CPAPtalk.com

Cereal Killer wrote:Conceivable? I think it was there most of my life. It took a near crisis stage to get something done about it. Doctors have been extremely lax on getting people diagnosed. "It's easier to prescribe a pill."

The thing is, I had anxiety, took the pills, anxiety went away. It was night and day. I had no sleep problems back then. Sometimes treatment is diagnostic.

Cereal Killer wrote:Your equipment profile shows you are using a nasal interface. You are breathing through your mouth at times during the night, and most likely you are having apneas that are causing the awakenings.

It's possible that apneas are waking me up, and I hadn't thought of that, but it could also be the loud rushing of air, stone-dry mouth, and aerophagic pain. When I have slept without a BiPAP in the past, I would sometimes wake up with tachycardia, presumably from the adrenaline rush. I definitely knew from that that I had an apneic episode. I never feel that way when I wake up from xerostomia.

Cereal Killer wrote:Air pressure is being lost through your mouth, and the therapy is no longer effective. Apneas and sleep deprivation are probably causing your current anxiety.

The onset of anxiety was coincident with lowering the dose of Lexapro and did not correlate to anything in my OSA treatment. BTW, the anxiety isn't crippling or anything. I just get a little, well, anxious and easy to rile (geez, is it showing? ).

Cereal Killer wrote:Are you using Sleepyhead to see what is going on in bed? If not, you SURE need to.

No, I haven't. I'll give a try this weekend. My PT finally got the 3G modem on my BiPAP working, so I can see a simple graph and report on PR's SleepMapper app and web site. Just looking at the SleepyHead screen captures, though, I can see that SleepMapper pales in comparison.

So Sincere wrote:stone-dry mouth

Man, if you want to feel good, you have to do something about dry mouth. Your CPAP won't maintain the correct pressure when air is rushing out your mouth. This could be the source of many of your problems such as tachycardia and adrenaline rush.

First, try a good chin strap.

Cereal Killer wrote:Your equipment profile shows you are using a nasal interface. You are breathing through your mouth at times during the night, and most likely you are having apneas that are causing the awakenings.

After last night, I think you're right about this. I do experience tachycardia when I wake up with xerostomia. I just hadn't noticed it before. Thanks for the heads up. I sent a message to my RT just now suggesting we either 1. reduce pressure to reduce xerostomia to reduce mouth leaks to reduce apnea (I know it sounds counter-intuitive) or 2. try a hybrid or full-face mask, although I've had really bad leaks with full-face masks before.

Whale Road wrote:

So Sincere wrote:stone-dry mouth

This could be the source of many of your problems such as tachycardia and adrenaline rush.

Up until last night, I had only noticed tachycardia when, for whatever reasons, I wasn't using my BiPAP unit at all. Now that I have observed the correlation between xerostomia and tachycardia while using BiPAP, I will definitely find a way to eliminate both.

Whale Road wrote:First, try a good chin strap.

Hmm... Does not sound fun at all. I've read that this keeps the jaw closed but not necessarily the lips, which is where the leakage occurs. I guess the thinking is that closing the jaw at least increases the likelihood that the lips are also closed. Thoughts?

So Sincere wrote:I've read that this keeps the jaw closed but not necessarily the lips, which is where the leakage occurs. I guess the thinking is that closing the jaw at least increases the likelihood that the lips are also closed. Thoughts?

You're right on both accounts. That's one reason some people tape their mouth in addition to wearing a chin strap.

It's all terribly annoying, really, but we do what we gotta do to get good therapy...

So Sincere wrote:After last night, I think you're right about this. I do experience tachycardia when I wake up with xerostomia. I just hadn't noticed it before. Thanks for the heads up. I sent a message to my RT just now suggesting we either 1. reduce pressure to reduce xerostomia to reduce mouth leaks to reduce apnea (I know it sounds counter-intuitive) or 2. try a hybrid or full-face mask, although I've had really bad leaks with full-face masks before.

You can certainly try a ffm. There are also many ways to experiment with keeping the mouth closed if you want to try and stay with the set-up you are used too. Many here use chin straps, tape, tongue positioning, soft cervical collars, home made straps from ace bandages and the like. I'm sure I'm forgetting a few as there are so many unique ways. I use tape with nasal pillows, but I also use tape with my ffm to prevent jaw drop. In the later, I just don't use as much tape so that I can still breathe through the mouth. It takes a lot of tape to keep my mouth closed with nasal interfaces.

You can try many ways or just get the ffm. If you do try tape, you must be comfortable with the practice and be aware of medical and other conditions that would "preclude" its use. You can search about the methods on the site or just ask here or in another post.

Best,

Mike

SleepyCarey wrote:

So Sincere wrote:I've read that this keeps the jaw closed but not necessarily the lips, which is where the leakage occurs. I guess the thinking is that closing the jaw at least increases the likelihood that the lips are also closed. Thoughts?

You're right on both accounts. That's one reason some people tape their mouth in addition to wearing a chin strap.

It's all terribly annoying, really, but we do what we gotta do to get good therapy...

I use a chin strap, and it greatly reduces leakage. It doesn't eliminate it, but keeps it within acceptable therapeutic levels. I'd try if before going to a FFM.

So Sincere wrote:

Whale Road wrote:First, try a good chin strap.

Hmm... Does not sound fun at all. I've read that this keeps the jaw closed but not necessarily the lips, which is where the leakage occurs. I guess the thinking is that closing the jaw at least increases the likelihood that the lips are also closed. Thoughts?

Chin straps did not work for me. I just recommend them as a first thing to try.

I pretty quickly went to a FFM and it works great. Easier to use than a chin strap + nasal interface.

Macpage wrote:If you do try tape, you must be comfortable with the practice and be aware of medical and other conditions that would "preclude" its use.

Hmm... I was a volunteer firefighter for several years but couldn't tolerate the SCBA mask, so I never fought from within a structure. I even had a deviated septum repaired, but that seemed like it just pushed the constriction to the other side. So... I might not be a good candidate for taping my mouth shut.

Whale Road wrote:First, try a good chin strap.

How 'bout a very bad chin strap? That's what I did last night and had one of the best nights ever. Looking around the house, I found a couple of very short stretchy things with Velcro on each end and hook-and-looped them together. That made the resulting loop just about the right stretchiness to go around my head and keep my jaw closed. I was super surprised that it stayed on all night and didn't slip off with my hair providing the necessary "lubricant." With my headgear on over that, it actually felt quite comfortable.

Before I MacGyvered the strap last evening, I ordered an "EasySleep Pro Red Adjustable Stop Snoring Chin Strap" from Amazon (http://amzn.com/B014XM3K3O). Should get here Monday. I'll also see what folks around here recommend.

You know, in all the years of being using a BiPAP, neither my neurologist nor RTs have ever mentioned chinstraps, mouth tape, or any other aid like that. They're always about the pressure--tweaking the BiPAP unit a little bit each visit. The neurologist once had me see a specialist dentist to get a jaw-repositioning appliance at great expense, time, and pain, but then once I started back working with her, again on the pressure, she said she didn't think I needed the appliance after all.

So Sincere wrote:

Whale Road wrote:
First, try a good chin strap.

How 'bout a very bad chin strap?

If it works and it's cheap, it's good.

Whale Road wrote:

So Sincere wrote:How 'bout a very bad chin strap?

If it works and it's cheap, it's good.

That's true, but, although I slept well, my AHI increased from 2.1 to 3.9 with that strap. The strap closes my jaw, but it also pulls my jaw back, which provides more slack in my throat, causing slightly more apneic episodes at a given pressure. Is this true of all chin straps or just of my improvised one? Maybe this is a peculiarity of my jaw or how my teeth mesh.

So Sincere wrote:Is this true of all chin straps or just of my improvised one?

It's a potential with just about any chin strap depending on how it is worn.
It's also a potential for even full face mask users depending on what that lower strap might be doing to the jaw. This might be why we see full face mask users sometimes needing more pressure to attain the same results that they might get with a nasal interface mask.

There's always the possibility that the higher AHI was just a coincidence too...you know one of those "off" nights where things look a bit uglier for unknown reasons...those can happen without changing or adding anything.

If adding a chin strap does seem to consistently increase the AHI (be sure to make sure that it is OA and hyponeas that have increased and not centrals(CAs) in that AHI) but it helps the mouth breathing and overall sleep in general then you may have to make one of those compromises I talk about.

So Sincere wrote:That's true, but, although I slept well, my AHI increased from 2.1 to 3.9 with that strap. The strap closes my jaw, but it also pulls my jaw back, which provides more slack in my throat, causing slightly more apneic episodes at a given pressure. Is this true of all chin straps or just of my improvised one? Maybe this is a peculiarity of my jaw or how my teeth mesh.

I can't help you much, except to say you eventually need to figure out if the strap is stopping the passage of air through your mouth.

I slept well

That's important.

WHOA

I have been on a cpap machine for a couple of years after finding out I had severe OSA (something like 70% oxygen at night). I thought that would solve my sleep problems and general feeling of fatigue. I slept and slept and slept like I hadn't slept in years. After a few months of this, however, I realized that something was fishy, but couldn't figure out what was wrong. I should not have been sleepy like that since I was getting good sleeps now. I even tested my oxygen using the finger thingy from the drs. office and it was fine. I have been really good at compliance and don't even nap without using my mask.

This condition of sleepiness did not get better, but got worse over time to the point where I feel like a heartbeat away from being disabled. I already stopped working and life has gotten to the point where I just get up in the morning and hope I can get through the day and get a couple of things done. Keeping my house clean and animals fed, etc are my big challenges. You guys would not believe how critical things have gotten. I developed fibromyalgia pain in my muscles after awhile of this kind of thing and slowly got to the point where I had great difficulty in staying awake at all.

GUYS! I have allergies and decided to go off of my Allegra since I've been on it 24/7 for a few years. OMG. My energy is 100% better and I am so mad MAD MAD, that this otc medication was doing this to me. So I have been searching on the internet for other people who might have experienced this and when I read your post about Lexapro I almost fell out of my chair. I have been on Lexapro for probably 8 years, but most of those years were when I was having the very severe sleep apnea. I never really liked being on the Lexapro and felt much more "sharp" without it, but a marriage counselor (ended up divorcing) insisted that I go on an anti-depressant because I wasn't feeling compassion for my ex-husband when we were in marriage counseling!!!! (I don't think I became more compassionate, but more compliant. Turns out I'm pretty angry, hah)