puff lips, flapping lips, mouth leaks full face masks?

[kenrose]

I have discovered that as I relax and fall asleep, my jaw tends to relax as well. duh! I have tried paper tape, works for not allowing air to leak out but no help for puffed cheecks etc. Scrunchies as chinstraps help but still have the problem. Kermit tried a device from HI that may or may not work, any news? Rested gal said the resmed ultra mirage ff was OK anyone with any exp.?
Ken

[Kermit]

Ken,

As a fellow mouth leaker, I can tell you that FF masks are very iffy.

I bought two, Resmed and Respironics's latests offerings ( FF masks ) and I like them as they are comfortable. Problem was that as my jaw relaxed, the leaks started and I could never get any sleep. Tried to use a chin strap but often interfered with the large seal footprint. These masks are like Snork once said, like a Hovercraft and difficult to seal.

That was my experience and both are in my drawer, about $400 worth of mask I might add.

If you decide to get one, I would recommend the Resmed one. Also they will ship you a 3D plastic sizing template.

Good luck. I know what you are going through. My holy grail was the dental guard that keep my tongue up against roof of mouth. as you know, I got it on line and have been tape free, leak free and chin strap free ever since and will be buying a spare just in case.

Kermit

[kenrose]

kermit, thanks for the quick reply. I will get started on Dr Sue asap. In the interests of lab rat science I purchased an anti teeth grinding mouthpiece from tarjay. I may try it to see what happens but if you got good results already I am on it. I have no problems with pressure (12) only want the auto pap for the software so I can tell what's going on, but the mouth leaks are driving me crazy. also rainout is really interesting when you've taped up your mouth, have 2 scrunchies as chinstaps and a mask. Nothing like getting a few tablespoons of water up your nose to have a restful nights sleep!
Ken

[Kermit]

Ken,

I know all about water injections into nose too. First one was with my Nasal Aire (NA1) two years ago and it hurt. Before that with the Adams. Got it again recently on my Breeze I decided to use once in a while. Because I cranked up the humidifier and the breeze has a very small manifold it swished right in at again it was painful. Have not re-visited the Breeze since.

Using my current favorite, Swift, has been a good experience as the large barrel holds water well and has yet to push it up my nose. I have the humidifier up so high that most days I almost empty out the tank.

I used tape for close to two years and did not have problems with tape and rainout. The problem was tape coverage and air blowouts on the sides. Using an ACE bandage as chin strap helped keep tongue from dropping when asleep and helped a lot with mouth leaks, it made the tape work less hard. It has only been ten days since I started using my mouth leak holy grail, the dental guard, and looking back I wonder how I managed all those nights. Cpap life is simpler now. I was anxious to see a FF Activa come to market to get away from taping as regular FF don't work for me. Now I don't care as I have the dental guard and Swift.

Kermit

[jdacal]

Hi Kenrose,

I had identical problem as you, flapping lips etc.,

I buy an oral jel at the pharmacy to keep my mouth moist (at least it does for a while).

And the Resmed full face mask.

I had the problem where my mouth would open and the seal would release too, but found that wearing the mast lower than where it would normally go took care of the problem. This however tends to leave a mark on the ridge of my nose, but I do get good sleep.

That and occasional Rhinocort or anything you find that keeps your nostrils open, helps to keep your mouth closed at night. Also started using a soft toss pillow that I would put betwen my chin and chest at night - which helped me to get used to not opening my mouth so much, since it helped to keep my chin closed.

Thanks for your help

[tater pie]

I've tried just about every chin strap on the market and none of them work for me. Once I get into a deep sleep, the jaw just drops open. I wouldn't waste any more money on full face masks either unless they come out with something a lot better than they have out there now. I have tried the Respironics Comfort Full and the Ultra Mirage. The Ultra Mirage was a lot better for me than the Comfort Full but it still leaked. Just about the time I would start to drift off to sleep, the darn thing would spring a leak. If I strapped it down tight enough, it wouldn't leak but then it was so uncomfortable I couldn't sleep. My pressure is 12 straight cpap also and the pressure doesn't bother me either. I'm stuck with my cpap for a while so I plan to try the Nose Breathe device that Kermit has as soon as I get the money. I just wonder if will work on a mouth shaped like mine. When I close my top and bottom teeth together, I can still put my thumb between my top and bottom teeth. My teeth don't protrude either. My lower jaw is just set way back. That's probably part of the reason I have apnea so bad but I can't afford to get it fixed right now anyway. I hope it will work for me anyway. I use mouth tape and a chin strap now but a lot of times I can blow a leak in the mouth tape not matter what tape I've used. Since this is a really common problem with cpap use, you think they would come up with something. Maybe this mouth guard is the thing!!!!

[dsm]

To KenRose

I am following kermit on this. Myself & a group of others have all been Dr Sue's website & ordered but sadly no responses yet.

I have a mouth guard already (dentist gave it to me after several crowns were placed on my top teeth). I have become quite used to it an believe that Dr Sue's one is very similar except he adds a free parking space for the tongue.

I did another set of experiments re mouth puff & mouth leak & aerophagia - these mirror similar paths that RG and WllSucceed have already been down (& I am happy to follow).

I was titrated at 15cms - but leaks etc: etc: etc: caused me to drop to 14.
then 13, then for 2 nights down to 12.

The cheek puffing & aerophagia & leaks have dropped away markedly BUT, I am suspecting that my alertness and energy level may have dropped a bit as well I am not certain, just wondering. One symptom is that when I went down to 13 & 12, I got great night's sleep (so did wife) but then I found myself yawning during the day. All day.


So, I have been getting full nights sleep but am now wondering if some OSA symptoms are returning.

RG, WillSucceed, others who have tried, have any of you trying this experiment had similar results or come to similar conclusions ?

Is this too soon for me to come to such conclusions ?

Is it possible that dropping cms further from the titrated level will increase OSA symptoms such as lower blood oxygen during the day ?

Cheers

DSM

[rested gal]

Is it possible that dropping cms further from the titrated level will increase OSA symptoms such as lower blood oxygen during the day ?

I don't know if ineffective cpap treatment during the night would affect oxygen levels during the day while awake. I don't think I've ever seen anything that said a symptom of OSA was "lower blood oxygen level during the day." Interesting thought.

Anyway, the poorer sleep due to more events while not using the titrated pressure could certainly leave a person sleepy during the day - the yawning could be just an attempt to give more oxygen to the brain even if it was already getting enough during the day. A mechanism to give it more to alert it more via yawns, even though it has plenty! Maybe.

So much about this kind of treatment is a trade-off. Upping pressure might give better results OSA-wise, but cause mask leaks and/or aerophagia. Possible net result, disrupted sleep.

A person could be getting great SPO2 levels during the night, but waking up so much due to mask problems or discomfort that they feel worse than pre-cpap. Sleepier. Feel miserable.

That's not to say they are better off to stop cpap treatment, of course. But comfort can be a make it or break it issue with this kind of treatment.

If dropping the cm's to just below the threshold that causes aerophagia lets a person sleep better, even if it is not giving them full "cpap" treatment, they might be better off temporarily trading some cpap benefit just so they can sleep without bloating pain waking them or making them feel awful the next day.

It's very possible that getting accustomed to a more comfortable pressure for a few weeks might let them finally work their way up slowly, a cm at a time, to a more beneficial titrated pressure. Some have reported less problem with aerophagia over time. Might take more time to get there, sneaking up to the titrated pressure that way, but if bloating pain is bad, getting acclimated slowly instead of trying to tough it out might be the best course for some people. Would be for me!

[dsm]

RG
As always, your commonsense and thoughtfulness is impressive. Again thanks for your input on this

Cheers

DSM

PS: Today, once I got busy (after breakfast), I stopped yawning & completed a whole lot of tasks I had planned, and as planned, so maybe am bit too sensitive to the slightest change in behaviour (such as the yawning )

D

PS2 - Tonight am upping cms to 13.

PS3 - I have some great photos of the S7 machine re what buttons to push etc. Will send you the link when I have added the RemStar and an S8.

PS4 - One other interesting event that happened this morning. Was off having a social breakfast 15 miles from home, at the beach, with friends. I was nose breathing ok, then I had a capachino coffee (lots of milk), then after eating (eggs benedict with bacon) had another capachino, then commented to my wife & friends that I suddenly couln't breathe thru my nose & had switched to mouth breathing.

I mentioned that a poster on this forum had said to me that he had to give up dairy products in order to relieve nasal congestion. They both agreed that could be the cause, but this friend also said to me "don't you get congested after drinking some brands beer" - yes says I, "and isn't that brands that have more so2 preservative" yes says I, "well bacon has so2 in it too". So was it dairy or was it s02 (sulphur dioxide) preservatives in bacon. -- I really wasn't sure - I will try to investigate -- the congestion lasted about 30 mins then eased such that I could nasal breathe again. Interesting! (to me).

D

[dsm]

Is it possible that dropping cms further from the titrated level will increase OSA symptoms such as lower blood oxygen during the day ?

I don't know if ineffective cpap treatment during the night would affect oxygen levels during the day while awake. I don't think I've ever seen anything that said a symptom of OSA was "lower blood oxygen level during the day." Interesting thought.

RG,
The point I raised could just me my naivety re OSA.
I had thought (or at least thought I was told at sleep clinic seminars?) that a symptom of OSA was low blood oxygen levels that flowed into daytime. I thought that some CPAP machines have facilities for monitoring this oxygen levels. I also have it in my head that twitching leg syndrome was a side effect of lowering blood oxygen levels during the night.

I guess it boils down to a belief I had developed, that low blood oxygen levels from sleep, carried over into the day. Perhaps what it should be is that the effects of nightime low blood oxygen levels, carry over into the day.

Cheers

DSM

(forever learning )

PS:
Just found this link which helps clear up some of this for me

http://www.chclibrary.org/micromed/00065500.html

The following quote from this link has my special interest ...
"A combination of the two forms is also possible, and is called "mixed sleep apnea." Mixed sleep apnea episodes usually begin with a reduced central respiratory drive, followed by obstruction. "
D

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[Kermit]

DSM,

I used to suffer a lot from bloating too. Rarely now.

I think what worked for me was using a little travel sized pillow under my neck that allowed back of head to rest on mattress. This straight neck sleeping position seemed to have helped with bloating and even help reduce the intensity of mouth leaks. It might not be for everyone but it seemed to have helped me resolve this.

I am now back to my original titrated pressure 100% of the time with no bloating. I remember that when I was bloating I dropped pressure in small steps to see where it stops. The lower pressure helped reduce bloating but hurt the therapy. Back then I used a contoured foam pillow and before that a regular pillow. I suspect the angle of my neck, chin towards chest, had something to do with it.

Today, I sleep with a straight neck and I rarely bloat despite using original titrated pressure that was causing bloating in the past. Bloating was the driving force for me to argue that I needed an autopap and got it. Yes sleeping at the low pressure end 90% of the time helped the bloating and was comfortable BUT increased daytime fatigue big time. So I made my 420e auto into a cpap, run at the higher pressure 100% of the time as I once did and no more bloating. Why? I still think it's the neck position. A side effect is that with a straight neck it does not tug my upper back muscles and the re-occuring upper back soreness often followed by headaches are a thing of the past for me.

Kermit

[Kermit]

Tater Pie,

I just thought of something you could do. Sneak over to the TAS forum and search out FrequentSeeker's DIY mouthguard. There are numerous posts over there on how to make one yourself. All you need are two or more $2 mouthguards from Walmart's sporting goods department. They are boil and bite ones that you make your impression then canabalize another to make the tongue shelf. She has photos and detail instructions.

I tried that first but am not very good at that sort of thing. Many there including our Rested Gal were successful. I was not and bought Dr Sue's that FrequentSeeker told us about.

Give it a shot and at least see if that's the kind of thing that will help even if it is not a perfect device.

Good luck.


Kermit

[rested gal]

Kermit, that's very interesting about how you eventually got relief from aerophagia by keeping your head and neck flatter down on the mattress. I can see how that would work. You do explain things well.

I've read about someone, perhaps more than one, who jams a pillow up under their chin to help keep the jaw closed. That would also probably keep a person from tucking their chin down toward the chest -- possibly straightening out the neck for side sleepers, too. I used to do that -- cram a pillow under chin to keep it raised and keep my head back more. I was doing it mainly because when using a low of 6 in my autopap range, I felt that my throat was closing as I drifted off to sleep. Didn't get that feeling if I kept my chin from tucking down.

Finally I said to heck with trying to keep a very low "low" pressure just for the sake of "low". I raised the low pressure to where it can keep my throat open easily - low of 8 or 9.

Like you, I've gradually begun sleeping with neck in a straighter position. For about a year I was using a stack of two thin pillows because the Tempur-Pedic pillow alone made me feel like I was heading downhill "head first" when lying flat. I use just the Tempur-Pedic now and am comfortable lying almost flat. Well, I cheated getting to this point...I did raise the head of the adjustable bed a bit while making the transition to using just the Tempur-Pedic pillow, but have been liking it flatter and flatter, with a straighter neck position as time goes by.

So many pieces to the puzzle.

[Kermit]

Hi Rested Gal,

Yes it certainly is a puzzle. I tried wedging a large bone shape car washing sponge from Walmart, new of course, to keep chin up and neck straighter. The darn thing kept popping away.

I don't have an adjustable bed so I propped the two headboard legs about eight inches high using small decorative cinder blocks that can't be normally seen. I suppose even though I sleep flat I am not as my whole body is in an incline. Sometimes I think we get used to doing things a certain way and don't realize that there are other ways to accomplish the same thing, like sleeping. Pillows are not used in many cultures. I wonder how many problems they cause.

I remember hearing a radio talk show guest which knew the subject state that brassiers on women, were thought to trigger breast cancer as it prevented the natural flow of whatever is in that area flow. Some cultures that don't did not know what breast cancer was. Then as some of the young ladies left the villages for the big city and had to wear bras, over time, breast cancer started showing up on them. Don't know how scientific her statements were but sounds plausible.


Kermit

[dsm]

Hi Rested Gal,

Yes it certainly is a puzzle. I tried wedging a large bone shape car washing sponge from Walmart, new of course, to keep chin up and neck straighter. The darn thing kept popping away.

I don't have an adjustable bed so I propped the two headboard legs about eight inches high using small decorative cinder blocks that can't be normally seen. I suppose even though I sleep flat I am not as my whole body is in an incline. Sometimes I think we get used to doing things a certain way and don't realize that there are other ways to accomplish the same thing, like sleeping. Pillows are not used in many cultures. I wonder how many problems they cause.

I remember hearing a radio talk show guest which knew the subject state that brassiers on women, were thought to trigger breast cancer as it prevented the natural flow of whatever is in that area flow. Some cultures that don't did not know what breast cancer was. Then as some of the young ladies left the villages for the big city and had to wear bras, over time, breast cancer started showing up on them. Don't know how scientific her statements were but sounds plausible.


Kermit

Hi Kermit,

I have noticed that doubling up my pillow under my neck improves back sleeping but I haven't yet worked out a good way to balance this with then rolling on my side.

I believe you are right re the benefit of raising the neck & horizontal sleep.
Interestingly, the tradition in asia for centuries, was to sleep on a 'neck pillow' . I used to wonder why plus how they managed to do it.

Seems they may have understood issues like this a long time ago.

Cheers

DSM