Posted: Sun Aug 19, 2007 6:26 pm
Thank you for all the ideas, Snoredog! Here are the facts about me:
Does that make sense from what you are saying?
Also, in your opinion, if I get worse aerophagia from cflex, is it likely I will get it from AFlex, too?
My GERD has been flaring up lately, but I'm not sure why. From what you are saying, this may be part of the reason for leaks.
I may try to do a saline rinse though I don't seem to have much congestion. I have a neti pot around that I used to use during allergy season and in the winter to prevent colds. But first, I'm going to try the Swift tonight. It's the one I've used the longest so I'll see how a few nights compare to the ones I was getting in the past.
Thanks for the wealth of information.
RosemaryB
[quote="Anonymous"]Did you possibly have a tonsillectomy as a child or adult?
If so, that could be why you cannot stop mouth breathing or the blow-fish syndrome. As the air pressure comes in from the nasal passage it has to push against the soft palate and Uvula against the base of the tongue. If you cannot maintain that seal between the base of the tongue and the soft palate, any air that gets by will escape out the mouth.
In order to maintain that seal, you need to keep your tongue planted up into the hard palate. When you plant your tongue into the hard palate it brings the tongue base and soft palate closer together improving that seal.
I spent some time playing around with that, using a small hand-held mirror and a small flashlight.
I wanted to see how far I had to open my mouth before that "seal" was broken. I was laying down in bed with the mask On, machine on at my starting pressure. Once the machine turned on I realized where the seal was being made. I then let my lips part keeping my tongue planted into the base of the tongue. I continued to let my mandible drop slowly watching in the mirror and holding the flash light to see what was happening inside. I was surprised to see my soft palate touching the base of the tongue, the Uvula was in the "vee" of the tongue making that seal, it was like that anatomy was molded for that purpose.
I continued to open my mouth wider while watching in the mirror until that seal broke. I was surprised I could open and part my lips about 1" before that seal broke.
My pressure never usually gets over 10 cm, but I imagine if my pressure was higher I probably couldn't hold that seal as long or open my mouth as far.
The point to all this was it showed me where the seal was being made. I could close my mandible and put my tongue back into the palate and things would reseal.
I did it a half dozen times.
So I can understand now why they suggest a chin strap. But from my own tests I learned that he chin strap doesn't have to apply a lot of pressure to keep your mandible from dropping. In fact, you don't even need a stretchy type strap, it just needs to be a belt-like strap that doesn't apply a lot of pressure, like a velcro strap.
Next if you study how a dental device works you learn that it moves the mandible down and out. This is probably not good for you TMJ because that movement out comes from the TMJ joint. If you use a chin strap that wraps around the crown of your head at the back, it will pull your mandible back into the TMJ joint beyond your natural relaxed position, not much be even if it is 2mm, that 2mm narrows your airway at the back of the throat by that same 2mm. Look at the MMA/GA surgery from Josh and others, they are lucky if that surgery gives them 10 to 14mm, but with that surgery you understand the concept.
All a chin strap has to do is keep your mandible from dropping. When it drops it drops when you are asleep, probably including some of the same muscle control that allows your tongue to fall into the back of the throat or the beer belly muscles that allow the airway to collapse.
So all the strap should do is keep your mandible from dropping. That strap doesn't need any real tension "IF" it can be held in place. The strap needs to be VERTICAL as opposed to attaching at the back or crown of the head. If you don't use one attached to the crown of the head it shouldn't pull the mandible back into the TMJ joint, should not narrow the airway at the back of the throat.
Something you could try:
1. Right before bed after you brush your teeth, take a teaspoon of honey and put it in your mouth, allow it to coat the top of the tongue and the palate.
2. Check your machine reports and compare leak rates the next day. The concept of using the honey is to make your tongue and soft palate "sticky" so it more easily maintains that seal. But just like those snore sprays, it may not work for you (e.g. if you had your tonsils taken out). But BreatheRight strips have been clinically shown to reduce RDI. All they do is keep your nose open and reduce congestion. They also make a snore spray which also has been clinically shown to work in reducing snoring, again NOT with everyone but those it did work with, they had observations with and without on those that seen positive results and it did reduce their snoring. All that spray does is the same thing as honey, it makes the soft palate stick to the tongue and you snore less. Honey does the same thing.
3. You also have to practice keeping your tongue planted in the hard palate, again the honey may help.
I think you can stop it, I used to mouth breathe all the time, I have the reports to prove it. My 30-day avg leak rate is around 10L/m. I could use 3 rolls of duct tape and never get my leak rate down that low. Probably a lot of that lower leak rate may be due to using the A-Flex machine. It has always been in Respironics algorithm to lower pressure on Large Leak. Could it be that the relief on inhale therapy offered by A-Flex reduce my mouth leaks? I don't know, but I follow a routine that seems to work well and if I was having Large Leaks associated with mouth breathing, I think it would show up on my reports.
My routine is:
1. Address any nasal congestion, I do that by using a saline rhino rinse regularly, sometimes only once a week, sometimes 2-3 depending on allergy season/conditions.
2. I use a BlueAir true HEPA filter in my bed room. It runs 24 hrs a day. Probably doesn't do any good at night because the machine filters the air I actually breathe in via the hose. I am allergic to dust mites like many, so I do a lot of vacuuming.
3. I use a Large BreatheRight strip across my nose every night, it fits under my Soyala nasal mask. I buy 2-3 boxes every time I go to Costco.
4. I use a Large Soyala nasal mask so that I'm sure there is no outside pressure on my nose contributing to any nasal congestion.
5. I have my bed elevated, I take a PecidComplete tablet before bed, berry flavor is best.
Some how I can't help but think the A-Flex has helped with controlling that leak rate obviously better than I ever got on Cflex or my 420e, but I haven't used the 420e since getting the A-Flex, been using it over a month now.
Other causes:
-If you have recently switched mask interfaces, I would try going back to the one you used prior, if you have for example a slight deviated septum and switch masks or cinch up on pressure it can put extra pressure on the end of your miss piggy nose and cause that septum valve to completely close.
-Paradoxical vocal cord dysfunction. PVD can also be a cause, it can be exacerbated with GERD. If your airway becomes blocked due to PVD dysfunction it will block your airway both directions. So not only does your airway become blocked it becomes harder for CPAP to open the airway, if there is a lot of thick mucosa it can act like glue and keep those vocal cords closed were no air can pass.
In other words, with PVD no amount of CPAP pressure will be able to force those cords open (also RG's theory on NR's being returned by Respironic auto machines), so the pressure backs up has no place to go so it has to come out your lips making it nearly impossible to maintain that tongue-palate seal. In that case you use 5 wraps of duct tape I think. If that is the cause, I would suggest elevating the head of the bed, try a PecidComplete before bed, make sure your allergies are not leaving a lot of mucosa at the back of the throat (can also make PVD worse, in that case you need a decongestant for several days to dry things out). But using a decongestant is even controversial, some think you need to let that mucosa flush things out. Again, I find the saline rhino rinse on a regular basis eliminates that from happening.
- I don't snore.
Tonsils out as a child.
Stage 2 GERD discoved 6 yrs ago.
Take max dose of Aciphex (PPI) 2xday
Head of bed is propped up to 10 inches!
My nasal allergies are better since I started a gluten free diet
I'm not aware of a lot of throat mucus since I began using the PPI.
I don't eat or drink after 5:30 or 6:00 p.m.
Does that make sense from what you are saying?
Also, in your opinion, if I get worse aerophagia from cflex, is it likely I will get it from AFlex, too?
My GERD has been flaring up lately, but I'm not sure why. From what you are saying, this may be part of the reason for leaks.
I may try to do a saline rinse though I don't seem to have much congestion. I have a neti pot around that I used to use during allergy season and in the winter to prevent colds. But first, I'm going to try the Swift tonight. It's the one I've used the longest so I'll see how a few nights compare to the ones I was getting in the past.
Thanks for the wealth of information.
RosemaryB
[quote="Anonymous"]Did you possibly have a tonsillectomy as a child or adult?
If so, that could be why you cannot stop mouth breathing or the blow-fish syndrome. As the air pressure comes in from the nasal passage it has to push against the soft palate and Uvula against the base of the tongue. If you cannot maintain that seal between the base of the tongue and the soft palate, any air that gets by will escape out the mouth.
In order to maintain that seal, you need to keep your tongue planted up into the hard palate. When you plant your tongue into the hard palate it brings the tongue base and soft palate closer together improving that seal.
I spent some time playing around with that, using a small hand-held mirror and a small flashlight.
I wanted to see how far I had to open my mouth before that "seal" was broken. I was laying down in bed with the mask On, machine on at my starting pressure. Once the machine turned on I realized where the seal was being made. I then let my lips part keeping my tongue planted into the base of the tongue. I continued to let my mandible drop slowly watching in the mirror and holding the flash light to see what was happening inside. I was surprised to see my soft palate touching the base of the tongue, the Uvula was in the "vee" of the tongue making that seal, it was like that anatomy was molded for that purpose.
I continued to open my mouth wider while watching in the mirror until that seal broke. I was surprised I could open and part my lips about 1" before that seal broke.
My pressure never usually gets over 10 cm, but I imagine if my pressure was higher I probably couldn't hold that seal as long or open my mouth as far.
The point to all this was it showed me where the seal was being made. I could close my mandible and put my tongue back into the palate and things would reseal.
I did it a half dozen times.
So I can understand now why they suggest a chin strap. But from my own tests I learned that he chin strap doesn't have to apply a lot of pressure to keep your mandible from dropping. In fact, you don't even need a stretchy type strap, it just needs to be a belt-like strap that doesn't apply a lot of pressure, like a velcro strap.
Next if you study how a dental device works you learn that it moves the mandible down and out. This is probably not good for you TMJ because that movement out comes from the TMJ joint. If you use a chin strap that wraps around the crown of your head at the back, it will pull your mandible back into the TMJ joint beyond your natural relaxed position, not much be even if it is 2mm, that 2mm narrows your airway at the back of the throat by that same 2mm. Look at the MMA/GA surgery from Josh and others, they are lucky if that surgery gives them 10 to 14mm, but with that surgery you understand the concept.
All a chin strap has to do is keep your mandible from dropping. When it drops it drops when you are asleep, probably including some of the same muscle control that allows your tongue to fall into the back of the throat or the beer belly muscles that allow the airway to collapse.
So all the strap should do is keep your mandible from dropping. That strap doesn't need any real tension "IF" it can be held in place. The strap needs to be VERTICAL as opposed to attaching at the back or crown of the head. If you don't use one attached to the crown of the head it shouldn't pull the mandible back into the TMJ joint, should not narrow the airway at the back of the throat.
Something you could try:
1. Right before bed after you brush your teeth, take a teaspoon of honey and put it in your mouth, allow it to coat the top of the tongue and the palate.
2. Check your machine reports and compare leak rates the next day. The concept of using the honey is to make your tongue and soft palate "sticky" so it more easily maintains that seal. But just like those snore sprays, it may not work for you (e.g. if you had your tonsils taken out). But BreatheRight strips have been clinically shown to reduce RDI. All they do is keep your nose open and reduce congestion. They also make a snore spray which also has been clinically shown to work in reducing snoring, again NOT with everyone but those it did work with, they had observations with and without on those that seen positive results and it did reduce their snoring. All that spray does is the same thing as honey, it makes the soft palate stick to the tongue and you snore less. Honey does the same thing.
3. You also have to practice keeping your tongue planted in the hard palate, again the honey may help.
I think you can stop it, I used to mouth breathe all the time, I have the reports to prove it. My 30-day avg leak rate is around 10L/m. I could use 3 rolls of duct tape and never get my leak rate down that low. Probably a lot of that lower leak rate may be due to using the A-Flex machine. It has always been in Respironics algorithm to lower pressure on Large Leak. Could it be that the relief on inhale therapy offered by A-Flex reduce my mouth leaks? I don't know, but I follow a routine that seems to work well and if I was having Large Leaks associated with mouth breathing, I think it would show up on my reports.
My routine is:
1. Address any nasal congestion, I do that by using a saline rhino rinse regularly, sometimes only once a week, sometimes 2-3 depending on allergy season/conditions.
2. I use a BlueAir true HEPA filter in my bed room. It runs 24 hrs a day. Probably doesn't do any good at night because the machine filters the air I actually breathe in via the hose. I am allergic to dust mites like many, so I do a lot of vacuuming.
3. I use a Large BreatheRight strip across my nose every night, it fits under my Soyala nasal mask. I buy 2-3 boxes every time I go to Costco.
4. I use a Large Soyala nasal mask so that I'm sure there is no outside pressure on my nose contributing to any nasal congestion.
5. I have my bed elevated, I take a PecidComplete tablet before bed, berry flavor is best.
Some how I can't help but think the A-Flex has helped with controlling that leak rate obviously better than I ever got on Cflex or my 420e, but I haven't used the 420e since getting the A-Flex, been using it over a month now.
Other causes:
-If you have recently switched mask interfaces, I would try going back to the one you used prior, if you have for example a slight deviated septum and switch masks or cinch up on pressure it can put extra pressure on the end of your miss piggy nose and cause that septum valve to completely close.
-Paradoxical vocal cord dysfunction. PVD can also be a cause, it can be exacerbated with GERD. If your airway becomes blocked due to PVD dysfunction it will block your airway both directions. So not only does your airway become blocked it becomes harder for CPAP to open the airway, if there is a lot of thick mucosa it can act like glue and keep those vocal cords closed were no air can pass.
In other words, with PVD no amount of CPAP pressure will be able to force those cords open (also RG's theory on NR's being returned by Respironic auto machines), so the pressure backs up has no place to go so it has to come out your lips making it nearly impossible to maintain that tongue-palate seal. In that case you use 5 wraps of duct tape I think. If that is the cause, I would suggest elevating the head of the bed, try a PecidComplete before bed, make sure your allergies are not leaving a lot of mucosa at the back of the throat (can also make PVD worse, in that case you need a decongestant for several days to dry things out). But using a decongestant is even controversial, some think you need to let that mucosa flush things out. Again, I find the saline rhino rinse on a regular basis eliminates that from happening.
