CPAPtalk.com

tazmania wrote:One might suggest I get up and take care of the dry mouth

Most likely you are mouthbreathing. Full face masks (FFMs) are made for people who mouthbreathe. I would try one of the more popular FFMs or the Innomed Hybrid.

Thanks CG.

That was the last step we thought I'd need to take if all the evidence points to that. I'm going to give this collar a try to see if it makes a difference before I jump into a FFM. If I could just get another 1 to 2 hours of sleep a night I think I'd be doing far better than I am today. I suspect a full set of stats will determine how effective my current set up is really working for me. Early indications are it is working quite well except for the leaks that are occurring.

If I can extend my sleep another hour or two are the leaks I'm seeing going adversely affect me? In other words is it still considered quality sleep despite seeing those leak numbers?

tazmania wrote: Second, the collar isn't any new culprit as I used it last night for the first time and this set of dailies was from Sunday night's sleep. I don't know what is waking me. To answer you CG, yes the discomfort is always a dry mouth, every morning and almost always I awake around 3-4am with this occurring. And every morning I do the same thing, turn off the machine and try to relieve myself of the dryness, then fall back to sleep without CPAP. Mind you prior to waking and shutting it down I really don't recall waking. I always sleep on my back and don't turn to my side as I can never seem to keep a good seal on the nasal pillows if I try side sleeping. Once the machine is off I always sleep on my side ... and I toss and turn several times during that last hour or two of restless, (most likely apnea filled sleep).

Ok, there are several interrelated issues that need to be dealt with.

1) Mouth breathing. CG is right: Waking up with a dry mouth is indeed a sign of mouth breathing. And even when it's not triggering official Large Leaks, the mouth breathing is leading to the dry mouth. A FFM should fix the leaks, but it may or may not help the dry mouth: A lot of air is moving through the mouth when you are mouth breathing, particularly with a CPAP, and it's the moving air that dries the mouth out. And many mouth breathers find the humidifier just can't keep their mouth moist even when they use a FFM.

2) Sleep position, comfort, and nasal pillows. Sounds like your natural sleep position is on your side, and you are trying to change your natural sleep position to accommodate using the nasal pillows mask. It's usually a mistake to try to change things to accommodate the mask if you can avoid it. You might be more comfortable and less likely to wake up to turn the machine off if you can figure out a way to fall asleep on your sides with the nasal pillows. You are using the P10 mask. And for all that's really good in that mask, there's the irritating fact that the headgear is one-size-fits-most. And thus it is not a very easy mask to "tighten" or "loosen" in an effort to customize the fit. The P10 can also be a bit more difficult (in my opinion) to control the angle the pillows rest against the nostrils, but the angle the pillows rest against the nose is critical in getting and maintaining a good seal, particularly when you are on your side.

So let' talk about how you are putting the P10 mask on and fitting it when you go to bed. Do you just pull it on and turn the machine on and then fiddle with the pillows while lying on your back and then try to turn onto your side? Can you feel the tip of the pillows touching the inside of your nose when you are on your side? Does the headgear feel to flimsy to keep the mask in place when you are on your side? Does the edge of the pillow barrel (where the pillows attach to the frame) hit your pillow and get dislodged when you are on your side? All of these things can be overcome with a bit of effort, but we need to know more about what's going wrong than, "the pillows seem to leak more when I'm on my side."

3) The middle of the night wake and returning to sleep without the mask. Yes, I understand you're waking up with a dry mouth. And it makes sense to turn the machine off so that you can work on relieving the dry mouth. I also understand why you're reluctant to get up and get a drink of water since you find it very difficult to get back to sleep after getting out of bed for any reason. But you've got to figure out a way to make yourself turn the machine back on after you've managed to get the mouth a bit rehydrated. It really is that simple. And that hard. It's ok to lie in bed for a few minutes to regroup and wet your mouth. But then when you snuggle back down to go back to sleep, you need to simply turn the machine back on. And at least try to get back to sleep with the machine on rather than intentionally allowing yourself to return to sleep without the mask.

Would it help to have a water bottle on the night stand? You could then take the mask off, drink some water, and then mask up and turn the machine back on when you snuggle back down to go back to sleep. With the right kind of water bottle, you ought to be able to do this in the dark and still not worry about spilling the water all over.

One might suggest I get up and take care of the dry mouth then try to sleep with the machine but I fear getting up. Normally once I'm up, I'm up and have a lot of difficulty getting back to sleep. So I don't even try getting up. I simply shut off the machine, try to work out the dryness naturally and then fade back to sleep.

Again: There's nothing wrong with shutting off the machine and working out the dryness naturally. But once your mouth is not so dry, you need to turn the machine back on before you "fade back to sleep."

What's going on here is that you are rewarding the subconscious part of your brain for waking up when it notices the dry mouth. When it wakes you up, you then take the dang mask off and go back to sleep and the subconscious part of the brain that doesn't fully believe this is the new normal is rewarded for its waking you up. The only way you will get over this hump is to learn to turn the machine back on after you've dealt with the dry mouth as best you can without getting out of bed.

This Sunday graph shows a large leak around the time that I shut the machine off but looking at the 4 days prior to that it doesn't show the leak happening just prior to me waking and shutting it down. I'll do some more analysis with each passing day to see if it is really the norm or the exception. There ARE large leak signs every night though. Just randomly throughout the night.

You may be randomly mouth breathing. Or you may be shifting around enough to break the rather fragile seal you seem to have with the P10. Learning how to get a better seal might help some of the random leaks.

The collar isn't too bad. As Granny says it doesn't interfere with the mask. I slept last night like I always do except for a brief stint where a dream woke me around midnight. FYI I don't really dream much while I'm using the machine (that I can recall). Is that a sign of anything? I do dream but if I recall correctly that usually happens after I've turned off the machine.

The normal pattern is for us to NOT remember our dreams. A lot of people with untreated OSA tend to remember their dreams more than normal because they frequently wake up in the middle of a dream due to apneas. And you typically remember a dream only when you wake up either in the dream or immediately after the dream is over.

If you remember fewer dreams when using CPAP, that probably is a sign that you are no longer having apneas when you are in REM. If you still remember the dreams when you are sleeping without the machine, that probably means that when you hit REM and you aren't using the machine, you also have a lot of events occurring and waking you up in the middle of the dreams.

One thing I remember about my adjustment period was that I missed the fact that pre-CPAP I had very vivid dreams that I frequently remembered. Most of these vivid dreams were good dreams and none of them involved choking or drowning sensations. But once I started CPAP, I started remembering so few of my dreams that for a very long time I was worried I was not getting sufficient REM sleep. In retrospect, I know my PAP-sleep was highly fragmented at the time, but I do think I probably was getting a reasonable amount of REM. But I was no longer remembering it because I was not arousing every 3 or 4 minutes while in REM due to the untreated OSA.

Grrr. I just spent the last 10 minutes typing a response Robysue and the site lost it for me. I knew I should have did a copy of the text before I hit submit.

Phew found it. Although this CAPTCHA thing isn't letting me submit it. I'm at work so maybe I can't submit large posts?

tazmania wrote:Phew found it. Although this CAPTCHA thing isn't letting me submit it. I'm at work so maybe I can't submit large posts?

The CAPTCHA thing is irritating and it does seem to kick in (a lot) on long posts. As someone who writes a lot of long posts, I'm all too familiar with it. (And it ate another one of mine yesterday.)

I've learned to do this: If the post is long, I "select all" and "copy" the text in the input window before[/] I hit Preview or Submit. That way if I lose the work because of the CAPTCHA, I can always "paste" it back into the text window and try again.

I seem to have more problems with the CAPTCHA when I'm also have trouble with cpaptalk being extra slow.

Phew, found it using the back button. I'm going to post it in a couple of posts. Seems it's too big to post.

Robysue, I sure do appreciate the time you're taking to help me out.

robysue wrote: 1) Mouth breathing. A lot of air is moving through the mouth when you are mouth breathing, particularly with a CPAP, and it's the moving air that dries the mouth out. And many mouth breathers find the humidifier just can't keep their mouth moist even when they use a FFM.

I may be able to get the humidifier to keep up but I've also noticed if I go above setting 2 or 3 with it then I get pooling in the hose, etc. At least on the old machine that was my experience.

robysue wrote: 2) Sleep position, comfort, and nasal pillows. Sounds like your natural sleep position is on your side, and you are trying to change your natural sleep position to accommodate using the nasal pillows mask. .... The P10 can also be a bit more difficult (in my opinion) to control the angle the pillows rest against the nostrils, but the angle the pillows rest against the nose is critical in getting and maintaining a good seal, particularly when you are on your side.

For the last 8 years or so I've learned to sleep on my back. I have a sleep number adjustable bed and because I can adjust I think I probably prefer to sleep on my back. If I sleep on my side I generally toss and turn more seeing a shoulder, arm or other body part gets sore, so I flop.

robysue wrote: So let' talk about how you are putting the P10 mask on and fitting it when you go to bed. Do you just pull it on ...

My routine is 1) I put the mask on, lie down, adjust the pillows so they are well sealed on my nostrils, then breathe through my nose so the Auto start kicks in. When I adjust the pillows I know what feels correct from a seal perspective. So I fiddle with them until they feel right.

robysue wrote:Does the headgear feel to flimsy to keep the mask in place when you are on your side? ..., but we need to know more about what's going wrong than, "the pillows seem to leak more when I'm on my side."

Sorry my statement about leaking on my side wasn't the correct way to say it. Yes, the pillows become dislodged. This happened with my old headgear as well as with this new P10 set. With my old gear I could adjust it to get a nice tight fit but the pillows would still dislodged. Yes this P10 one-size-fits-all is definitely flimsy. There is no way I could use it on my side. It works well enough for lying on my back so I'm content to keep sleeping on my back. I do like the way the P10 feels. It's far less intrusive then my prior headgear. That goofy thing would leave marks in my face. My wife sewed fabric around it so it would minimize the lines where it pressed against my face.

robysue wrote: 3) The middle of the night wake and returning to sleep without the mask..... And at least try to get back to sleep with the machine on rather than intentionally allowing yourself to return to sleep without the mask.

I can certainly try doing some of these things to rehydrate, however I would like you to know that the current habit I have came after many failed attempts to restart the machine. Maybe because I have always been so filled with the body chemical that comes from being aroused. I've always been a light sleeper and so it is usually very hard for me to return to sleep after having been asleep for awhile. Dreams, nightmares, noises, wake me and I usually need a good amount of time to fall back to sleep. Also I have issues balancing the humidity level in relation to the temperature in our home. My wife runs warm (now) and she likes it cool at night (64 degrees or less). Some mornings I wake and my sinuses are on fire because the humidity level isn't warming the air enough. It's warming up outside so this is less of problem right now.

Not saying I can't try again. I do what I do now because it is far easier and I've found success being able to fall back to sleep (although bad sleep) after 5-10 minutes or so.

The normal pattern is for us to NOT remember our dreams. A lot of people with untreated OSA tend to remember their dreams more than normal because they frequently wake up in the middle of a dream due to apneas. And you typically remember a dream only when you wake up either in the dream or immediately after the dream is over. ....

Thanks for that. I wasn't sure if remembering dreams was a good or bad thing. What you've explained here makes perfect sense.

So some new news that occurred yesterday. Good news I think.

First off, last night I slept from 10pm until 4am before I woke. Talk about habit. I didn't really have a very dry mouth but when I turned to see what time it was the mask came off and the weight of the hose made it drop to the floor. Instead of grabbing the mask and putting it back on I did the usual ... shut off the machine.

Prior to going to sleep I was talking with my wife that I didn't notice any improvement the first night wearing the collar and she said something very interesting. She normally goes to bed long after I do.
"OMG it was so quiet when I came to bed last night. I didn't realize how much noise you made before. It must have been you letting air escape out your mouth."

So for now, I am encouraged in that I got 6 solid hours of interrupted sleep (still need to pull the stats to be certain) and that it appears the collar is helping me to keep my mouth shut. I'm hopeful that this set up will become a working solution. I can always go get a FFM if it doesn't but last night felt like a step in the right direction.

So tonight I'm going to do the same except if I wake up early in the morning I'm going to try to go back to sleep with the machine. I'll grab one of our non-spill water bottles to help if I need it. All I have to remember is turn up my radio alarm. I'm so used to having it pretty quiet seeing I'm not using the machine. Heh, maybe I'll get lucky and sleep through my alarm. get a little cheat sleep.

I'm not sure if the 6 hours of sleep is having a placebo effect or not but I definitely feel more alert, more upbeat this morning.

tazmania wrote: Phew, found it using the back button. I'm going to post it in a couple of posts. Seems it's too big to post.

Robysue, I sure do appreciate the time you're taking to help me out.

robysue wrote: 1) Mouth breathing. A lot of air is moving through the mouth when you are mouth breathing, particularly with a CPAP, and it's the moving air that dries the mouth out. And many mouth breathers find the humidifier just can't keep their mouth moist even when they use a FFM.

I may be able to get the humidifier to keep up but I've also noticed if I go above setting 2 or 3 with it then I get pooling in the hose, etc. At least on the old machine that was my experience.

The old machine was a WHAT???

Is your current humidifier set to "Classic" mode or "System One" mode? On my (somewhat older) Series 50 System One, I've never had any problems with rainout when the humidifier is set to 5 in System One mode. That mode monitors the ambient conditions and adjusts the heat in the humidifier to minimize the chances of rainout. System One humidification is the default setting on System One machines.

Are you using a heated hose with your System One?

Also, there are ways of dealing with rainout---the water pooling in the hose---if you really need to turn the humidifier up to the point where you start to get rainout.

For the last 8 years or so I've learned to sleep on my back. I have a sleep number adjustable bed and because I can adjust I think I probably prefer to sleep on my back. If I sleep on my side I generally toss and turn more seeing a shoulder, arm or other body part gets sore, so I flop.

So why do you typically start sleeping on your sides after you take the mask off each night?

robysue wrote: So let' talk about how you are putting the P10 mask on and fitting it when you go to bed. Do you just pull it on ...

My routine is 1) I put the mask on, lie down, adjust the pillows so they are well sealed on my nostrils, then breathe through my nose so the Auto start kicks in. When I adjust the pillows I know what feels correct from a seal perspective. So I fiddle with them until they feel right.

If you want to fall asleep on your side for some reason this same procedure should allow you to get a seal when sleeping on your side.

After you wake up and you take your mask off to rehydrate the mouth, you need to fit the P10 mask in the same way, except you should be lying on your side before you start adjusting the pillows. Once the air turns on with Auto start, fiddle with the pillows while lying on your side.

Sorry my statement about leaking on my side wasn't the correct way to say it. Yes, the pillows become dislodged. This happened with my old headgear as well as with this new P10 set. With my old gear I could adjust it to get a nice tight fit but the pillows would still dislodged. Yes this P10 one-size-fits-all is definitely flimsy. There is no way I could use it on my side. It works well enough for lying on my back so I'm content to keep sleeping on my back. I do like the way the P10 feels. It's far less intrusive then my prior headgear. That goofy thing would leave marks in my face. My wife sewed fabric around it so it would minimize the lines where it pressed against my face.

Have you tried the slightly older Swift FX nasal pillows mask? It's almost as minimal as the P10, but it does have an adjustable headgear. The pillows on the FX are not attached to a rigid platform the way the P10 pillows are. They're totally soft and smooshy; and this allows me to get a really phenomenal seal regardless of what position I'm in. The downside to the FX is its jetstream style exhaust flow, however.

robysue wrote: 3) The middle of the night wake and returning to sleep without the mask..... And at least try to get back to sleep with the machine on rather than intentionally allowing yourself to return to sleep without the mask.

I can certainly try doing some of these things to rehydrate, however I would like you to know that the current habit I have came after many failed attempts to restart the machine.

What do you mean by "many failed attempts to restart the machine"?

Maybe because I have always been so filled with the body chemical that comes from being aroused. I've always been a light sleeper and so it is usually very hard for me to return to sleep after having been asleep for awhile. Dreams, nightmares, noises, wake me and I usually need a good amount of time to fall back to sleep.

I have more understanding of this than you might expect. When my insomnia was at its peak, getting back to sleep was a huge issue. And (in my case) physical discomfort coming from the machine aggravated the situation. Eventually I learned how to manage this problem through a lot of hard work with cognitive behavior therapy for insomnia (CBT-I). 'Twasn't an easy thing for me to do, but in the long run the CBT-I did help me to teach myself how to get back to sleep more quickly when I woke up in the middle of the night.

Also I have issues balancing the humidity level in relation to the temperature in our home. My wife runs warm (now) and she likes it cool at night (64 degrees or less). Some mornings I wake and my sinuses are on fire because the humidity level isn't warming the air enough. It's warming up outside so this is less of problem right now.

Sounds to me like you need to turn your humidifier up. Do that first and if you start getting rainout, then ask for help on dealing with the rainout.

There are two different heated humidifiers that are sold for the System One Series 60 machines. One can be used with a heated hose and the other cannot. Do you know which humidifier you have for your System One Series 60 machine?

Not saying I can't try again. I do what I do now because it is far easier and I've found success being able to fall back to sleep (although bad sleep) after 5-10 minutes or so.

If you can fall back asleep in 5-10 minutes without the mask on your nose, you can teach/train yourself to fall back asleep in 5-10 minutes with the mask on your nose.

The old machine was a WHAT??? Another Respironics machine. M Series CPAP.

Is your current humidifier set to "Classic" mode or "System One" mode? I didn't change this from the default. If I recall it is set to System One Humidifier.

Are you using a heated hose with your System One? No.

So why do you typically start sleeping on your sides after you take the mask off each night? I have back issues which why we bought the adjustable bed. After sleeping on my back for 5 to 6 hours it gets kind of sore so I tend to sleep on my side. Also I know that sleeping on your back isn't a good thing if you have sleep apnea and are not using a PAP.

Once the air turns on with Auto start, fiddle with the pillows while lying on your side. Thanks. For now I think I'll see if I can get back to sleep on my back. If that doesn't work I'll use those tips to see if I cna get it to work on my side.

Have you tried the slightly older Swift FX nasal pillows mask? I haven't tried any other masks. Coming here I realize it's cheaper to buy these outright instead of using insurance. So prior to coming here I wasn't all that keen on spending money on overpriced masks, supplies, etc. Sorry I do not know what kind of nasal pillow headgear is my older set. I'll look into these if I am unable to go back to sleep on my back and if I can't get the two masks to work on my side.

I have more understanding of this than you might expect. When my insomnia was at its peak, getting back to sleep was a huge issue. And (in my case) physical discomfort coming from the machine aggravated the situation. Eventually I learned how to manage this problem through a lot of hard work with cognitive behavior therapy for insomnia (CBT-I). 'Twasn't an easy thing for me to do, but in the long run the CBT-I did help me to teach myself how to get back to sleep more quickly when I woke up in the middle of the night. Is this something you'd recommend for someone such as myself?

There are two different heated humidifiers that are sold for the System One Series 60 machines. One can be used with a heated hose and the other cannot. Do you know which humidifier you have for your System One Series 60 machine? Mine does take the heated hose. I don't have one.

I have more understanding of this than you might expect. When my insomnia was at its peak, getting back to sleep was a huge issue. And (in my case) physical discomfort coming from the machine aggravated the situation. Eventually I learned how to manage this problem through a lot of hard work with cognitive behavior therapy for insomnia (CBT-I). 'Twasn't an easy thing for me to do, but in the long run the CBT-I did help me to teach myself how to get back to sleep more quickly when I woke up in the middle of the night. Is this something you'd recommend for someone such as myself?

Depends on what problem you are trying to fix, how patient you are, and how willing you are to change your behavior patterns that aggravate the problem. In my case, the insomnia was totally out of control, it took a good 4-6 weeks of hard work before I saw much in the way of positive results, and about 6 months of hard work to really bring everything under control. Smaller problems don't take as long.

If I don't see improvements in the next few weeks I'll try a few more options to see if my sleep quality improves. If we've knocked all logical options off the list of things to try I can always address additional changes like the behavioral training you're experienced with at that time.

Thanks for the feedback.

tazmania wrote:If I don't see improvements in the next few weeks I'll try a few more options to see if my sleep quality improves.

Here is a checklist of some basic items that I think every CPAPer should follow. Maybe you want to look at it to see if there is anything easy that you have overlooked.

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Optimize emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.

CG

ChicagoGranny wrote:

tazmania wrote:If I don't see improvements in the next few weeks I'll try a few more options to see if my sleep quality improves.

Here is a checklist of some basic items that I think every CPAPer should follow. Maybe you want to look at it to see if there is anything easy that you have overlooked.

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Optimize emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems.

CG

That's an excellent list CG.