My girlfriend caught me...

socknitster · Post by **socknitster** » Wed Nov 07, 2007 1:34 pm

Chin straps do work for a few people. I have read a few people here for whome they work. They don't for me. I use the 3M paper tape now and it works really well for me. I often have to get up at night with my 4 year old and I rip it off and reapply sometimes several times and it keeps working.

The thing about runners and the tongue is true. But I'm no athlete and I caught/catch myself doing it all the time. The first time I noticed it was at the gym when running on the eliptical trainer. I had read about it and suddenly caught myself doing it. It HAS to be hard wired in us. How "in shape" our tongue is could be another issue though.

The other night I strapped on my pillows mask and opened my mouth--wider and wider and wider until it was open as much as possible and only then did air come out of my mouth. There has to be something positional about why this all goes south for me when I am sleeping. I'm finding as i train myself to sleep on my side, my taping is coming loose less and less (nothing like drooly wet tape fluttering in the wind!) and I'm considering trialing not taping to see if I can do it without tape now.

So, I'm currently thinking that back sleeping must make mouth leaks worse. It has got to be all about the tongue! Side sleeping could be the key to all around better therapy for me.

Jen

ozij · Post by **ozij** » Wed Nov 07, 2007 1:43 pm

For me it inconsistent. I can sleep tapeless and leakless one night or 2, and the third comes, and I'm mouthleaking all over the place.

I've even woken up from a mouthleak with me tongue stuck firmly to the roof of my mouth - really stuck because it dried there - and the air pouring out merrily from both sides of it....

O.

Flying_Norseman · Post by **Flying_Norseman** » Thu Nov 08, 2007 6:37 am

This is wierd. Since taping the last few nights, my AHI has gone up dramatically. I may have been puffing air out of my mouth before, but at least my AHI was a lot lower. I had some pretty noticeable leaks around the nasal pillows this morning. I think I am going to try a size bigger tonight.

ozij · Post by **ozij** » Thu Nov 08, 2007 7:12 am

Not weird at all - now that the air is not going out of your mouth the machine idetifies apneas. Before when you had an obstruction the air went out of your mouth, and the machine had now way of knowing the air was not going where it was meant to.

All those event clusers starting after the second hour happen when your leak goes way up. I seem to me like you have a major mask management problem.

O.

Flying_Norseman · Post by **Flying_Norseman** » Thu Nov 08, 2007 7:39 am

I see what you mean, but isn't weird that the average leak number is right where it should be according to the manufacturer?

ozij · Post by **ozij** » Thu Nov 08, 2007 8:15 am

Which manufacturer is that?

Unless the Swift II has a higher leak rate than the Swift, then actually, your average leak rate is too high relative to the average pressure.

At an average pressure of 11.7 I'ld expect the average leak rate to be a little more than 36, see http://www.internetage.com/cpapinfo/leak-rates-1.html. Your average leak rate of 38 is about where it would be if your average pressure were 13. You many not be leaking a lot all night through, but, when you leak a lot, the machine can no longer supply you enough pressure to handle the apneas.

Compare the leak rate for the first 2 hours, when you were at the top of the range, with relatively few obstructive events, to what happens when the leak rate rises. And what's more, the minute the leak stops, your events disappear too.

You're scratching the top pressure even without leaks - see the first 2 hours.

If it were me, based on the first 2 hours I would try raising the bottom pressure a bit, and the top too. In addition to searching for a better seal.

If the leak doesn't bother you, and we see it doesn't bother the machine either (it isn't considered "major") then possibly just the change in both bottom and top pressure could be enough.

O.

DreamStalker · Post by **DreamStalker** » Thu Nov 08, 2007 8:28 am

Yep .. O has it ... you need to bump that min pressure up.

In both cases, with and without taping, your 90% pressure is 16 cm ==> you are topping out. The machine is to slow to respond as you begin to have an event -- by the time the machine tops out at 16 your tongue is lodged in your throat and the machine is having a tough time trying to dislodge it. Air has nowhere to go but to dislodge pillows instead and leaks spike.

Did your PSG show any central apneas? Snoredog or RG may be better able to figure out what is happening with your issue ... you may be one of those candidates better suited for the P&B 4320E auto with all those snores?

Try Ozij's suggestion first and bump the low end 1 or 2 cm.

Flying_Norseman · Post by **Flying_Norseman** » Thu Nov 08, 2007 8:41 am

Ozij,

Thanks for the advice. I am going to try and get the leaks under control before I change the pressure range. I was Titrated at 10cm so that is why I started the bottom range at 8.

I'll try the next size up for nasal pillows tonight and see if that stops the leak issues and then go from there. It's funny, when stuff like this happens I can't wait to get back to sleep to try the changes. The only problem is I can't possibly sleep until late tonight. I used to be able to sleep at the drop of a hat, but since CPAP I don't get tired until I have been up for 15 + hours.

krousseau · Post by **krousseau** » Thu Nov 08, 2007 10:11 am

Chances are the solution won't be just one factor/variable.
Check your bed pillow-it could be forcing your head/neck/jaw into a position that promotes obstruction.
The topaz chin strap wasn't totally effective-a velstretch strap from the velcro fastener section of Lowe"s worked best since you can run it under your chin and over the top of your head and fasten it firmly-once you find a good position for it sew/fasten the velstretch to your other headgear to keep it in place.
The chin strap on the Opti isn't meant to keep your chin up and if tight enough to to that may tip the pillows slightly out of good contact with your nostrils. Having said that it does seem to serve as a tactile reminder to keep my chin up/lips closed during sleep. When using the Opti or Opus I tape the pillows to my nose. I usually use the Bravo now but do switch between Opus or Opti to relieve occasional sore spots. (Tempted to try that plumbers silicone stuff on the nasal pillows-it is in my CPAP kit-just a little leary.) I'm considering making some kind of net velstretch contraption to support the whole nose piece as I still get leaks after 4-5 hours of sleep.
Training??? It does seem to be possible. Besides all of the above-I use a small chunk of a sugar free cough drop to assure falling asleep with my tongue in the right position. After about 16 months it seems I've got the right pieces in place and have few problems and AHI < 1 (mostly due to hypopneas). Face masks just seemed to offer more places for leaks to occur. I concentrated on getting the least skin/interface contact. With nasal pillows I can concentrate leak management to a small area-and use tape/chinstraps whatever to control mouth leaks.
A bed wedge also helps me.

Flying_Norseman · Post by **Flying_Norseman** » Fri Nov 09, 2007 6:43 am

Ok, tell me THIS isn't weird...

I used the next size up for nasal pillows and I could tell right away that they fit better, there were no leaks from them and they stayed in place very nicely. I woke up this morning feeling pretty good and thought I would have some good numbers. Well here they are:

Wulfman · Post by **Wulfman** » Fri Nov 09, 2007 7:05 am

Well, the first three hours and about 20 minutes were pretty good even though the pressure was all over the place chasing your snoring and leaks.
Do you sleep on your back? (or roll over on it) Have GERD?
SOMETHING is happening......

Den

Flying_Norseman · Post by **Flying_Norseman** » Fri Nov 09, 2007 7:09 am

I think I have been ending up on my back a lot. My right hip hurts if I lay on my right side too much and if I lay on my left I am venting air at my girlfriend. I haven't been diagnosed with GERD, but I am almost positive that I have it. I usually take a couple of Tums before I go to sleep.

ozij · Post by **ozij** » Fri Nov 09, 2007 7:39 am

Of course SOMETHING is happening - you're leaking massively - and thats when the events start and can't be cotroled by the machine. Point your mouse at where those events start piling up (hour 3 20) and scroll up to the pressure graph and down to the leak graph. The events stop when the leak stops. (look at hours 5 and something to 7 same pressure, no leaks no events.)

Could you be dislodging the maks when turning around?

And how about if your girlfriend and you change sides, so you can sleep on your less painful side without blasting her?

O.

Flying_Norseman · Post by **Flying_Norseman** » Fri Nov 09, 2007 7:55 am

I have the "stopper end" taped up with plumber's tape. Could it be the elbow part where the hose attaches to the mask? I don't hear or feel anything leaking.

It is odd to me that without taping and with verified lip fluttering, my AHI is usually below 1.0 and always below 3.0. The leak looks the same regardless as well.

I am getting a FF mask on Monday, so I will be able to see if that makes a difference. I will have a whole new problem then though because I will have a lot larger surface area to try and stop from leaking.

ozij · Post by **ozij** » Fri Nov 09, 2007 9:14 am

I was thinking more along the lines of having the mask dislodged from your nose.... all it takes is a little push from one side to the other.

People have been using Mack's silicone earplugs with great success to help in sealing full face masks. Look at the recent Liberty thread if you haven't followed it.
I hope the FF works better for you.

O.