Correlation between Leaks & AHI?

[NateS]

My AHI has been good since starting VPAP a year ago.
But I have not been satisfied with my leaks since noticing mouth-breathing about a couple weeks ago, so I have begun using chin-up tapes after first trying taping over my mouth and not liking the resultant sense of panic.
With the chin-up strips in place, I do not feel panic, and my leaks stay impressively below the ResMed red line.

However, I tend to have a few red apnea signposts appearing on the chart now, instead of just a few hypopnea blue blobs. My AHI last night was 2.3. For the last 7 days it averaged 1.2. Before the taping or chin-ups it was usually under 1.0.

So I am wondering whether the use of chin-up strips and/or taping is causing an increase in AHI, or whether reducing the leaks is simply giving me more accurate AHI reporting.

Any seasoned opinions on this would be welcomed.

Thanks, Nate

[Pugsy]

If your leaks are below the red line then it is unlikely that the machine was missing some events.
From what I can tell the leaks need to be above 50 L/min before the machine has total loss of ability to flag events...normally they are flagged yellow as unknown before the leaks are so bad it misses the event entirely.
See my "Really really bad leak" thread I started today. Massive leaks from last night and the machine was able to flag them.

The variation you are seeing in AHI could just be a part of the normal varying that we see from time to time.
Some nights my AHI is below 1.0 and might stay there for a long time then I will have some AHI nights of 2 or 3 and not change anything. It happens sometimes.

[Kitatonic]

If your ResMed leak is under 24, or the real expert Pugsy suspects even higher, the AHI should still be accurate. I share your leak concern, so I taped my mouth for a few weeks, then months later, under the chin and around the mouth for a few weeks. Although both taping mouth and the chin cut my leak down and the AHI remained low, I feel more refreshed in the morning if I don't tape and mouth breath a bit. Could having tape on be causing central arousals hence the higher AHI? Maybe you could post your data of the event breakdowns and leak numbers for the experts.

[NateS]

If your ResMed leak is under 24, or the real expert Pugsy suspects even higher, the AHI should still be accurate. I share your leak concern, so I taped my mouth for a few weeks, then months later, under the chin and around the mouth for a few weeks. Although both taping mouth and the chin cut my leak down and the AHI remained low, I feel more refreshed in the morning if I don't tape and mouth breath a bit. Could having tape on be causing central arousals hence the higher AHI? Maybe you could post your data of the event breakdowns and leak numbers for the experts.

Okay a quick chart extract:



Does this add more info to the picture?

Nate

PS to Pugsy: As you suggested, I am also looking up and reading your other thread. Many thanks.

[Pugsy]

The difference between an overall average of 1.0 or less and 1.2 is really insignificant in the grand scheme of things.
Likewise an AHI of 2.3 last night could just be a normal night to night variance.
If your leaks in the past, with the slightly lower AHI, were not hugely different than your leak line from last night I doubt the machine was missing events and maybe giving you a slightly false lower overall average.
Barely going above 24 L/min for very short periods of time isn't going to allow a truck load of events to pop up and be totally ignored by the machine.

Do you think that you feel different with an AHI of 2.3 vs the less than 1.0? Or are you just number watching?

[NateS]

Do you think that you feel different with an AHI of 2.3 vs the less than 1.0? Or are you just number watching?

My concern started when the dry mouth started. Starting somewhere over the last month or two, I have begun waking up about three (3) times a night with a very dry mouth, which was uncomfortable enough that each time I had to take a sugarless lozenge and suck on it in order to get a sufficiently comfortable "mouth-moisture level" needed to fall back asleep.

I happened to have a scheduled dentist appointment and I discussed it with him and he cautioned me that untreated dry mouth can cause gum problems for me in the future, which I also substantiated on the 'net, e.g.

Besides causing the aggravating symptoms mentioned above, dry mouth also increases a person's risk of gingivitis (gum disease), tooth decay, and mouth infections, such as thrush.

http://www.webmd.com/oral-health/guide/ ... -dry-mouth

That is why I have tried taping, which I didn't like, and now chin-up strips which are also a nuisance because of my mustache and beard but at least do not make me feel like I'm a bank robbery hostage. Before trying these remedies, I replaced my Ruby chinstrap because I thought maybe it had stretched out, but the new one of the exact same size also is allowing mouth-breathing. (I like the Ruby because it does not slip around like conventional chin straps, and stays put very much in the same manner that papcap users describe, but with less bulk. But it no longer seems to be keeping my mouth shut when used alone.)

So, to answer your question, the higher AHi numbers are not affecting my daytime comfort level and sense of feeling well-rested, but the mouth-breathing and resultant nighttime dry mouth is interrupting my sleep, and causing me concerns about maintaining my present dental health.

Regards, Nate

PS - Last night, my AHI was 1.7 and my 95% leak rate was 7.2. Despite the chin-up strip, I was awakened 3 times again with dry mouth.

[Pugsy]

the higher AHi numbers are not affecting my daytime comfort level and sense of feeling well-rested, but the mouth-breathing and resultant nighttime dry mouth is interrupting my sleep, and causing me concerns about maintaining my present dental health.

Okay, that makes sense. Not so much the AHI but the leaks (which might be mouth breathing) and dry mouth and sleep disturbances and possible dental issues.

Only surefire way to guarantee zero mouth breathing would be tape and have it undisturbed the next morning.
I can speak from personal experience that it doesn't always take a lot of mouth breathing to dry the mouth out. I have woke up with super dry mouth and my mouth is open yet when I go look at the reports I might just barely have a little blip of an increase in leak...barely worth looking at like maybe 5 L/min above flat line of 0.0 and maybe 10 minutes.
It doesn't always mean massive prolonged mouth breathing resulting with a leak well into large leak territory.

You will just need to try to isolate what gives you the best results that meets your needs and see if any compromises are needed.
Taping has it's own potential issues.
Full face masks won't eliminate dry mouth which is a main concern for you.
Just about anything you do or don't do has the potential to disturb sleep. Damned if you do and damned if you don't.

Have you tried any of the Biotene products?

[NateS]

Have you tried any of the Biotene products?

Not yet, but that's an excellent suggestion!

Nate

[idamtnboy]

So I am wondering whether the use of chin-up strips and/or taping is causing an increase in AHI, or whether reducing the leaks is simply giving me more accurate AHI reporting.

Any seasoned opinions on this would be welcomed.

Thanks, Nate

I charted several months worth of CAI and OAI numbers vs. leak rate back in April 2011. There was no correlation at all between AI and leakage.

[Kitatonic]

My reply was after Pugsy's since I was looking up my AHI while I was taping.

A previous post recommended the Biotene gel---is this it?
http://www.amazon.com/gp/product/B005OZ ... 02_s00_i00
or would the Biotene mouthwash do as well?

Since CPAP, my mouth exfoliates mucous wads (not my tongue) the next morning. I've changed away from the alcohol mouthwashes, as my hygienist thinks they are drying, to Pro-Health mouthwash and toothpaste. This exfoliation is probably from dryness, so I should add the Biotene.

[NateS]

A previous post recommended the Biotene gel---is this it?
http://www.amazon.com/gp/product/B005OZ ... 02_s00_i00

Not exactly. That link leads me to:

Pearl Izumi Women's Symphony Knicker

Nate

[Kitatonic]

Guess you were not interested in wearing knickers! My apologies---I ordered those knickers last week.
Here's the Biotene:
http://www.amazon.com/Biotene-Mint-Toot ... KNWC071AL8

[Bobby269]

Here in San Antonio Wal Mart has the best price for Biotene.

[helpmesleep66]

Not sure if this is relevent or not. Do you breathe easily through your nose during the day? If not that maybe the reason you are opening and breathing throught your mouth causing a dry mouth. I wa son a CPAP 8 years before a friend told me to goto an ENT doctor and see if I had enlarged Terminates. Terminates are a part of your nose that sometimes enlarge and prevent easily breathing through your nose. I was a mouth breather for years. In 2 months by using an inhaler I could easily breathe through my nose and did a whole lot beather with the CPAP equipment. My sleep apea doctors never said a word about my breathing. Hope this will help some people.

[NateS]

Not sure if this is relevent or not. Do you breathe easily through your nose during the day? If not that maybe the reason you are opening and breathing throught your mouth causing a dry mouth. I wa son a CPAP 8 years before a friend told me to goto an ENT doctor and see if I had enlarged Terminates. Terminates are a part of your nose that sometimes enlarge and prevent easily breathing through your nose. I was a mouth breather for years. In 2 months by using an inhaler I could easily breathe through my nose and did a whole lot beather with the CPAP equipment. My sleep apea doctors never said a word about my breathing. Hope this will help some people.

Thank you very much for your thoughtful suggestion. In my case, however I do breathe very easily and well through my nose, except perhaps when I have a very bad cold. But I rarely have colds since going on VPAP.

Best wishes,

Nate