Mouth puffs with nasal mask?

CatherineF · Post by **CatherineF** » Fri Jul 22, 2011 9:20 am

I don't know what should I do. I am using swift fx mask, along with chin-up strips, it manages to keep my mouth closed but there are small "puffs" of air when I exhale, it protects me from maintaining sleep and wakes me up every 10 sec :/ Everything is ok when I am trying to keep my tongue right behind my front upper teeth, but when I am falling asleep and my body relaxes, my tongue falls back and "puffing" begins. I've been trying taping my mouth along with chin-up strips, but I am salivating excessively at night and the tape drops off. Even if the tape is keeping my mouth shut this puffs are happening, or air is blowing into my cheeks with the same effect.

I've read here that it is possible to "train" the tongue to stick it behind the upper front teeth, but is this really true? Don't you have such problems?

Pugsy · Post by **Pugsy** » Fri Jul 22, 2011 10:59 am

CatherineF wrote:I've read here that it is possible to "train" the tongue to stick it behind the upper front teeth, but is this really true? Don't you have such problems?

Yes it is true. I used to have those "puffs" where my cheeks would inflate and air exits mouth. I call them chipmunk cheeks. After a couple of months of taping and tongue position practice, they went away. I never get them now. My leak rate line is well within acceptable limits and often near zero the whole night.

Bright Choice · Post by **Bright Choice** » Fri Jul 22, 2011 12:33 pm

I am a "puffer" too. Last night I tried just about every trick (chin strap, mouth strap, boil and bite, nti, & nothing) with no luck at all. I was using nasal pillows. Too much puffing. I have very diligently tried to seal off the back of my throat to no avail. I can't figure out where that air comes from but it must be from the jaw relaxing. Would a nasal mask be any better than a nasal pillow? I kind of doubt it but am looking for input. I don't know if it will ever be possible to use a nasal interface with my asv but I really want to try. Using Mirage Quattro with pretty good success but I want to get away from having so much on my face.

pugsy: If it took some months to "train" you tongue did you sleep at all during that time? I don't think I'd sleep - it just keeps waking me up.

Wish I had some suggestions. I only have questions...

Pugsy · Post by **Pugsy** » Fri Jul 22, 2011 12:36 pm

Bright Choice wrote:pugsy: If it took some months to "train" you tongue did you sleep at all during that time? I don't think I'd sleep - it just keeps waking me up.

Main training was to keep mouth shut using tape (couple of months). Chipmunk cheeks didn't happen much at all after a week or so. Tongue to roof of mouth was easy for me. I guess the cpap gods wanted to give me at least one thing that was easy.

CatherineF · Post by **CatherineF** » Fri Jul 22, 2011 1:01 pm

Bright Choice wrote:I am a "puffer" too. Last night I tried just about every trick (chin strap, mouth strap, boil and bite, nti, & nothing) with no luck at all. I was using nasal pillows. Too much puffing. I have very diligently tried to seal off the back of my throat to no avail. I can't figure out where that air comes from but it must be from the jaw relaxing. Would a nasal mask be any better than a nasal pillow? I kind of doubt it but am looking for input. I don't know if it will ever be possible to use a nasal interface with my asv but I really want to try. Using Mirage Quattro with pretty good success but I want to get away from having so much on my face.

At least mirage quattro works for you... For me this FFM is leaking in the area of my chin, I have deep bite and retruded mandible (not so much retruded though :/) and it seems that quattro leaks when my jaw is relaxed and falls back. Uhhh this mask struggling issues are killing me. Like OSA/UARS wouldn't be enough haha Today I will tape myself totally, maybe it will stick for few hours and I won't drown in my saliva...

Bright Choice · Post by **Bright Choice** » Fri Jul 22, 2011 2:21 pm

CatherineF wrote: At least mirage quattro works for you... For me this FFM is leaking in the area of my chin, I have deep bite and retruded mandible (not so much retruded though :/) and it seems that quattro leaks when my jaw is relaxed and falls back. Uhhh this mask struggling issues are killing me. Like OSA/UARS wouldn't be enough haha Today I will tape myself totally, maybe it will stick for few hours and I won't drown in my saliva...

Oh boy, yes, it is always something

What do you use for a chin strap? I have had good success with a home made strap made out of 24" of ace "self adhering" bandage. I wrap it around my head (top of head to chin) twice and then secure the loose ends with a safety pin. I wear the safety pin on the top so that it doesn't create pressure on my cheeks. It is quite snug and really stays in place. I don't know if that would help keep your jaw in place.

Then there is a modification (if you are using nasal pillow / mask). Take the top loop and pull it up over your mouth to keep your lips sealed.

When I taped, I used 3M microfoam tape which really was quite good. It is a surgical / wound tape and stays on really well and comes off easily. It is not the 3M micropore tape that you find in drug / grocery stores. I got it from Amazon. I drool a lot when taping so that's not a hot item for me right now. Putting the ace over my mouth is ok, it absorbs some moisture.

There is also the antileak strap from padacheek for use with the Quattro. Have you tried that? Many swear by it. It creates downward pressure right at the hose elbow. http://padacheek.com/PAC_AntiLeak_Strap.html. I bought this but have used it only one night. It slipped off the back of my head. There is a piece of velcro on the back to help it stay in place so maybe I need to experiment with this again. I also did yet another modification with the "ace" and slipped the upper loop over the elbow. That worked pretty good too. If your jaw retreats maybe this would help snug things up.

I guess I am just frustrated with the whole mask business too. Things were going pretty well with the quattro, ace and padacheek modification and then I thought I'd try to see if I could get the nasal pillows to work and I made a mess of things last night.

Maybe you have tried all of this stuff - let me know what else you come up with.

Good luck!

BlackSpinner · Post by **BlackSpinner** » Fri Jul 22, 2011 3:47 pm

I found the hybrid fit to my face better and the chin flap keeps my jaw from falling open and out of the mask.

Bright Choice · Post by **Bright Choice** » Fri Jul 22, 2011 6:05 pm

BlackSpinner wrote:I found the hybrid fit to my face better and the chin flap keeps my jaw from falling open and out of the mask.

Thanks. That may be my next trial. How about you catherinef?

Any reason to think that I would not have puffer cheeks with a nasal mask instead of pillows. Seems like it would be just as bad but I thought I'd ask.

CatherineF · Post by **CatherineF** » Sat Jul 23, 2011 6:07 am

I am from Europe and don't have access to this straps you mentioned BrightChoice. I am paying from everything out of my pocket, my insurance doesn't cover anything and I am simply mad that I have to spend so much money on those things, besides I am not so rich yet because I am 22. I am new to those CPAP issues also.

At home I have two masks: swift fx and mirage quattro. Quattro leaks with higher pressures (I need 13 and to eliminate UARS i suppose it should be higher like 14-15cm), it is better when I sleep on my side without moving, I need less pressure. But it is hard. Anyway it is way easier for me to fall asleep with FFM (am I crazy?) than with swift fx. With swift I can barely fall asleep and I am using only chin-up strip, sometimes along with 3m tape. I don't use any chinstrap. I think those strips are enough, my mouth is shut.

I have bigger problems with those little puffs coming out through my lips than hamster cheeks. It wakes me up every 10 sec, so if my UARS wakes me up say every 20-30sec it is even worst and more harmful to sleep with CPAP! It is quite weird that it wakes me up, because my grandmom have those puffs even without CPAP and she is still sleeping while having them. Maybe I will get used to it?

Hmmm I have a theory that it is easier to get used to sleeping with nasal mask without having puffs if someone has wider upper jaw, with wide front part of the jaw. The tongue can stick right behind them more easily. I don't have wide enough arch so it is harder. I am considering orthodontic treatment with DNA appliance or Homeoblock to widen my palate, but isn't it another crap? It is quite new and I don't know if it really works...

And maybe I will try a hybrid too...

BrightChoice I see you are using an ASV, does FFM jumps on your face? When I am using EPR it jumps like crazy and leaks more, so EPR is only possible for me to use with swift and swift is not a good option because of the above etc.... EHHH

Bright Choice · Post by **Bright Choice** » Sun Jul 24, 2011 3:05 pm

CatherineF wrote:Hmmm I have a theory that it is easier to get used to sleeping with nasal mask without having puffs if someone has wider upper jaw, with wide front part of the jaw. The tongue can stick right behind them more easily. I don't have wide enough arch so it is harder. I am considering orthodontic treatment with DNA appliance or Homeoblock to widen my palate, but isn't it another crap? It is quite new and I don't know if it really works...

That's a great observation CatherineF! I'll bet that's what's going on with me. As hard as I try to block off the airway in the back of my mouth it just doesn't work. I'll bet it is a problem of sizing of tongue and upper jaw.

And maybe I will try a hybrid too...

I think that I am going to try that route too. I am currently doing pretty good with M Quattro and a chin strap. It is the "ace" solution I have mentioned before. Now I put it on after I put the mask on and pull a bit of it up onto the mask. Leaks zero last night. Without the chin strap my jaw drops and it gives me aerophagia. So, maybe the hybrid will help that. I really hate the dents the Quattro puts into my cheeks. I thought that if I alternated it with a hybrid the dents might have a chance to fill out.

BrightChoice I see you are using an ASV, does FFM jumps on your face? When I am using EPR it jumps like crazy and leaks more, so EPR is only possible for me to use with swift and swift is not a good option because of the above etc.... EHHH

The Quattro FX jumps around like crazy. I absolutely could not get it to work. The M Quattro does not seem to do that. I am using Remzzz - perhaps that helps with the prevent the "jumping" and leaking. Yes, my pressures are higher with the ASV and I have had to give up on Swift LT and FX - much to my disappointment! When I was using the S9 autoset in cpap mode, I did use EPR and liked it. I didn't have jumping then but pressure was low at 7.

shooter · Post by **shooter** » Sun Jul 24, 2011 3:53 pm

I struggled with the same problem. I tried different masks. I tried tape. The puffing cheeks would wake me even though I had solved the leak problems with varying degrees of success. Then I learned about someone's experimentation with a DIY mouth appliance made from an athletic mouth guard and I began to experiment.
<< http://www.talkaboutsleep.com/message-b ... php?t=4750 >>
I made two or three mouth pieces from the "boil and byte" mouth guards and had excellent results though I was never really happy with the home made mouth appliance. I discussed this with my dentist and he agreed to make a professional one for me. It fits like an orthodontic retainer and provides a comfortable resting place for my tongue behind my upper front teeth. I have been using this for almost two years now and usually always have zero leaks. I never have puffed cheeks, and never use tape any more. The only time I have leaks is when I roll over and sleep on my mask which pushes it off. My pressure is 12 and my typical AI is zero. When its not zero it is .1 or .2
Hope this helps.

Need a nap · Post by **Need a nap** » Sun Jul 24, 2011 4:59 pm

I have just started using a CPAP nasal pillow mask machine, and I have found that while I don't mind the nasal pillows, I am also getting air pushed out of my lips (sometimes forcefully) and my cheeks puff out. I have used a headband around my bottom lip, which increased the cheek puffing and didn't entirely eliminate the air from coming out my lips. I wasn't a mouth breather before the CPAP machine unless I slept on my back (I generally sleep on my side.) How can you tell if you have too much pressure vs. needing a different type of mask? I don't think I can tolerate the full face mask (claustrophobic.)

DaveL · Post by **DaveL** » Mon Jul 25, 2011 10:04 am

Incredible thread...want to keep an eye on it. I'm suffering with mask replacement so all your help does count.

Getting crankier ....

DaveL

Resister · Post by **Resister** » Mon Jul 25, 2011 11:31 am

I'm keeping an eye on this thread too! Mouth puffs keep me awake constantly.

Breathe Jimbo · Post by **Breathe Jimbo** » Mon Jul 25, 2011 11:56 am

I found that lower my pressure a little eliminated the puffs. However, my numbers were low and stayed low with the lower pressure. This option may not work if your numbers are high or increase with lower pressure.

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