Mouth Puffs - Help!

I used to be a stomach or back sleeper. I gradually trained myself to sleep on the side, as I was experiencing back pain from the stomach position. It may be (since I have always snored) that I wasn't as comfortable breathing while sleeping on my back, so I just went for the two sides.

It was a matter of reminding myself whenever I was conscious. It is probably similar to a very sound sleeper who is a new parent developing a sense of when the baby is crying. Maybe reminding yourself right before falling asleep (for example, after the xPAP mask is on) will help.

I would also suggest that if lying down while awake, maybe while reading or watching television, that you lie on your sides only. In this way, it may become more habitual.

Some people used to remind themselves to remember their dreams back in the '70's. It has to be similar; besides, the memory is best when information is entered before sleep. (This is why I used to review right before sleeping the night before the test. Dr. Dean Edell just mentioned a study on his radio show last weekend about this very thing.)

Best of luck, and if all else fails you may be able to play a horn as well as Dizzy Gillespie eventually.... .

Snoredog wrote:Taping the mouth is NOT to completely seal it against the cpap pressure, big misconception here.

Misconception? Not for me. I tape my mouth securely to completely seal it against any escape of the cpap pressurized air. As well as to prevent myself from trying to breathe air in through my mouth.

I've been taping that way -- sealing the mouth off completely from any air escaping or being breathed in -- almost every night for over two years. Works for me.

I think you've written that you use only an inch or so of a piece of tape over just part of your lip area, Snoredog, but I may be wrong about what method you use. I tape over and beyond my lips...a big secure patch over my entire mouth, blocking the mouth completely. I don't want any air, not even a puff or a wisp, escaping out my mouth when I'm wearing a nasal mask or nasal pillows mask. I don't want to be able to breathe air in through my mouth either. I want ALL the treatment air to be coming in and out through nose breathing when I use anything except a full face mask -- which, thankfully, I rarely have to use.

Snoredog wrote: Tape only keeps your lips from parting but even it can be too late in the sequence of events.

I really don't mean to be argumentative, but secure taping does not keep my lips from parting. I turn my lips inward (rooster's method) while applying the tape. When I finish taping and let my mouth relax, my lips can and do open slightly behind the tape and my jaw can relax, parting my lips slightly more, yet no air can escape past the big patch of tape.

Snoredog wrote:If you are a blowfish, then you need to explore other events.

The blowfish effect (or chipmunk cheeks or balloon cheeks, whatever we call it) is a consequence of having the mouth securely taped over, but the tongue is not maintaing a good airtight seal WITHIN the mouth. You're absolutely right, Snoredog, that the tongue is the key if a person wants an airtight seal inside the mouth.

Snoredog wrote: -- keeping your tongue planted into the hard palate as that is what actually seals against the cpap pressure.

Actually, there's more than one way to skin a cat. For some, perhaps most people, keeping most of the tongue up against the hard palate does best, as you say. Sometimes with tip of tongue forward against the front teeth, upper or lower. But a lot of things about the architecture of the inside of each person's mouth can effect whether the tongue is actually going to stay planted up there all through the night during the complete relaxation of sleep.

A few people can probably slap a small piece of tape vertically on their lips, or a ChinUp strip to keep the jaw from dropping a lot. For that matter, some find that the much maligned chin straps can give enough jaw support to help the tongue maintain a roof-of-the-mouth seal.

However, I think it all depends on the geometry inside each person's mouth...height and width of the arch of roof of mouth, width and thickness of tongue, dentition, length and width of lower jaw, and probably a lot of other factors. Exactly WHERE in the mouth the tongue needs to be to form the most airtight seal INSIDE the mouth is going to depend on a lot of factors for each individual. Keeping it there during sleep is a whole other ballgame.

While tongue against roof of mouth works for most people, a completely different tongue position may work better for some during relaxed sleep. Letting the tongue drop way back to block off the back of the throat works better for some. Of course that would be advisable ONLY while using CPAP, since the tongue dropping back is a known contributing factor toward OSA in many people. However, as a way to have the tongue block off mouth breathing as well as preventing CPAP air from detouring out through the mouth, it's the cool method used by the guy snork1 met:

snork described it here:
Jul 01 2004 subject: yes, mouth leaks again...a new variation

Letting the tongue drop back and widen/thicken at the entrance to the throat inside the mouth works far better for me than trying to keep the tongue up against the hard palate. Of course, without cpap pressurized air being breathed in through the nose, it would NOT be good for the tongue to drop back that way. But...with the machine going, the CPAP pressure would push on down past a lolled back tongue as we breathed. No problem.

Snoredog wrote:It is not easy, sometimes you give up and just use a Full Face mask.

Yup. Luckily tape works very well for me. Complete seal.

I've had the blowfish effect occasionally, and have learned to just suck my cheeks in (the kind of motion you'd do if you were trying to drink an extra thick milkshake through a straw), then kind of work the air on back with tongue movements, as if getting ready to swallow....but don't. Once the air is moved to the back of the throat, just breathe in naturally and the air back there gets whisked on down along with the stream of incoming cpap air. Sounds complicated, but can be done easily in a split second after getting the hang of it.

Now whether a person can do that reflexively in their sleep, I doubt it. But if a person is awake and chipmunk-cheeked, the air certainly doesn't have to be swallowed to get rid of it. Just work it backward while breathing naturally, and.... whisk....it's gone. Instantly.

The less air that gets into the mouth, the better, of course. I think a soft, stretchy strap horizontally around the cheeks helps prevent the cheeks from ballooning out in the first place. Not a bad use for a discarded chinstrap. By lucky chance, since the homemade strap I add around the front of almost every mask I wear goes over my cheeks to the back of my head, that's probably why I rarely get the blowfish effect.

It doesn't take much horizontal strap pressure along the sides of the cheeks to prevent them from ballooning outward. Higher cpap pressures might become more problematic. A little bit of cpap air entering the mouth from the back of the throat is not a problem. A little can stay contained comfortably inside the securely taped mouth. But if a LOT of air gets into the taped mouth, to the point that the cheeks balloon out like a blowfish, waking you up, I'd just add a comfortable strap horizontally around the head -- support against the outside of the cheeks to help keep them from ballooning so much.

Rested Gal wrote:

While tongue against roof of mouth works for most people, a completely different tongue position may work better for some during relaxed sleep. Letting the tongue drop way back to block off the back of the throat works better for some.

With all due respect, I'm really shocked seeing this coming from you:

"Letting the tongue drop way back to block off the back of the throat works better for some"

According to all the animations from nearly all medical sites that is complete blockage of the airway and the exact thing you are trying to prevent. I can show pictures if you want.

just in case you ask:

http://resmed.com/Shared/StaticFiles/-n ... 40x380.swf

[quote="rooster"]6 months on cpap and have been taping mouth securely last few months but the therapy is no longer working for me. I am looking for a post, that someone made, about chipmunk cheeks or pressurized air leaking into the mouth. Can someone point me to this post?

I have come to the conclusion that I am having slight arousals about once per minute due to small air puff in mouth that I then have to swallow to fall completely asleep again. I am trying to get a Hybrid Mask through Apria but until then I desperately need to get some sleep.

Any advice will be appreciated,

rooster (with no cock-a-doodle-do)

rooster wrote:The Swift pillows do not seem to be leaking and my wife has been very good about telling me if they were. The lips are taped air tight and are not leaking. Do you think my statement "I have come to the conclusion that I am having slight arousals about once per minute due to small air puff in mouth that I then have to swallow to fall completely asleep again" might accurately reflect my problem?

I wish I could answer that, but I don't think there's any way to know if you're having slight arousals once per minute -- no matter what the cause may be, without being able to view some type of analytical data. It would be purely conjecture on our part. For what it's worth, I know we don't swallow much while we're sleeping. It would be unusual to swallow every minute throughout the night. If you're conscious of doing so, I believe your theory has merit. But again, that is just speculation.

Snoredog wrote:Rested Gal wrote:

While tongue against roof of mouth works for most people, a completely different tongue position may work better for some during relaxed sleep. Letting the tongue drop way back to block off the back of the throat works better for some.

With all due respect, I'm really shocked seeing this coming from you:

"Letting the tongue drop way back to block off the back of the throat works better for some"

According to all the animations from nearly all medical sites that is complete blockage of the airway and the exact thing you are trying to prevent. I can show pictures if you want.

just in case you ask:

http://resmed.com/Shared/StaticFiles/-n ... 40x380.swf

With all due respect, Snoredog, I really think you should have quoted one more sentence in what I said. That would bring it into context.

What I wrote....
"Letting the tongue drop way back to block off the back of the throat works better for some. Of course that would be advisable ONLY while using CPAP, since the tongue dropping back is a known contributing factor toward OSA in many people."

Presumably a sleep study titration to find the pressure needed was done while the person was on his/her back and in REM. Worst case scenario. If so....then it doesn't matter (imho) if the tongue drops back while on CPAP. Breathing in with cpap air to add "push" will move the obstruction out of the way while (hopefully) still leaving enough of the tongue in place back there across the entrance to the throat to prevent mouth air leaks and/or mouth breathing.

Makes sense to me and works for me. That's exactly the method I use (tongue dropped wayyy back) whenever I take a break from taping and switch to the "DIY" homemade mouthguard described in frequenseeker's long thread on TAS:

Topic started by frequenseeker Dec 01 2004 subject: mouth leak solution, cheap DIY oral appliance

When I tried to make my first one to simply hold my tongue up to the roof of the mouth, air could still rush out around the back of my tongue and back molars.

When I revised the mouthguard thingy to shove my tongue back instead of up, it worked. My mouth can hang open, totally relaxed during sleep and still hold a leakproof seal with the DIY keeping my tongue pushed back almost to the gagging point. Nothing is touching my hard palate..not the DIY nor my tongue. I get my usual low AHI like I always do when there are no leaks. Taping just happens to be more comfortable for me on a night after night after night basis, or I'd use the DIY all the time.

ResMed's "Understanding Sleep Disordered Breathing" is a neat animation. Very good to show how the tongue, soft palate, etc. close WHEN NOT USING CPAP. I'm using CPAP, however, when I have the DIY shoving the tongue back. Big difference.

Here are other puffs that, unlike me, do not live by the sea:

http://www.cisl.ucar.edu/nets/intro/sta ... utoadjust/

http://www.sleepnet.com/apnea52/messages/734.html

Cool links, Magic Dragon! LOL!! That screen shot of the LT's software data display is exactly what I wanted to see. Gee, they really did log "Exhale Puffs"!! How interesting...as was that old post on sleepnet by Perry.

I sure am glad this board allows Guest posts. Such interesting nuggets of info are dug up by Guests sometimes. I appreciate your finding those references to a machine that recorded "Exhale Puffs." Thanks!