Questions for the other mouth-breathers among us

[adrienneiii]

All right, I've been using CPAP for about 40 days now and it is pretty darn magical. I even have had a night or two when I slept all the way through. But now that I've got the basics down I find that I still have questions.

I usually try to start the evening breathing through my nose, but it often gets stuffy, so I wind up breathing through my mouth at some point. I'm still learning to walk the fine line between too much (makes my nose stop up) and too little (gives me a scratchy throat) humidification. I find that once I've been breathing through my mouth for a period of time there is a lot more humidity in the mask and hose than there was before; is it correct to assume that the extra moisture is coming from me? (Think of the scene in Mr Holland's Opus with the trombone player, the spit valve, and the girl in the next row.) I'm bright enough to turn the humidifier down a notch when I wake up dripping, but is there more to this picture?

Second, the pressure feels different through my mouth than it does through my nose. On a stuffy-nosed night, the 7 that I am prescribed does not feel as though it is doing its job -- although on a good, clear-nosed night, it seems to work fine. Also, it feels as though I could use different pressures for different situations -- clear nose, stuffy nose, sleeping on back, sleeping on side, various combinations of the above. Any thoughts about that? My machine does not have a smart card, so I'm going pretty much on how I feel, which is admittedly going to be subjective.

Oh, and a third question: sometimes I feel like I'm not getting enough air inside the Hybrid mask, but a quick check of the exhalation ports tells me that plenty of air is flowing through. Is this most likely just me, or might something else be going on? I don't usually have much problem with claustrophobia; took care of that long ago when the Air Force taught me how to wear a gas mask.

My "sleep doc" is a person who I have never met, who read the sleep lab report and prescribed the therapy. My family doctor is fine but his specialties are family practice and sports medicine -- not sleep. I have a call in to the RT and plan to ask them how to address this moving target. I'm assuming that the tools will include the ability to track what's going on and possibly some kind of auto-adjustment instead of the straight pressure with c-flex. Any help in formulating the right questions to ask would be appreciated.

[Wulfman]

Without having a data-capable machine (and the software) you really don't know for sure how your therapy is working. It's true that how you "feel" is a good test, but it's always nice to see some corroborating evidence to back it up. If there's any chance of upgrading your machine to the M Series Pro, I'd suggest pursuing it. (software would help, too) If you have the extra money, get the Pro out-of-pocket and keep the Plus for a backup.

I would highly suggest getting a copy of your PSG (sleep study). One night in the sleep lab doesn't mean everything has to be etched in stone. My titration/prescription was WAY off. Your prescribed pressure may not be "right on", either.

If you're still stuffing up during the night, it's possible that the humidifier is still set too high.

Den

[ww]

If you can get a good full face mask like the ResMed Ultra Mirage Full Face, it may work better for you than the Hybrid. I have both and use both but never get as good results with the Hybrid. Breathing through your mouth is not nearly as good as breathing through your nose on cpap, even with a full face mask or hybrid. Yes, you are contributing the humidity from your mouth breathing. Scan the forums for information on Sinus Rinses or Neti Pots that may help you. A prescription Nasal Spray for allergies seems to be widely used and some sleep docs recommend it. I have to turn my Humidifier off when the local humidity is normal to high or I get congestion from my own humidifier. The breath rite strips seem to really help me breath better through my nose at night. Good luck.

[DreamStalker]

Yes ... moisture comes mostly from your own breath.

Yes ... the position you sleep in does affect how much pressure is needed to keep apneas at bay. Of course, a stuffy nose can restrict airflow too ... develop a new habit of flushing your sinuses with a saline nasal rinse --- can you say Google?

Yes. quite likely you are getting used to the pressure and in time it becomes very normal.

As for masks ... everyone is different and what works for some don't for others and visa versa.

.... and yes what Den said ... get a data capable machine, preferably an APAP machine.

[adrienneiii]

Many thanks for all your suggestions. I'm still waiting for the RT to call back, but that is just as well; more time for me to plan exactly what to ask!

As for saline rinses -- been using the NeilMed Sinus Rinse squirty bottle for years. Thanks for the tip anyway; it's a very good one.

As for the Breathe Right strips, I'll definitely try those. I tried them briefly, years ago. They did nothing for the snoring (imagine that !) but they did make it easier to breathe.

As for mask, yes, on paper the UMFF would be perfect for me, and was actually my first mask. Unfortunately, even the small size was just too big and to keep a seal at all I had to keep it much too tight. When I took the pressure off of my sinuses the support dug into my forehead, and when I took the pressure off of my forehead the dang thing would dig into my sinuses.

As for nasal sprays, I have to be VERY careful, as I have a tendancy toward central serous retinopathy, which is a fancy term for blisters on my retina. In my case (the retinologist thinks) CSR was brought on by a nasal spray that did wonders for my allergies but sent my vision blurry for months. I stopped the steroidal nasal spray and my vision cleared up, though there is a tiny bit of damage left over. Please don't let this scare anyone away from nasal sprays; it's very rare. But I have it. So my decongestant choices are limited to the sudafed-type decongestants and to saline rinsing. If steroids will reverse a life-threatening situation I'll take them in a heartbeat, but if it's just about comfort, or if there is something else I can use instead, I had rather keep my vision, thanks.

Also, thanks for confirming my thoughts about how to make xPAP work better. Now where do I sign up for my "Junior Lab Rat" T-shirt?

Adrienne

[RafterRattler]

Sounds like your experiences have been very similar to mine.

I suffer from chronic sinus problems, and my nasal passages will close up in a heartbeat. I was addicted to afrin/sinex/etc. for several years because it was the ONLY thing that kept me from banging my head against a wall from the claustrophobic feeling of being stuffed up. Doctors always say that eventually regular constricting nose sprays won't work, but they worked for me every time for MANY years, and lasted for hours. I really miss the feeling. Unfortunately, my Doc finally convinced me to stop because he said it was causing scaring of my nasal tissue. His solution was to prescribe Flonase (a topical steroid). Now I have a HUGE hole in my septum. Apparently, it's a very rare, known side effect of nasal steroids. Now I can't use anything. So...um...how was Flonase better for me? The strange thing is that I breathe a little better now that I have the hole...

At any rate, all these problems are the reason I'm a mouth breather as well. I just can't keep my nasal passages open reliably. I did find that taking Sudafed and using Breathe Right strips before putting on my mask helped most of the time. On really bad nights, I also found that cleaning my nasal passages with rinse and then swabbing on some menthol nasal moisturizing gel also helped to open them up. I've even been known to swallow a spoonful of mustard on occasion.

The bottom line was that I eventually went to a FF mask because I just couldn't keep my mouth from dropping open for very long, even with a chin strap. I now use the Resmed Mirage Quattro - which is a variation of the UMFF. You might want to see if the small version of the Quattro is any better for you.

I know this probably didn't help much, but I figured you at least might like to know you're not alone. Keep working on it, and you'll eventually find something that works for you. Good luck!!
Mike

[adrienneiii]

Sounds like your experiences have been very similar to mine.

I suffer from chronic sinus problems, and my nasal passages will close up in a heartbeat. I was addicted to afrin/sinex/etc. for several years because it was the ONLY thing that kept me from banging my head against a wall from the claustrophobic feeling of being stuffed up. Doctors always say that eventually regular constricting nose sprays won't work, but they worked for me every time for MANY years, and lasted for hours. I really miss the feeling. Unfortunately, my Doc finally convinced me to stop because he said it was causing scaring of my nasal tissue. His solution was to prescribe Flonase (a topical steroid). Now I have a HUGE hole in my septum. Apparently, it's a very rare, known side effect of nasal steroids. Now I can't use anything. So...um...how was Flonase better for me? The strange thing is that I breathe a little better now that I have the hole...

Geez. Now tell me again how pharmaceutical products are going to be the saving of us all?

Anyway, here's what I found out. Had a nice chat with the RT, who in a nutshell said my question is out of his league and I should talk with my family doctor. Which is fair enough, and what I expected, but I had to start somewhere. Then I did some research on capabilities of various machines and on how to go about procuring one. I had an appointment this morning with the PA that I usually see at my family doctor's office. I told her what was going on and asked about upgrading my machine so that I can use a Smart Card. She thought it was a great idea, as long as I found a sleep doctor to work with once results start flowing in.

So I set out on a quest for an accredited sleep facility that's also in my insurance company's network. My 1st sleep study was at an excellent facility that turned out to be out of network and therefore unaffordable over the long haul. My 2nd sleep study -- where they did the cpap titration -- was at a place that was in-network for insurance but not accredited. Go figure.

But now that I'm beginning to regain those working brain cells, I went to the American Academy of Sleep Medicine and found a list of accredited facilities, then pulled a list of in-network facilities from my insurer's web page, connected the dots, and found a (uh, THE) place and a doc that just might work. Granted, finding a physician this way is not rocket science, but before the cpap started working I was not really capable of any science at all and didn't even know it!

Anyway, I phoned the new sleep facility, was up front with the receptionist about what I wanted to do. The receptionist was neither shocked nor appalled that I should be so proactive; this is a good sign. Have scheduled an appointment with the new sleep doc for 15 September, so will see what develops.

Wow, it's nice to have a brain again.

Adrienne

[neverbetter]

I can't imagine a resmed product being more comfortable than the hybrid, but that's just me.
You want to breathe through your nose all you can. That the genius idea behind their chinflap. it should gently teach you to keep your mouth shut, but allow you to mouth breath when you absolutely have to without messing up the therapy.
Try Flonase