Drooling/Lip Buzzing/Noise

[funky-rat]

My husband and I are both CPAP users. He's been on since 2007. I am 99% sure his machine is the Respironics RemStar (it's an older machine). For the past 8-9 months, he's been having issues with excessive drooling, lip buzzing, snoring like noises, and exhaling through is mouth. He uses the Wisp mask. This was never an issue before for him. His readings on his machine (it needs a special card reader - as I said, it's an older machine but our insurance will not get him a new one because the old one still works) are good, but something else is going on. You have always helped me in the past, and he doesn't do internet forums, so I was hoping you might have some suggestions.

He wears a bite plate/grind guard when he sleeps because he grinds his teeth. We have to use the OTC ones because our dental insurance won't cover it. I'm thinking maybe the bite plate is positioning his tongue oddly, and that may be some of it.

Other than that, I'm low on thoughts. He doesn't use the humidifier - he doesn't like the heated air - but before it's never been an issue. He's not mouth breathing while he sleeps - I would hear it. He doesn't like full-face masks. He has a fuller face, and they tend to not fit him really well. I was always a mouth breather, so I use a full face mask. I had surgery a few years ago to correct nose issues, and rarely mouth breathe anymore but still prefer a more full face mask and I use the Amara View, and love it. I can't convince him to try anything other than the Wisp. He's a bit stubborn.

Any thoughts are welcome. He's sleeping 8-9 hours but not feeling rested at all, and if I can't figure anything else out, I'll see if he can get a new sleep study, but since this is a somewhat new thing (the buzzing, "snoring", excessive drooling, etc), I was hoping it might be a more simple solution.

[funky-rat]

This looks like his machine. I can't guarantee this is the exact model, but it looks like this. It's not an auto pap - it's fixed pressure.

[Pugsy]

That is the M series model.
There should be a model number on the bottom of the blower unit.
Do you see the word "Pro" on the blower unit? If you do there is some data available on the machines LCD screen.
Not much but there is a 7/30 day average for leak and AHI.

Is he sleeping well and feeling decent?
Is it affecting your sleep quality and not his?

[funky-rat]

I'll check it when I get home. I know when he goes to the DME, they have to use a special card reader. The card looks like a credit card.

It affects me some, but it affects him much more. He's cranky and says he's constantly tired. Some nights, I can hear him in the living room if he's gone to bed before me. He's 50 feet away from me if I'm in the living room and he's in the bedroom.

I'm considering asking him to go without the guard for one or two nights to see if it helps. But he does grind badly - he had a broken front tooth when he was younger, and he ground the extension off down to the post, which our dentist then had to remove. So if it's the plate, we'll have to find a different solution.

[Pugsy]

I am familiar with the M Series machine. It was my first cpap machine so I am also familiar with that smart card (looks like a credit card) and the special card reader that is needed to use the available software.
Some machines collected data that could maybe shed a light on if his therapy is sub optimal.
Unfortunately some machines don't put anything but hours of use on that smart card and simply using the machine for X number of hours doesn't guarantee optimal therapy.

So my first thought is find out which machine for sure is being used and if there is some data available...let's look at it first.

Sounds like there may be some mouth leaking going on even if you don't hear direct mouth breathing. It may or may not be negatively affecting the therapy (if it is even happening).

Once you tell me exactly which machine you have...if it does have some data available I will point you to how to find it.
If it doesn't have anything but hours of use..well, we get to have a different discussion but let's see if there is anything on the machine itself first.

The drooling is common and I don't know that we can do much about it or that we even need to do much about it if that is all that is going on.
I woke up with some slobber on my pillow this morning myself. But just drool alone doesn't necessarily mean sub optimal therapy.

[avi123]

The problem with the Wisp nasal mask is that there is no room over the head to add a chinstrap strap. A chinstrap could keep the mouth almost closed and also hold together the jaws with the anti grind dental device.



Ruby chinstrap at Amazone:



Could he try this nasal mask which I use together with the chinstrap?

[funky-rat]

He has a mask similar to that - it's the one he preferred before he switched over the Wisp. Funny enough, he only switched over because it was the one originally assigned to me when I first got my machine, and I had to go back 2 days later and ask for something different because I couldn't keep my mouth shut. They gave me a FFM, and told me to keep the Wisp. He liked it and started using it. I'm pretty sure we still have one of those other masks on hand. I'll have to look.

We have a Ruby chin strap - we both hate it. It has a seam on the chin that irritates both of us. I have a different chin strap I'll have to dig out. Not sure if that will help with the lip buzzing.

As for the drooling, it's excessive - it soaks the pillow. That's why I mentioned it - wasn't sure if it was important or not. We're washing pillow cases frequently.

[Pugsy]

For some people having something in their mouth stimulates saliva production.

How would he do with a nasal pillow mask?
The Tap Pap comes with its own mouth guard (used to hold the pillows in place) and would provide considerable protection from the teeth grinding and it's small enough that maybe the extra saliva wouldn't leak out so much?
There is a separate headgear available for purchase if need be but I found it quite stable without the headgear..
https://www.cpap.com/productpage/tap-pa ... roved.html

[funky-rat]

Interesting. Not sure how quickly he might grind through that mouthpiece, unless it's really sturdy. He tried pillows once before but he has a high pressure setting, and he said he had difficulty with them. Still, I'll show it to him.

[Pugsy]

It's a boil n bite guard and pretty darn sturdy. I imagine he would have to do a lot of grinding to wear through it.
I use pressures exceeding 20 cm in some form almost every night and they stayed in place actually better than some of the other nasal pillow masks I have used. If I got a leak it wasn't at the pillows with the Tap Pap...it's the mouth coming open.
Now some of the other nasal pillow masks with elastic headgear of some sort...yeah the headgear slips a bit and the pillows end up slipping a bit but when I used the Tap Pap the pillows themselves never moved.

The only reason I changed was that I tried the ResMed AirFit P10 and fell in love with the venting system on that nasal pillow mask. If I could have that venting system on the Tap Pap...would be pretty much the perfect mask for me.

[D.H.]

Here's a suggestion a little out of the box. If you know how to set his machine and your machine to the prescribed pressures, switch machines and see if the noise goes away (or transfers to you).

[robysue]

Interesting. Not sure how quickly he might grind through that mouthpiece, unless it's really sturdy.

Does he grind through the OTC night guards he currently uses? How long does a guard last before he has to replace it?

He tried pillows once before but he has a high pressure setting, and he said he had difficulty with them. Still, I'll show it to him.

What's his pressure setting?

[funky-rat]

Hey guys - sorry for the late response.

He decided to call the sleep med doctor. They asked him to come in. His machine reads like nothing is wrong but he is just exhausted all the time. He got concerned when he felt like he could doze off while driving.

So, he's been scheduled for a new sleep study - he has it Tuesday night. This should be interesting.

I have an extra cushion for my Amara view that is larger - it's too large for me, but I tested the mask for the DME, so I got multiple sizes, and I kept it for emergencies, as it could get me through for a day or two. He said he wants to see if it fits, because he doesn't do well with full face masks, but with his drooling and lip buzzing and mouth breathing (only on exhalation), something has to give.

I'm not sure what his pressure is set at. I'll have to see if the machine will tell me. He's going to use his normal mask and machine. The sleep med doctor seemed to think that it may be time for a new machine - a variable pressure. He tried one once before while his machine was checked to see if it was working and he didn't like it, but I think it's because he's used to the fixed pressure.

[robysue]

I'm not sure what his pressure is set at. I'll have to see if the machine will tell me.

You will need to get into the clinical menu to find out what the therapeutic setting is. If you don't have a clinical manual for your husband's machine, you should be able to get one from apneaboard.com

He's going to use his normal mask and machine. The sleep med doctor seemed to think that it may be time for a new machine - a variable pressure. He tried one once before while his machine was checked to see if it was working and he didn't like it, but I think it's because he's used to the fixed pressure.

A variable pressure (APAP) machine can be set to CPAP mode if your husband doesn't do well on APAP.