Mouth Breathing-How to Figure Out?

[Jay Aitchsee]

Hi - I am looking at the TNET Sleep Apnea Information to try again to figure out how to post a Sleepyhead Graph. It shows to order the graph by

Event Flags, Flow Rate, Pressure, Leak Rate, Snore and Flow Limit

The choices on my report from an AirCurve VAuto night are:

Event Flags, Time at Pressure, Leak Rate, Snore, Flow Limit, AHI, Mask Pressure, Resp. Rate, Tidal Volume, Minute Vent., Insp. Time, Exp. Time, I:E Ratio

Is the "Resp.Rate" on a Bipap the same as "Flow Rate" on an Auto and "Time at Pressure" same as "Pressure"?

You're getting there, but Resp Rate and Time at pressure are not the same as Flow Rate and Pressure.

Look at the bottom right side of your SleepyHead display. There is a drop down box where the graphs can be turned on/off. See if Flow Rate and Pressure are listed and turned on, click to turn green.

If the graphs desired are not listed, go to SleepyHead File/Preferences/Waveforms and ensure the boxes for Flow Rate and Pressure are checked.

Once you have the desired graphs displayed, they can be ordered by left clicking/and hold in the graph label area and moving it up or down as required.

Your leak line doesn't look like you have a lot of mouth leaks. But the Flow Rate and Pressure graphs will be helpful in determining what's going on.

[Dallaslady51]

Ok - thanks - found the other graphs and reordered the screenshot

Is it correct how I am doing this to just copy the Linked BBCode and add in the .png after the file code?

[Jay Aitchsee]

Your image posting looks OK to me, but I'm not an Imgur expert. However your doing it, it looks like it works.

I really can't tell that your are mouth breathing. You would need to zoom in quite a bit and have a look at the Flow Rate, maybe a 5 minute interval, but it doesn't look like it.

I think I would increase the EPAP and see if you couldn't get rid of the hypopneas. Maybe to something like 12. Clearing up the hypopneas may get rid of the Obst. Apneas as well.

Our resident expert, Pugsy, should be along in a minute, let's see what she thinks.

[Pugsy]

If you are mouth breathing it isn't so much that you are getting massive large leaks....so the machine can compensate for whatever leaks you are having because they aren't massively big.
I have let worse leaks slide but if any leaks cause sleep disruption then they need to be worked on.
The machine can compensate for a good amount of excess leak no matter what the cause of the leak (mask movement or mouth breathing) and whatever your leak is caused from it really isn't all that big and certainly within where the machine can handle things.
You spent very minimal time over 24 L/min...I wouldn't give that small of a percent above 24 L/min a second glance.

If that were my report I would increase that minimum EPAP from 10 to maybe 11 and if that didn't help enough then I would try 12 EPAP min.

Was this report above when you were using a nasal mask or full face mask?

I don't know what to make about your centrals/Clear Airways....you admit to being a wake with some congestion during the night so some of those CAs could simply be Sleep/Wake/Junk getting flagged and SWJ doesn't count.

My thoughts are to try to fix what we can fix with pressure from your machine which would be the OAs and hyponeas and see how many centrals end up getting flagged once the obstructive stuff is better dealt with.

[Dallaslady51]

Thank you. I will bump the EPAP to 11 tonight and then 12 tomorrow night. This graph was with a nasal mask (just couldn't make myself put on the full face least night). I'm definitely trying a full face mask tonight at least for a while and try to see if I can get it to keep a seal (Simplus) - it's very comfortable - just seems when the machine gets up above 13 or so, air starts blowing out everywhere. But I'm going to give it a try.

My nose is definitely closing either halfway or all the way for a large part of the night. I woke up a lot last night, and every time, I could not breathe through my nose at all, so no surprise I was waking up. On my APAP, I had moved the minimum pressure from a 10 to a 12 and improved the AHIs, so it should help on the BiPap as well. Reducing the Pressure Support from a 5 to about half that, made the BiPap much more comfortable for me. I may continue to adjust that, but will start with changing the EPAP to 11.

Clear airway episodes are higher than when I was on an APAP - not a huge increase, but about double.

Thanks for your help everyone. Off to try another night.

[Pugsy]

Can you do a little experiment for me please.
Take your fingers and put them on the sides of your nose up around the nasal bridge area (sort of wear your glasses would rest if you wore glasses) and press gently on the sides of the nose to mimic the pressure that the nasal cushion mask will put on that area.
See if the pressure causes congestion and if it does how long does it take for the congestion to go away when the fingers are removed.

Did you have this same congestion with the APAP machine? If not...what changed? Did you change the humidity settings?
Change from a non heated hose to a heated hose or the other way around?

What humidity setting are you now using...and are you using a heated hose and if so at what temp?

If you use the full face mask you will likely need a little more pressure so don't panic if a little more pressure doesn't help much with the full face mask.

Try to limit any changes to one at a time if at all possible....so that you can better gauge the results. If you make too many changes all at once you don't know what to blame or pat on the back.

[Dallaslady51]

It really didn't cause any congestion when I pressed on my nose - it's almost like my nose just gets congested at night - it is rarely that way during the day. And I had surgery long ago for a deviated septum.

I struggled with rainout with the APAPs - had a climate hose on both the Airsense 10 and the Dream Station, and with the Auto setting, the Airsense 10 would drown me (rainout x 10) with almost every mask except the Breeze Nasal Pillows, which is not made anymore. Returned it 3 times - no luck. Manual on the lowest setting would be rainout x 3. The Dream Station was ok with little rainout, but I could not handle its algorithm - kept waking up in a complete panic thinking I was dying - one morning called 911. Just gave up on it - scariest thing ever.

That's when I thought since it had been 6 years since the sleep study, I would get another, and had to have 2 because of Medicare requirements. I did get the same type of congestion on the APAPs, but many times it was not as noticeable, because of the rainout that was Spraying in my face (actually kept my nose a little open until it woke me up). Hose wrapped, etc, etc, temp in room ok, etc etc. Just weird, because only a few people seemed to complain about it. Never had an issue with the S9 Autoset, but ResMed built more humidity into the Airsense 10, and that little bit messed me up.

The Aircurve VAuto does not have much rainout with most masks, but I cannot use my new favorite the F&P 407 - just major rainout on auto or manual of 1. They told me I could wrap the mask in duct tape, but really? The Mirage, SoftGel, and the others are pretty much ok, but on auto climate, they actually feel too dry. My nemesis is obviously the humidity issue. I will keep working on it - maybe a full face or a different pillows with the VAuto will work ok.

So tonight I will try the Simplus full face with auto humidity and climate line hose, and the only change will be increasing the EPAP to 11.

Thanks for your help, Pugsy. Hoping for a good night, and same for you.

[Dallaslady51]

Tried the Simplus full face mask last night - lasted about an hour, and as soon as I moved, air was blasting out from everywhere. Could not stop it, whether looser or really tight or in between. Switched back to nasal mask and woke up again in a panic. AHI was good - about 3, but I felt my sleep was horrible. There was no rainout, but the humidifier was almost dry, and nose stopped up. Had the machine set to 20 IPAP/11.4 EPAP/Pressure Support of 2.4. It's so scary waking up like that every day with heart pounding, and thinking the world is ending. Also woke up early morning with choking and coughing (happens occasionally).

Going to set up an infrared camera in a couple of days to see if I tell what is really going on - mouth breathing, leg movements, restless sleep - whatever. I just want to know. The sleep study was useless - they said they were mainly monitoring my machine and their "filming" was too "blurry" to see if I was breathing through my mouth. I have bad leg movements, but do take a low dose Klonopin to try and help - tried the Requip, etc but could not tolerate.

Ugh - wish it wasn't such a struggle - just would love to wake up peacefully and not with heart pounding and terrified. I dread having to go to sleep....

[Jay Aitchsee]

Ugh - wish it wasn't such a struggle - just would love to wake up peacefully and not with heart pounding and terrified. I dread having to go to sleep....

Geez, Dlady, I wish I could help.

It is possible that your nasal congestion is your primary problem. If your nose becomes stopped up and you take a few (3or4) breaths in a row through your mouth while wearing a nasal mask, the machine will score an apnea because it doesn't sense any flow (it's connected only to the nose).

You mentioned you had surgery for deviated septum some time back, so there has been some problems there. What about Breathrite strips? Have you tried them? I have never used them, but I understand they are helpful to some. As I and Pugsy mentioned, your leak line doesn't really look like you have a lot of mouth leaks, but you do have a fair amount of snores depicted (again back to the nose). I believe Breath Rite claims to reduce snoring as well. So maybe...

I don't know why you have such a problem with rainout. How about not using the humidifier at all. Or just using it in a "pass over" mode - water, but no heat. If you are trying to compensate for dry mouth, most CPAP machines can't help. The humidity function is only for nasal dryness.

I think a camera is a good idea. Set it up to see your face and legs. You may have to run it more than one night to capture both. Make sure to synch the camera and cpap clocks.

J

[Dallaslady51]

Thank you. Yes, I will run the camera for a few days here and there - just to see what's going on.

I just tried different masks for comfort and seal while awake a few minutes ago. I really like the nasal masks - there are some very light ones. The full face are so uncomfortable to me. I always liked the pillows but have only tried the Swift and my old Breeze. I tried a couple of chin straps but could not fall asleep and they kept pulling the masks around.

I always thought my problem was the pillows not giving me enough air, but now I know that's not the case. It's my nose and it's nighttime quirkiness. Tried the nose strips in the past and skin was sensitive to them, but I will try them again just to see if it helps.

I'm having just awful anxiety during the day as well and that could be a factor with the panicky wakeups - scared to face the night and scared to face the days.
I would sure like to get off the Klonopin - even at the very lowest dose, I have very intense and confusing nightmare type dreams from it - another factor. But they tell me I have pretty bad leg movements.

The Aircurve Bipap is definitely better overall in regulating rainout - so much better than the Airsense 10. It has only given me major problems with the F&P masks - I guess because they are a thinner plastic? - who knows. But good idea on the "pass over" mode - I will try that sometimes.

This was last night - even though I woke up shaking and heart pounding, the AHI was better. Used a Nasal Mask/No Chin Strap-EPAP increased to 11.4 - all else the same.

Have you ever seen a report do this - I did have the card back in the machine and started trying to sleep before midnight, but the graphs start at exactly 1 in the morning and are all smooshed to the right, but the entire use time is there. Can't figure out how to fix it. Have never seen one like this before.

[Jay Aitchsee]

See at the bottom left under "Session Information", you have 3 sessions listed (one is turned off- clicked red). The first starts around noon, 12:12, and runs for an hour 25 minutes. The Display at the right of the page is including that session so it's starting at 12:12, but there's no data in it. Looks like the machine was running for a while - maybe you were trying or testing something. Anyway, just click it off, and your display will look normal.

[Dallaslady51]

Yes I was trying masks - thanks.

[Jay Aitchsee]

I understand klonopin is a favorite to treat RLS and PLMD. However, I'm not sure of its effectiveness. I have taken it for PLMD and I found if the dosage was high enough to seemingly prevent PLMD, it left me so groggy the next day that it was better (for me) to suffer the PLMD.
Unfortunately, Klonopin, a benzodiazepine, tends to be habit forming, if not addictive, and many are now suggesting benzo's be used quite sparingly due to the likelihood of cognitive impairment from long term use.
I have tried most of the medications for PLMD (leg movements) and none seemed to work to provide a restful night's sleep. I finally chose just to ignore the PLMD. Instead, I worked hard at improving my Sleep Hygiene. Over time, my sleep became restorative, though I still have leg movements. Two things I think that helped me the most were curtailing caffeine use and early morning exercise. I don't have any caffeine (from any source) after 10 AM and I (try to) ride my bike or walk for an hour just after sunrise every day.
Early morning exercise seems to calm the mind, give one a sense of well being, stave off anxiety, and promote better sleep, at least for me.
The another sleep hygiene practice that seemed to help me a lot was going to bed early enough to get a good night's sleep. I've always been an early riser, no matter what time I go to bed. So if I went to bed at 1AM, after the TV shows, and got up at 5 or 6, I didn't get enough sleep. I started religiously going to bed every night at 10 PM and now when I get up at 5 or 6, I've had plenty and I don't miss seeing the late night shows.
Sorry if this has been a little preachy, but I'm a big believer in Sleep Hygiene. You may very well practice all the precepts now, but if you don't, you may find doing so helps during the day as well as at night. I'm just sayin

PS: while your trying masks, give the P10 a shot if you can.

[Dallaslady51]

That is such an accurate and wonderful summary of the Klonopin, etc issue and Sleep Hygiene and Exercise. Every reminder I needed and so well put.

I love your idea of just weaning off the Klonopin - I take the tiniest dose, but it causes the worst anxiety-producing dreams, and I feel like I've been run over for the first 3 hours of the day - like walking in wet cement. And the Mirapex, etc caused weight gain and all sorts of issues. Honestly, the Klonopin is not really doing anything for the leg movements anyway. Like the idea of one less medicine to take that really has no positives.

Been working on the Sleep Hygiene and made some changes today. I am a member of many FB health-related groups (I have many medical issues), and would spend at least 2 hours before sleep every night reading posts on my phone (instead of reading a pleasant book like I used to). And most of the folks on the groups have the saddest stories - almost like a country song. In just the previous week, their brother may have died, their pet may have died, and they have just been diagnosed with all sorts of horrible things. I'm a sensitive person, and was taking it all very hard - no wonder I'm a nervous wreck when I wake up and feel like the world is ending - duh. Sometimes I am slow to realize something. But I stopped all notifications on every group this morning. If I need to research something, I can look on Google. Plus it was making me so afraid of how my own issues might progress, and I think my brain just absorbed it and decided to worry about it all night - no surprise there.

And Exercise - boy do I need that. Weight issues and other things that will benefit from exercise. Seeing a chiropractor next week and starting physical therapy in 2 weeks to work on balance and function issues, and planning to go to a rec center to use the recumbent bikes and other "doable" exercises. I can't walk right now more than a few yards due to back problems, but I think the PT/Chiro/Other will help that. I have been drinking Diet Coke all day every day. In the process of weaning myself off that as well - terrible stuff and I need to kick those chemicals out of my life (and tons of caffeine).

It's just sort of interesting that you discussed the exact 3 things I am beginning to work on. You have reinforced my efforts and given me enthusiasm and hope for improving my daily life. None of it was preachy - just enormously helpful! Thank you for taking the time to offer such well-worded wisdom.

And the P10 mask is one of the ones that I have on my list to try....

[Jay Aitchsee]

Thank you...

You're welcome. Sounds like you're on the right track. Good luck with your changes.