How did YOU Resolve Your Mouth-Leaks? (poll)

[Kitatonic]

Until I started using a soft cervical collar, I would never have zero leaks. Since even "acceptable" leaks were correlated with wake-ups, dry mouth and increase in obstructive apneas, I've adapted to this hot collar after four months. All the other methods, taping, chin strap, and PapCap failed for me.

[NateS]

I am still struggling with dry mouth which I believe is due to mouth leaks. Sugarless lozenges periodically through the night help relieve the driness but of course not the leaks.

I have collected the following attempted remedies: ResMed simple chin strap; Ruby Chinstrap; Respironics Deluxe Chinstrap; Papcap; 3 inch foam collar; 4 inch foam collar and various tapes over my mouth.

All the chinstraps either slip off or hurt my head when tightened enough to not slip off, and they are especially a problem with the Wisp, which I otherwise love as a mask, because putting the chinstrap on either under or over the curved cheekstraps of the Wisp seems to distort their design - the Wisp seems intended to just "float" in front of the nose and become attached by suction when the machine pressure is turned on, but all the chinstraps seem to distort the shape of the Wisp's cheekstraps, pushing the nosepiece either too close or too far from my nose to make a good seal. Without a chinstrap, the Wisp works perfectly.

I have had some better luck with either the 3 inch or 4 inch foam collar, but not always.

I have tried tape and beside the feeling of having been taken hostage, I have actually had to pull it off during the night to insert my sugarless lozenges because my dry mouth persisted even with the taping.

Biotene tooth paste, gel and mouthwash seem to make no difference and I find their consistency somewhat annoying for some reason.

My dentist doesn't seem to have a clue. So far he has seen no evidence either resulting from or caused by my nighttime dry mouth. During the daytime I am not aware of any dry mouth symptoms.

And I continue to see a bunch of nightly jumping above the red line in ResScan, making me question my great low AHI scores.

Grrr!

Regards, Nate

[DaveL]

Incredible thread.

I am lost trying to solve this problem. I have tried 5 FFM and 1 hybrid. No patience with the hybrid. Didn't work for me at all!

Losing patience with the Ultra Mirage. It keeps slipping up? Mouth has been very dry a couple of times a night. Tried readjusting it. Darn mask sounded like a French Horn!

[NateS]

Outlining all my efforts above and expressing my frustrations seems to have helped clear my head to try something different.

Last night, at the suggestion of my girlfriend, I tried a different combination.

I removed the medium nosepiece from my Wisp, and replaced it with the large nosepiece which I had previously thought to be too large.

I went back to my Ruby size Large Chinstrap, and pulled the Wisp/Large over on top of it. The Wisp seemed to fit a little more snugly, but not uncomfortably so.

And I had a great night - the leak alarm on my machine did not go off even once, I did not have to do any readjustments. And here is my chart:



Leaks almost all staying below the red line and a nice low AHI ! I did continue to have mouth dryness but it did not seem anywhere near as bad. Fewer lozenges taken than usual during the night.

I'll report back to see how long this good news lasts.

Regards, Nate

[NateS]

Incredible thread.

I am lost trying to solve this problem. I have tried 5 FFM and 1 hybrid. No patience with the hybrid. Didn't work for me at all!

Losing patience with the Ultra Mirage. It keeps slipping up? Mouth has been very dry a couple of times a night. Tried readjusting it. Darn mask sounded like a French Horn!

Dave,

Have you ever tried a nose-only mask like the new Wisp? It doesn't slip around, and unlike a duo-nasal pillow mask, there is no constant re-adjusting. There is nowhere for it to go because it covers the entire nose and hovers in place with gear that seems to have been designed by a suspension-bridge engineer. (Of course it's not going to solve the mouth leak issue.)

Regards, Nate

[DaveL]

Thanks Nate! I'll take a look.
Much Appreciated!
Dave

[NateS]

Outlining all my efforts above and expressing my frustrations seems to have helped clear my head to try something different.

Last night, at the suggestion of my girlfriend, I tried a different combination.

I removed the medium nosepiece from my Wisp, and replaced it with the large nosepiece which I had previously thought to be too large.

I went back to my Ruby size Large Chinstrap, and pulled the Wisp/Large over on top of it. The Wisp seemed to fit a little more snugly, but not uncomfortably so.

And I had a great night - the leak alarm on my machine did not go off even once, I did not have to do any readjustments. And here is my chart:



Leaks almost all staying below the red line and a nice low AHI ! I did continue to have mouth dryness but it did not seem anywhere near as bad. Fewer lozenges taken than usual during the night.

I'll report back to see how long this good news lasts.

Regards, Nate

Now ten (10) days since the above report, and this combination is continuing to work for me. My charts continue to pretty much resemble the one above. No leak alarms. Although the Biotene toothpaste and gel seem to be of no help to me at all, I do find that their Mouthwash, just before lying down, tends to reduce my mouth dryness somewhat. Down from 5 sugarless citrus lozenges to about 3 a night, taken only when the dryness wakes me up momentarily. (How do I keep count? - empty wrappers on the nightstand or the floor in the morning! ) Wish I could eliminate it entirely.

I am thinking that the mouth dryness may not necessarily be due to mouth-breathing, as I had previously assumed, but maybe just the constant air pressure up and down from the machine, since it fills both my nose and my mouth before being exhaled. Anyone have a different opinion on this?

I have concluded that, with an ASV pushing my pressure constantly up and down, I can never expect flat Leak lines like Pugsy's, but as long as I am mainly below the red line, having only momentary spikes here and there above it, I think this is working for me and my AHI readings should be accurate. My AHI for the last 7 days averaged 0.59

Regards, Nate

[SleepingUgly]

I would be a complete disaster after a night of leaks like yours. I guess whether your leak situation is considered a success or failure depends on whether you are disturbed by all those leaks. You're obviously partially disturbed (sleeping people do not suck lozenges). If you aren't tired during the day and can tolerate it like this, I guess that's success.

[NateS]

I would be a complete disaster after a night of leaks like yours. I guess whether your leak situation is considered a success or failure depends on whether you are disturbed by all those leaks. You're obviously partially disturbed (sleeping people do not suck lozenges). If you aren't tired during the day and can tolerate it like this, I guess that's success.

Could you post a typical chart?

Thx.

Nate

[Jay Aitchsee]

Nate, I have to agree with SU. Your leak line would be very disturbing for me. Below is a recent night using the Quattro FFM. Like you, I am a throat leaker and I have found no other way to overcome it save from a FFM. I don't like the FFM, but it works.

Looking at your latest posted leak line, I think you are still having a lot mouth/throat leaks. Hence, the dry mouth. Look at those leaks around 4 AM and 7 AM, I think those shapes are characteristic of mouth leaks. Also, I question whether or not you AHI is accurate if you are experiencing mouth leaks, regardless of the red line. Think about it. A mouth leak is shunting the pressure before it gets to an obstruction. Look at your pressure line under those long flat leaks, see how it just stays at minimum? Doesn't that seem odd?

Now, I'm not an expert and I have no experience with VPAP, just my thoughts.

Jay

AI=0.0, HI=3.9, Leaks = Median 0.0, 95% 2.5, Max 30.0


Edit: Nate, in case you missed it, you may want to review this by Ozij: viewtopic.php?f=1&t=49212&st=0&sk=t&sd= ... 45#p453680

[quietmorning]

I'd put 'other' but the option isn't up there for what the actual problem was and how it was resolved.

Suggestion from my doc to reduce AHI without messing with my pressure was to turn my C-flex down to 2 or 1 from 3. I turned down to 2 with no mouth breathing, and my ahi did reduce. I then tried 1 and all the sudden my mouth started opening at night or I ended up with chipmonk cheeks if I taped. First time that ever happened. . .so last night I changed the C-flex back to 2 - still have the reduced ahi, but my mouth didn't open once.

[Jay Aitchsee]

...

Losing patience with the Ultra Mirage. It keeps slipping up? ...

Dave, check this out:
viewtopic.php?f=1&t=85334#p776113
Jay

[NateS]

FWIW, here are my stats and chart for last night:





You're saying this is bad, for a variable pressure machine? I thought it was good.

Sign me confused.

Regards, Nate

[Pugsy]

Sign me confused.

Hi Nate...my leak lines aren't so perfect always because I know that I do occasionally have my mouth drop open. It rarely registers in large leak territory and I sleep right through it and yes, sometimes have the dry mouth thing but as long as I sleep well I don't care.

Now you are using mouth drops during the night...so we know you have some awakenings or you wouldn't be popping those mouth drops. I think that is the main concern here...the fractured sleep.
It doesn't take a lot of mouth breathing to dry the mouth out. I have a perfect example of it somewhere. I woke up right at my normal wake up time with my mouth slightly open and I was gently mouth breathing. I figured what the heck, will just lay here and continue the mouth breathing just to see how bad the leak line ends up being. So I did that for about 15 minutes.
BTW my mouth was extremely dry when I woke up. When I looked at the leak line itself...barely a little budge off the baseline so not all mouth breathing means massive loss of therapy pressure and it doesn't take much mouth breathing to dry the mouth out. Not nearly what some people might think and that is why I always ask to see the leak line when someone complains of a bit of dry mouth. Dry mouth doesn't always mean a person just HAS to be using a FFM if they don't want to.

If you are sleeping well and feeling great and it doesn't seem to negatively impact your quality of life with those wake ups to put the mouth drops in to help with the dry mouth...don't worry about it. I wake up at least 3 times a night for whatever reason anyway. It's very rare that I don't wake up for something..

No, your leak line isn't real pretty and yes you wake up enough from the dry mouth to want to pop a mouth drop but if you are feeling great...who cares. Now if you are waking up a gazillion times ...and feel like crap then that is a different story.

Sometimes we make compromises...perfectly flat leak line or just getting good sleep in general. I can get a perfectly flat leak line if I tape but I don't want to tape because the tape disturbs my sleep more than a little mouth leaking ever thinks about doing.
If you are satisfied with a handful of wakeups and popping a mouth drop and you are feeling great...then your overall sleep quality is probably not hugely negatively impacted and to try to fix what you see on the reports could create more problems than it fixes.
What's the number one goal? A perfect test score or good quality restorative sleep?

[NateS]

SleepingUgly, Jay Aitchsee, and Pugsy:

Thanks to each and every one of you for these additional comments.

This study is very interesting and pretty convincing, that there is definitely a correlation between sleep quality and mouth leaks:

Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture

http://erj.ersjournals.com/content/14/6/1251.full.pdf

but I note that it was confined to bilevel machines, and therefore does not address, one way or the other, whether or not eliminating mouth-breathing is possible with constantly varying pressure in ASV machines. Maybe it would help to see some charts of forum members on ASV? Yes, a flat line in Leaks is desirable, but can you have a flat line with ASV?

Yes, I do feel rested when I get up in the morning, and feel great all day except for my unrelated back and leg pains, but there are times when I tend to doze off momentarily in the evening.

Regards, Nate