Should I use a chinstrap with an FFM?

[park_ridge_dave]

Hi,

Well, I got an FFM (Mirage Quattro) because I am a mouth breather and I was having problems with my nasal mask when my allergies "kicked in" last week.

OK, so I still am waking up with dry mouth (I have tried a higher Humidifier setting but no luck).

I was definitely not getting good therapy from the nasal mask and the cardinal chinstrap, so I want this FFM to work.

So I was wondering if I should try a "papcap" chinstrap?

Does anyone have any experience with this? Or any other suggestions

Cheers,

Dave

[steelheadid]

I use the Mirage Quatro a chin strap. I use them both for two reasons, one I started using the chin strap in hopes of training myself to not be a mouth breather and second to see if it would improve my therapy. I have found that I my mouth breathing seems to be getting better becaus I switch to a nasal mask once every week or two, just for a couple of nights at a time, for a change up in therapy and my mouth breathing does seem to be better, less leaks and improved therapy than before on the nasal mask. But I do still get far better therapy with the full face mask. I also seem to feel better using the chin strap with the full face mask. According to my data I have less, not markedly but less events using the strap as not but the difference is so small that it may be just my imagination.

[Thomas F.]

I used Pap cap with Quattro FFM. I discovered that I would open my mouth during REM sleep and depending on body position my tongue would block my airway. I now use a fanny pack on my back to prevent sleeping on back or even tilting towards my back. I believe a closed mouth or nearly closed mouth is better for trapping the tongue. A dry mouth would indicate mouth breathing with your FFM. This is OK provided your tongue is out of the way and not blocking or restricting your breathing. Are you using software to track your apnea index?? If so what is the results and how does it compare to the nasal mask you were using.

[park_ridge_dave]

I used Pap cap with Quattro FFM. I discovered that I would open my mouth during REM sleep and depending on body position my tongue would block my airway. I now use a fanny pack on my back to prevent sleeping on back or even tilting towards my back. I believe a closed mouth or nearly closed mouth is better for trapping the tongue. A dry mouth would indicate mouth breathing with your FFM. This is OK provided your tongue is out of the way and not blocking or restricting your breathing. Are you using software to track your apnea index?? If so what is the results and how does it compare to the nasal mask you were using.

OK my AHI is going UP was 4.9 now it is averaging 7.6 (last week).

I have ordered a CPAP Pillow so I can sleep on my side easier.

I sleep on my back a lot as my sinuses plug up if I sleep on my side (I have no idea why it has always been like this even pre-cpap).

I use a night guard to stop bruxing damage, so I think my tongue is out of the way.

In looking at the graphs from my last several nights, I see some strange stuff in terms of waveshapes of my breathing patterns (OBTW my machine is set for CPAP only no CFLEX etc. and pressure is set to 12cm H2O).

I have periods of periodic breathing and my average OA (2.9) and average CA (3.2) numbers are about the same. Adding my average Hypopnea (1.5) i.e. so when all three numbers are added (I assume that is the way the machine does it to get the overall AHI number I see 7.6.

Thanks for the help,

Dave

[Thomas F.]

when you used nasal mask how did you keep mouth closed? If you used tape then my hunch is that you are opening your mouth too much with your FFM and as result mouth drys out more and therepy is not as good as your were experiencing before. I expect the night guard does not has no feature to hold mouth closed. Before buying papcap you could try using a strap made of scarfs to keep your mouth from opening and see what data shows.

I have same nose clogging problem and recently started using Nasonex every night prior to sleep. This issue with Nasonex is you MUST use it every day. My nose breathing is better than it has been in 20 years. You might be able to get back to the nasal mask soon if you use Nasonex every day (one puff in both sides is all that's needed; don't use more because it waaaay too expensive).

The root cause of my apnea is lower jaw is not forward enough to provide adequate space during REM sleep. During REM my mouth opens and the tongue attached to it moves backward into trouble zone. The problem with FFM is they are pushing on your lower jaw in the exact direction I don't want my jaw to move. Nasal masks don't have this problem which I think is one of their biggest advantages.

I suggest the following 2 options:

A: use nasonex to open sinuses and get back to nasal mask which was working for you before.

B: make a temporary chin strap for testing with FFM.

[Gekko]

That's good advice... I wish I hadn't ordered the chin strap yesterday! I'm also using a FFM and I continue to snore (although my AHI is down from 40 to around 5-9, even with the snoring).

The snoring comes from years of mouth breathing due to polyps in my nose (now removed). However, I have a recessed jaw, which is obviously contributing to the snoring and apnea. I tried a mandibular device (the cheap ones you buy over the 'net) before I was diagnosed and it did improve my snoring to a certain extent, but I found it hard to tolerate and it seemed the improvement was not worth the effort.

I'll report back on the chin strap when I get some data. I may also try to combine the mandibular device with CPAP. One thing I found was that the device did keep my mouth closed.

[Thomas F.]

I was using a mandibular device + quattro FFM and was getting AHI around 7-10. My M. device is hinged however and what I found out is my mouth opened and this led to the apneas even with the device and CPAP. I then tied the M device closed so I could not open my mouth and the apneas went away. I am now using the mandibular device by itself without APAP and the results have been excellent. Maybe I should start a posting with pictures of the device so people can see what I am describing.

[Ms.Snuffleupagus]

I sleep on my back a lot as my sinuses plug up if I sleep on my side (I have no idea why it has always been like this even pre-cpap).

Hi Dave,
My respiratory therapist told me that this is often due to a deviated septum. Nasonex and nasal rinsing with NeilMed saline solution in a nettipot or bottle, has helped me. I also use a small wedge to get my head elevated a bit. I also find that nasal pillows or a hybrid mask helps keep my sinuses open because of the air being pushed through.

As well, some people have more apneas if they sleep on their backs. Check your sleep study results to see if this was the case. This may be another reason why your AHI's are high.

[Gekko]

As well, some people have more apneas if they sleep on their backs. Check your sleep study results to see if this was the case. This may be another reason why your AHI's are high.

I have this problem (more apneas on my back), but I find that during the night, I roll onto my back when I fall into deep sleep.

I seem to be a bundle of bad habits! In fact, if I can sort out the mouth breathing and the rolling onto my back, I think my treatment will go from 5-9 AHI to 1-2 AHI (which were the results I was getting in the first week of treatment... now that my body is used to the mask, it seems to be reverting back to old habits!

[park_ridge_dave]

Whoa

An international solution Thank you all so much! I will be trying these things ASAP!

Many good tips here. I really love this forum. It's like having an experienced friend to talk with anytime I need one.

(see my signature quote )

Cheers,

Dave

[park_ridge_dave]

I was using a mandibular device + quattro FFM and was getting AHI around 7-10. My M. device is hinged however and what I found out is my mouth opened and this led to the apneas even with the device and CPAP. I then tied the M device closed so I could not open my mouth and the apneas went away. I am now using the mandibular device by itself without APAP and the results have been excellent. Maybe I should start a posting with pictures of the device so people can see what I am describing.

Thomas,

That would be a most excellent idea (IMHO)

Was it one of those "prescribed" devices or did you get it without a prescription?

What was the approximate cost?

Pictures would be FANTASTIC

Cheers and Thanks!,

Dave

[Thomas F.]

The device I have is called Suad. You can get more information about it by googling. The picture below is pulled off the internet not an actual picture of mine. I got fitted by a dentist in atlanta area that works with a sleep clinic. The device is hinged so you can open your mouth fairly easily -- this became a problem for me as I explain next . You can see one rubber band in the picture which is there mainly to keep the top and bottom half together when you take it out of mouth. The problem for me is my mouth would open during REM sleep and apneas would happen even with the device in place!! I fixed this problem with using now 3 rubber bands on each side and there is no way my mouth can drop open now. My Oximeter is showing excellent O2 levels during sleep. Recently I have been using the Suad device without APAP for the past week and my results have been excellent. I will keep you posted as I get more experience with this approach.

The SUAD is expensive > $1000 but I was able to get part of it covered by insurance.

[Country4ever]

I've often thought that some oral appliance might be the best way to keep our mouths shut (if you could tolerate that big honkin' thing in your mouth!).
I've gotten sort of used to my MORA (mandibular orthopedic repositioning device) for TMJ, but it doesn't keep my mouth closed.
Awhile back, someone invented a new small dental device for TMJ. It was a small clip-on plastic thing that you'd wear on your front teeth and it would prohibit you from biting down too hard. Seems like they could invent something like that for us mouth breathers too. I realize you can still puff around those devices, but I think it would still help to some degree.

[park_ridge_dave]

The SUAD is expensive > $1000 but I was able to get part of it covered by insurance.

Thanks Thomas

Yes, I expected it would be expensive as the dentists want their cut. If we lived in another country, e.g. U.K. we could order the $165.00 mold it yourself kind of MAD unit

I will be working with my "sleep doctor" to see if I can get insurance to cover at least part of the cost. He had mentioned a MAD the first time that I saw him.

Thanks for your efforts and advice, Thomas, it is most appreciated.

Cheers,

Dave

[Thomas F.]

I've gotten sort of used to my MORA (mandibular orthopedic repositioning device) for TMJ, but it doesn't keep my mouth closed.

Using a Pap cap would do a good job of keeping your mouth shut. It has a very strong stretch strap attached to a cap you wear on the head. I have tested this and it does the job.

I think there are some internet available boil and bite devices that are similar to what I have at much less cost. They are worth trying before going for the more expensive route.