TapPap...questions

[Tigerlily]

I've been using my TapPap for a few weeks now. A couple of questions....

My #'s aren't as good as they were with my ill-fitting nasal mask. So, I'm a bit discouraged by that. Do you all have advice for how I could improve them?

Also - I'm sometimes mouth breathe - last night it woke up hubby and me. And....I taped! It's hard to tape using that mask, but I taped on each corner. It didn't stop me from opening though and air coming out.

Would the chinstrap for TapPap be effective - anyone here use it with success?

I haven't tried re-boiling and re-fitting yet, but I think my fit is just a bit too snug. But, I plan on trying that and hopefully it will be more comfortable.

[pianokay]

When I started using the tap pap pillows consistently (about 4 weeks ago) I had similar results, in that my numbers weren't as good as they had been with my nasal mask. The numbers are getting better for me. I refit my mouthpiece a couple of times, but what really helps me is to run it under hot tap water for a few seconds before I put it in, and it feels much better. The first few nights I didn't know how I could ever adjust to the mouthpiece, but now everything is beginning to feel like it "belongs". The last few nights my leaks have been getting higher than I would like, and I really don't know why, but my AHI last night was at 1.0 which isn't bad. I had lots of leaks with my nasal mask, and the nasal pillows are working much better for me, and no leak there. Just can't figure out when I am leaking from my mouth as I'm not ever aware of it. I usually will cough 2-3 times in the first 15 minutes I put it on and know I open my lips slightly sometimes. But, in general it is feeling more natural and almost getting to the point it feels "soothing" to me. Just give it some more time and be sure to run mouthpiece under hot water for a few seconds before inserting. Good luck.

[Pugsy]

My #'s aren't as good as they were with my ill-fitting nasal mask. So, I'm a bit discouraged by that. Do you all have advice for how I could improve them?

What kind of numbers are we talking about here? Not just the overall AHI but the break down into each category?
Was the ill fitting mask leaking so bad that maybe it was missing some events at times and thus giving a maybe false low AHI?
Remember...we can't do much about centrals and if the bulk of the difference is central in nature...can't do anything and wouldn't want to unless they were horrible 1 or 2 difference per hour is statistically insignificant.

Would the chinstrap for TapPap be effective - anyone here use it with success?

I don't remember seeing anyone comment about using the chin strap except the guy in New Zealand and I think he is on a holiday right now.

How much mouth breathing leak are we being worried about? Does it wake you up? Do you spend much time in large leak?
I mouth breathe sometimes...I know it as sure as I know my own name but it rarely is a problem so I don't worry about trying to fix it. Maybe 10 minutes in large leak territory...most of the time short segments of mouth breathing (probably when I am on my back) below large leak territory and I never know it till I see the report.
So just how "bad" is it? Is it a problem or are you striving for a perfectly flat leak line?

If it's excessive and prolonged enough to negatively impact therapy or you wake up often from it..then we would of course want to fix it but if it is minimal and doesn't disturb sleep then maybe it isn't worth worrying about.

You could try a cheap chin strap to see if it would help (like just use an ace wrap) but I know from past experience that unless the chin strap is like a vise it won't stop the lips from parting just a little. Wearing a vise is much more trouble than allowing a little minor parting of the lips to happen.

So...just how badly are you mouth breathing and does it wake you up?

[khauser]

When I started using the tap pap pillows consistently (about 4 weeks ago) I had similar results, in that my numbers weren't as good as they had been with my nasal mask. The numbers are getting better for me. I refit my mouthpiece a couple of times, but what really helps me is to run it under hot tap water for a few seconds before I put it in, and it feels much better. The first few nights I didn't know how I could ever adjust to the mouthpiece, but now everything is beginning to feel like it "belongs". The last few nights my leaks have been getting higher than I would like, and I really don't know why, but my AHI last night was at 1.0 which isn't bad. I had lots of leaks with my nasal mask, and the nasal pillows are working much better for me, and no leak there. Just can't figure out when I am leaking from my mouth as I'm not ever aware of it. I usually will cough 2-3 times in the first 15 minutes I put it on and know I open my lips slightly sometimes. But, in general it is feeling more natural and almost getting to the point it feels "soothing" to me. Just give it some more time and be sure to run mouthpiece under hot water for a few seconds before inserting. Good luck.

In what way are you noticing the leaks? Is it waking you up? Or are you just noticing it in the data? If it doesn't bother you and it's not a huge leak, ignore it! I go to sleep each night leak free but seem to always have a bit of a leak by morning, but never enough to matter. I don't feel it except on a hand or arm that happens to get in the way. (I hate when that happens though because once I am aware of it I seem to tunnel-think about it.)

For the OP: In what way and to what degree did the numbers change?

[Tigerlily]

Later tonight or tomorrow when I have more time I will gather comparison info for you guys, but last night was one of my worst yet with TapPap. I mouth breathed again, it did wake me at times and my mouth was very dry. Here are last nights charts.

[Pugsy]

You had enough clustering of OSs that you might also have had needed to mouth breathe which might also lead to more dry mouth and more general mouth discomfort. In terms of size of the mouth breathing leak....it isn't horrible by any means.
The worst it ever got to was that one spike up around 80 L/min.

If you never go above 80 L/min for very long then that isn't enough leak to negatively impact therapy all that much (if any).

You had events show up even when there wasn't any leak. Looks to me like the minimum pressure is not quite able to do the best job. Maybe you are sleeping on your back more..maybe some REM stage sleep.

If this was a random fluke.. I wouldn't do anything but if I saw this night after night then I might think about just a little more minimum pressure. Speaking in terms of pressure and events only no matter which mask.

Now in regards to mouth breathing...and it waking you up...that of course we don't want because it is disturbing your sleep.
Now maybe it is some of the events that are also behind some of the arousals. There's enough of them in clusters that they could be a factor.

So I guess you have 2 choices...try a little more pressure with and/or without some sort of chin strap.
Or try just adding a chin strap of sorts now to see if it helps.

[Tigerlily]

I've been playing around with pressure since I got the machine.

I actually had increased it last night from 11.5 to 12. And I increased the top from 14.5 to 15. Do you think the top pressure is enough? It spent some time up there at the limit.

It's just crazy to me that I need almost double the pressure of what I needed at my sleep test and my prescription (7). I still don't get that.

You had enough clustering of OSs that you might also have had needed to mouth breathe which might also lead to more dry mouth and more general mouth discomfort.

By that do you mean that I might need to use a FFM and that TapPap might not be the mask for me?

I originally thought I would need a FFM and that pillows wouldn't work for me, but I couldn't wear the Quattro and I have some issues with the Mirage Liberty, but can tolerate it ok.

[Pugsy]

By that do you mean that I might need to use a FFM and that TapPap might not be the mask for me?

No, no...not at all. I was meaning that maybe it was the events themselves causing the mouth to open.
You know...a few events close together causing maybe a little shortage of air and the body says "whoa, gotta open my mouth and get some air moving".

I did that a lot before cpap therapy. It was the sleep apnea and lack of air that was causing me to open my mouth all night long.
Now I still do a little because of habit but it rarely amounts to much so I ignore it.

Whatever mouth breathing you are doing...it isn't much..you don't get to large leak territory and even when you get close you don't stay there long.
It takes very little mouth breathing to dry the mouth out. I know I have woke up with desert mouth and go check my leak graphs and not even see a little blip to indicate bad mouth breathing. So I either was only doing just a little bit or it sure didn't last very long because the mouth was really dry.
Not all dry mouth equals massive mouth breathing. I have a report where I flagged specifically for a time frame when I know for sure I as doing some mouth breathing because I woke up with lips slightly open and mouth breathing....so I lay there and continued for about 20 minutes before I finally just turned the machine off and got up because it was morning anyway. I looked at the leak line during that time frame and if I hadn't known for sure I was mouth breathing I wouldn't have spotted it. See the circled area? I was awake mouth breathing with lips barely parted..nice slow even breaths...but I had massive dry mouth.

Oh...you can easily see the other mouth breathing too. 30 minutes skirting the 24 L/min line where with this machine the S9...large leak territory begins. I slept right through that one. I am not going to wear a chin strap or use a full face mask to try to fix that. It ain't going to happen..not worth the aggravation.