Resp. Effort Related Arousals and Leaks

[~Q~]

A little background: My sleep study diagnosis was Upper Airway Resistance Syndrome. So, most of my events tend to be arousals, as opposted to OSA events.

I have been watching my RDI (similar ot AHI) average in sleephead as it relates to leaks and I'm seeing a consistent correlation. I'm using a nasal pillow mask (i.e., F&P Opus 360), so leaks can be a real issue when you open your mouth. Rarely do I get into large leak territory, but I do have arousals. Following is my sleepyhead output from last night (feeling not so good today):




I'm wondering if I need to start getting more aggressive with stopping the leaks? I did try a FFM for one night, but didn't like it. I'm wondering if I should:

a) Try taping my mouth shut of some other more aggressive action to stop the leaks;

b) Get the FFM again and try to get used to it. I only used it one night, so it is entirely possible that my dislike was because I just wasn't used to it.

Thoughts/suggestions?

Thanks

[Pugsy]

If it were me I would try to eliminate the biggest and easiest to fix possible leak factor first. Take any possible mouth breathing leaks out of the equation in the simplest way possible without introducing other leak factors or contributing to discomfort which comes with its on set of possible sleep disturbance factors.

I would tape my mouth for one night. See what happens with the leaks and the arousals.

Trying to fiddle with a FFM and its leaks is going to possible create arousals also..You won't know if the RDI is related to mask fiddling or just something that would happen at your pressures.
Take everything out of the equation that you can remove so that you can evaluate the RDI as cleanly as possible.

Easiest way is to use the mask that you sleep best with and has minimal leaks and minimal fiddling with AND tape the mouth to eliminate that possible factor in leaks. See if those leaks are mouth breathing (even low level) or at the mask level.
Then compare the reports and how you feel and decide what you want to do to address whatever you see.

[kaiasgram]

Following up on Pugsy's suggestion: There are a lot of discussions about taping and different ways people do it. Just use the search box to find some of these discussions. My taping routine evolved into something I'm pretty comfortable with. 3M micropore tape, small piece of fabric where the tape goes over your lips, and cut a safety slit through the fabric. I've been able to cough a little or release "chipmunk cheek" air without having to remove (or blow off) the tape. I pushed a paper clip through the slit for illustration purposes:

[Todzo]

First, I am suspicious that the hypocapnic excursions which happen in Upper Airway Resistance Syndrome could be mediated by EERS[1] or dynamic CO2 therapy[1]. Please bring these up in your next visit with your doctors or otherwise communicate with them concerning these.

Second, I have found that stress is the major player in my tendency to over breath and that over breathing is the major source of feeling like I need to “fight the resistance”. If you are not breathing much air resistance is not an issue. It simply does not count. Indeed, with less air passing through the airway and better metabolism resistance may well not develop. If you reduce stress there will be less tendency to over breath.

Third, anti-inflammitory foods may help keep inflammation down and so help by making for less resistance in the airway.

Fourth, breathing reflexes are involved. Time learning to breath quietly with the machine during the day may help. Time walking or cycling at fat burning, aerobic, and some at 85% of your maximum heart rate (maximum heart rate stuff only if you are in shape!) I find helps with stabilizing breathing reflexes. It is also generally good for the body.

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721