Uncomfortable night last night - SleepyHead report attached

[sleepychar]

I have been using a chin strap for a couple of weeks now with mostly good results. However for the last 3 nights or so, I have been waking up with very dry mouth periodically during the night and I can feel air coming from my throat and seeping out my mouth. The thing is, I don't think I am sleeping with my mouth open (there is the chin strap for one thing) and I am fairly certain I am not inhaling through my mouth. In fact, I have found that while I have the nasal pillow mask on and air is flowing from the CPAP machine, I can't inhale through my mouth even if I want to. It is like air is blocked from going to my lungs through my mouth when air is flowing down my throat from the machine. So... I'm not sure what I can do about this, short of switching to a full face mask which I am very reluctant to do. CPAP is still pretty new to me. I've been using CPAP machine a little over one month now. For awhile after I started using the chin strap, it seemed that this problem of air short circuiting out my mouth instead of being pushed into my lungs had stopped but now it is happening again. The CPAP machine only reported an 8 for overall leak level and there were only 2 OS, 1 hypopnea, 1 RERA, 9 Clear Airway events. But after sleeping the first 4 hours pretty well, it felt like I was waking up alot during the rest of the night and every time with air leaking out my mouth and mouth very, very dry. This morning I woke up feeling unrested and very grumpy. My APAP pressure range is 4-16. Jay already suggested from a previous post that I try increasing the lower pressure up to 6 and I am definitely going to run that by my doctor when I see him (or his nurse practitioner) in about 10 days from now. The second time I was awake and took mask off for about 15 minutes, I forgot to turn off the machine and when I went to put mask back on, I found air was still flowing through the tube. Not sure if that messed up any results or not. I could not see anything myself. Here is my SleepyHead report from last night. If anyone has time to take a look at it, I would appreciate hearing any thoughts/suggestions.

[Pugsy]

Do you take any medications that could be making the mouth dry out more easily?

If you are doing any mouth breathing it isn't enough to show up as a bad leak on the report but the dry mouth is waking you up so that part of it isn't good.
If it weren't waking you up we wouldn't be so concerned.

Some people just get a dry mouth easier than others for any number of reasons.

[sleepychar]

Thanks for your response, Pugsy. No, I don't take any meds that would make my mouth dry out. I know the dryness is from the air going into my mouth from my throat because I feel the air in my mouth when I wake up. It appears it isn't enough to cause an increase in apneas but it is uncomfortable and it is wrecking my sleep...

[LSAT]

I have been using a chin strap for a couple of weeks now with mostly good results. However for the last 3 nights or so, I have been waking up with very dry mouth periodically during the night and I can feel air coming from my throat and seeping out my mouth. The thing is, I don't think I am sleeping with my mouth open (there is the chin strap for one thing) and I am fairly certain I am not inhaling through my mouth. In fact, I have found that while I have the nasal pillow mask on and air is flowing from the CPAP machine, I can't inhale through my mouth even if I want to. It is like air is blocked from going to my lungs through my mouth when air is flowing down my throat from the machine. So... I'm not sure what I can do about this, short of switching to a full face mask which I am very reluctant to do. CPAP is still pretty new to me. I've been using CPAP machine a little over one month now. For awhile after I started using the chin strap, it seemed that this problem of air short circuiting out my mouth instead of being pushed into my lungs had stopped but now it is happening again. The CPAP machine only reported an 8 for overall leak level and there were only 2 OS, 1 hypopnea, 1 RERA, 9 Clear Airway events. But after sleeping the first 4 hours pretty well, it felt like I was waking up alot during the rest of the night and every time with air leaking out my mouth and mouth very, very dry. This morning I woke up feeling unrested and very grumpy. My APAP pressure range is 4-16. Jay already suggested from a previous post that I try increasing the lower pressure up to 6 and I am definitely going to run that by my doctor when I see him (or his nurse practitioner) in about 10 days from now. The second time I was awake and took mask off for about 15 minutes, I forgot to turn off the machine and when I went to put mask back on, I found air was still flowing through the tube. Not sure if that messed up any results or not. I could not see anything myself. Here is my SleepyHead report from last night. If anyone has time to take a look at it, I would appreciate hearing any thoughts/suggestions.

Raise your minimum pressure to 6-7...just as suggested. Try it and then you can tell your doctor whether it worked or not.

[sleepychar]

I think I'm going to do as you suggested, LSAT... If I keep having nights like last night, 10 days is going to be a long time... Thanks.

[yaconsult]

Note that you can still blow air out through your lips even when your teeth are together. So a chinstrap doesn't necessarily stop mouth breathing. This is something I caught myself doing as I was waking up. I trained myself to stop doing this by using 3M Micropore tape to keep my lips closed. After a few weeks of this, I found that I didn't need the tape any more.

[Jay Aitchsee]

Your doctor may not even notice if you raise your pressure...and it's not like you are going against his order. He did order 4-16 and 6 is certainly in that range.

Your results look good except for those few CA's which seem to be marking when you are disturbed from the leaks (probably mouth) more than anything, although the pressure swings from 4 to 10 Could be bothersome as well.

The pressure goes up, the leak goes up, then the disturbance, the CA. See it on the chart? It is natural for a mouth leak to increase with an increase in pressure.

Not only would I raise the minimum, I would lower the maximum. Higher pressures are needed to control obstructive events (OA and H), but you have none. I know you are not yet comfortable changing your pressures and that's OK. It's just what I would do, but I've been doing it for years

You might try the hair band again. Did you cut ear holes? It will slow the mouth leaks so they're not so disturbing. Here's the link: viewtopic.php?f=1&t=112758#p1086296 Or, you might try some tape as Yaconsult suggests. With tape, I would suggest just 1 piece vertically, from under the nose to the indent below the lips. I agree that a chin strap is likely not going to be much help.

Oh, you didn't hurt anything leaving your machine on and mask off. It figures out in a couple minutes you're not there.

[avi123]

In my opinion everything looks good. Continue like this for at least 5 more years.

[Pugsy]

Unfortunately some people just get dry mouth easier than others even without meds being a factor.
You might add one of the products designed to help with dry mouth (Biotene or Orajel) in an effort to prevent the dryness from waking you up.

Anything that wakes us up is unwanted for sure...even if whatever it is that is happening isn't technically bad enough to impact therapy itself.

It's one thing to keep the lips closed...it's an entirely different thing for the tongue to stay in place and keep that back door closed so that air doesn't enter the mouth via the back of the mouth. Not all dry mouth comes from mouth breathing...it can come from the air sneaking past the backdoor and getting into the mouth. Even with the lips closed.

Using a full face mask at maximum humidity doesn't guarantee no dry mouth either.
Sometimes it just happens despite us doing everything we can to try to prevent it.

[sleepychar]

"It's one thing to keep the lips closed...it's an entirely different thing for the tongue to stay in place and keep that back door closed so that air doesn't enter the mouth via the back of the mouth. Not all dry mouth comes from mouth breathing...it can come from the air sneaking past the backdoor and getting into the mouth. Even with the lips closed."

-- That's just what I believe is happening... air sneaking past the backdoor and getting into the mouth...

Jay - Thanks... I raised the lower pressure to 6 and will see what happens tonight. One baby step at a time... I reviewed my SleepyHead reports and the highest pressure so far has been 12.08 and that was only one time - night before last which, interestingly was similarly a rough night with the dry mouth and air from throat into mouth issue. I'll see how it goes with the increase in the lower pressure level and go from there.

I was experiencing this issue in the first couple of weeks of CPAP. I don't know why, after I started using the chin strap this issue kind of went away for a little while and now it's back again even with the chin strap. I could try the tape or the scrunchie again but I think the problem is the air coming from the back of my throat into my mouth and I don't think those are likely to help in this case. But I'll try everything as time goes on to try to get past this so I can hopefully get a good night's sleep at some point.

[Guest]

Yes, the hairband doesn't stop the air flowing out through the mouth, it just slows it down which tends to reduce the drying effect while also making it quieter and less disturbing. Since the air can escape, there's less of a chance of chipmunk cheeks than with tape. IMO, for mouth leaks of air coming from the back of the throat, both the band and tape are more effective than a chinstrap.

[Jay Aitchsee]

it's an entirely different thing for the tongue to stay in place and keep that back door closed so that air doesn't enter the mouth via the back of the mouth

An OBTW, the "back door" is the velopharyngeal sphincter, a group of muscles used primarily in speech and swallowing to separate the oral and nasal cavities. The effect of the group can be felt when making a "K" sound.

Some speech defects can be caused by poor velopharyngeal muscle tone and a treatment that is sometimes used to promote better muscle tone is to practice sounding certain parts of speech while using nasal CPAP therapy. http://emedicine.medscape.com/article/9 ... atment#d11

Could such practice during the day aid in learning to keep the "back door" closed during sleep? I don't know, could be worth a try.

[Pugsy]

Could such practice during the day aid in learning to keep the "back door" closed during sleep? I don't know, could be worth a try.

You know I can mask up and with pressure I can open my mouth...yawn big...stick out my tongue with wide open mouth...and talk...all without having any air enter my mouth. I wasn't able to do that when I first started therapy. It took some time but I don't remember how long it took. And certainly don't know what I did to learn to keep the door closed no matter what position the tongue is in.
Now it is so second nature that the back door stays closed that I have to really work hard at making an effort to open the back door and let the air enter my mouth.

So I don't know what I did but I know it is more than tongue placement. Tongue placement was part of it initially though so that's all I know to tell newbies to try since I can't explain the other.
Maybe some speech exercises would help that reflex action for those muscles that keep the back of the oral cavity closed off. Sure wouldn't hurt.

[Jay Aitchsee]

So I don't know what I did but I know it is more than tongue placement. Tongue placement was part of it initially though so that's all I know to tell newbies to try since I can't explain the other.

To me, it's more of how the back of the tongue is placed as in making a "K" sound, as I mentioned above. I can easily control this leak while awake and I am getting better at controlling it while asleep, but I still benefit from using the hair band mouth cover as I've outlined in another post.

I couldn't find the details of speech therapy using CPAP other than it is administered for "up to 24 minutes per day, 6 days a week". I'm thinking, though, that just practicing stopping the leak with straight nasal CPAP pressure applied for a few minutes a day while awake might help in learning to do so while asleep. I envision starting a pressure that is somewhat difficult and working up from there. I know I can stop the leak at my normal, rather low, therapy pressure, but I don't know about higher. I'll have to try it to see if it's more difficult with increased pressure. Intuitively, I think it would be, but I don't know for sure.

[sleepychar]

Update - Well, interestingly, I don't feel as crappy this morning as yesterday morning although my SleepyHead numbers are worse. I have to say, I think just getting emotional support goes a long way toward improving my mood! Anyway, I again had numerous small awakenings last night with feeling air in my mouth and very dry mouth but only one major awake period vs the 3-4 major awake periods I have many nights. I did increase the lower pressure to 6. I could tell the difference in the beginning in that I didn't feel like I had to inhale as forcefully when the machine starts up as I do with the pressure at 4. So probably worth keeping the pressure there if for that reason alone. Still had an overall low leak number of 8 but SleepyHead reported 3 large leaks last night, 20 clear airway, 3 OA, and 1 Hypopnea events. I will try Jay's scrunchie idea again tonight. I have been looking at those clear airway events and trying to compare them with the video example/explanation of how to tell if they are from little restless/ awakening periods vs central apneas (https://www.youtube.com/watch?v=xallwxPCg84&t=50s) and, to me, it looks like at least some (clearly not all or possibly not even most) of the clear airway events may really be central apnea events. I am aware that this is where a little knowledge can be dangerous. I don't want to be diagnosing myself as I really don't know what I'm doing and that is what I have a doctor for. I am going to let my doctor know that I am still not sleeping well and see if I can get him to investigate a little further. One theory I have developed for myself, could be totally off-track, is that if I am having a central apnea, or even when there is an obstructive apnea, I am not breathing at that point and so, of course, air not going to lungs has to go someplace so - into my mouth... With central apnea though, if I am understanding it correctly, you are not even trying to breathe when that occurs whereas with obstructive apnea, you are trying to breathe but airway is blocked so opening it up with more forceful air pressure can help. I think I'm going to back off the analytical stuff at this point, keep track of number and type of events, try the scrunchie, possibly tape over my mouth, and let my doctor worry about why I'm still not sleeping well. I have kind of an analytical mind and I can drive myself nuts sometimes... My diagnosis was mild obstructive sleep apnea and the sleep study report shows mostly obstructive apneas with a small number of "unclassified" apneas. This was a home sleep study with sensor around my chest, oxygen thingy on my finger, and sensor at my nostrils. The thing is, if I'm not going to feel more rested, I'm not really sure if my sleep apnea is bad enough to continue the CPAP - although at some level I know it's not good to have those periods of apnea at all. In my sleep test I had some periods that measured over a minute and a half and with the CPAP, the apnea events are more like under 20 seconds for the most part. So probably I will continue with the CPAP. I am just feeling a bit frustrated at this point, that's all.