figure out if it's the mask leaking or mouth air leaks. Dry mouth in the morning despite using a heated humidifier is often a sign that there was mouth air leaking or mouth breathing going on.

Duke · Post by **Duke** » Sat Oct 20, 2007 7:51 am

Snoredog, rested gal, thanks or the informationon how to check for air leaks and all the information on my Resmed elite S8.
jennmary, your'e right about it hurting a little when you open your'e mouth, I did the same thing ,several times. It's gonna' take some tome to learn to relax the whole night whithout doing that. Thanks for evrybodys input,

Duke

Easygoing · Post by **Easygoing** » Sat Nov 03, 2007 3:52 pm

Snoredog wrote:However, if you had your tonsils out as a kid or had other surgery such as a UPPP to that anatomy you may not be able to maintain that seal at all, you are then pretty much forced to use a Full Face mask.

I should probably sue my previous doctor. Ten years ago, I was diagnosed with severe sleep apnea. My "Sleep Doctor" sent me to a surgeon to that specialized in removing some of the soft flesh in the back of my mouth. After that surgery, additional sleep studies resulted in a sleep apnea diagnosis. The doctor prescribed a CPAP machine with a nasal mask. Some technician stayed with me one night to get the right pressure. He said he had troubles because at the necessary air pressure, air would come out my mouth.

Well, my wife also watched the air from the CPAP machine go through the nasal mask into my nose and back out of my mouth. I told the doctor about it and he suggested a couple things. I got a head strap to keep my mouth closed .... that didn't work. I duct taped my mouth shout..... that didn't work. I subsequently gave up and have been living a very tired and mentally fatigued life. My Doctor from ten years ago never prescribed a "full face mask." I say this, assuming "full face masks" were available ten years ago.

Today, out of the blue, I decided to look for a sleep apnea forum. Came to this one and found the snoredog's above-quoted post. Snoredog probably saved my life or at least extended my life. THANK YOU SNOREDOG, I AM IN-DEBTED TO YOU. I am going to get a "full face mask" and start using a PAP machine again. However, it looks like I should probably upgrade to a new machine. Ten years ago, there were CPAP machines only. Now, they have APAP and BiPAP/VPAP.

Does anyone have any suggestions about which APAP and BiPAP/VPAP machines are reliable and have high ratings from their users?

rested gal · Post by **rested gal** » Sat Nov 03, 2007 4:44 pm

Easygoing wrote:Does anyone have any suggestions about which APAP and BiPAP/VPAP machines are reliable and have high ratings from their users?

All of them are pretty reliable, imho. What I'd get (for sheer comfort and feeling like more like natural breathing) is one of these two:

Autopap:
Respironics REMstar Auto/A-flex M series

or

BiPAP:
Respironics BiPAP Auto with Bi-flex
Either the older pre-M model or the M series model

I like the integrated heated humidifier for the pre-M machines, but if I were going to get an M series machine, I'd skip getting the integrated humidifier for the M. Instead, I'd buy a separate heated humidifier -- the Fisher & Paykel HC 150 humidifier. Can be used with any brand/model machine.

A plus about getting a Respironics machine is that they have made software patients can buy (Encore Viewer.) Having software to monitor one's own treatment can be extremely helpful.

Another machine I like very much is the Puritan Bennett 420E autopap. The Silverlining software for that machine is very good and is easily purchased by patients.

Easygoing · Post by **Easygoing** » Sat Nov 03, 2007 6:28 pm

Thanks a bunch "rested gal."