Apneas, Desaturations & Mouth Openings

[NightHawkeye]

Night before last I was just about convinced that mouth openings were not going to be too much of an issue. I even laughed when I saw the one recorded O2 desaturation of the night from 99% to 95%. Last night was a different matter though. Not that it was a bad a night's sleep really, at least compared to pre-xPAP days, but I woke up feeling not that well and wondering why, since I'd slept through five hours, that I didn't feel better. I was aware that I'd had some mouth openings but didn't think it was really a big deal.

The oximeter results showed otherwise though with seven desaturations, possibly the most since I transitioned to using a nasal mask two weeks ago. Interestingly, although I didn't think so when I first looked at the data, Encore Pro even managed to somewhat record the events also, as can be seen in the following charts.


. . . ..
For me it's becoming increasingly obvious that the mouth openings are a problem which needs to be addressed. I was feeling pretty good about the tongue position thing going to bed last night and it did seem like I was getting a pretty good seal early in the night. However, the seal obviously did not hold well.

I'm thinking maybe a chin strap is the next thing to try. I haven't ordered one yet because I'd kinda like to try using materials on hand first to see if a strap's gonna help in my case. (Call me skeptical, and I'm not gonna try the nylon pantyhose thing either, although with four females in the house, there is no shortage of material.)

I'm also thinking that the oximeter continues to prove its worth, because the extent of this problem is just not revealed in the Encore Pro data.

As always, suggestions gratefully appreciated.

Regards,
Bill

[krousseau]

Just some ideas that have occured to me while trying to devise a rig using an old knee support that will keep the mask and a chin strap in place (I don't like the one available commercially)
Try wide elastic and velcro sew the front chin part into a slight curve so it cups around your chin. If you have an "old" fabric covered neoprene type wrist, elbow, or knee support & you don't mind cutting it up-try that and some velcro. For a non sewing project maybe a pair of good stretch socks would work-just make sure you have some give so you can open your mouth in an emergency??? Pin the socks in a configuration similar to your mask head harness so it doesn't slide around on your head. And don't just cup the chin-have some support back under your chin too-that way the floor of your mouth and base of the tongue get a little support. I've considered sewing velcro fuzz part around a baseball cap (with visor removed) and just putting elastic and velcro hook straps on the mask and the neoprene chin cup. A Pirate cap would be a whole lot spiffier than an old (or new) pair of nylons-pick your favorite team/sport etc.

[NightHawkeye]

Thanks krousseau,

Great suggestions. I'll probably see what I can do with socks tonight. (I've already got candidates in mind!) You also provided the answer to another question I've had about using a chin strap. I will need support under the chin to keep my jaw from moving backwards and inducing apneas.

Long term the baseball cap sounds like a really good solution. My kids would think that was a hoot.

Regards,
Bill

[Snoredog]

while you can try it, chin straps don't work, in fact they make your OSA worse by pulling the lower jaw up/back.

FF mask or tape is about the only thing I've found that actually worked. Mouth breathing/leaks show up on reports just like a large mask leak cause the machine don't know the difference.

[Snoredog]

I should add:

I don't see where you have a problem with mouth breathing based upon your reports, if you look at the Remstar reports at the top, your leaks are NOT all that bad, if you were truly mouth breathing the leak graph would be above 75 or leave black tics at the very top of the graph where the LL is.

If your SAO2 levels are correct along the vertical time line, the drops are associated with "runs" of hypoapnea and apnea events.

If you look at your pressure chart at top, the Remstar is "probing" for events from the minimum pressure, there is 3 of these at the start and 5 at the end.

Bottom line:
If you want to get better sleep and keep your oxygen levels more consistent, then increase the bottom pressure from what looks like 5cm to 7cm or 8cm then compare to your above graphs. From your reports, I'd say 8cm is probably the ideal min. pressure.

[NightHawkeye]

I don't see where you have a problem with mouth breathing based upon your reports, if you look at the Remstar reports at the top, your leaks are NOT all that bad, if you were truly mouth breathing the leak graph would be above 75 or leave black tics at the very top of the graph where the LL is.

That is certainly what I originally expected to see in Encore Pro, but even though I have awakened numerous times to find myself mouth breathing, it just has never been detectable as any kind of leak, much less a "large leak" in Encore Pro. I suspect the reason for this is that the machine uses a timeline of "minutes" for detecting leaks, rather than seconds, which is what it uses for apneic events. For me air blowing out my mouth tends to wake me up, often immediately, I believe.

If your SAO2 levels are correct along the vertical time line, the drops are associated with "runs" of hypoapnea and apnea events.

True, and I also think that apneas, and maybe to a lesser extent hypopneas, tend to pop my mouth open when they occur.

If you want to get better sleep and keep your oxygen levels more consistent, then increase the bottom pressure from what looks like 5cm to 7cm or 8cm then compare to your above graphs.

I wish I could. All other things being equal, that would be good advice. Unfortunately, my lower esophageal sphincter also leaks like a sieve, causing aerophagia. (My father's LES was so bad that he had to have hiatal hernia surgery. I'm thankful I don't have that problem at least.)

So I guess you could say I'm doing a balancing act here. At lower pressures, aerophagia isn't much of a problem and I have been able to beat it back a little, but if I tried to spend the whole night at 10 cm pressure, my wife would probably end up cleaning pieces of me off the ceiling the next morning. Also, as you can see from the chart, even 10 cm is not enough when I roll over onto my back.

I'm thinking that my best recourse at the moment is to be to try to resolve this mouth opening thing. Whose knows, maybe it'll work for me. Lots of folks seem to manage to use nasal masks.

Regards,
Bill

[krousseau]

A chin strap helps me-my problem is a small head-even an adjustable chinstrap can't adjust quite right-then adding the mask head harness compounds the problem. Thus my new sewing projects. I'm glad to see you use the words mouth openings. I don't think my mouth is opening to breathe. It seems that I sleep more deeply-get more relaxed & my jaw drops a little and my mouth opens slightly. As you said the rush of air (I call it "looping") wakens me immediately.

[cijit]

Some people report that the chin strap does not solve the problem .
If you try this - with your mouth closed and your upper and lower teeth biting together in their normal position, blow air out gently through your lips .Now while there is air blowing through your lips take your index finger and holding it parallel to your lips press gently half way ( approximately)between chin and mouth . The pressure from the finger should close the bottom lip enough to stop the air passing through your lips .
If your "mouth leak" is this form some suggest an adjustable sports sweat band placed between the chin and mouth and obviously around the back of the head has solved their problems .
A chin strap will hold your jaw up but air may still leak through your lips .

[NightHawkeye]

Thanks, cijit,

You just saved me the expense of a chin strap. I'd been studying them today and was planning on ordering one tomorrow. I didn't really have great hopes for one, but performing your test told me everything I needed to know. While I am able to largely stop the leak with my finger to the upper chin, a strap like you describe would have the undesirable effect of pulling my jaw back, and I already know that induces apnea.

Not sure where exactly that leaves me. One step closer to seeing an ENT, I imagine, although there are still a few things I want to try first.

Regards,
Bill