why better AHI when taping mouth with full face vs not

[blackberry37]

Fellow cpapers,
I was wondering why my AHI would be overall better when I tape my mouth closed when using my resmed mirage liberty full face mask compared to when I don't tape my mouth with my mirage liberty? When I tape my mouth my AHI is always under 5.0 which I want. But then when I don't tape my mouth, my AHI is well above 5.0 but mostly HI index not AI index. Does anyone have any ideas why my AHI is better when I tape my mouth closed with my mirage liberty compared to when I don't tape my mouth closed? Any ideas would be greatly appreciated. Thanks for your help.

Sincerely,
Chad

[echo]

When you don't tape your mouth shut, your jaw probably falls open and you end up breathing exclusively through your mouth... and you probably need more pressure to keep your airway open when breathing through your mouth. In theory you should need the same pressure through both nose and mouth, but then again I have heard that CPAP therapy works "better" when delivered from the nose than the mouth. A chinstrap could also help in this situation, it will keep your jaw closed, forcing you to breath more through your nose, but it also won't completely prevent you from mouth breathing in case you need to, for example when you're congested.

Does this correlate with how you feel the next day? Do feel like you slept better when you tape your mouth?

[blackberry37]

Echo,
I feel like I am more rested when I tape my mouth and use my mirage liberty full face. I don't feel as rested when I don't use tape on my mouth. Do any other cpapers have any suggestions for me. I would appreciate them. Thanks again.

Sincerely,
Chad

[LoQ]

Echo,
I feel like I am more rested when I tape my mouth and use my mirage liberty full face. I don't feel as rested when I don't use tape on my mouth. Do any other cpapers have any suggestions for me. I would appreciate them. Thanks again.

Sincerely,
Chad

I use a full face mask and still have to do some taping. I don't tape my mouth completely closed, but I do tape around it to hold my jaw shut. Perhaps a chin strap would do the same, but I can't make those work for me. Maybe you should try a chin strap?

[blackberry37]

I have tried chinstraps but they don't seem to work. Does anyone else have any ideas on why my AHI is better when I tape my mouth closed compared to when I don't tape my mouth. Any suggestions would be appreciated. Thanks for the help.

Sincerely,
Chad

[LoQ]

I have tried chinstraps but they don't seem to work. Does anyone else have any ideas on why my AHI is better when I tape my mouth closed compared to when I don't tape my mouth. Any suggestions would be appreciated. Thanks for the help.

Sincerely,
Chad

Well, alright, try the chin-up strip, or make one of your own. That's what I do, except that I put pieces of tape from under my chin up to just beside my nose under my eye on each side, and a stablizing piece across connecting the 2 just below my lower lip.

[DreamDiver]

Chad, have you tried the pap-cap? I've tried other chin straps with very poor results. They're generally too stretchy and don't isolate the jaw so much as just add more neoprene straps around your face.

However, the pap-cap really does work. I set the strap so that there is about an eight of an inch gap between my upper and lower teeth, but my mouth will stay closed behind a full face mask. That means I breathe through my nose exclusively without taping because, as echo pointed out, the pressure is identical for mouth and nose in a full-face. It's the only chin strap I've found that works. I've got the plus-4 model that comes with extra velcro tabs, so it also replaces my headgear. There are no strap pressure points because all the force load is distributed relatively evenly across the cap. Mask torsion from turning over is considerably reduced, so you don't have to spend as much time re-adjusting the mask when you turn over.

It works for me. My AHI averages about .7 right now, and my large leak line is fairly flat.

[nanwilson]

Well, alright, try the chin-up strip, or make one of your own. That's what I do, except that I put pieces of tape from under my chin up to just beside my nose under my eye on each side, and a stabilizing piece across connecting the 2 just below my lower lip.[/quote]
LoQ
You can buy 2" tape and just cut a "U" in it for chin up strips. That way you have a one piece strip instead of 3. My brain won't tell me the exact word I need here......I'll try this way...when I first made them I did the same as you then switched to the 2 inch ...grrrrrrr can't think.. its a pressure balance..... three strips can separate, but not one full piece. Is the word fulcrum? I give up, need another cup of coffee, obviously I didn't have a good night.
Hope you can figure out what I was trying to convey.
Coffeeeeeeee.......
Nan

[LoQ]

You can buy 2" tape and just cut a "U" in it for chin up strips. That way you have a one piece strip instead of 3. My brain won't tell me the exact word I need here......I'll try this way...when I first made them I did the same as you then switched to the 2 inch ...grrrrrrr can't think.. its a pressure balance..... three strips can separate, but not one full piece. Is the word fulcrum? I give up, need another cup of coffee, obviously I didn't have a good night.
Hope you can figure out what I was trying to convey.

Yes, I tried the 2 inch tape and cut a mouth window in it. That worked OK, same as a chin-up strip, but it's not as effective as what I'm doing.


You are imagining my taping scheme wrong. I assure you, it is completely stable. I am not doing an H, I am doing an inverted A.

And the word you are looking for may be rigidity. The "A" has it; the "H" does not.

[DoriC]

I know you're not asking this question but I notice that your titration was 12cms and your minimum is set to 8. What does your data indicate? Where is your 95%? Just a thought about raising the minimum to 9cms or 10cms and see if that helps with AHI.

[chunkyfrog]

I use different strategies on different nights; the same thing doesn't always work
Half of a polident strip between my lips works pretty good with a 1-1/2" piece of blue tape across the center of my lips.
On other nights, I use a home-made 'chin-up' strip.
Sometimes I use my home made biker bandanna 'papcap'.
I mix it up to fool my sleeping self from learning how to mess it up.
(the sleeping me can be very clever)

[brain_cloud]

I have tried chinstraps but they don't seem to work. Does anyone else have any ideas on why my AHI is better when I tape my mouth closed compared to when I don't tape my mouth. Any suggestions would be appreciated. Thanks for the help.

Sincerely,
Chad

I don't know why exactly either, but the same holds true for me. So whether you figure out why or not, keep doing it!

[LoQ]

I don't know why exactly either, but the same holds true for me.

I know what it is for me, though it may be different for others. Even with a full face mask, when my jaw relaxes, it falls so far down that a gap is created between my lower lip and the bottom of the mask. It really falls more "backward" (towards my spine) than down (towards my feet). That really can't be controlled by adjusting the straps, so I choose to tape my jaw closed, but leave my mouth open.

[ozij]

Effect of nasal or oral breathing route on upper airway resistance during sleep
ERJ November 1, 2003 vol. 22 no. 5 827-832
M.F. Fitzpatrick 1 , H. McLean 1 , A.M. Urton 1 , A. Tan 2 , D. O'Donnell 1 and H.S. Driver 3

Abstract
Healthy subjects with normal nasal resistance breathe almost exclusively through the nose during sleep. This study tested the hypothesis that a mechanical advantage might explain this preponderance of nasal over oral breathing during sleep.

A randomised, single-blind, crossover design was used to compare upper airway resistance during sleep in the nasal and oral breathing conditions in 12 (seven male) healthy subjects with normal nasal resistance, aged 30±4 (mean±sem) yrs, and with a body mass index of 23±1 kg·m2.

During wakefulness, upper airway resistance was similar between the oral and nasal breathing routes. However, during sleep (supine, stage two) upper airway resistance was much higher while breathing orally (median 12.4 cmH2O·L−1·s−1, range 4.5–40.2) than nasally (5.2 cmH2O·L−1·s−1, 1.7–10.. In addition, obstructive (but not central) apnoeas and hypopnoeas were profoundly more frequent when breathing orally (apnoea-hypopnoea index 43±6) than nasally (1.5±0.5).

Upper airway resistance during sleep and the propensity to obstructive sleep apnoea are significantly lower while breathing nasally rather than orally. This mechanical advantage may explain the preponderance of nasal breathing during sleep in normal subjects.

[echo]

Thank you for posting that Ozij! I knew there had been a study about that I'd seen before.