Mouth Breathing?

[pdeli]

I just searched for the subject of "mouth Breathing" and got 14,400 references. Reading all of those will not be part of what I want to do for the rest of the day.

Here's my question: is there not a distinction between "Mouth Breathing" and "Exhaling through the Mouth"? No inhale, just exhale.

The pressure from the Nasal Mask can sometimes force air OUT of my mouth, and without getting into a debate about tape, it will sometimes force the air out of any small exit if the tape was not quite long enough. My major complaint is not so much that my throat opened to let air into my mouth, but that it wakes me up. The second major complaint is dry mouth.

[Wulfman...]

I just searched for the subject of "mouth Breathing" and got 14,400 references. Reading all of those will not be part of what I want to do for the rest of the day.

Here's my question: is there not a distinction between "Mouth Breathing" and "Exhaling through the Mouth"? No inhale, just exhale.

The pressure from the Nasal Mask can sometimes force air OUT of my mouth, and without getting into a debate about tape, it will sometimes force the air out of any small exit if the tape was not quite long enough. My major complaint is not so much that my throat opened to let air into my mouth, but that it wakes me up. The second major complaint is dry mouth.

Of course. One is called "mouth-breathing" (self-explanatory) and the other is called "mouth-leaking" (losing your therapy air).
Both can be detrimental to therapy (with a nasal mask) and both usually result in "dry mouth". Even with a full-face mask, you can have dry mouth from mouth-breathing, but the therapy is still pretty much intact.


Den

.

[Pugsy]

No distinction that I am aware of.
If air pressure is exiting the mouth...it's exiting the mouth whether you are inhaling after the exit or not.

"Mouth breathing" is sort of a catch all term. I guess we could also use "mouth leaking".

The tongue needs to keep the backdoor to the airway shut so that air won't try to exit the airway prematurely at the first opening it sees which is the oral cavity.

Since you say it wakes you up...it's disturbing sleep and needs to be fixed.
Dry mouth... most often in relation to cpap therapy simply means some air is passing through the mouth...it takes very little air going through the mouth to dry out the oral mucosa. For some people as little as 5 minutes of this air moving through the mouth.
And just exiting the mouth could be enough air movement doesn't have to include the inhale/exhale exchange.

If this "exiting" of the air wasn't waking you up..and if you looked on the leak graphs and you weren't seeing big prolonged leaks then I would just suggest letting it go. I know that sometimes I do some actual mouth breathing where I inhale and exhale and get a bit of dry mouth and when I look on the software reports in the time where I woke up with mouth open...I either don't hit large leak territory or I can't even find a leak that might be from the mouth breathing/leaking during that time frame. I normally sleep right through any mouth breathing/leaking episodes and only know about them when I see a bit of leak on my reports.

Using a full face mask doesn't guarantee fixing the dry mouth issue though.

[pdeli]

Thanks for the input.

I've looked at the leak graphs on Sleepyhead, but quite frankly I don't know what I'm looking at. I've also read your tutorial, but I'm still a bit confused.

My AHI is pretty much <1.0, and over the last two weeks my leak graphs have been under 20 on the bottom line and <50 on the total leak line (although SH Statistics will sometime show slightly higher total numbers). My most recent settings are EPAP 5.5, IPAP 9.5, PS 4.0.

Although I think my numbers aren't bad, I've previously had mild gingivitis, and I know that dry mouth can lead to both gum disease and tooth decay. At this point my plan is to tape my mouth as I try to program my tongue to stay up where I put it. Even the waking up is generally once, maybe twice a night, but I go right back to sleep and get a minimum of 8 hours.

Although I'm pretty energized all day, getting up is pretty problematic (Bedroom TV), and sometimes can take a couple of hours including email responses. One problem is that I'm retired so pretty much everything is deferrable. Next week my wife will be recovering from hip surgery so I'll a good chance to find out if I'm really tired or just lazy.

Phil

[Pugsy]

Total leak (top line in SleepyHead)...large leak territory is up around 80 to 90 L/min depending on pressure used and the machine that is used. Remember that total leak number includes the mask's intended vent rate.
If your leak line on your graph stays below that large leak territory number then leaks aren't going to impact therapy itself as the machine does a good job compensating.

Now if leaks wake a person up or the mouth breathing or leaking or whatever is waking a person up and disturbing sleep then we want to try to fix it if we can but because it is affecting sleep quality and not therapy.

[apw5746]

Just got back from visiting my local DME (LINCARE). They read my ResMed smart card, and confirmed what I already knew. Besides being incontinent which leads to leaks (not good), due to the fact I'm a mouth breather, I also leak, again not good Although this time it's air Unfortunately, I can't use Pugsy's trick of blocking off the leak with my tongue as I've had UPPP and lots of soft tissue removed from the back of the mouth. My only alternative is to go to a FFM. Has anyone tried this? http://1800cpap.com/respcare-hybrid-ful ... MgodOXwAuQ.

I'm due for a mask replacement towards the end of next month. Currently I use the ResMed Swift FX pillow with head strap, but it appears this is the only solution I might be able to tolerate. Only draw back is that I currently have facial hair, to include a mustache, and this hybrid just might not seal properly. In fact I don't remember any FFM that worked well, and didn't leak, with facial hair.

Pat

[Julie]

A couple of men with beards have had luck with the Forma mask...

[apw5746]

A couple of men with beards have had luck with the Forma mask...

That mask has some serious issues going on. Namely it looks as though it would rub on the forehead and bridge of the nose. It looks like I've got to make the tough decision, shave, and forget I've worn the thing for 50 years. I also wear glasses, so I can't give up everything.

[Pugsy]

Unfortunately, I can't use Pugsy's trick of blocking off the leak with my tongue as I've had UPPP and lots of soft tissue removed from the back of the mouth. My only alternative is to go to a FFM. Has anyone tried this? http://1800cpap.com/respcare-hybrid-ful ... MgodOXwAuQ .

Another reason why I wouldn't have a UPPP...

If I was going to use a full face mask it would be the Hybrid you linked to above.
There are men who use it, and various other full face masks, who have facial hair but it does present a problem.
How well they can get a seal and keep it depends on several factors...like length of hair and maybe condition...stiff and bristly or soft and lay down easy.
So a few more challenges than for those without facial hair but it can be done.

I take it we are talking about big leaks that are prolonged on your reports? Did they just go by the 95% number or actually look at some graphs?
Sometimes the 95% number makes things out worse than it really might have been. I have seen it happen personally myself.
Leak number made it look like my entire night was in the toilet in terms of leaks but actually I was only in large leak territory for a short period of time. It didn't even amount to enough time for Mr Red Frowny face to show up on the machine.
Wasn't a pretty leak line for sure but even if I had it every night I still wouldn't get a full face mask.

So when you can get some detailed reports...make sure we look at the leak graphs and not just the 95% leak number.

The Hybrid..takes some fiddling to get it just right. I did try it once just for grins. Thought I needed something for when I might have a cold and couldn't breathe through my nose. Ended up giving it away. With my first cold I was still able to use my nasal pillows and my neck doesn't do well with masks that have straps coming low around the jawline..so I knew I would never use it and I gave it to someone who didn't have insurance and wanted to try that mask.
I was able to sleep with it and not have any big leaks...though it took me about an hour to get it all fixed just right.
If for some reason I had to use a full face mask (nose surgery maybe) I would try it again. I don't like anything on my nose...so it's good thing I do well with nasal pillows.

[apw5746]

Unfortunately, I can't use Pugsy's trick of blocking off the leak with my tongue as I've had UPPP and lots of soft tissue removed from the back of the mouth. My only alternative is to go to a FFM. Has anyone tried this? http://1800cpap.com/respcare-hybrid-ful ... MgodOXwAuQ .

Another reason why I wouldn't have a UPPP...

If I was going to use a full face mask it would be the Hybrid you linked to above.
There are men who use it, and various other full face masks, who have facial hair but it does present a problem.
How well they can get a seal and keep it depends on several factors...like length of hair and maybe condition...stiff and bristly or soft and lay down easy.
So a few more challenges than for those without facial hair but it can be done.

I take it we are talking about big leaks that are prolonged on your reports? Did they just go by the 95% number or actually look at some graphs?
Sometimes the 95% number makes things out worse than it really might have been. I have seen it happen personally myself.
Leak number made it look like my entire night was in the toilet in terms of leaks but actually I was only in large leak territory for a short period of time. It didn't even amount to enough time for Mr Red Frowny face to show up on the machine.
Wasn't a pretty leak line for sure but even if I had it every night I still wouldn't get a full face mask.

So when you can get some detailed reports...make sure we look at the leak graphs and not just the 95% leak number.

The Hybrid..takes some fiddling to get it just right. I did try it once just for grins. Thought I needed something for when I might have a cold and couldn't breathe through my nose. Ended up giving it away. With my first cold I was still able to use my nasal pillows and my neck doesn't do well with masks that have straps coming low around the jawline..so I knew I would never use it and I gave it to someone who didn't have insurance and wanted to try that mask.
I was able to sleep with it and not have any big leaks...though it took me about an hour to get it all fixed just right.
If for some reason I had to use a full face mask (nose surgery maybe) I would try it again. I don't like anything on my nose...so it's good thing I do well with nasal pillows.

When it came to the UPPP, I snored LOUDLY. I had to do something to control it, even though it leaves the back door open. The cat wouldn't even sleep in the same room You could stand in the middle of the street, and hear my snoring (with the windows closed). In fact my wife slept in one of the girls old rooms, (she's a light sleeper). No need for a seance in this house, I could wake the dead. They'd communicate just to shut me up After 40 years of marriage, she left, but snoring was a 1/10 of the situation. Best of friends since she moved out.



Anyway, I don't like anything on my nose or mouth, but will shave should the Hybrid work. It's funny that I can dredge for around an hour a crack, and my divers mask isn't an issue. Of course I'm concentrating on finding gold, not trying to relax and sleep. I want to enjoy the full benefit of therapy. At least my usage is 98%. Social security is getting their monies worth.

They didn't just base their comments solely on the 95% number. My leakage was significant - 36 L/min. I like my pillows, especially the comfort level. Having straps around the head doesn't bother me. Since I'm bald, the bad hair thing isn't a issue The Hybrid, should I get it, is definitely going to take some getting used to. Since I'm a big mouth breather, your Tap Pap would be a waste for me.

With regards to a dental problem, I just brush more often, longer, and see the dentist 3 times a year.

[pdeli]

Pugsy,

I've been horsing around with this mouth breathing issue for quite awhile, and except for the taping routine, I can't seem to find any success. In fact, it seems to me that maybe there is no solution here that includes a nasal mask.

After all, there is constant air pressure coming through the nose, and keeping one's tongue up against the roof of your mouth all night is really quite a trick.

It's been awhile since I've used a full f ace mask, but what if I went back to a FFM, breath through my month, and tape or otherwise plug my nose?

Just a thought.

Phil

[Pugsy]

Why do anything at all to your nose if you are going to use a full face mask?
There's no need to worry about which opening the air goes in or out with a full face mask. That's the whole idea of using a full face mask.

Though..if plugging the nose sounds like something you might want to try, have you ever looked at the Oracle?
https://www.cpap.com/productpage/fisher ... -mask.html
I have never even seen one of these..and it would never be something I could use because I am a nose breather and it would bug the crap out of me not to be able to breathe through my nose...I wouldn't get much sleep.

I understand some people don't want to deal with taping or chin straps or whatever in an effort to keep the mouth shut. We all are individuals and have different preferences, different needs and different stuff that just bugs the heck out of us.
Mine is "stuff on my face"...I want as little as is possible and that's why I use what I use. If my mouth opening was horrible...I would tape before I would go the full face route. Tape is less on my face than a full face mask would be but I totally understand that someone else would feel the other way.
My job isn't to decide for someone what mask they should or shouldn't use...my job is to try to help them use what they want to use if at all possible and explain options, alternatives and pros and cons.

If it has been a while since you have used a full face mask...maybe look at the new models.
Lovers and haters of all of them..you never know what you would be until you tried one.

It's been awhile since I've used a full f ace mask, but what if I went back to a FFM, breath through my month, and tape or otherwise plug my nose?

[pdeli]

pugsy,

Do you think lowering either the IPAP or PR would make a difference? Currently they are at 9.5 and 4.0 respectively.

And how do you abswer so damn fast?

Phil

[library lady]

pdeli, I'm half joking here but for what's it's worth, maybe you need a pacifier! Do they make those in adult sizes? Actually, maybe there's something that would fit comfortably in your mouth, under your tongue to hold it up. Ping-Pong ball, wiped clean each day?

[Pugsy]

Do you think lowering either the IPAP or PR would make a difference? Currently they are at 9.5 and 4.0 respectively.

Make a difference in what? The times the air leaks out the mouth? Probably not..if your pressures aren't all that high.

What are your pressure settings?
And are you in Auto mode or bilevel mode.

IPAP 9.5???
Pressure support of 4.0...
that would give EPAP of 5.5 for exhale...
All these are relatively low pressures. You really can't go much lower.

Now if you are in Auto mode and your IPAP and EPAP is able to go a lot higher...yeah, maybe limiting IPAP might help with mouth leaks a little but it won't totally stop them.