Want to get the old-time nosebreathing religion?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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roster
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Want to get the old-time nosebreathing religion?

Post by roster » Tue Jun 01, 2010 6:01 pm

This is for SU, instead of continuing to clutter up snipsnsnails' first thread.

SU, look at some of the religion here http://www.emptynosesyndrome.org/turbinate.html

Things like,
The job of supplying the lungs with warm, moist and filtered clean air, while maintaining laminar airflow patterns – steady in stream and forward pressure – is entirely up to the nose. One can breath through the mouth only or an opening in the trachea, but it is highly uncomfortable, hazardous in the long term for the lungs’ health, and very unsatisfying.
That’s why – only nasal breathing is satisfying, healthy and relaxing.
....
It processes the air that you breath before it enters your lungs. Most of this activity takes place in and on the turbinates, located on the sides of the nasal passages. In an adult, 18,000 to 20,000 liters of air pass through the nose each day.
....
Your Nose Protects Your Health By:

Filtering all that air and retaining particles as small as a pollen grain with 100% efficiency.
Humidifying the air that you breath, adding moisture to the air to prevent dryness of the lining of the lungs and bronchial tubes.
Warming cold air to body temperature before it arrives in your lungs.
....
Mouth breathing causes dry mouth, which increases the risk of mouth and throat infections and reduces the sense of taste. Mouth breathing also pulls all pollution and germs directly into the lungs; dry cold air in the lungs makes the secretions thick, slows the cleaning cilia, and slows down the passage of oxygen into the blood stream.
....
This heat and especially – humidity – are crucial for pulmonary health and function, and any reduction in it will cause breathing difficulties, fatigue, and long term nasal and perhaps even pulmonary complications (nasal – atrophic rhinitis, chronic sinusitis, pulmonary – asthma, chronic obstructive pulmonary disease – COPD, etc`).
....
As the lungs rely totally on positive pressurized steady airflow and high dynamic air pressure values of sucked in inspired air to inflate them, the air must be very humid and warm – or the fine narrow tubes (the bronchioles and the alveoli) might not get inflated properly, or not get inflated at all at the most remote ends of the lungs. If proper lung inflation is denied chronically – this can result after some years into a life threatening lung disease called Emphysema. Humidification is also crucial for sustaining the integrity and survival of the cilia blanket’s hairy layer, which covers the entire respiratory tracts, including the nose. One-hundred and fifty to three hundred cilia are present in each cell, they are covered by a blanket of mucus that catches particles. The cilia beats in a rhythmic and uniform manner, moving the mucus gel layer to the back of the nose, into the nasopharynx. Cilia cells are durable; they are able to resist cold, heat, smoke, and even infection. However, they have one deadly enemy: dryness.
....
And finally – highly humidified and warm air (heated to body temperature) is crucial for proper gas exchange to take place between the pulmonary capillaries in the alveoli and the surrounding blood net of arteries and veins, receiving oxygen through membranic diffusion and passing out the waste – the carbon dioxide in the same way. The membranic diffusion of the gasses is aided by being saturated in high humidity and body heat temperature conditions in the alveoli sucks, where the exchange occurs. If these conditions are not met, the alveoli cannot inflate properly and simply shut down, just like in a severe attack of asthma.
....
Conclusion: The Nose is the air-conditioner and filter of the lungs, mainly thanks to the Turbinates that are made up of extremely rich and vascularised nasal mucosing tissue. Without the humidity supplied from the nose:
I – the lungs cannot inflate to their maximum capacity.
II – the gasses exchanged at the end of the breathing process (in the alveoli) will not exchange fast enough or to their fullest potential.
III – extensive damage is created to the respiratory epithelium of the respiratory system – primarily starting in the nose. The first layer to get damaged is the “Cilia”. Dryness means – death to the cilia!
Death to the cilia means a dramatic reduction in mucus secretions, and no mucociliary transport of the dried up mucus and debris.
IV – the turbinates with, their large volume of mucosing tissue, and with their role as the airflow regulators of the nose – are essentially the “heart” and “engine” of the nose, and supply the most critical mass of humidifying heat exchanging mucosa in the nose. This is a fact that any surgeon planning to cut out any portion of turbinate mucosa must take into account, and try and preserve as much as possible of it.
A lifetime of a dry nose can lead to further damage to the cilia down the trachea and even in the lungs, as they get overtaxed – with having to humidify and clean themselves. This can lead to many respiratory and lung infections and eventually to life threatening complications of Chronic Pulmonary Disorders. The nose is the Guardian of the Lungs.
....
Through organizing the pattern of airflow by the turbinates, the nose manages to get all the inspired air to stream relatively slowly around and along the heavily ciliated turbinates, emitting heat and humidity into the inspired air streams, saturating the inspired air-born particles and micro-organisms, hence making them heavier and causing them to sink onto the mucosal layer, where they are processed by different immune systems cells, and enzymes, neutralized, and propelled by the beating of the cilia towards the naso-pharynx and the esophagus.


Nearly all particles greater than 5 µm and about 50 % of those from 2-4 µm in size are deposited on the ciliated mucosa, and are propelled towards the pharynx so that they can be swallowed or expectorated within 15 minutes.
....
Hopefully someone can tell me whether CPAP mitigates some of the negatives from mouthbreathing described above.
Rooster
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Re: Want to get the old-time nosebreathing religion?

Post by jnk » Tue Jun 01, 2010 6:15 pm

I haven't read the other thread, but here is ResMed's take:
Every time you take a breath, your nose and other airways humidify – add moisture to – the air so that it enters your lungs with the necessary humidity. Your nose is responsible for about two-thirds of this process. As the air passes further into your airway, it becomes warmer and more humid. By the time air reaches your lungs it is at the ideal temperature and humidity. When you exhale your nose conserves water by recovering about a third of the moisture present in each exhaled breath. That moisture is then used to assist in the humidification of your next breath. . . . If you breathe through your mouth, you may develop a dry throat. By breathing through your mouth, you bypass your nose, which is responsible for two-thirds of humidification. This means that you've tripled the humidification workload of your upper airway. If you add positive airway pressure on top of that you may start to experience stronger symptoms. Even if you're only exhaling through your mouth, you are still losing valuable moisture because you aren't allowing your nose to recover the moisture your body invested in the air as you "inhaled" it. A 1997 study found that nasal symptoms cause mouth breathing and that mouth breathing causes nasal symptoms. Because one symptom causes another, a vicious cycle can develop.--http://www.resmed.com/us/patients_and_f ... c=patients

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Re: Want to get the old-time nosebreathing religion?

Post by sleepmba » Wed Jun 02, 2010 12:13 am

I have to deal with this often at the sleep lab. Check out my blog where I wrote a little about my experience:
http://www.sleepandcpap.blogspot.com
For commentary from a 10 year Sleep Technologist visit my blog at: Recent Topics: Picture of the new baby/ Switching to Swift FX
http://www.sleepandcpap.blogspot.com
http://www.cpapmaskreview.blogspot.com
http://www.facebook.com/sleepandcpap

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Re: Want to get the old-time nosebreathing religion?

Post by john_dozer » Wed Jun 02, 2010 4:57 am

I can't breath enough through my nose to function beyond sitting. If I exercise using only my nose to breath, I'd pass out.

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Re: Want to get the old-time nosebreathing religion?

Post by hose-head2010 » Wed Jun 02, 2010 8:28 am

Great site. Much more user activity than others I have been to. I am 2 months into my therapy and I think it is really finally starting to have an impact on the quality of my life. According to my wife, the DR. I've had sleep apnea since we got married 20 years ago.
Thanks to Rooster for re-posting the info on the body's natural humidification process, which is what caused me to hit the "post" button......
If the body is soo good at humidifying itself, why are there so many cpap machines with humidification options? Just seeking to understand, not looking for a fight
Dare I say it....is it no more functional [really] than a vinyl top was to the 67 Catalina? Is it just a way for the mfgr's to get their hands juuuuust a little further into our pockets?
I have found that my Respironics System One works just fine for me with the humidity turned off. This may of course change when indoor RH is in the low to mid 30's this coming winter.
Thanks again for sharing all your stories. I look forward to being a contributing member.

Todd

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Re: Want to get the old-time nosebreathing religion?

Post by jnk » Wed Jun 02, 2010 8:55 am

hose-head2010 wrote:Great site. Much more user activity than others I have been to. I am 2 months into my therapy and I think it is really finally starting to have an impact on the quality of my life. According to my wife, the DR. I've had sleep apnea since we got married 20 years ago.
Thanks to Rooster for re-posting the info on the body's natural humidification process, which is what caused me to hit the "post" button......
If the body is soo good at humidifying itself, why are there so many cpap machines with humidification options? Just seeking to understand, not looking for a fight
Dare I say it....is it no more functional [really] than a vinyl top was to the 67 Catalina? Is it just a way for the mfgr's to get their hands juuuuust a little further into our pockets?
I have found that my Respironics System One works just fine for me with the humidity turned off. This may of course change when indoor RH is in the low to mid 30's this coming winter.
Thanks again for sharing all your stories. I look forward to being a contributing member.

Todd
The process of pressurizing the airway generally requires venting the pressurized air at a rate that depletes the natural moisture of the throat and nose. Some people can deal with that OK, but many of us can't do so comfortably, depending on where we live. That is why a humidifier is now considered standard in the U.S. when using PAP therapy.

Stick around. Don't lose your wariness of the system. Continue to research.

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Re: Want to get the old-time nosebreathing religion?

Post by BlackSpinner » Wed Jun 02, 2010 10:02 am

Since I have had my hybrid I have found I breathe through my nose even when I am awake now. It, with the extra humidity seems to have been very beneficial for my sinuses. Even this spring with its over abundance of pollen as everything is blooming early and at the same time seems to not be as problematic.

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Re: Want to get the old-time nosebreathing religion?

Post by hose-head2010 » Wed Jun 02, 2010 10:27 am

Continuing on with the info that Rooster re-posted....me, being new to CPAP and this forum, has anyone or group put together a "top TEN" of facts regarding CPAP and associated therapies? The info re-posted by Rooster appears and sounds like a fact. I have been looking into getting a full face mask to alternate when my ResMed Mirage Activia LT becomes bothersome. Actually, it's the neoprene chin strap (too hot) that is annoying [but essential] and so I was looking for a full face mask (FFM) figuring that if my mouth is open....so what. Based on what I read, if I'm a mouth breather and I wear a FFM then I will not be benefiting from the natural humidification of breathing through my nose. This to me, if it does qualify as a fact, is essential information to anyone shopping [buying] CPAP gear. Make sense or is my 02 level too low

Along these lines, what do nasal only folks do when the inevitable congestion makes your nose merely something to keep your glasses from falling off?

Thanks!

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Re: Want to get the old-time nosebreathing religion?

Post by jnk » Wed Jun 02, 2010 10:44 am

hose-head2010 wrote:Continuing on with the info that Rooster re-posted....me, being new to CPAP and this forum, has anyone or group put together a "top TEN" of facts regarding CPAP and associated therapies? The info re-posted by Rooster appears and sounds like a fact. I have been looking into getting a full face mask to alternate when my ResMed Mirage Activia LT becomes bothersome. Actually, it's the neoprene chin strap (too hot) that is annoying [but essential] and so I was looking for a full face mask (FFM) figuring that if my mouth is open....so what. Based on what I read, if I'm a mouth breather and I wear a FFM then I will not be benefiting from the natural humidification of breathing through my nose. This to me, if it does qualify as a fact, is essential information to anyone shopping [buying] CPAP gear. Make sense or is my 02 level too low

Along these lines, what do nasal only folks do when the inevitable congestion makes your nose merely something to keep your glasses from falling off?

Thanks!
It would probably be a top-100 list.

Rooster enjoys posting information that will provoke discussion. And he is perty darn good at it, I might add.

It is good to have a full-face mask (FFM) in the drawer, even if you never have to use it, just in case, in my opinion, especially if your OSA is severe.

It is better to breathe through the mouth with a FFM than to mouth-leak with a nasal mask, so it is a trade-off. The humidified, filtered, heated air that comes through your CPAP has already been nose-ified by the machine, in a sense, and breathing pressurized air ain't exactly natural, no matter what orifice it enters--again, a trade-off. So if wearing a full-face mask is what makes PAP therapy work for someone, full-face it should be.

That being said, yes, it is preferable that breathing be done through the nose. But it is infinitely more important that breathing take place all night, every night, one way or the other.

In my opinion, that is.

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Re: Want to get the old-time nosebreathing religion?

Post by Wulfman » Wed Jun 02, 2010 11:03 am

hose-head2010 wrote:Continuing on with the info that Rooster re-posted....me, being new to CPAP and this forum, has anyone or group put together a "top TEN" of facts regarding CPAP and associated therapies? The info re-posted by Rooster appears and sounds like a fact. I have been looking into getting a full face mask to alternate when my ResMed Mirage Activia LT becomes bothersome. Actually, it's the neoprene chin strap (too hot) that is annoying [but essential] and so I was looking for a full face mask (FFM) figuring that if my mouth is open....so what. Based on what I read, if I'm a mouth breather and I wear a FFM then I will not be benefiting from the natural humidification of breathing through my nose. This to me, if it does qualify as a fact, is essential information to anyone shopping [buying] CPAP gear. Make sense or is my 02 level too low

Along these lines, what do nasal only folks do when the inevitable congestion makes your nose merely something to keep your glasses from falling off?

Thanks!
Way too much information to condense into 10 or even 100.......in my opinion.
Here's a few links that may help.

http://smart-sleep-apnea.blogspot.com/

(This one is for the yellow lightbulb icon above)

wiki/index.php/Main_Page

our-collective-cpap-wisdom.php


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Re: Want to get the old-time nosebreathing religion?

Post by jnk » Wed Jun 02, 2010 12:29 pm

Wulfman wrote:Way too much information to condense into 10 or even 100.......in my opinion.
Good point.

However, this would be my personal top-five hints, based on what I've learned from you, Den, and your fellow cpaptalkers, if I HAD to condense things down that far:

--------

Jeff’s list of what he considers important info for anyone starting out on PAP therapy:

1. DOCUMENT AND RESEARCH: It is your life, so get complete copies of your sleep tests and your prescription so that you can study them and research the specifics of your condition at sites like cpap.com and cpaptalk.com.

2. FIND THE RIGHT MASK: The mask is the key to successful PAP therapy, so either buy mask insurance if you buy from cpap.com or only deal with a local DME that will let you trade in masks that you can’t make work for you within 30 days, at no cost to you. The first mask you get may not necessarily be the perfect one for you, so don’t judge the therapy based on your first mask.

3. GET A FULL-DATA MACHINE: Your having a machine that can give you leak and AHI data will allow you and your medical team to make your therapy as effective and comfortable as possible. Your local DME may not understand that concept (or may pretend not to, for financial reasons), so be sure to get a list of in-network DMEs from your insurance before you speak to any DME. That may allow you to push for a full-data machine, or perhaps allow to shop around in the interests of healthy competition among businesses. Many users have found it cheaper and less frustrating to buy their own full-data equipment online instead of paying their insurance co-payments at local-DME prices. Some users have even found ways to get reimbursed from their insurance for online purchases.

4. GET THE RIGHT KIND OF MACHINE FOR YOU: Straight pressure as delivered by a regular CPAP machine does fine for most people with obstructive sleep apnea. But many have found great benefit in the use of an APAP (auto-adjusting machine), and many with high-pressure prescriptions (over 15 cm H2O, for example) have benefited from the use of a bilevel machine (also called Bi-PAP or VPAP). Machine users with a high number of significant central apneas may do better on specialized machines designed to deal with that problem.

5. DON’T THINK YOU HAVE TO GO IT ALONE IF YOU HAVE DIFFICULTIES: Your doctor works for you. Your DME works for you. They can’t help you if you aren’t being sufficiently vocal and specific about your needs. Furthermore, online forums, such as cpaptalk.com, exist for you to get quick help from fellow patients any time you need it. Please don’t give up without reaching out to (1) the professionals you have paid to be there for you or (2) the fellow patients who pride themselves on being helpful to other patients in the forums. Online you can find helpful hints such as this one: “Don’t set your ramp too low (or set your starting minimum pressure too low on an APAP), since that might make you feel starved for air or even keep your machine from taking care of your apneas as well as it otherwise could.”

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Re: Want to get the old-time nosebreathing religion?

Post by roster » Wed Jun 02, 2010 1:24 pm

jnk wrote:
Rooster enjoys posting information that will provoke discussion.
OK Jeff, post that and then post something that I absolutely agree with and think is extremely important for those of us who obsess about our health:

jnk wrote:

.... yes, it is preferable that breathing be done through the nose. But it is infinitely more important that breathing take place all night, every night, one way or the other.
Nothing provocative there, Jeff.

On the other hand, maybe I can get you on a technicality.

Infinitely is an awfully big number. Let's see, suppose in one case, lifespan is increased from 58 to 84. That is 44.8% increase - a long way from infinitely.

"Pursue perfect health and you are likely to lose good health." (Rooster, 6/2/2010)
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Re: Want to get the old-time nosebreathing religion?

Post by roster » Wed Jun 02, 2010 1:47 pm

jnk wrote:
The process of pressurizing the airway generally requires venting the pressurized air at a rate that depletes the natural moisture of the throat and nose.
This one I will have to think about, but my initial gut feelings question its truth.

I have long maintained that an apneic person using a properly operating CPAP system will have no more airflow through any parts of his airway than if he were not apneic and breathed normally.

CPAP is only creating a pressure. The rise and fall of the diaphragm determines the volume and speed of the airflow.

Now the volume of airflow using CPAP, while not any greater, is more dense, but only by about 1% (at 10 cm CPAP).

So I have doubts that a properly working CPAP will cause any significant drying. Maybe someone with the appropriate engineering background will correct me.
Rooster
I have a vision that we will figure out an easy way to ensure that children develop wide, deep, healthy and attractive jaws and then obstructive sleep apnea becomes an obscure bit of history.https://www.youtube.com/watch?v=0ycw4uaX ... re=related

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Re: Want to get the old-time nosebreathing religion?

Post by DreamStalker » Wed Jun 02, 2010 2:24 pm

roster wrote:
jnk wrote:
The process of pressurizing the airway generally requires venting the pressurized air at a rate that depletes the natural moisture of the throat and nose.
This one I will have to think about, but my initial gut feelings question its truth.

I have long maintained that an apneic person using a properly operating CPAP system will have no more airflow through any parts of his airway than if he were not apneic and breathed normally.

CPAP is only creating a pressure. The rise and fall of the diaphragm determines the volume and speed of the airflow.

Now the volume of airflow using CPAP, while not any greater, is more dense, but only by about 1% (at 10 cm CPAP).

So I have doubts that a properly working CPAP will cause any significant drying. Maybe someone with the appropriate engineering background will correct me.
I don't have the appropriate engineering background, but do have the same science background as an engineer and I will back your doubts. Airflow through the human respiratory system while using properly working CPAP will differ insignificantly or none at all compared to airflow under normal breathing conditions without CPAP.
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Re: Want to get the old-time nosebreathing religion?

Post by jnk » Wed Jun 02, 2010 2:25 pm

roster wrote:
jnk wrote:
The process of pressurizing the airway generally requires venting the pressurized air at a rate that depletes the natural moisture of the throat and nose.
This one I will have to think about, but my initial gut feelings question its truth.

I have long maintained that an apneic person using a properly operating CPAP system will have no more airflow through any parts of his airway than if he were not apneic and breathed normally.

CPAP is only creating a pressure. The rise and fall of the diaphragm determines the volume and speed of the airflow.

Now the volume of airflow using CPAP, while not any greater, is more dense, but only by about 1% (at 10 cm CPAP).

So I have doubts that a properly working CPAP will cause any significant drying. Maybe someone with the appropriate engineering background will correct me.
I have no engineering background, in fact no "appropriate" background in anything much, but I believe it is the venting, not so much the pressure itself, that can cause the drying. The air is vented to make sure CO2 is vented, but that process wicks away moisture at the same time, and a higher pressure makes for a higher vent rate and less moisture. That is why higher pressure may mean a higher setting on the humidifier, at least for some.

Think about it: The mask continues to vent even while you are breathing in, not just breathing out, unlike a non-masked sleeper. All that expelled air takes moisture away because in that particular sense, there is increased airflow, not in and out of the throat, but out of the loop, at the mask, because of the pressure, nonetheless.

But I could be wrong. I often am.

(Please ignore all the weasel words used above--it is only my vain attempt to keep Rooster and his ilk from catching me on a technicality. )
Last edited by jnk on Wed Jun 02, 2010 2:31 pm, edited 1 time in total.