Air blowing out of mouth when pressure ramps up

[Apneanderthal]

Hi all,

I've been on ASV for two weeks now. So far I'm getting pretty comfortable and feel much better during the day than I did a couple weeks ago. It is obvious that when I'm sleeping, I'm getting MUCH higher quality sleep than I was before.

But with that said, I still wake up a lot. Several times an hour. Sometimes it is just general discomfort, such as my hips hurting from spending too much time on my side. I was a stomach sleeper before, and this is taking some adjusting to. I know that will go away with time.

The thing that wakes me up most is when the pressure ramps way up in response to a central apnea. I use a Swift FX nasal pillows mask, and find it very comfortable. I'm not a mouth breather, and keep my mouth shut pretty tight. But when the pressure gets into the 20+ cm range, it forces my mouth open and the air comes shooting out. My teeth are clenched, but my lips blow open in a sort of "burp". This seems to wake me right up every time, in a startling way. I keep my tongue pretty tight to the roof of my mouth to keep it cut off, but once I fall asleep it relaxes allowing this to happen.

So the question is, does anyone else have this problem? Did it go away with time? Do I need to consider a full face mask so that the pressure is equalized between my mouth and nose? If I could solve this problem, I think my nights would be much better.

Thanks in advance for any advice!

[Pugsy]

Your tongue needs to learn to stay in place and block that air from trying to exit the airway via the mouth.
What you are describing is a common problem. We call it chipmunk cheeks because normally the cheeks inflate before the mouth gets forced open.
The tongue does a great job while awake...needs to stay planted in the roof of the mouth to block that door but when we sleep sometimes it gets lazy and opens the door.
Practice keeping your tongue in the roof of your mouth every chance to think of it so that it sort of becomes a habit for the tongue to stay there. It may take some time.
The other alternative is of course to get yourself a full face mask so that even the mouth comes open no pressure is lost but did you know that you still may have the awakenings when the chipmunk cheek things happen. Full face won't stop that part of the air entering the mouth. All a full face mask does is prevent loss of therapy pressure when you do open your mouth...so it might not stop the awakening thing.

[john5757]

I was under the impression that you can not use a pillow mask with a AVS machine due to large pressure swings to resolve centrals and you will loose the tongue seal.

[Apneanderthal]

Thanks for the responses.

I was under the impression that you can not use a pillow mask with a AVS machine due to large pressure swings to resolve centrals and you will loose the tongue seal.

John, this got me searching the internet, and it looks like this used to be the case, but not any more. It was due to technical issues with the masks, not the "chipmunks cheeks".

With that said, I'll see if I can train my tongue to behave. If not, maybe a full face mask is in order. Or perhaps a hybrid, which I just discovered. That might be the ticket.

Thanks!

[tomma]

I'm also an ASV user, I had the same issue a while back. When my pressure would get really high the air would kind of putter out of the corner of my closed my mouth. This is what worked for me:

viewtopic/t53666/Controlling-mouth-leak ... -glue.html

I've been using that same setup for months and months and now and it's been working fine. Might be worth a try.

[jamiswolf]

Apneanderthal,
I think this is something you need to talk over with your RT. Even if you are a hands-on user that doesn't mind experimentation. I have centrals...almost 50% of my apneas. I currently use a BiPap ST though I recently purchased a used autosv advanced which I may transition to.

It's my understanding that the asv or st pulses used to treat centrals are merely to trigger your body to breathe and not to breathe for you. My ST central pulses are not adjustable but also they are not super strong pulses. They seem to do the job yet don't awaken me.

Now this is where my knowledge is a little iffy. If the maximum pulse is too high, and you experience these heroic pressures that leak and awaken you...I believe that can be adjusted. I'm thinking the PS (pressure support) setting is tied into this.

But like I said, unless you know your machine inside and out...consult with RT.
J

I

[TahoeGal]

I am a new xpap user (2 mos) and have central apnea. I use an asv machine, with max pressure at 25. My DME started me using pillows. He gave me 4 types of pillows and 1 nasal mask. They all leaked unless I had them very tight against my face. I also had the " lip flapping " problem, even if I was awake and had my teeth clenched together. I also had aerophagia.
Because of advice I got here, I got a full face mask. The DME was reluctant to give me a FFM, but I insisted. That solved not only my mask leaks ( I still need to wear it tight) but also the lip flapping and aerophagia.
I sleep much better. I only awake 3 or so times per night, with only one to go to the bathroom. On my sleep study, I had 18 awakenings in the 5.5 hours I slept. I feel much better. I love mt asv machine. Once I'm asleep, the breathing feels very natural. When I awake I'm very comfortable. I am surprised that the machine reacts to my breathing when I awake- I guess I still have periodic breathing. Good luck with the masks. I haven't found the "one", but because of the pressure points I am currently cycling between 2 FFM masks to avoid the sore spots and possible sores.
TahoeGal

[Apneanderthal]

Thanks for the responses all. I have an appointment with the sleep center in a couple weeks and I will mention this to them. In the meantime, the solution offered by tomma seems to work, at least for the limited trial so far. I got an ACE bandage and sewed a band out of it and that seems to have worked. I'll know in a couple nights. Last night I only got about 30 minutes on the PAP because of nasal congestion. But it did seem to work.

I'm also an ASV user, I had the same issue a while back. When my pressure would get really high the air would kind of putter out of the corner of my closed my mouth. This is what worked for me:

viewtopic/t53666/Controlling-mouth-leak ... -glue.html

I've been using that same setup for months and months and now and it's been working fine. Might be worth a try.