Chinstrap helps Stop Mouthleaks, but Now Teeth Hurt!

[Bob3000]

Good afternoon, fellow hose heads!

I've been trying this whole CPAP thing for nearly six months now and have had many problems that this forum has helped me resolve. One major problem is mouth leaks. I use a nasal mask (swift fx) and if I do nothing, I wake up throughout the night with air blowing out of my mouth. I've tried taping and that works OK, but it requires that I shave off my goatee. I like my whiskers so I decided to just use a chinstrap. I've been doing that for six weeks and I just can't get it right. If the strap is too loose, it does not stop mouth leaks. If it's a bit tighter (enough to keep my lips sealed but not enough to force my teeth to touch), I wake up in the morning or occasionally at night with sore front teeth. If the chinstrap is tight enough that my mouth is well-closed with teeth touching and lips sealed, then my front teeth get even more sore. It's a problem because as time goes on it seems to take less tightness from the chinstrap to cause pain. Also, teeth move around in response to pressure and I don't want to completely screw-up my front teeth.

With the chinstrap on, my AHI is low (almost always under 5, sometimes at 2) but I still feel un-rested. I just bought the software/hardware package for my machine to see detailed leak rates, so maybe my AHI is low but I am switching to mouth breathing throughout the night which would be enough to cause an arousal and prevent deep sleep. My machine produces a smartcode each morning that gives me the percentage of time a leak was detected, but that's never been more than 1% so I am not sure if that's an issue. Thus my predicament is that I want to tighten my chinstrap enough to really prevent mouth leaks, but I don't want to screw-up my front teeth. BTW, I have a 'clicking jaw' so likely my jaw is destabilized and that's contributing to the problem.

A few questions:

Does wearing a chinstrap cause pain in your front teeth?

How do you deal with it? (e.g. boil-n-bite mouth guard)

How tight are you wearing your chinstrap? (barely on, lips sealed/teeth not touching, lips sealed and teeth forced to touch)

[LSAT]

The solution to your problems might be trying a FF mask! That's what they were designed for.

[So Well]

The solution to your problems might be trying a FF mask! That's what they were designed for.

An Amen! back to you LSAT.

There seems to be much time and trouble invested in this forum to avoid the excellent solution of a full face mask.

Bob3000, if you can get the chinstrap to work, good for you. But realize that chinstraps just don't solve the mouthbreathing problem for the majority (my estimate) of people.

[cflame1]

Usually a 'clicking jaw' means TMJ... so the pressure from a chin strap isn't a good thing as the joints in your jaw aren't in good shape.

I'm going to agree with LSAT on this one... go with a FFM. But I'll also go one further... try one with a chin cup to remind yourself to keep your mouth shut at night.

[Ms.Snuffleupagus]

HI Bob,
Which chin strap are you using? If you are not ready to use a full face mask as yet, you may want to try a different chin strap. Some recommend the PaPcap. I myself use this chin strap:
https://www.cpap.com/productpage/deluxe ... hleak.html

I find this chin strap very comfortable, although it does cover the ears. You have to play around with how tight the strap is, so that it prevents mouth leaks but does not leave your front teeth sore. I use this one when I use my Swift fx.

As for full face masks, I really like Innomed's Hybrid mask. You may want to consider this mask at some point if you cannot find a chin strap that works.

[SoftPretzel]

Bob3000,

I have used the nasal pillows with a chin strap and experienced the mouth leak problem. Yes, the chin strap helps keep your mouth closed, but eventually your mouth is going to open at some point even with the strap.

So here's the solution I found and highly recommend:
The Mirage Liberty CPAP mask by ResMed

It has nasal pillows but also covers your mouth which will solve your hurting teeth problems. This mask is the most comfortable I've ever used. Try it!

[fidelfs]

The solution to your problems might be trying a FF mask! That's what they were designed for.

An Amen! back to you LSAT.

There seems to be much time and trouble invested in this forum to avoid the excellent solution of a full face mask.

Bob3000, if you can get the chinstrap to work, good for you. But realize that chinstraps just don't solve the mouthbreathing problem for the majority (my estimate) of people.

I think most of people trying to find a solution are the ones that cannot use a full face mask. I tried several masks and I could not have a proper seal with them. It was a lost war trying to fix it, until I used the tape and I had a proper rest night. I finally stopped mouth breathing all together, keeping my tongue up, I know that I don't keep my lips close because I drool while asleep, but a lot less that at the beginnings, but the tongue does the trick.

The chinstrap don't work for me. My jaw, teeth and face hurt while using the chinstrap, only the tape and tongue trick worked for me.

[Bob3000]

I think most of people trying to find a solution are the ones that cannot use a full face mask. I tried several masks and I could not have a proper seal with them. It was a lost war trying to fix it, until I used the tape and I had a proper rest night. I finally stopped mouth breathing all together, keeping my tongue up, I know that I don't keep my lips close because I drool while asleep, but a lot less that at the beginnings, but the tongue does the trick.

The chinstrap don't work for me. My jaw, teeth and face hurt while using the chinstrap, only the tape and tongue trick worked for me.

Pretty much this. I've tried three full-face masks and just cannot maintain a proper seal. I struggled with them for two months (Jan/Feb) until I had nasal surgery in early March so that I could finally breathe through my nose and use a nasal pillow mask. Going back to struggling with a FFM sounds like hell. Plus, the Swift FX is comfortable and I get a good seal with no struggle.

I taped a bit in March but decided to just do the chinstrap. I am going to try repositioning the chinstrap so it pulls my jaw up AND back. I know that in theory this could lead to a higher AHI but it would also mean my jaw is secured and won't fall forward and cause my front teeth to push against each other (bottom v. top). Otherwise, if I can't get this settled by the end of this week, I am shaving my goatee and trying taping again. The problems I had with taping were (1) needed to shave my whiskers, (2) don't like not being able to talk or breathe through my mouth if necessary and (3) it's possible with a taped mouth to still attempt to breathe through the tape or against it. I read on this forum a cpap'r who watched someone else sleep with a taped mouth and nasal mask and saw the person struggling to breathe through the tape while asleep. If that's what's happening, it's as bad as a hypopnea or even an apnea.

[roster]

I read on this forum a cpap'r who watched someone else sleep with a taped mouth and nasal mask and saw the person struggling to breathe through the tape while asleep. If that's what's happening, it's as bad as a hypopnea or even an apnea.

I am no longer a fan of taping, but that story you saw doesn't sound right. I did tape for six months (and wrote this viewtopic.php?t=9653&), so I have some experience.

Regarding the post you saw, when someone has open nasal passages and CPAP is holding the airway in their throat open, they will not "struggle to breathe". I would say if they could be observed struggling to breathe through their mouth (or any orifice) then their CPAP therapy was not effective and they were in apnea.

What the observer saw I don't know, but it could have been something that has been called the blowfish effect. This is when CPAP pressure backs up in the mouth and inflates the cheeks of a taped mouth. This is sometimes a side effect of taping that will interfere with sleep and has to be resolved.

I can make an argument against taping, but if you can't get the chinstrap to work, I would agree with you that taping is a good next step. Hopefully you can then get some good therapy, get more comfortable and confident with the therapy and get in better shape. Taping tided me over for six months and then I switched to a full face mask.

[Bob3000]

I can make an argument against taping, but if you can't get the chinstrap to work, I would agree with you that taping is a good next step. Hopefully you can then get some good therapy, get more comfortable and confident with the therapy and get in better shape. Taping tided me over for six months and then I switched to a full face mask.

I just ordered a Hybrid. I had one before but returned it. Now that I have fewer options, perhaps I can get it to work for me. That, or I'm throwing good money after bad...

[roster]

Bob3000,

I have used the Swift nasal pillows and would like to compare them to the Hybrid mask. I find that a properly adjusted mouth cushion on the Hybrid provides an excellent stable base for the Hybrid's nasal pillows.

Occasionally I imagine what I would do if my mouthbreathing were miracously cured. In this daydream I see myself switching back to the Swift nasal pillows, but they leak as I change positions in the bed and they rub sores on my nose. So eventually I switch back to the Hybrid and the problems disappear.

For the last 16 months I have slept almost exclusively on my tummy and switch my head from right-facing to left-facing positions a few times per night. Many would maintain that this is the most difficult position to sleep in with a CPAP mask. But the Hybrid mask works well for me in this "most difficult" position and "large leaks" are infrequent.

Here are some tips on sizing and adjusting the Hybrid mask: wiki/index.php/Hybrid_Mask_Modifications

Whatever you do, best wishes for getting a good therapy working soon.

[Ms.Snuffleupagus]

Bob, don't get discouraged if you find it hard to control the leaks at first with the Hybrid. It took me several days before I was able to get the straps adjusted just right. I am now able to use the Hybrid without any additional straps to hold the pillows in place (95% pressure 11 to 12). I do however use Padacheek strap covers for added comfort and to prevent strap marks on my face.

[Bob3000]

Thanks for the support. My Hybrid should be here tomorrow, we'll see how it goes.

[Uncle_Bob]

A few questions:

Does wearing a chinstrap cause pain in your front teeth?

Not since chaonging from a regular chin strap to the papCap. The pap cap has a wide cotton strap that sits toward the back of the throat and not cupped around your chin

http://www.pur-sleep.com/products/produ ... category=6

Also the strap is cotton and not that flexible material. I can get a nice position to support my jaw and it stops it dropping during the night causing mouth leaks.

How do you deal with it? (e.g. boil-n-bite mouth guard)

How tight are you wearing your chinstrap? (barely on, lips sealed/teeth not touching, lips sealed and teeth forced to touch)

Because the support is at the back towards the throat i can see open my teeth and drink through a straw

[roster]

Bob, don't get discouraged if you find it hard to control the leaks at first with the Hybrid. It took me several days before I was able to get the straps adjusted just right. I am now able to use the Hybrid without any additional straps to hold the pillows in place (95% pressure 11 to 12). I do however use Padacheek strap covers for added comfort and to prevent strap marks on my face.

Agreed. There is something to this that I don't fully understand. It may be a little bit like my sailing experience. I only learned to sail as an adult. I wanted to do it on my own without instruction. So I read a bunch of instruction books over and over and bought a small sailboat. My wife and I launched it one cold winter day and lines of the books were running through my head as I adjusted the tiller and the sails. We sailed quite mechanically around the bay for an hour that day without hitting anything or running aground and were at the end successful getting the boat to the landing, the sails down and folded and the boat back on the trailer.

Numerous outings thereafter were like this. Always rehearsing in my mind instructions from the books before making any moves. Everything was mechanical and thought out.

After some months I forgot what was in the books and began to sail by the seat-of-my-pants method. This meant I looked at the wind direction and speed, the waves direction and speed, the tilt of the boat and more importantly gauged the feel of the boat. I no longer thought about what needed to be adjusted. I just did it through instinct.

Learning to use the Hybrid mask seems like this. At first everything is mechanical as I strictly follow the manufactuer's recommendations to adjust the mask. After a few months I have forgotten the instructions and adjust the mask by "feel".

So like Ms.Snuffleupagus says, don't get frustrated with your mask adjustments during the early period. It will get easier with time.