weight loss, mouth breathing, and pressure changes

[Chairman Meow]

I started cpap about 3 years ago and it has mostly been a huge success for me. However, after recently losing approximately 30lbs, I suddenly started mouth breathing at night. I've never had any problems mouth breathing prior to this, and it's becoming a real problem. I've tried 3 different chin straps, taping my mouth, a soft cervical collar, and a full face mask..and none of them have worked...if I can't open my mouth I just swallow air and wake up miserable.

I currently use a Resmed S9 on constant pressure of 12, and I wondered if there is any wisdom to switching it to a variable pressure range to see if that will help? Is there a "starter range" I should try? Are there other things I should try first? Are there sleepy head graphs I could post that might help see if this is something other than the weight loss?

I'm a long way from done losing weight (I've lost 10 more lbs since the mouth breathing started) so I don't want to go for a new sleep study until I get much closer to my goal...but is that what I should do before messing with my pressure?

Thanks for any and all advice.

[Goofproof]

Basically Sleepyhead should be as good as a sleep study for over 90 % of problems from sleep apnea. Some do better with auto some of fixed. both it set right are fine. I move around sleeping on back and rt side, should ues my apap, but am using my first machine cpap until it dies, it's like that Bunny, it just keeps going and going over 16,000 hours.. Jim

Others can help you with Sleepyhead suggestions, I use something else.

[Cpapian]

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[Chairman Meow]

According to my husband the air is simply escaping from my mouth but I am still inhaling and exhaling through my nose.

My AHI is usually less than one. I am including my graphs from last night, AHI was 1.18 but for the last hour I was wearing my mask I was awake and talking, so I don't know if that makes a difference.

Here is last nights graph - I left off the pressure graph because my machine is set for a constant 12 pressure.

https://imgur.com/a/2qnLx


Just for additional information, this was from a few nights before when I was trying to handle wearing a chin strap.

https://imgur.com/a/dBMbF


Thank you for your help!

[Goofproof]

Others here would say your leaks are OK, the machine will cover them, I don't, I say they need attention... Jim

[Pugsy]

What does the statistic say for percent of time over the red line threshold? It's below the list of statistics on the left side.
We can't see it due to the pie chart taking up space. You can turn off the pie chart...Preferences/Appearance tab and remove the check mark.
No need to redo these though.

ResMed won't even give your Mr Frowny face for leak management until you spend 30% or more of the night in large leak.
Problem with the large leaks is often the AHI is unremarkable but we don't know if nothing happened during those large leak times or the machine was simply clueless as to what might be going on.
It's not that the machine goes immediately in the toilet when the leak goes from 24 L/min to 25 L/min....it's more of a the further you go the worse it gets thing.
Up to around 35 L/min ResMed machines will most likely flag something. You might get some "unknown" flags because the machines knows something is going on but doesn't know what to call it.

Is your machine missing something when it is say in the 40 L/min leak territory??? Don't know for sure but I doubt it is missing much because you don't have any unknowns showing up to speak of. Usually when the machine starts getting clueless there is a progression where something will show up and get an unknown flag.
Can't be sure 100% sure that your nice low AHI is accurate or not.

I learned a long time ago that trying to obtain a "perfect..no large leak" graph usually meant that I had to sacrifice sleep quality or sleep itself.
I decided that I wasn't going to worry about short periods of large leak as long as they didn't wake me up.

[Chairman Meow]

For the time over leak red line threshold I it says 11.62% on Monday night and 21.68% last night.

My leaks prior to losing weight and mouth breathing were very minimal or nonexistent and my AHI has been consistently less than 1 since I started therapy 3 years ago. The leaks are a pretty huge problem for me because I'm either waking up with terrible dry mouth (if I don't tape or strap), or terrible stomach pain and bloating (if I do tape or strap). Since the problem started with the weight loss (and I'm not going to gain weight back to stop it) I'm hoping that there is some other adjustment I can make to reduce or stop the leaks/mouth breathing.

Do you think that reducing my pressure, or switching to a variable pressure may offer me some relief?

[Pugsy]

Reducing the fixed pressure or switching to auto mode might help the air trying to sneak into the mouth and then out through the lips..
Would for most likely help with the aerophagia issues.

Worth trying and you have some room for allowing a small number of events slip past the defenses (if it even happens which it might not).
You have lost weight and may not even need this same pressure.

I think if it was me I would do a real experiment and try auto mode with min of 6 or 7 and max of 10 and see what happens in terms of events happening and leak management and the aerophagia issues and does the machine even want to go to 10 type of thing.
Maybe you could get by with less pressure in terms of your OSA therapy and that might in turn help with the aerophagia and mouth leak stuff.
Sort of back up and do a home titration to see what pressure you need now. Don't know that it has changed but it might have.

[Chairman Meow]

Thank you! I have adjusted the settings from cpap to auto-set and will report back tomorrow with the results. Can you tell me what to expect with the change when I go to bed tonight? I don't use the ramp, so I'm at a 12 pressure right from the beginning...in an auto-set mode will it start at the lower pressure?

[Pugsy]

It will start at the lower minimum starting point of 6.
It may be a bit uncomfortable dropping from 12 to 6 cm starting point...meaning you may feel a bit air starved.
If you do and you can't get passed it then back up and make a smaller drop (like to 10 minimum) and we can work our way down.
You've been used to 12 for a long time so you may find 6 a bit uncomfortable.

[Chairman Meow]

Thanks again... I'll definitely report back tomorrow! I'm so excited I kind of want to try and go take a nap now.

[QueSera]

I just posted elsewhere about a mask question I have and then I read this thread. My mouth leaks have really begun in the last month or so, when I began to make good progress with weight loss, so .. very interesting! I’ll keep following this thread.

[Holden4th]

One thought that occurred to me was that with weight loss you also get a loss of body fat. Could this possibly be making your mask too loose?

[QueSera]

The mask seems to fit better now that I've losst the weight.

[Bertha deBlues]

One thought that occurred to me was that with weight loss you also get a loss of body fat. Could this possibly be making your mask too loose?

Interesting point! I've lost a great deal of weight by changing my diet, and my face is thinner. It does affect the mask fit. The lower body weight has also affected the pressure I need, so I lowered my minimum pressure just a touch. That helped with the chipmunk cheeks, which were forcing my mouth open. The only "problem" is that I have wrinkles that weren't there before. All that fat was stretching out my skin and hiding them.