Fact or False Belief?

[LoQ]

One of the things that I have heard several RPSGT's say is that patients will stop breathing through their mouths once they get the correct pressure and can then successfully use a nasal mask. I believe the argument is that patients are opening their mouths because they can't get enough air through their noses due to OSA. One sleep lab I know only uses nasal masks.

I think the techs mostly agree that if you have nasal congestion, you will probably need a full-face mask, so let us just consider the case of no nasal congestion.

One of the points that the techs make that seems to have some validity is that they don't like full face masks because there is a tendency for a FFM to pull your lower jaw back, which could worsen apneas. That makes sense. So I would love to use a nasal mask, but I don't think there is any cpap pressure that would enable me to do that.

Here are my thoughts on this, and I'd like to hear from anyone else, on either side of the issue. I hope both patients and professionals will feel free to add to the conversation.

First, it seems unlikely to me that a correctly titrated pressure is the right pressure for you every night all night long. I admit that I don't have any evidence for this, other than a general knowledge and appreciation for the wide, wide variance of human physiology, even in the same human and even in a single night.

Second, I have observed in myself and in comments from people on the board, that many patients are opening their mouths not because they need to breathe through them, but because their jaw muscles simply relax, and the jaw naturally falls open. To believe the assertion that every patient having a patent airway will breathe through his nose means that no patients could have the problem of a jaw relaxing, causing their mouth to open.

The fact that so many sleep techs seem to believe the assertion in the first paragraph makes me wonder. Do they believe that because they see it empirically in the lab when they do titrations, or do they believe that because that is what they were taught?

I will say that in my first few nights on CPAP therapy on a nasal mask (as prescribed by the sleep study), I was waking up every time I opened my mouth because of the rush of air, and that was prompting me to close my mouth. After several nights of that, I found that I was no longer waking up because of this. I incorrectly assumed it was because I was no longer opening my mouth. What actually happened was that my brain learned to ignore the air rushing out, so I was just sleeping with my mouth open without knowing it.


I welcome alternative opinions or interpretations of the observations I have made. I would be glad to be wrong about those and find out how I could actually use a nasal mask without taping.

[trip68]

I am not sure.
Your string is a little deep for me.

I know you said "lets take nasal congestion out of the example" I have always been a mouth breather.
It is rare for me to breathe totally out of my nose. I catch myself breathing through my nose while driving, movies, etc. I am sure I shut my mouth while sleeping, if I was relaxed enough and decongested enough.

[SleepingUgly]

One sleep apnea surgeon did say to me that I open my mouth because I have sleep apnea. But I don't know why having sleep apnea would cause someone to open their mouth (although I do know why opening one's mouth could cause someone to have sleep apnea...but no one wants me to cite THAT article again! )

My perception, which may be inaccurate (after all, I'm asleep!) is that since my surgery, I keep my mouth shut more at night. I can't be sure that goes on all night, but when I wake up, I often have my mouth clamped shut. I will know soon whether I keep my mouth shut, as I am going back on CPAP to do some experimentation and I'm going to try not to use a chin strap or tape. So far for a handful of nights on 4 cm of pressure, my leaks have supposedly been OK. I would also like to not have to tape or use a chin strap, so I hope this continues.

[Julie]

Sleeping U.... you breathe through your mouth (as well as your nose) when you need more air, which is as good as reason as any for using Cpap if it's set up properly and your mouth stays closed (or you use an FF mask/tape/chin strap.

As far as the RT's go? I think they say all kinds of things, but what percentage of them are valid I'm not at all sure. Don't know what 'med' school they went to sometimes!

[Tired Linda]

One of the things that I have heard several RPSGT's say is that patients will stop breathing through their mouths once they get the correct pressure and can then successfully use a nasal mask

The RT at my DME says patients will stop breathing through their mouths once they get the right humidity. Unfortunately, I could never find that level. I draw the line before rain forest. I'm just not comfortable when it's too moist. I figure taping is the lesser of two evils.

I don't mouth breathe when I'm awake. I don't have allergies, congestion, or other nasal issues. When I fall asleep, my jaw just flops open, especially if I'm on my back.
I really don't think there is a pressure that would keep my mouth shut. Tape does. Come to think of it, I haven't noticed it as much the last few nights since I attached tennis balls to the back of my sleepshirt and can't sleep on my back.


Linda

[chunkyfrog]

My husband and I have seen (and heard) each other sleep with mouth open--gaping wide open, or a lip curled just enough to let air escape.
My brother claims to have trained his mouth to stay closed--my sister-in-law agrees. Is he the rule or the exception? I don't think the professionals really know either.

[jnk]

My understanding is that a healthy person who can get in (and out, of course) enough air through the nose will usually tend to breathe through the nose. It is also my understanding that wrong pressure or improper humidity can cause someone to open his or her mouth. Those rules of thumb can always be combined to make other anecdotal rules of thumb that may come in handy for techs and therapists in their line of work, but those very same rules of thumb may not be especially useful or even remotely applicable to a specific patient dealing with a particular problem.

So, fact or false belief? Yes. And yes.

[Bons]

I breathe through my mouth quite often when I'm awake, much to my dentist's horror. Since starting bipap, I am breathing through my nose more when I'm asleep than I do when I'm awake, I think, because I'm often breathing through my nose when I awaken during the night.

[rosacer]

I think I can say I trained my mouth to stay closed.

Before starting CPAP, I started mouth breathing. Nobody told me that but I saw the evidence on my pillow LOL, and I woke up with a very dry mouth almost every day.

When I started CPAP I was using a nasal mask and the feeling of something touching my upper lip helped me to remember to keep the mouth closed; as weird as it could sound.

Then all the sudden I started to open the mouth again while asleep, I don't know why.

I decided to try to think each night before falling asleep that I need to keep my thong against the roof of my mouth. At the same time I started taping with surgical paper tape, I did it not more than 6 times. I noticed the tape made an indentation on the sides of my mouth.

Because I don't need another wrinkle, I thought that maybe I could try to put a very small strip of tape (1/4 in X 1 in) in the front of my mouth vertically, instead of the whole tape from side to side. The idea was to send the message to my brain that my mouth was taped because it needed to stay closed.

I did it a couple of nights and continued thinking at keep the mouth shut and that worked.

Now after at least 3 or 4 months I don't open the mouth any more even if I don't use a nasal mask (I use nasal pillows which don't touch at all my face only the nostrils). Some times when the pressure goes high (I'm on
APAP now) I kept the mouth closed so hard that I woke up with a weird feeling on the front teeth due to the pressure exerted with the thong.

I think it's possible to train the brain to keep the mouth closed. For sure you need to fix any sinus congestion first.

[cobra4x4]

First, it seems unlikely to me that a correctly titrated pressure is the right pressure for you every night all night long. I admit that I don't have any evidence for this, other than a general knowledge and appreciation for the wide, wide variance of human physiology, even in the same human and even in a single night.

I'm a firm believer that you do not sleep the same every night and therefore an auto adjusting pap machine is the only way to go when setup correctly. I think that the low number should be your titrated pressure and the upper limit should be 3 or 4cm above that. To me your titrated pressure is the pressure which eliminated most events on that particular night (in my case in a hospital on an uncomfortable small bed).

I'll be requesting a new prescription soon for an Apap (S9 autoset) with a pressure range of 7cm to 11cm.

I am a lucky person in that I have and still continue to sleep with my jaws locked tight each and every night. If I open my mouth while sleeping its usually due to a dry mouth or on a rare occasion severe congestion (flu,cold or allergy).

[brain_cloud]

As a noncongested user of both a full face mask and also tape to keep from mouth breathing, I had hoped that using tape for several months would have trained me to breath through my nose. So a couple nights ago, I left off the tape. Woke up about 2:30am with an extreme dry mouth, open. The four hour AHI at the time was 4.7. Lately I usually do between 1.0 and 2.5. Guess I'll have to keep using the tape.

[JohnBFisher]

Unfortunately, over the years, I found that I went from breathing through my nose to breathing through my mouth. I mostly breathe through my nose, but my mouth does open. Taping is not an option. So, I've switched to a full face mask from nasal pillows. I would rather use nasal pillows, but they are incompatible with my machine. However, I do try to use the Innomed Liberty mask from time to time. It works fairly well, and allows me to both have my mouth open and breathe through my nose.

By the way, I've heard more than one RT note that is you have a BiPAP machine, the variance in pressure can make users breathe through their mouth. I do know that in my case, with a ASV machine, since it RAMPS up the pressure when I stop breathing, not having a full face mask would not work. Going from 10cm H2O to 25cm H2O blows out the seal on just about any mask. And it would instantly start heading out my mouth, if I just used a nasal mask.

So, I use a full face mask.

[Jersey Girl]

I am not a mouth breather and so I use nasal pillows but I do have a full face mask on hand just in case I get a really bad cold and cannot breathe through my nose. My husband has an s9 and mirage quatro ffm because his mouth DOES drop open EVERY night at some point - several times a night and his therapy would escape out of his mouth. The good news is that with this new therapy, he no longer wakes me up snoring, he no longer has tons of arousals and leg movements and we are both now sleeping soundly. I don't believe that everyone can make themselves keep their mouth shut if they normally mouth breathe during the night. A few can, but some cannot. Also, I don't think that it is a humidity issue. My husband has the climateline and has wonderful termpature and humidity and still his mouth drops open during the night!

Regards to all,

Jersey Girl

[LSAT]

I do believe that the FF mask can affect your lower jaw. My dentist told me that when we were discussing the CPAP mask. I try not to pull the lower straps too tight. I was getting some jaw clicking which he attributed to the mask. I use the FF mask because I have a tendency to leak through my mouth on exhale even though I am a nose breather. My jaw issues have subsided
at the present time. I really would hate to give up my Quattro....I find it more comfortable than my Comfort Gel Nasal Mask.

[jnk]

. . . I've heard more than one RT note that is you have a BiPAP machine, the variance in pressure can make users breathe through their mouth. . . .

Here are figures from ResMed (although I can't vouch for their grammar) that appear to confirm that observation:

•Mouth leak experience by around 40% of CPAP users
•Mouth leak experience by almost all bilevel users

http://www.resmed.com/us/patients_and_f ... c=patients

Other interesting links:

http://www.resmed.com/us/patients_and_f ... c=patients

http://www.resmed.com/au/patients_and_f ... leaks.html