Taping

[rested gal]

Wayyyy back on page 6 of this thread....
viewtopic.php?p=653476#p653476

Here is your chance to ASK Dr. Park
http:// doctorstevenpark.com/ask-dr-park-anything-about-sleep-apnea-11811

Gumby was replying to archangle, but Gumby's post gave me an idea. I signed up for Dr. Park's "Ask Anything About Sleep Apnea" teleseminar for Nov 8, 2011.

I not only signed up, but even submitted a question to Dr. Park.

This was my question:

"Some cpap users choose to put tape over their mouths to prevent mouth breathing while using nasal or nasal pillows masks. Tape over the mouth is often a hotly debated subject on the cpaptalk forum. If a person has made prolonged and serious but unsuccessful efforts to use chin straps or Full Face masks, and has found more effective therapy breathing exclusively through the nose, but continues to have mouth breathing issues during sleep, is putting tape over the mouth (with a tab on each end for quick removal) a reasonably safe thing for a mentally and physically competent cpap user to do?"

I ordered the MP3 audio recording of Dr. Park's November 8 interview. Ten minutes and 30 seconds into it, he read my question verbatim.

This was Dr. Steven Park's answer:

"Honestly, I think that's...if you try it and it works, keep doing it. I see no harm in using CPAP because that's essentially no different than if you were to use a full face mask or use a chin strap. Just make sure that you can easily take the tape off, and that's a great idea to put a tab on one end."

When he said, "essentially no different than" I think he was referring to the desired result -- preventing CPAP air from escaping the machine/patient circuit (FF mask) and/or trying to prevent mouth breathing (chin strap) -- and was not making an absolute comparison of taped mouth as being the same as wearing a FF mask or wearing a chin strap.

Dr. Park went on to talk about why breathing through the nose is better than breathing through the mouth before he moved on to the next question.

[LinkC]

Just make sure that you can easily take the tape off, and that's a great idea to put a tab on one end.

Note that Dr. Park thought even ONE end was not dangerous. Ppl here recommend BOTH ends (as you clearly said in your question to him...)

[LinkC]

Link, I was almost going to skip this thread as it doesn't apply to my husband...he wears a FF mask! Is there a link to this incident? And do I want to read it?

Look closely, I was addressing Chicken Little's "vomit asphyxia" rant. I don't have the link anymore, but the details (as I recall them) are it was a young patient in a hospital setting, with limited mobility. Vomited into a FF mask and essentially drowned. No, probably wouldn't apply to your hubby.

[moresleep]

DoriC, that alarm of yours looks ideal for people here who rely on mains power. All should order it immediately. It's better than the Radio Shack unit I suggested, as that had only an alarm and no strobe lights. At $16, it's cheap insurance.

I'm gratified Dr. Park did not dismiss taping out of hand. I'm not sure why most sleep doctors do, given that doctors recommend somewhat risky procedures all the time and much of medical treatment involves weighing one risk against another. But, he's not entirely accurate in the comparison of taping to wearing a full face mask. It is conceptually the same--but only if one adds the anti-asphaxia valve. Normally, the mouth serves that function; but, with it taped, an inline valve would seem in order, to provide the safety functionality of the full face mask. (If anyone finds one, please let me know.)

As for "tabs," I, too, fold over tape to create 1" tabs at both ends. It's worth doing; but, remember, if the sleeper who does not fully awaken as CO2 builds up instinctively grabs at the face, he/she is probably more likely to pull off the mask, which is easier to grab and probably would seem more the source of the distress. The real danger is in not arousing enough to do anything.

[SMenasco]

Rested Gal, thanks so much! It's such a relief to find out I don't have to smear chicken dooky all over my mouth anymore. Tape tastes so much better!

[kempo]

Rested Gal, thanks so much! It's such a relief to find out I don't have to smear chicken dooky all over my mouth anymore. Tape tastes so much better!

Now SMenasco, you will have everyone googling "smearing chicken dooky on the mouth" just to see how risky it is.

[rested gal]

I'm gratified Dr. Park did not dismiss taping out of hand. I'm not sure why most sleep doctors do

I'm not sure "most" sleep doctors do (dismiss taping out of hand.) I doubt if many sleep doctors have even been asked their opinion about a CPAP user voluntarily using tape that way.

But, he's not entirely accurate in the comparison of taping to wearing a full face mask.

I didn't take his comment to be comparing the items themselves (tape, chinstrap, FF mask) but rather a comparison of the results those items might achieve in keeping CPAP air contained in the machine to user loop. All three of the items have the goal of preventing CPAP air from simply gushing out into the bedroom when CPAP is being used by people who have a big problem with mouth air leaks during sleep.

[M.D.Hosehead]

I not only signed up, but even submitted a question to Dr. Park.

RG, you are a peach! No one else thought of that.

[archangle]

I'll try it again with my present machine, which has an anti-asphyxia valve in the inlet to the humidifier tank.

I think the "anti-asphyxia valve" at the inlet to the humidifier tank is not considered an anti-asphyxia valve. I remember when Respironics changed the design. It was described on the online seller's web site as a better way to keep water from spilling back into the blower unit from the humidifier. By the way, that design, like most anti-asphyxia valves may keep autostart from working.

Having a valve at the tank may actually increase the CO2/O2 problem in the case of a power failure. When I unplug my machine, there's some resistance to air flow through the blower unit and filters as I try to breathe. The positive and negative pressure in the mask this cause seems to cause some airflow through the exhale vents. If I try the same experiment with the hose disconnected at the machine end, the air in the mask seems to be worse than it is when connected to a dead machine. Try it yourself and see what you think.

By the way, this actually adds another risk to the scenario. If you manage to pull your hose loose from the machine in the middle of the night, your CO2/O2 problems may be even worse than if the machine cuts off. You also aren't fighting against as much back pressure, so you might not be as likely to wake up as you are if the power shuts off.

[SMenasco]

Archangle; thanks for contributing to subjects that have entertained so many of us with a topic that has had (can you believe) 5,000 hits, generated the heated passions of a few and brought out the infantile silliness of some of us. I know you mean well and are very informed on the subjects discussed on the forum. However, you really don't have to win every discussion over to your way of thinking. That tends to put off some people. I know this because I am guilty of it as well. The subjects of taping, vomiting, and suffocating on CO2 are like chewing raw chicken fat; the longer you chew it, the bigger it gets.

[archangle]

This was my question:

"Some cpap users choose to put tape over their mouths to prevent mouth breathing while using nasal or nasal pillows masks. Tape over the mouth is often a hotly debated subject on the cpaptalk forum. If a person has made prolonged and serious but unsuccessful efforts to use chin straps or Full Face masks, and has found more effective therapy breathing exclusively through the nose, but continues to have mouth breathing issues during sleep, is putting tape over the mouth (with a tab on each end for quick removal) a reasonably safe thing for a mentally and physically competent cpap user to do?"

I ordered the MP3 audio recording of Dr. Park's November 8 interview. Ten minutes and 30 seconds into it, he read my question verbatim.

This was Dr. Steven Park's answer:

"Honestly, I think that's...if you try it and it works, keep doing it. I see no harm in using CPAP because that's essentially no different than if you were to use a full face mask or use a chin strap. Just make sure that you can easily take the tape off, and that's a great idea to put a tab on one end."

Well, I'm glad to see Dr. Park apparently agrees with me about there being a risk of aspiration. Otherwise, why would you need to be sure you can easily take the tape off quickly?

Would he consider a FFM with no anti-asphyxia valve to be safe? How is a nasal mask with the mouth completely taped over different from an FFM with no anti-asphyxia valve? Are anti-asphyxia valves in FFMs unnecessary?

Why limit the question to mentally and physically competent CPAP users? If taping is a risk to mentally or physically unfit CPAP users, should we pretend it isn't? If it's dangerous to granny if she tapes on the nights she takes a heavy dose of her pain meds, don't you think it's a good idea for people to know that? Or if it's dangerous to someone recovering from a stroke, an Alzheimer's patient, etc? Or if it's dangerous to Uncle Jimmy to tape up after he's had a few six packs before bed?

Please post here again when you find a doctor who will disagree with my two statements that started this discussion.

1) There is a risk of suffocation if the machine quits blowing and you don't wake up while taped with a nasal mask.

2) You risk aspiration pneumonia if you vomit before you can get the tape off.

By the way did he actually say "I see no harm in using CPAP" or was it "I see no harm in using tape?" I'm guessing you heard it wrong.

[moresleep]

I'll try it again with my present machine, which has an anti-asphyxia valve in the inlet to the humidifier tank.

I think the "anti-asphyxia valve" at the inlet to the humidifier tank is not considered an anti-asphyxia valve. I remember when Respironics changed the design. It was described on the online seller's web site as a better way to keep water from spilling back into the blower unit from the humidifier. By the way, that design, like most anti-asphyxia valves may keep autostart from working.

Having a valve at the tank may actually increase the CO2/O2 problem in the case of a power failure. When I unplug my machine, there's some resistance to air flow through the blower unit and filters as I try to breathe. The positive and negative pressure in the mask this cause seems to cause some airflow through the exhale vents. If I try the same experiment with the hose disconnected at the machine end, the air in the mask seems to be worse than it is when connected to a dead machine. Try it yourself and see what you think.

By the way, this actually adds another risk to the scenario. If you manage to pull your hose loose from the machine in the middle of the night, your CO2/O2 problems may be even worse than if the machine cuts off. You also aren't fighting against as much back pressure, so you might not be as likely to wake up as you are if the power shuts off.

You’re probably right about my humidifier valve. I did find it odd that Respironics would put an anti-axphyxia valve that far away from the breather. The vents, then, are apparently just to let the water drain out of the humidifier while the flapper valve prevents it from going into the machine.

I’ll have to do some calculations and experiments with a detached hose, when I get a chance. No doubt a “dead” six- or eight-foot hose would cause a lot of re-breathing even without the Cpap at the end. I think there is a valid worry that the lack of resistance coupled with gradual CO2 buildup might not rouse some sleepers. It would be good to know whether CO2 buildup would continue to dangerous levels or first reach some point of equilibrium. Meanwhile, before I forget, I think I’ll add some form of strain relief, to keep me from inadvertently pulling the hose loose from the humidifier…

[rested gal]

By the way did he actually say "I see no harm in using CPAP" or was it "I see no harm in using tape?" I'm guessing you heard it wrong.

He clearly said "CPAP" in that sentence. He probably did mean to say "tape" at that point.

[brain_cloud]

Please post here again when you find a doctor who will disagree with my two statements that started this discussion.

1) There is a risk of suffocation if the machine quits blowing and you don't wake up while taped with a nasal mask.

2) You risk aspiration pneumonia if you vomit before you can get the tape off.

There are even more risk scenarios. For example:

3) Your piece of tape contains a rogue heliobacter pylori bacterium, which is transported to your lips and thence into your mouth. Said bacterium colonizes your stomach, resulting in sundry health issues.

Is this scenario more or less likely than the ones above? More or less likely than being struck by lightning? Derive all of the respective probabilities from first principles--show your work.

[DoriC]

Hi Brainy, good to see you here again! Makes me wonder how Jaylee is doing?