want to give CPAP a try again...but discouraged

[jnmv1969]

Dear All:

It's been a while since I was last on this board, and since I last tried CPAP. I want to give it a try again because, as most of you would understand and know, sleep apnea is making my life miserable and will eventually shorten it.

I'd like to tell you the problem that I keep running into - but please do not ask me to post data from my card. The reason I say this is because I never get far enough in the process to have any data to post given the problem that I keep running into each time I've tried CPAP. I apologize if I sound cranky. I'm running on empty at this point.

The problem I keep running into is that no matter how high or how low the pressure, my airway always still closes up, the air does not stent it open. This happens instantaneously after I fall asleep. I end up with chipmonk cheeks (blowfish, as some call it). I have tried a chin strap, and I have tried training my tongue to stay up against the roof of my mouth, but neither works. I still end up with my airway closing once I doze off. I have also tried taping my mouth, which did not work either. I have tried both a set pressure and the kind that adjusts itself - but neither worked.

I've also tried different positions, but no luck. My doctor is suggesting a dental device, but I'm not sure if that is going to be the solution. My gut instinct tells me to that the mask and machine are my route. But I just don't know what to try next. If anyone has any suggestions, I'd much appreciate it.

Thanks,
JV

[LSAT]

Full Face Mask

[cowlypso]

Just because you are getting chipmunk cheeks, it doesn't mean that your airway is closing up. You can try it out yourself while you're awake... Put on the mask and turn on the machine, then let your cheeks puff out. You'll still be able to breathe just fine. The problem is that your cheek muscles are relaxing and you aren't able to keep your tongue in a position to block the air from entering your mouth.

Taping your mouth shut won't help, since the fact that you're getting chipmunk cheeks means that you aren't having a problem with air leaking out your mouth.

Have you tried a full face mask? That is the first thing that I can think of that might make a difference for you.

[DoriC]

What range of pressures have you tried, what set pressures? What was your titration? Have you tried a FF mask? Sorry for all the questions but the answers might help give better suggestions. Glad you came back for help.

[mars]

My doctor is suggesting a dental device, but I'm not sure if that is going to be the solution. My gut instinct tells me to that the mask and machine are my route.

JV

Hi JV

It may be that a dental device could just give you the edge that allows your machine to work.

Have you tried different positions for sleeping. Many people have less apneas sleeping on their side. And others have less apneas sleeping on their back.

Position can be a major factor to consider

cheers

Mars

[raggs]

Do not give up I am on my 3 month and I feel the difference in my level of energy. I read somewhere " That a bad night of sleep with the VPAP is better than a good night without it " I am a believer now Get your doc to let you try a biPAP or the VPap .I also started with forcing myself to sleep with it for 4 hours a night and then switched to without it. I am also one of the few it seems to use a full face. DO NOT GIVE UP

[Janknitz]

The problem I keep running into is that no matter how high or how low the pressure, my airway always still closes up, the air does not stent it open. This happens instantaneously after I fall asleep.

Many here would like to help, but could you explain a little more so we know what's going on? What do you mean "my airway always still closes up"? Can you describe what you mean? Do you feel like you can't breathe? Do you see this on the data, do you wake up with a start? Is the sensation just for a second, or does it last for several seconds?

Clear Airway apneas (no obstruction) can occur in "transitional sleep" when you are transitioning from wakefulness to sleep. Some people are startled awake by that. Other's find out only because the data will show a number of CA's as they are falling asleep or coming awake again--typically at the very beginning and/or end of the data charts.

If that sensation is startling you awake and keeping you from sleeping, how do you fall asleep WITHOUT the mask and machine? Presumably the same thing would be happening then. Maybe figuring out how you manage without the mask and machine is the key to getting through it with the mask and machine.

[chunkyfrog]

Full face mask--either Phillips Respironics Comfort Gel or Devilbiss Easy fit gel. The latter can also use a silicone cushion.
There also is Mojo; but it has a non-replaceable cushion.

[ozze_dollar]

Good luck with it all. I would say try a FFM but myself I dont like them. I have found that the biggest thing that really helps is TIME. Once you give it time everything gets easier. I remember i used to go to so much trouble not to drink too much liquid before I went to bed and make sure I urinate before i go to sleep just so i would not have to get up throught the night. Now,who cares,its so easy to go if need be and anyway I dont need to.

[archangle]

How will a full face mask help chipmunk cheeks?

[robysue]

How will a full face mask help chipmunk cheeks?

Chipmunk cheeks result when you are using a nasal mask or a nasal pillows mask, but the oral cavity is not sufficiently blocked off from the nasal cavity by the position of the tongue and upper palate*. So air gets into the mouth. And if your lips are sufficiently tightly closed, this additional air can't leak out that way. Since the air is trapped, it puffs your cheeks out. Opening the mouth to try to expel the excess air triggers a mouth leak which causes additional air to flow into (and out of) the mouth at relatively high velocity and can make the situation worse once you close the mouth since even more pressurized air is now trapped in the mouth.

With a FFM you can open your mouth and equalize the pressure on the inside outside of the mouth without triggering a mouth leak.

* NOTE: In SU's current thread Tongue on roof of mouth--Please explain, -SWS posted this link about tongue and upper palate positions. Slide 3 is the relevant slide here: It looks like this:



If the upper palate and tongue are where they are supposed to be, the oral cavity is blocked off and NOT pressurized by the CPAP air. But if the back of upper palate & back of the tongue don't mesh correctly, air will get into the mouth and if the lips are sealed, the cheeks have to puff out.

[archangle]

How will a full face mask help chipmunk cheeks?

Chipmunk cheeks result when you are using a nasal mask or a nasal pillows mask, but the oral cavity is not sufficiently blocked off from the nasal cavity by the position of the tongue and upper palate*. So air gets into the mouth. And if your lips are sufficiently tightly closed, this additional air can't leak out that way. Since the air is trapped, it puffs your cheeks out. Opening the mouth to try to expel the excess air triggers a mouth leak which causes additional air to flow into (and out of) the mouth at relatively high velocity and can make the situation worse once you close the mouth since even more pressurized air is now trapped in the mouth.

That doesn't sound right. If you have, for instance, 10 cm pressure, you'd get 10 cm in the the throat. If air leaks from the throat into the mouth, it would have to be at 10 cm or less. If you have a full face mask, the pressure outside your mouth would be at 10 cm. Opening your mouth would not leak from your mouth to the mask, air would flow into your mouth and make the problem worse.

Or to put it another way, if the CPAP pressure in your mouth gives you chipmunk cheeks, opening your mouth with a FFM is not going to reduce the pressure in the mouth.

Maybe there's some reason a FFM prevents chipmunk cheeks, but air pressure through the mouth isn't it. Maybe the physical pressure of the mask on the face prevents it somehow.

A FFM would help prevent air leaks, but I still don't see how it would prevent chipmunk cheeks.

[Sleepy Taz]

I think everyone is missing the most important part of this. If her mouth is filling up with air then she is not breathing through her nose. What I believe she needs to do is sit up and watch TV or read a book while using the Cpap and mask. She needs to get used to the pressure and learn to breathe normally with the mask on.

[jnmv1969]

Dear All:

Thanks so much for the suggestions and questions. It will take me a while to read through each, but I will. If I figure out what the fix is, I will certainly share it.

I do in fact breathe through my nose. I have tried wearing the CPAP mask for a few hours at a time while just reading, in order to get used to it. I have even tried a couple of full-face masks, and hybrid masks. But somehow the pressure of the air is just not enough to keep my airway open, and I wake up choking and with chipmunk cheeks. I have had at the very highest pressure experiences where the air builds up in my cheeks, and eventually becomes so intensely built up that it forces my throat to open up again - but it is a very strange sensation and it is impossible to sleep that way. And like I said, I've tried everything from the lowest pressures. As for my data, all I can remember at this point is that I get indicators of events, and have a high AHI for just a 15 or 20 minute time span.

But thank you again for your suggestions. And like I said, I will read through each one.

Sincerely,
JV

[archangle]

I think everyone is missing the most important part of this. If her mouth is filling up with air then she is not breathing through her nose.

Why do you say this? If I put on my nasal mask and breathe through my nose, air will sometimes leak out from my throat into my mouth.