new cpap user-problems with mouth leakage even with chinstap

[Pugsy]

On the machine...can you pull up any data on the LCD screen like AHI, leaks, etc? If you can, then "Sleep Quality" is ON and you should then have detailed data available on the SD card. If not you will only have hours of usage. There is nothing on the machine pertaining to "full" data. No wonder you can't find it.

Do you have the clinical manual? It tells how to get to Sleep Quality setting in the machine. Available in Uncle Bob's signature line also.

Did you watch the video tutorial about the software? Most people find it explains all that is needed.

Some ResMed users will be along tonight and can give you step by step what to do. In the meantime I know it has been discussed here before, I will see if I can find it. I need to make a copy of it I guess. I can't ever remember. Now my machine and software I can give step by step on.

The video about your machine might explain the settings.
http://www.cpaplibrary.com/machines.html

Sorry I can find the steps needed. Will have to wait for ResMed user.

[msr0459]

The machine has to be set to gather full data and not just summary data. I don't use your machine so I can't tell you exactly which setting. Something in the clinical menu setup and turning Sleep Quality ON. Also must choose all detail data in the download process as it defaults to summary data.

Once you can get the full details and not just summary (someone that uses your machine can give specific steps if you can't get it figured out) you can then post an image of the report. I just use screen shots.

Here is how I do it.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

This is all I can get the software to upload and/or the S9 to give me:
http://s1141.photobucket.com/albums/n58 ... enshot.jpg
http://s1141.photobucket.com/albums/n58 ... nshot2.jpg

I will ask the person tomorrow at the medical supply co. if she knows a way to allow more detailed data.

Thanks again

[Pugsy]

I will ask the person tomorrow at the medical supply co. if she knows a way to allow more detailed data.

She will have a fit. We aren't supposed to be smart enough to find this stuff out.

You almost have it. You got the data...it is there on the SD card.. you need to make a change in the download from the SD to "all detailed data" or similar wording. Right now you have the summary data.

Your leak isn't that bad on the one report I saw for 1 week averages.

Max was 21 L/min that is the maximum leak you reached for the week. quite good really.

and 95% leak was 11.4 L/Min (meaning 95% of the time you were at or below this number) very acceptable for anyone especially a newbie.

Mean average was 0.0....which is great. A good bit of the time you did not leak at all to achieve this median average.
Quite excellent.

ResMed says the machines can handle leaks up to 24 L/min. You were close on the maximum but it was probably a leak spike or re position of the mask. You probably have a rather ragged leak line at times but for the most part you are well within acceptable leak limits and you may not be mouth breathing nearly as bad as you thought.

Your overall AHI for this week was..... 0.4
of that 0.2 was apneas and 0.2 were hyponeas. this is an hourly average index.
Total number of each divided by number of hours.

This is an excellent report. I think overall you are doing much better than you think.
Once you get the detailed reports figured out I think you will understand what I am saying maybe a little clearer.
I would be quite happy with what you are showing right now if this was my report.

[Pugsy]

SleepyHead will work also.
It pulls all the detailed data automatically if it is there.
http://sourceforge.net/projects/sleepyhead/

But what I saw on the summary reports is really quite good and I don't think you need to worry so much.
At your worst leak you never hit the 24 L/min line.

[apneawho]

Hi there. If the question is about viewing detailed data in ResScan...After you open patient and choose download data, there is a box that allows you to choose both summary and detailed data. Choose that, then hit download. Anytime you get a message asking if you want to overwrite or delete choose overwrite. Once data download is done, the dates will show up on left hand side. Highlight the day you want to look at in detail. There are tabs at top of page that say Summary graphs, Detailed graphs. Click on detail. You can save a report for any day by choosing create report.
The ResScan tutorial will help with more info on how to move graphs and change scale, etc. montfordhouse.com/cpap/resscan_tutorial/

[apneawho]

Did you figure out how to get to the Sleep Quality menu? From home menu, hold down the bottom rectangular silver button and the push the dial in simultaneously and hold both down until clinicians menu comes up. Settings are first, scroll down to Options and select. Then select sleep quality and select on.

[msr0459]

Hi there. If the question is about viewing detailed data in ResScan...After you open patient and choose download data, there is a box that allows you to choose both summary and detailed data. Choose that, then hit download. Anytime you get a message asking if you want to overwrite or delete choose overwrite. Once data download is done, the dates will show up on left hand side. Highlight the day you want to look at in detail. There are tabs at top of page that say Summary graphs, Detailed graphs. Click on detail. You can save a report for any day by choosing create report.
The ResScan tutorial will help with more info on how to move graphs and change scale, etc. montfordhouse.com/cpap/resscan_tutorial/

Here's what downloaded after I made that change. I have no idea yet what that data represents.

http://s1141.photobucket.com/albums/n58 ... nshot3.jpg


Marc

[msr0459]

Did you figure out how to get to the Sleep Quality menu? From home menu, hold down the bottom rectangular silver button and the push the dial in simultaneously and hold both down until clinicians menu comes up. Settings are first, scroll down to Options and select. Then select sleep quality and select on.

Thanks, I've made the change. I'll check tomorrow after work and see what additional info I've collected.

[msr0459]

I will ask the person tomorrow at the medical supply co. if she knows a way to allow more detailed data.

She will have a fit. We aren't supposed to be smart enough to find this stuff out.

You almost have it. You got the data...it is there on the SD card.. you need to make a change in the download from the SD to "all detailed data" or similar wording. Right now you have the summary data.

Your leak isn't that bad on the one report I saw for 1 week averages.

Max was 21 L/min that is the maximum leak you reached for the week. quite good really.

and 95% leak was 11.4 L/Min (meaning 95% of the time you were at or below this number) very acceptable for anyone especially a newbie.

Mean average was 0.0....which is great. A good bit of the time you did not leak at all to achieve this median average.
Quite excellent.

ResMed says the machines can handle leaks up to 24 L/min. You were close on the maximum but it was probably a leak spike or re position of the mask. You probably have a rather ragged leak line at times but for the most part you are well within acceptable leak limits and you may not be mouth breathing nearly as bad as you thought.

Your overall AHI for this week was..... 0.4
of that 0.2 was apneas and 0.2 were hyponeas. this is an hourly average index.
Total number of each divided by number of hours.

This is an excellent report. I think overall you are doing much better than you think.
Once you get the detailed reports figured out I think you will understand what I am saying maybe a little clearer.
I would be quite happy with what you are showing right now if this was my report.

Well I don't know what to say. If the reports aren't that bad, then why do I feel worse than before trying the cpap. Could it be that because most the time in bed I wasn't even a sleep,... because that's certainly the way I've felt this past week. Well, as I posted below, I've enable both the machine and software to collect more data, so I'll post when able. Perhaps at some point all of this will start to make sense to me.

Thanks to everyone for the input.

[Pugsy]

Well I don't know what to say. If the reports aren't that bad, then why do I feel worse than before trying the cpap. Could it be that because most the time in bed I wasn't even a sleep,

Yep.

There is more to this therapy than just getting "good" numbers. I wish it were that easy. If it were I would feel like a million dollars every day...and I don't.

Several things impact how we feel.
How many hours of real sleep do you get each night? Not just laying there trying to sleep?
Trouble going to sleep or staying asleep? Insomnia? Pain? What wakes you up?
Were you having these problems before starting on the machine?
Fragmented sleep for any reason?
While your leaks aren't hugely bad, do they wake you up? If so, anything that causes sleep fragmentation needs to be worked on.
Other health issues possibly affecting how you fee?
Get up to pee a lot during the night?
See where I am going here? Lots of things impacts how we sleep.

This last report shows only a handful of hours. Is this normal for you?

Finally, sometimes it just takes time for your body to heal and for a person to start seeing some benefit.
But you won't until you can use the machine and get 6 to 8 hours of real sleep using the machine, every night.

Your summary showed an average of about 5 hours a night. That isn't enough even if you slept the whole time, much less laying there awake for however long.

The cpap machine only fixes the sleep apnea thing. It doesn't do a darn thing for any other issues...unfortunately.

[msr0459]

Well I don't know what to say. If the reports aren't that bad, then why do I feel worse than before trying the cpap. Could it be that because most the time in bed I wasn't even a sleep,

Yep.

There is more to this therapy than just getting "good" numbers. I wish it were that easy. If it were I would feel like a million dollars every day...and I don't.

Several things impact how we feel.
How many hours of real sleep do you get each night? Not just laying there trying to sleep?
Trouble going to sleep or staying asleep? Insomnia? Pain? What wakes you up?
Were you having these problems before starting on the machine?
Fragmented sleep for any reason?
While your leaks aren't hugely bad, do they wake you up? If so, anything that causes sleep fragmentation needs to be worked on.
Other health issues possibly affecting how you fee?
Get up to pee a lot during the night?
See where I am going here? Lots of things impacts how we sleep.

This last report shows only a handful of hours. Is this normal for you?

Finally, sometimes it just takes time for your body to heal and for a person to start seeing some benefit.
But you won't until you can use the machine and get 6 to 8 hours of real sleep using the machine, every night.

Your summary showed an average of about 5 hours a night. That isn't enough even if you slept the whole time, much less laying there awake for however long.

The cpap machine only fixes the sleep apnea thing. It doesn't do a darn thing for any other issues...unfortunately.

No doubt I agree with all the above. Even during the actual sleep study itself I didn't sleep much at all, which may be normal, I don't know. Now, since starting the cpap theray, I don't feel like I've been sleeping nearly as good as before the therapy, which certainly wasn't good at all.

Every night since starting the nasal pillow, I've been awakened by air leaks from my mouth. I've tried a chin strap to no avail, and last night, I taped my mouth, and still, I would be awakened by air "puffing" my cheeks out, and/or air making noise blowing through the small cracks in the tape I guess. Either way, I'm sure at this point that the nasal mask is making things worse, due to my tongue falling back and letting the air out of mouth.

I'm going to swap the nasal mask for a full face today hopefully. I reaaalllly hope that I can tolerate it. I'm at the end of my rope, and it's only been a week!

[Pugsy]

No doubt I agree with all the above. Even during the actual sleep study itself I didn't sleep much at all, which may be normal, I don't know. Now, since starting the cpap theray, I don't feel like I've been sleeping nearly as good as before the therapy, which certainly wasn't good at all.

Every night since starting the nasal pillow, I've been awakened by air leaks from my mouth. I've tried a chin strap to no avail, and last night, I taped my mouth, and still, I would be awakened by air "puffing" my cheeks out, and/or air making noise blowing through the small cracks in the tape I guess. Either way, I'm sure at this point that the nasal mask is making things worse, due to my tongue falling back and letting the air out of mouth.

I'm going to swap the nasal mask for a full face today hopefully. I reaaalllly hope that I can tolerate it. I'm at the end of my rope, and it's only been a week!

Hopefully the full face mask will allow a more unfragmented sleep. Mask fit, comfort and finding the right mask are the hardest part of this therapy. You may also have some insomnia issues going on...either falling asleep or staying asleep. That can be even harder to work on.

[Bobby269]

This will tell you how to set your machine: http://www.cpaplibrary.com/machines.html\
This will show information aboiut your software: http://montfordhouse.com/cpap/resscan_tutorial/

[rested gal]

Every night since starting the nasal pillow, I've been awakened by air leaks from my mouth. I've tried a chin strap to no avail, and last night, I taped my mouth, and still, I would be awakened by air "puffing" my cheeks out, and/or air making noise blowing through the small cracks in the tape I guess. Either way, I'm sure at this point that the nasal mask is making things worse, due to my tongue falling back and letting the air out of mouth.

I'm going to swap the nasal mask for a full face today hopefully. I reaaalllly hope that I can tolerate it. I'm at the end of my rope, and it's only been a week!

If one or another FF mask doesn't get the job done for you, there's yet another thing you can try, to stop the mouth breathing with your nasal pillows mask:

This link is to a long discussion about frequenseeker's "DIY" (Do It Yourself) mouthguard to stop mouthbreathing and mouth air leaks:

Topic started by frequenseeker Dec 01 2004 subject: mouth leak solution, cheap DIY oral appliance
http://www.talkaboutsleep.com/message-b ... php?t=4750

Topic with pictures of snork1's creation:
viewtopic.php?t=3265

Topic with pictures of a one piece design by freelans:
http://www.talkaboutsleep.com/message-b ... 71242#7124

____________________________________________

Direct link to the photos of homemade DIY mouthguards:
http://www.tnlc.com/Lara/laura/osa/DIYmouthleakPhotos/

One that I made worked well for me. The first one I made did not, because I was trying to have it keep my tongue up against the roof of my mouth. That tongue position works for many people, but for me air can still gush out around the sides of my tongue at the back, along my back molars.

When I continued to work on the boil'n'bite again (and again, and again) I finally made one that literally shoved my tongue backwards almost to the point of gagging...to seal off the entrance to my throat at the back of my mouth. THAT worked. No CPAP air could sneak into my mouth from behind. Making my tongue form a wide dam back there kept the CPAP air directed the right way as I breathed through my nose. Kept it going straight down instead of detouring from my throat into my mouth.

msr, I know this all has to be discouraging to you so far. If this is any consolation, be assured you're not the only one who is feeling worse and LESS rested using CPAP than you did before CPAP.

Right now you've traded off the sleep disruptions of apneas/hypopneas for the sleep disruptions of CPAP mask issues. Perhaps even more sleep disruptions than before. And you're painfully aware of these "equipment" sleep disturbances. You were having sleep disrupting arousals with the OSA events before, but you were not aware of the arousals. They would wake you so briefly, you weren't aware of them. Now you are very much aware of mask issue wakeups, and difficulty getting to sleep with all this "stuff."

It will get better...easier to do...as you work through each problem one by one.

The mask is the key to being able to "do CPAP" comfortably enough to actually "sleep" again. Either a FF mask, if you can find one that lets you do that. Or perhaps a boil'n'bite to make your tongue dam off the air that is sneaking into your mouth while letting you use your less obtrusive nasal pillows mask.

I know it sounds counter-intuitive to think about deliberately SHOVING your tongue back there with a DIY mouthguard, since tongue "falling back" is a big part of what can cause obstructive apneas/hypopneas for many people. But, it's usually not just the tongue doing that. It usually also involves other soft tissues at the back of the mouth and in the throat...like the soft palate relaxing down to meet the tongue. And other soft tissues in the throat collapsing inwardly.

CPAP air will keep all those soft tissues (and the tongue) out of the way, so you don't have to worry about, "Gee, if I fix a boil'n'bite that pushes my tongue BACK toward my throat, won't that cause even MORE apneas????" The CPAP air will keep things open back there, including the BACK of the throat, even with the tongue pushed back enough to seal off the FRONT entrance to the throat at the back of the mouth. And you'll finally be getting a truly therapeutic amount of air pressure since the CPAP air won't be getting lost by detouring into your mouth.

And wonder of wonders...you won't have to use a chin strap if you can make a boil'n'bite that works to keep the CPAP air back where it's supposed to be...in your throat. Your mouth can hang open and the boil'n'bite mouth guard will still act like a dam to keep the CPAP air from shooting into your mouth from the back.

The long term benefits to your health and quality of life are worth sticking with this. But in "sticking with it" I don't mean to try to get used to it the way it is for you now. There are things to keep trying...things to handle the mouth breathing, whether the solution is a FF mask or a DIY mouthguard, and things to make the whole "new way of sleeping" more comfortable. You're obviously trying hard. You've come to the right place (this forum) to find more and more pieces that can make the HOW CAN I EVER SLEEP LIKE THIS puzzle come together for you.

Good luck!

[msr0459]

Every night since starting the nasal pillow, I've been awakened by air leaks from my mouth. I've tried a chin strap to no avail, and last night, I taped my mouth, and still, I would be awakened by air "puffing" my cheeks out, and/or air making noise blowing through the small cracks in the tape I guess. Either way, I'm sure at this point that the nasal mask is making things worse, due to my tongue falling back and letting the air out of mouth.

I'm going to swap the nasal mask for a full face today hopefully. I reaaalllly hope that I can tolerate it. I'm at the end of my rope, and it's only been a week!

If one or another FF mask doesn't get the job done for you, there's yet another thing you can try, to stop the mouth breathing with your nasal pillows mask:

This link is to a long discussion about frequenseeker's "DIY" (Do It Yourself) mouthguard to stop mouthbreathing and mouth air leaks:

Topic started by frequenseeker Dec 01 2004 subject: mouth leak solution, cheap DIY oral appliance
http://www.talkaboutsleep.com/message-b ... php?t=4750

Topic with pictures of snork1's creation:
viewtopic.php?t=3265

Topic with pictures of a one piece design by freelans:
http://www.talkaboutsleep.com/message-b ... 71242#7124

____________________________________________

Direct link to the photos of homemade DIY mouthguards:
http://www.tnlc.com/Lara/laura/osa/DIYmouthleakPhotos/

One that I made worked well for me. The first one I made did not, because I was trying to have it keep my tongue up against the roof of my mouth. That tongue position works for many people, but for me air can still gush out around the sides of my tongue at the back, along my back molars.

When I continued to work on the boil'n'bite again (and again, and again) I finally made one that literally shoved my tongue backwards almost to the point of gagging...to seal off the entrance to my throat at the back of my mouth. THAT worked. No CPAP air could sneak into my mouth from behind. Making my tongue form a wide dam back there kept the CPAP air directed the right way as I breathed through my nose. Kept it going straight down instead of detouring from my throat into my mouth.

msr, I know this all has to be discouraging to you so far. If this is any consolation, be assured you're not the only one who is feeling worse and LESS rested using CPAP than you did before CPAP.

Right now you've traded off the sleep disruptions of apneas/hypopneas for the sleep disruptions of CPAP mask issues. Perhaps even more sleep disruptions than before. And you're painfully aware of these "equipment" sleep disturbances. You were having sleep disrupting arousals with the OSA events before, but you were not aware of the arousals. They would wake you so briefly, you weren't aware of them. Now you are very much aware of mask issue wakeups, and difficulty getting to sleep with all this "stuff."

It will get better...easier to do...as you work through each problem one by one.

The mask is the key to being able to "do CPAP" comfortably enough to actually "sleep" again. Either a FF mask, if you can find one that lets you do that. Or perhaps a boil'n'bite to make your tongue dam off the air that is sneaking into your mouth while letting you use your less obtrusive nasal pillows mask.

I know it sounds counter-intuitive to think about deliberately SHOVING your tongue back there with a DIY mouthguard, since tongue "falling back" is a big part of what can cause obstructive apneas/hypopneas for many people. But, it's usually not just the tongue doing that. It usually also involves other soft tissues at the back of the mouth and in the throat...like the soft palate relaxing down to meet the tongue. And other soft tissues in the throat collapsing inwardly.

CPAP air will keep all those soft tissues (and the tongue) out of the way, so you don't have to worry about, "Gee, if I fix a boil'n'bite that pushes my tongue BACK toward my throat, won't that cause even MORE apneas????" The CPAP air will keep things open back there, including the BACK of the throat, even with the tongue pushed back enough to seal off the FRONT entrance to the throat at the back of the mouth. And you'll finally be getting a truly therapeutic amount of air pressure since the CPAP air won't be getting lost by detouring into your mouth.

And wonder of wonders...you won't have to use a chin strap if you can make a boil'n'bite that works to keep the CPAP air back where it's supposed to be...in your throat. Your mouth can hang open and the boil'n'bite mouth guard will still act like a dam to keep the CPAP air from shooting into your mouth from the back.

The long term benefits to your health and quality of life are worth sticking with this. But in "sticking with it" I don't mean to try to get used to it the way it is for you now. There are things to keep trying...things to handle the mouth breathing, whether the solution is a FF mask or a DIY mouthguard, and things to make the whole "new way of sleeping" more comfortable. You're obviously trying hard. You've come to the right place (this forum) to find more and more pieces that can make the HOW CAN I EVER SLEEP LIKE THIS puzzle come together for you.

Good luck!

Thank you all for your support,

I'm really interested to see what my sleep doc has to say about my initial sleep study results. Remember, only my medical supplier person has looked at my chart, and given me HER opinion on what was going on(which she wasn't supposed to). I'm still a little in denial I suppose. If what she says is correct, I only had 12 hypopneas an hour, and my oxygen didn't drop at all. I only slept for a total of 280 or minutes, of which less than half was REM (if I remember correctly). I'm surprised I slept at all under the circumstances. These results to me don't sound like they warrant cpap therapy, but I'm not the expert. In a way though, I was glad that they supposedly found something wrong, if not, I'm not sure what else I could have tried.

The sleep study was my last hope to try and figure out why my sleep had gone in the dumper, so to speak. All that I've read, and even the same medical supplier above agreed that hypopneas were indeed rare for thin guys, especially on those who are otherwise in perfect health.Not bragging, but over the last 30 some odd years I've done weight training, treadmills, bikes, martial arts, and my nutrition is impeccable. So you can imagine why I'm amazed that the results show that I have a problem with breathing at night.

Again, this is what makes me have to wonder if the sleep study was accurate at all, due to the most "non sleeping" type of scenario for me (too much outside noise, too much light, non regulated temperature, wires hanging off, etc.) that I can imagine.

That being said, I'm giving my best attempt to comply and see if my sleep improves. The full face mask (ResMed Quattro FX) was for sure better than the nasal pillow/chin strap debacle. At least this morning I feel like I sleep some. Not great mind you, but also not nearly as bad as with the nasal pillow combo. It was a little disconcerting feeling the air "puff" on such a large portion of my face. The occasional "mouth full of air", kind of like a facing a strong wind, would also awaken me at times, and for sure the infamous "nose itch"!,which of course turns into an awakening event, what with having to turn off the machine, take off the mask, etc. All in all though, much better.

I still have to wonder if purchasing that mouthpiece from "Nosebreath.com" would do the trick. As compared to the DIY in the links you supplied, it directly keeps the tongue in place so as to not let it fall back and open up the throat, IF it works as advertised. Some on here said it works wonderfully, others, not so much. It's expensive though, at $300.00 for the "heavy mouth breather", which is the one most likely to work, supposedly, since it also has a bottom tray. I'm not even sure if I would prefer the nasal pillow for comfort, as compared to the full face. Both have there advantages. I guess at some point I'm going to have to come out of pocket and purchase one or the other, so as to have both on hand for experiments.

Lastly, I also still wonder if perhaps having my tonsils and adenoids out would perhaps alleviate my symptom, especially if combined with the aforementioned "nosebreath" mouthpiece. I can look at the back of my throat and it does look pretty narrow to me, again, what do I know. I'm surprised that my sleep doc never even considered that option, but I do plan on bringing it up when I finally go an see him for a follow up. That is supposed to happen after 30 days of cpap therapy, so we'll see how it goes until then, if I can hang on.

Thanks again for taking the time.