Some newbie questions for CPAP

[Midtek]

Hi everyone,

I'm new to CPAP -- just got my machine (Dreamstation) less than 3 week ago. I've been reading this forum ever since to find answers to all of my questions since I have little support in general in my personal life. I've read through the newbie FAQ and I still have a lot of questions, so please forgive me if I missed something obvious already. I did put my machine/mask info in my profile, but please say if I did that wrong.

Overall I am feeling a lot better using the machine. The DreamMapper app from Philips tells me that my AHI is usually below 1, which is really amazing. (My untreated AHI was 27.) But I still get very anxious about even little things going around. I have a history of depression and anxiety for most of my life, and so these little setbacks really do get to me I suppose.

1... Red mark on nose.
Right now I am using the AirFit F20 (nose and mouth mask) because the person who came to my home initially with the machine suggested it since I said I tend to mouth breathe or otherwise open my mouth during the night. The mask fits over the bridge of the nose, as opposed to the AirFit F30, which is another nose and mouth mask that doesn't. (I forget why I didn't choose the AirFit F30 initially.) Anyway, the mask has been leaving a very visible red mark on the bridge of my nose which does not go away. In fact, after the first few days I developed some sort of rash. I was getting some acne in the area and my skin was peeling.

I've tried using ResZZz mask liners, which seemed to fix the problem, but then I also had some problems with the mask fit (but that could be for another reason). I tried a nasal gel pad, but the pad ended up moving too much during the night for it to be effective. Last night I just put a Band-aid over the bridge of my nose, and that seemed to work -- the red marks did not get worse at least.

Questions:
What is the best option for dealing with this?
Would changing to something like the AirFit 30 be better since it doesn't fit over the bridge of the nose?


2... Air filters
The Dreamstation has two air filters. The larger is mandatory, filters out larger particles like pollen, and can be washed and reused. (Eventually it has to be replaced but I was told something like once every 3 months.) The smaller filter is "optional", filters out smaller particles like smoke, and should not be washed. Once it is too dirty, it should just be disposed and replace. I was told that the smaller filter should be replace about once every two weeks.

I do not smoke. I do not have any pets.

However, I am finding that I have to replace the smaller filter every 2 days, not every 2 weeks. I'm not being overly cautious either. A few nights ago I was woken up throughout the night by the machine because even when I was breathing normally (no apnea) the machine was sort of going crazy and increasing the pressure when I inhaled. It was super uncomfortable since the mask was being pulled in and out, and a lot of air was just rushing through the exhale ports on the hose elbow. On top of that, I was still noticing some apneas anyway (e.g., waking up suddenly with my heart racing and feeling a bit dizzy). The first night that happened caused me a lot of anxiety since I thought the machine was defective and it would take me another 5-6 weeks to get another. I tested the machine without the mask on, and it was hardly blowing any air out of the hose even at a setting of 8. After an hour or so, I finally solved the problem -- it was the smaller, optional air filter. Once I removed it and replaced it with a new one, the hose was pumping out air again. I was able to sleep.

Well... I've had to replace the air filter 2 more times since then. Each time it's the same thing -- the machine is not able to provide enough air. So even though it says the pressure is 8, I'm actually getting a much lower pressure. It still detects my breathing, and so it pumps up the pressure to the max of 12, which does little to actually help my breathing before it goes back to the default of 8 (i.e., no air).

I've compared the dirty filters to clean filters under a light, and the dirty filters really are dirty. You can hardly see through them. I ran my finger across one and a chalky, white substance came off.

Questions:
Have others encountered this issue? Is the only solution just to keep replacing the filters?
I don't mind *that* much having to replace the filter possibly every day since replacements are fairly cheap, but still, I would like not to have to worry about it.
Again, I don't smoke and I don't have pets. What could be the cause of having to change the filters so often? Is my apartment just that dusty?

3... Dry mouth
With the AirFit F20 I am getting a lot of dry mouth. As the FAQ states, and from what I can tell myself, it's because I am sometimes mouth breathing. I've read about a few products on this forum that can help, but I'm not really sure about which to try: mouth tape, chin strap, orajel, prescription toothpaste, etc.

Questions:
What have you found the best way to stop mouth breathing?
In the meantime before you stop mouth breathing altogether (is that possible?), what have you found to be the best option for preventing or helping with dry mouth?

4... Mask fit
This is my first mask, so I'm still a bit unsure of whether I should change masks or what the pros and cons of other masks are. Right now one of my biggest issues with the AirFit F20 is that I feel like it might be too small, particularly around the mouth. When it's on and fit snugly but not tight, I can feel that the corners of my mouth are just at or beyond the edge of the face cushion. So any relaxing of my mouth or movement of my jaw or mouth just leads to a leak. I'm not smiling or frowning in bed, but if I were to smile or frown, the mask would not fit over my entire mouth, and I could feel some air leaking out. The therapist initially gave me a Medium since that's what the sizing chart suggested.

Questions:
Does this suggest I should just go with a Large?
Or maybe just get a different mask?
In the other questions I was also considering changing to AirFit F30. I've also considered using a nasal mask or nasal pillows, but then I would really have to get my dry mouth under control since otherwise the mouth breathing would make the mask useless. Is it worth trying out the other masks and how long do you typically try to get used to a different mask before trying another?


Thanks so much for any help you can give me. If you can answer any of my questions (not all), I would much appreciate that. I know I've typed a lot. I am just very optimistic about using CPAP, but I really do want to get everything right. Otherwise I get much too anxious and I can't sleep anyway.

--Joe

[Pugsy]

I did put my machine/mask info in my profile, but please say if I did that wrong.

There is a problem right now with the equipment profile link not being visible. So even though you added your equipment to your profile it's not showing up right now because of a problem with forum software. My equipment profile doesn't show up either....no one's profile is showing up and hasn't for several weeks now.

Just keep all your questions to this thread and people will be able to see your equipment....at least for now.

And tell us exactly which model DreamStation you are using. Model name/number is critical.

Would changing to something like the AirFit 30 be better since it doesn't fit over the bridge of the nose?

To avoid red marks or skin problems on the nose....yes...change to a mask that doesn't come in contact with the nasal bridge area.
It does sound like you are having some skin sensitivity issues which are more than just red marks from pressure.
Mask liners obviously help with contact but then they also can cause problems with leaks. Damned if you do and damned if you don't but unless the leaks wake you up or are so big they seriously impact therapy effectiveness I would take leaks over contact dermatitis.

Be aware that if you are sensitive to the silicone itself then going to something like the F30 may just cause issues around the mouth but it's definitely worth trying. Seems like the skin on the nose is sometimes more sensitive than skin on other areas of the face.

For your filter issues....those disposable filters should last a lot longer than 2 or 3 days. They will normally last a lot longer than the 2 week recommended swap out time frame.
Next time you change that filter also give the washable filter a good washing and rinsing and pat dry. Just in case the discoloration is coming from the washable filter.
Are you a candle burner or use wood heat or anything that might add particles of anything to the air?

I can't really help much with mask fit or sizing issues for a full face mask...never really used one.

How to fix dry mouth from mouth breathing......figure out what the cause of the nasal breathing might be first and foremost.
Do you normally breathe through your nose just fine during the day or is your nose so congested that you have to mouth breathe to move enough air to be comfortable?
I thought I was a mouth breather initially and was told I needed to use a full face mask (which wasn't high on my want list) but I breathe just fine through just my nose during the day...so then I looked at why I might be needing to mouth breathe during the night and come to find out I didn't really need to and my dry mouth and mouth breathing was more from habit due to the apnea events causing me to gasp for air and mouth breathe. It did take a bit of time to break that habit but it can be done as long as there is no physical reason causing a person to not be able to be comfortable with just breathing through the nose.

There are ways to reduce mouth breathing as long as the cause of the mouth breathing isn't a chronic nasal congestion issue.

[Pugsy]

If you just have to use a full face mask (over the nose type) for some reason and there are skin issues...take a look at the ResMed AirTouch F20. It uses memory foam in the area that touches the skin.

[Miss Emerita]

To address a couple of your questions....

Some people get relief from dry mouth by using Xylimelts, which are small discs that stick to your teeth or gums and release a substance throughout the night that stimulates the production of saliva.

If you breathe through your nose through the day, you may well be able to switch to a nasal interface. Here are some ideas about avoiding mouth-breathing:

So, if you want to keep trying with a pillow mask, here are some ideas about reducing or eliminating mouth leaks. Many people find that chin straps are actually counterproductive, because they tend to pull the jaw back, which makes it harder to keep the mouth closed.

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon.

3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

Note about tape: Some people avoid it, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. However, you can sacrifice one strip to see for yourself how well you can pull you mouth open in an emergency using only your jaw muscles. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, out of an abundance of caution, I've put a circuit alarm in a plug on the same circuit as my machine. It will wake me up immediately if I lose power to the machine.

[Midtek]

Thanks so much for the quick responses already!

There is a problem right now with the equipment profile link not being visible. So even though you added your equipment to your profile it's not showing up right now because of a problem with forum software. My equipment profile doesn't show up either....no one's profile is showing up and hasn't for several weeks now.

Just keep all your questions to this thread and people will be able to see your equipment....at least for now.

And tell us exactly which model DreamStation you are using. Model name/number is critical.

Machine: DreamStation Auto CPAP Machine with Heated Humidifier
Mask: RedMed AirFit F20 Fullo Face CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier

To avoid red marks or skin problems on the nose....yes...change to a mask that doesn't come in contact with the nasal bridge area.
It does sound like you are having some skin sensitivity issues which are more than just red marks from pressure.
Mask liners obviously help with contact but then they also can cause problems with leaks. Damned if you do and damned if you don't but unless the leaks wake you up or are so big they seriously impact therapy effectiveness I would take leaks over contact dermatitis.

Be aware that if you are sensitive to the silicone itself then going to something like the F30 may just cause issues around the mouth but it's definitely worth trying. Seems like the skin on the nose is sometimes more sensitive than skin on other areas of the face.

For your filter issues....those disposable filters should last a lot longer than 2 or 3 days. They will normally last a lot longer than the 2 week recommended swap out time frame.
Next time you change that filter also give the washable filter a good washing and rinsing and pat dry. Just in case the discoloration is coming from the washable filter.
Are you a candle burner or use wood heat or anything that might add particles of anything to the air?

I can't really help much with mask fit or sizing issues for a full face mask...never really used one.

How to fix dry mouth from mouth breathing......figure out what the cause of the nasal breathing might be first and foremost.
Do you normally breathe through your nose just fine during the day or is your nose so congested that you have to mouth breathe to move enough air to be comfortable?
I thought I was a mouth breather initially and was told I needed to use a full face mask (which wasn't high on my want list) but I breathe just fine through just my nose during the day...so then I looked at why I might be needing to mouth breathe during the night and come to find out I didn't really need to and my dry mouth and mouth breathing was more from habit due to the apnea events causing me to gasp for air and mouth breathe. It did take a bit of time to break that habit but it can be done as long as there is no physical reason causing a person to not be able to be comfortable with just breathing through the nose.

There are ways to reduce mouth breathing as long as the cause of the mouth breathing isn't a chronic nasal congestion issue.

Thanks for all the help.

I will definitely try out the AirFit F30 and, if necessary, the AirTouch F20. I think they both use the same hose elbow connection as the AirFit F20, so replacement shouldn't be too much of an issue. I'm not getting any skin sensitivity around my mouth, just my nasal bridge. The mask actually feels tighter around my mouth than around my nose, but the skin is just a lot thinner at the nasal bridge, so it makes sense my skin is more sensitive there. It's just a matter of the medical supplier getting it to me -- I would rather not have to order one myself out of pocket.

As for the other issues and your questions...

1. Air filter
Thanks, I will try washing the washable filter to see if that's the problem. I have a new pack of disposable filters, so I can start with a fresh disposable filter and a freshly cleaned washable filter to really test this. I don't burn candles or use wood heat. The only thing I can really think of is my external humidifier. I got used to using it before I had my CPAP and I typically use filtered tap water in it (not distilled). Using distilled water on the large humidifier was just too expensive, and I didn't mind washing the humidifier a bit more often than if I was using distilled.

I speculate that the water filter I use is not quite getting enough of the heavy particles out of the water. The tap water here is generally just fine to drink out of the faucet, but, of course, tap water, always has some heavy minerals in it. So perhaps over the course of the whole night, the heavy particles eventually clog the air filter. I can try not using the large external humidifier (or maybe putting it a lot farther away from the CPAP machine?), but I'm worried that the smallish tank of the machine cannot keep the air humidified the whole night. (My bedroom typically is at about 20% humidity if I'm not actively using a humidifier.)

2. Dry mouth
During the day and when I'm getting to sleep I breathe through my nose just fine. No chronic nasal congestion issues. In fact, some nights I have felt like I had some congestion, but the pressurized air just blew past it anyway, so I didn't notice it once I got in bed. So it's like you said -- I'm just used to mouth breathing from having untreated apnea for so long.

So how do you break this habit anyway? How do you break a habit while you are unconscious? Did you use tape or a strap to try to "train" your brain not to mouth breathe?

3. Mask fit
I'm going to try the masks you suggested and perhaps ask about a larger size too. I guess it just takes some trial and error. I agree that I would rather have some leaks than a skin rash, as long as my AHI is still low and my sleep quality is high regardless.

[Pugsy]

So how do you break this habit anyway? How do you break a habit while you are unconscious? Did you use tape or a strap to try to "train" your brain not to mouth breathe?

I tried both tape and chin straps.
The chin straps I found annoying and would slide all over my head and ended up causing more problems sleeping than they fixed mouth opening issues.
So then I tried taping and had better luck with that and did it for about 3 months and since my mouth opening was more of a habit than a need physically eventually I found I was opening my mouth much less often so I quite taping.
I sometimes still will open my mouth on occasion but it isn't often and doesn't last long when I do and it doesn't wake me up...so I just don't care if I have a little bit of mouth opening leaks. My sleep is my primary goal. I don't worry over minor leaks that don't wake me up as long as they aren't huge or prolonged.

You can use OSCAR software to see the actual details as to just how long any big leaks last.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

some examples can be found here
viewtopic/t158560/How-to-post-images-for-review.html

[Midtek]

To address a couple of your questions....

Some people get relief from dry mouth by using Xylimelts, which are small discs that stick to your teeth or gums and release a substance throughout the night that stimulates the production of saliva.

If you breathe through your nose through the day, you may well be able to switch to a nasal interface. Here are some ideas about avoiding mouth-breathing:

So, if you want to keep trying with a pillow mask, here are some ideas about reducing or eliminating mouth leaks. Many people find that chin straps are actually counterproductive, because they tend to pull the jaw back, which makes it harder to keep the mouth closed.

1. Tongue position. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

2. Collar. If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon.

3. Although chin straps tend to pull the jaw back, which is not helpful, the Knightsbridge Dual Band strap has a design that pulls the jaw straight up, which makes it a possible alternative to a cervical collar.

4. Tape. Some people (including me) rely on tape to keep the lips from opening. (I can't rely entirely on the tongue thing.) When the lips open, all too often that eventually leads to a noisy and disruptive mouth leak. To see whether tape would be feasible for you, I recommend that you invest in a box of Somnifix strips. They are very gentle on the skin but hold very well. Be sure to curl your lips inward per instructions before placing the strip. If these work for you, then you can experiment with lower-cost options.

Note about tape: Some people avoid it, for two reasons. (1) If you suddenly need to vomit in the night, the tape could lead to your aspirating some vomitus, which would be bad. However, you can sacrifice one strip to see for yourself how well you can pull you mouth open in an emergency using only your jaw muscles. (2) If there is a power failure and your machine goes off while you're sleeping, you won't be able to do the natural thing and open your mouth to breathe. As for that, out of an abundance of caution, I've put a circuit alarm in a plug on the same circuit as my machine. It will wake me up immediately if I lose power to the machine.

Thanks so much for the advice. I was able to get a box of Somniflex strips and will be trying them tonight for the first time. I watched some YouTube videos on the product and it looked like it's rather easy to pry your lips open if you really have to. I'm going to try tonight myself. I don't have chronic nasal congestion, so I think I'm just mouth breathing out of habit or gravity or both.

I also saw an option for just buying a roll of micropore tape. (3M makes it, and it's cheaper.) But I'm going to take your advice and try the strips first, and then experiment with other options. I keep reading that the strips are one-time use only, but everyone various forums and videos say they get 2 or 3 uses out of them. They just take the strip off in the morning and place it on their night table until the next night. Have you used the strips? Do you recommend using them once and discarding?

I do have a backup battery for power outages. (In fact, I had one last week for about 5 hours during a snowstorm, and I was very anxious about whether it would be fixed in time for sleep. It was, but it was enough to make me go out and by a backup.) I also ordered a failed circuit alarm just for extra peace of mind.

[Miss Emerita]

I don't try to reuse Somnifix strips because mine tend to get fairly wet from saliva during the course of the night. Occasionally they get so wet that they fail to stick at the corners toward morning, but happily those leaks aren't large or disruptive.