Mouth sealed completely--AHIs go through roof

[Paul22]

If I stop my mouth leak completely, the AHI readout on Encore Viewer goes up through the roof. The machine is a Respironics Bipap Auto Series M, set to the Bilevel (non-auto) mode, pressure 11/8. I am using a Nasal Aire II cannula (extra large). I can embed a picture in an email but have not been able to copy a screen into this server, so I will tabulate the readout for four days:

Date AHI Av. Leak

01-02 1.4 48
01-03 32.1 37
01-04 26.6 39
01-05 2.4 54

The first and last days are with a tape seal only (not a mouth complete seal): the other two days are with a tape and dental cream seal (complete mouth seal).

This pattern first presented itself a couple of weeks ago when I first got a complete seal—so I stopped trying to get a complete seal. It didn’t make any sense to me so I tried again--with the above results.

If I tape my mouth with paper tape only, I cannot get my lips to seal—and the tape is porous. So I build a thick pad of tape over my mouth which results in a usable leak rate. I discovered that if I use the sealing dental cream on my lips and some tape over my lips I can get a complete seal on mouth leaks for the night—but AHIs go through the roof. Also I have trouble going to sleep and feel like I never did get fully to sleep. Using the tape only, I have no trouble going to sleep and normally sleep soundly for 5 or 6 hours—with acceptable AHIs. I do not feel too badly the next day after a night when I sealed my mouth leaks completely. I think I remember DSM saying something about one machine giving him a better night’s sleep but feeling better the next day after using the other machine,

Centrals? Artifacts of the machine? Side effect of the dental cream? And what I really do not understand is why stopping the mouth leak completely prevents my going to sleep.

Any help, or telling me where I might find help, would be greatly appreciated.

Paul22

[Goofproof]

If you AHI goes through the roof when you moth is sealed, it's probably because when you mouth wasn't sealed, the machine couldn't treat you and the data was faulty. Please post your Dailies and link to them. Jim

[dsm]

Paul,

Interesting problem, from a logical perspective, if the AHI goes up like shown, the cause is apneas but to see such a jump from nasal breathing is the odd part. The situation seems to suggest that your cause of apnea is where your nasal passage enters the throat & that if your mouth isn't blocked, you automatically breathe past any blocks there ?

Am sure others will have some insights.

Good luck

DSM

[Goofproof]

Put the dailies on a place like photobucket, and post the link url. Jim

[Goofproof]

If these numbers are correct, 01-05 2.4 54), and I had my mouth taped shut, I'd have a mirror looking for the hole in my neck. You need a FF mask in the worse way, just to see if it helps. Jim

[Wulfman]

If you have Viewer, you should be able to see when the events occurred and what your leak pattern looked like. A couple of things come to my mind at the moment.......either the leaks are hindering the event detection or your pressure isn't sufficient.

Den

[Paul22]

Have, I think, the URLs on photobucket--tried to post them 3 times but each time received an internal error message. Do not know what else to do. Would like to post the screen shots themselves but have not been able to find any specific instructions (and I do need specifics) for that either.

Thanks for the replies that I have received.

Paul22

[jules]

viewtopic/t37508/viewtopic.php?p=318303#p318303

this is a round about way to give you the information - I have a link in that message and then in link in that message --- hope it is all clear as mud --

however I have been having problems myself with photobucket lately on getting the right url copied with the IMG option ---- have to click on the left side then do a control C I think to copy it

[Paul22]

Here are the first 2 urls. Next 2 will follow in next post.

Paul22

[Paul22]

Surprise, Surprise, the screen shots themselves came through on the first 2. Here are the next 2.

Paul22

[Paul22]

I was so surprised when, after 5 or 6 error messages, the daily screens were posted that I didn't post some pertinent informatiom. The first part of the last screen, 1/5/2009, was with my "porous pillow" of paper tape over my mouth. The last part screen is a record of what happens when there there is nothing on my mouth--took off the paper tape when I got up to go to the bathroom.

FWIW, a tech at Respironics some sometime ago told me that with the BIPAP Auto series M that any leak rate was considered OK if below 50, and I believe that the vent rate of the Nasal Aire II extra large cannula is over 30.

Paul22

[Goofproof]

I think what we see here is with a high leak rate the data is faulty, you are having way more events that are unrecorded due to excessive leaks. I would be hunting for a FF mask fast, you need to take the leaks out of the mix. After the leaks are under control, then I'll bet you will need more pressure, but first address the leaks. Jim

[GumbyCT]

If I stop my mouth leak completely, the AHI readout on Encore Viewer goes up through the roof. The machine is a Respironics Bipap Auto Series M, set to the Bilevel (non-auto) mode, pressure 11/8. I am using a Nasal Aire II cannula (extra large). I can embed a picture in an email but have not been able to copy a screen into this server, so I will tabulate the readout for four days:
<snip>
Centrals? Artifacts of the machine? Side effect of the dental cream? And what I really do not understand is why stopping the mouth leak completely prevents my going to sleep.

Any help, or telling me where I might find help, would be greatly appreciated.

Paul22

Have to agree with the others but have sooo many unanswered Questions too.
Why a bipap? Assume there must be a reason but what?
Why such a low pressure on a biapap? Same as above
Why not using auto mode?
Ever had a PSG or titration? What was the pressure(s) determined there?
Do you find it hard to exhale when taped up?
Feel anxiety?
Unkown meds and medical Hx.

Without seeing your setup - how long is hose etc. I would guess your pressure is too low and that leaks will increase when pressure is raised.
I would say you need to fix the leaks and titrate yourself on auto to see what shows up.

Good Luck,
GumbyCT

[roster]

Paul,

Sometimes in life you just need to move on. Get a FF mask.

I taped for six months but gave it up 30 months ago for a Hybrid FF and am very glad.

Best of luck,

[rested gal]

I think the data really is showing such a horrendous number of Obstructive Apneas, that my guess (I'm not a doctor, though!) that the EPAP is set WAYYYYYY too low.

I'd do what it takes to stop the mouth leaks and change the IPAP/EPAP. If it were me, and I were going to use that machine in just bilevel mode (which is what it's in now), I'd set IPAP at 13 or 14 and EPAP at 10. And even 10 may not be high enough for EPAP.

EPAP is what is supposed to be set high enough to prevent obstructive apneas when using "bilevel", as I understand it. That EPAP of 8 is not putting a dent in the Obstructives.

If a higher EPAP setting still results in data that bad with mouth leaks under control, then... back to the drawing board.