How did YOU Resolve Your Mouth-Leaks? (poll)

[JoyD.]

Regarding the concern about taping . . .

Back when I used to tape I spent about $15 on Amazon and purchased a small plug-in Power Outage Alarm with Light. I plugged it in right next to my bed. The alarm is not as loud as I would like, but provides an added sense of security . . . even though I am convinced that I would wake up quickly if I couldn't breathe.
http://www.amazon.com/Reliance-Controls ... cr_pr_pb_t

I stopped taping after about 9 months when I couldn't keep it on. Started taking it off during my sleep. By that time I had trained myself to position my tongue sufficiently that I wasn't waking up with dry mouth anymore, and my software was indicating that any mouth breathing I might have been doing was minimal enough that it didn't bother my AHI.

Joy

[SaltLakeJan]

Bob3000

What brand and model did you end up settling on?

I'm not sure which paper tape I am using. I bought a roll of store brand from Walgreen's and one from Walmart. I opened both rolls - then forgot which was which. I use such a small amount each night, that I am still using the roll.

My only excuse in not paying attention . . . is that I was sleep deprived at the time I bought the tape I didn't think straight. I'll have to start over when my roll is finished. I did try the 3M tape - it's bond was too strong, when I pulled it off, it took some skin with it.

Jan

[ecocyber]

I vote for taping....... I am a proud taper!

Here is what has been very effective for me. I know many of you are going to cringe, but here goes. I used to use 3m micropore like so many of you do. I had to change because I found that even putting on 3 or 4 layers, I could push air out through it if I tried (and no doubt I did this involuntarily while asleep). Some mornings I would wake up and the tape had blown through in one section.

So, I switched to the real expensive black color duct tape you get at Home Depot or Lowes (it is about a little under 2 inches wide). It is non-porous so no air can leak through it. Now for the potential irritation on the skin. This is handled by first wiping a skin barrier on where the tape will be. Something like "Skin Prep" by Smith and Nephew or any number of other brands available. You find them in the Ostomy section of your DME or drug store. People who have to wear a collection pouch due to colon cancer use it to prevent skin irritation from the adhesives on the pouches they must wear. It lays down a very thin protective barrier that helps protect the skin; and remains slightly tacky so the tape stays on more securely.

So, skin prep wipes and the expensive black duct tape. Never had one leak on me yet. And, I have fairly sensitive skin and I have never gotten as much as a rash.

As for the nasal mask, I swear by the Opus 360. I get no unintentional leaks. It is extremely light weight and comfortable for me. My two cents.

[plr66]

^^^^^^
I taped my mouth shut and switched to the Swift FX and slept for an hour or two, but again, woke up, this time because of aerophagia. I'm learning that I cannot sleep on my side unless I want to eat air (and then wake up). I will try sleeping supine tonight.

Bob, what pressure are you using? To my knowledge, side-sleeping does not in itself encourage aerophagia. And supine sleeping is certainly not recommended, as gravity tends to pull your airway closed. I would suggest slightly decreasing your pressure by .5 or 1.0 IF you continue to have a big problem with the aerophagia after several nights using the Swift and taping. With many months of trials, I have found that I do have to increase my pressure with FFM's including the hybrids, and need a bit less pressure with nasal pillows. This is following a year and a half of pretty successful therapy with long-term experimentation with both mask-types. Just a suggestion.

[grandmma]

I voted that I used to have the problem. When I started CPAP, I had huge mouth leak problems, and ended up using Polident strips, which worked a charm.

By the time they stopped selling them in Australia, I'd realised that somehow my tongue had trained itself to sit in the correct spot. Was not concentrating on this, didn't really understand how that process worked ..... but there you are. Very good leak numbers (or lack of them) now, and never have a problem.

Now, after a lifetime of mouth breathing due to allergies, etc, I'm a constant nose breather 24/7.

Another side benefit of CPAP!!

[Bob3000]

Something like "Skin Prep" by Smith and Nephew or any number of other brands available. You find them in the Ostomy section of your DME or drug store.

How's this look?

I find the blue painter's tape to be slightly irritating, so last night I went back to the micropore. Both do the job well, and the micropore is more comfortable while wearing it, but hurts more coming off. I think I might buy the skin prep.

How long does it take to wash the skin prep off? Does it require alcohol?

[Ms.Snuffleupagus]

I use Hypafix medical tape. It is slightly stretchy and sticks really well. Sometimes I cover it with a layer of inexpensive tape as the Hypafix tape has very tiny holes in it, but usually I don't have to. The tiny holes in the tape are not big enough to allow any air out. I put lip balm and roll my lips in before applying the tape, being careful to have the edges of the tape doubled over at each end for quick removal.

To remove it I let a layer of cold cream sit over the tape and edges for a few minutes. Then I remove it bit by bit, all the while adding more cold cream to the area that the tape is being removed from. When I finish I rub in the cold cream that is on my face. Works great. With this I get no skin irritation.

I have tried chin straps and even the Papcap, which I can use without taping, but I have to have it quite tight for it to work. I also don't like having the extra pressure against my jaw. For me the less gear the better and I have finally discovered that a small nasal pillow mask (Opus or Swift fx) and taping (with no chin strap) is the most comfortable for me.

[Starlette]

I use a chinstrap and dental appliance.

Can someone PM to tell me what the tongue trick is? Don't wish to take away attention from this thread.

When I first got dental appliance in August, I sounded like a baby gurgling. My body was readjust to the new contraption in my mouth. I'm glad to say the gurgling as stopped. I'm trying to think hard. I honestly don't think I have mouth issues at this time.
Could be wrong. I don't wake with a dry throat anymore.

Starlette

[Craig P]

I use the Swift II nasal pillows and have developed my own custom chin strap with a piece of elastic that covers my mouth. This works to keep my jaw from falling open and seals my lips without using tape, glue or any other foreign substance.

[DreamStalker]

I use the Swift II nasal pillows and have developed my own custom chin strap with a piece of elastic that covers my mouth. This works to keep my jaw from falling open and seals my lips without using tape, glue or any other foreign substance.

You mean sort'a like this?

viewtopic.php?p=435648#p435648

[Craig P]

I use the Swift II nasal pillows and have developed my own custom chin strap with a piece of elastic that covers my mouth. This works to keep my jaw from falling open and seals my lips without using tape, glue or any other foreign substance.

You mean sort'a like this?

viewtopic.php?p=435648#p435648

Actually mine is much less bulky and easier to put on. Now don't laugh, just because I use underwear elastic. I have tried regular elastic from a cloth store and found that it cannot withstand constant skin contact without breaking down and I cannot find a source of similar elastic. I actually just made this one last night. It is the fourth one I have made over the years. Very easy to remove in the event you have to get out of bed in a hurry or if you might have a panic attack.



No tongue tricks No tape.

[briank]

A chin strap helps me keep my jaw closed, and the tongue trick helps keep the air from rushing out between my lips. I generally have my humidifer on 4 (out of 10, which provides comfortable nasal humidity without excessive condensation), but sometimes still have some dry mouth. I brush thoroughly every morning to help combat increased plaque build-up that comes with the dry mouth.

[ozij]

Bob,
Your doc must have read this:

Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture
Eur Respir J 1999; 14: 1251-1257
H Teschler, J Stampa, R Ragette, N Konietzko, and M Berthon-Jones

(Teschler and Bethon-Jones are MD's, and central figures in ResMed's research and development of algorithms)

Mouth leak is common during nasal ventilatory assistance, but its effects on ventilatory support and on sleep architecture are unknown. The acute effect of sealing the mouth on sleep architecture and carbon dioxide tension (Ptc,CO2) was tested in 9 patients (7 hypercapnic) on longterm nasal bilevel ventilation with symptomatic mouth leak. Patients slept with nasal bilevel ventilation at their usual settings on two nights in random order. On one night, the mouth was taped closed. Leak was measured with a pneumotachograph.

Results, with added emphasis mine:
Median leak fell from 0.35+/-0.07 (mean +/- SEM) L x s(-1) untaped to 0.06+/-0.03 L x s(-1) taped.
Ptc,CO2 fell in 8/9, including all hypercapnic patients.
Across all patients, the mean Ptc,CO2 fell by 1.02+/-0.28 kPa (7.7+/-2.1 mm Hg) with taping (p = 0.007).
Arousal index fell in every patient.
Mean arousal index fell from 35.0+/-3.0 to 13.9+/-1.2 h(-1) (p<0.0001),
and rapid eye movement (REM) sleep increased from 12.9+/-1.5% to 21.1+/-1.8% sleep time (p = 0.0016).
Slow wave sleep changed inconsistently, from a mean of 13.1+/-1.6% to 19.5+/-2.2% of sleep (p = 0.09).
Sleep latency and efficiency were unchanged.
In four healthy volunteers ventilator-induced awake hypopharyngeal pressure swing during timed bilevel ventilation fell by 35+/-5% L(-1) x s(-1) of voluntary mouth leak (p<0.0001).

Mouth leak reduces effective nasal bilevel ventilatory support, increases transcutaneous carbon dioxide tension, and disrupts sleep architecture

http://erj.ersjournals.com/cgi/reprint/14/6/1251

On the control night, patients slept as usual. On the
treatment night, conditions were identical to the control
night excepting that the mouth was taped closed several
minutes prior to lights out, using several layers of hypoallergenic
medical grade adhesive tape. The last 5 cm of
the tape was folded over to provide a nonadhesive quickrelease
tab, and the patient shown how to use this. On both
nights, great care was taken with mask fitting and headstrap
adjustment, to minimize mask leaks.
The polygraph records were scored manually for sleep

This study clearly demonstrated that when patients are receiving noninvasive
ventilatory support via the nasal airway during
sleep, the occurrence of mouth leak reduces effective ventilation,
induces multiple arousals, and reduces the amount
of REM sleep: the prevention of mouth leaks improved
ventilation, greatly reduced arousals, and markedly increased
REM sleep.

There is an urgent clinical need for a safe and effective
method for preventing mouth leaks during bilevel ventilatory
support. Taping was used in this study in preference to
other ways of sealing the mouth such as a full face mask,
because existing full face masks have higher deadspace,
leak, and discomfort than nosemasks, and arousal data
would be uninterpretable. However, the authors do not at
this stage advocate taping the mouth for indiscriminate
long-term home use, because of the risk of asphyxia in the
presence of nasal obstruction, machine or power failure, or
regurgitation.
Since performing the present study, ~30 carefully chosen
patients, relying on nocturnal support for ventilation but
unable to be satisfactorily treated due to mouth leak, unable
to tolerate a full face mask, highly alert, with no history
of regurgitation, and faced with the alternatives of
tracheotomy or untreated respiratory insufficiency, have
elected to use tape at home for periods of up to 6 months.
The tape is well tolerated and no adverse events have been
observed. In one patient, taping the mouth caused the
Ptc,CO2 to fall acutely from 8.91 kPa to 5.32 kPa (67
mmHg to 40 mmHg), and it was necessary to reduce the
ventilator settings to compensate.

I user 3M's Micropore tape - I react alergically to band-aids and such, but not to the Micropore, also identified as "surgical" and "hypoalergenic".

Recently, my leaks -- or palate seal breaches --have become such a nuisance that I'm trying a Full Face Mask.


O.

[Bob3000]

...I user 3M's Micropore tape - I react alergically to band-aids and such, but not to the Micropore, also identified as "surgical" and "hypoalergenic".

Recently, my leaks -- or palate seal breaches --have become such a nuisance that I'm trying a Full Face Mask.


O.

Great find. Thanks!

[briank]

Can someone PM to tell me what the tongue trick is? Don't wish to take away attention from this thread.

You've probably already gotten PMs about this by now, but I think the answer is relevant to the thread so I'm going to reply here anyway for the sake of newer readers.

The "tongue trick" is just teaching your tongue to rest up against the top of your mouth to create a "velolingual seal". I think it took me about two weeks to become habit.

When I'm awake, I can open my lips at least half an inch and still maintain a seal. Asleep, I need the help of a chin strap, which also helps eliminate "chipmunk cheeks".