Mouth Leak?

[Timefliesby]

Hello everyone. I'm not sure if anyone remembers me but I posted here a month or two ago about my concerns of starting CPAP therapy. Well, here I am now and I've been using my APAP for about 1-2 months. I didn't "feel like a whole new person" like some people do after using their PAP the first time but more of a gradual shift. I did notice that my headaches that occur 2-3x per week have completely stopped (except the wine-related ones...). I also noticed that I don't feel the need to immediately flop on the couch and pass out for 2-3 hours after work.. This is huge! The past few weeks I've been waking up an hour early to workout in the morning. I've actually felt really amazing which is something that I never felt before from exercise. Before, exercise would make me more tired and miserable. I've even lost about 5 pounds! Obviously, things are going great and I hope they continue to get better.

Now onto the subject of this post... I woke up Wednesday morning to work out on my stationary bike. I noticed that I wasn't able to work as hard as I usually do since starting my APAP. After working out, I was so dizzy that I was walking funny and could barely stand up in the shower. I thought I was just hypoglycemic so I had something carby for breakfast but it didn't work. The whole day at work I was so out of it. I felt like I couldn't read and understand what I was reading.. or understand people that were talking to me. I got home after work and passed out on the couch for 3 hours then went back to sleep and slept 9 more hours that night. I felt a little better yesterday but still not back to my new "normal." Today, same thing! But worse! I just got home and I'm about to pass out after I write this because I am so sleepy.

When I came home earlier, my husband said that I "was making farting noises" from my mouth all night and he could barely sleep at all. He just noticed this last night but not on any other night. This obviously sounds like mouth leak and really explains my overall fatigue. My question is, how the heck can I realize this is happening besides my husband noticing? I haven't woken up from mouth leak that I can recall. None of the data on my machine seems to have really changed significantly as far as last night compared to nights previous. Am I missing something? Is there some way to notice this by looking at the data?

My other question: since it is Friday, I won't be able to go to my DME supplier. It's my husband's birthday this weekend and I would hate to be dead the entire weekend. Anyone have any advice for jimmy rigging a chin strap?

I don't think I've found the "perfect" mask yet. My mirage fx is bulky and leaves red marks on my face so I got the airfit p10 nasal pillows. I love how minimalistic they are but I feel like I'm suffocating when I wear them at times. Some nights I can tolerate them and others, I wake-up and need to change back to my nasal mask. I have noticed my AHI is lower when I use the nasal pillows. Not sure why that is. I've been alternating between the two masks.

Here is my info if anyone needs it:
- Resmed Airsense autoset 10
- Resmed mirage fx & air fit p10 nasal pillow

Data from machine:
- Pressure 5-10 (this is low but I haven't seen my doc to titrate up yet, will see him next month)
- Pressure 8.8 ?? is this the average pressure.. not sure
- Average AHI 5.8 (will probably need pressure increased to lower this number?)
- Central AI 0.5 I dont' know if this is an average or what
- Leak 1 L/min again.. not sure if this is an average. Because the leak on all of my nights have had "smiley faces" which means good.

Last night my events per hour was 6.5 with my nasal pillows... usually with nasal pillows my events per hour is less than 5

[Holden4th]

Before you go the chinstrap route, go to your local pharmacy (drugstore?) and get a soft cervical collar. Works like a treat for me and is so much easier to wear.

[Sheriff Buford]

You used the term "passed out". That can mean a lot of things. Please tell me what you mean by that.

Sheriff

[SleepyGramps]

I've been using CPAPs for 26 years and nasal pillows for 3½ years, and a few months ago I started having my sleep interrupted by mouth leaks. I will be almost asleep, and suddenly air puffs my cheeks and squirts out of my mouth, sometimes with a farting noise from my throat. Really annoying! I have found two ways to deal with it: (1) Wear a dental guard. I don't know why, but it works. (2) Bend my neck (turn head to side or prop up on pillows). This decreases the diameter of the larynx and has worked the two times I have tried it.

Taping the mouth shut is an interesting idea, and I might try that, too.

Then there's full-face masks, but they give me jaw problems, a completely different topic.

[Julie]

It's quite possible your BP is now lower because Cpap will do that, so you need to be careful. If it was 'too' high before, it should be more normal now, but if it was normal (or even lower) previously, it may be too low when getting up and you should take it easy, slower, and not immediately exercise. Get hold of a good home BP -machine - your doctor or pharmacist could guide you - and test yourself very first thing on waking, but do it for a week to get a real average, vs one night. If it is consistently low, you should talk to your doctor about whether it's 'too' low, but don't just quit Cpap until you know a lot more.

[Jay Aitchsee]

Mouth leaks (pressurized air leaking from the nasal passages out through the mouth) are difficult to control because they are allowed by a failure of the of the back of the tongue to seal at the throat. An example of a proper seal can be experienced by noting the placement of the tongue when starting to make a "K" sound. Holding the tip of the tongue at the roof of the mouth behind the front teeth places the tongue in a similar position and aids in making a seal. People practice, and some learn, to keep the tip of tongue in this position while sleeping to help reduce leaks. "Learning" this can take some time.

People are often disturbed by the noise and feeling of these leaks and therapy effectiveness may be reduced by a loss of airway pressure with them. In Leak Graphics, mouth leaks are typically represented by longish, flat, plateau shaped traces. (a Smiley Face tells little about the nature of leaks - SleepyHead is needed)

Chin straps are often ineffective because they do not stop the air flow out of the mouth as can be seen by the ability to exhale through clenched teeth. But chin straps may help prevent mouth breathing (inhalation through an open mouth) which I see as a slightly different problem.

To prevent these leaks, air has to be stopped from flowing through the throat and out of the mouth. It can be done in one of three ways: Keep the tongue in the proper position, keep the lips sealed by tape or other means, or wear a full face mask. A full face mask eliminates the differential in pressure between mouth and nose which promotes the leaks. (Note: A FFM may eliminate mouth leaks, but might not prevent mouth breathing.)

Get SleepyHead by following this link to TNET Sleep Apnea Information.

[jfung28@yahoo.com]

I've been on cpap therapy for about 6 weeks. I have tried both the nasal pillows as well as the full face mask. Definitely have been getting much better ahi readings with the nasal pillows. Anytime I try the full face mask my ahi shoots up (15-21 readings). Thus I've been trying to stick to the nasal pillows. However, I have found myself occasionally feeling pressure buildup in my mouth and I find myself releasing soft puffs of air...from reading your forum, I am learning that this is called leaking mouth. I even tried taping my lips one night but that did not help.

Not sure what I should do if the mouth leaks worsen or continue...I asked my pulmonologist about the release of puffs of air with my nasal and she didn't seem concerned about it. Any thoughts/suggestions? Should I just continue with my nasal pillow as long as the ahi remains below 5? Thanks