Posted: Fri Jun 13, 2008 9:30 am
thanks O! That's good to know I can fiddle around with the concentration some if I need to.
new-to-BiPAP wrote:I'm not sure if the chin strap is really tight enuf.
A chin strap doesn't have to be tight enough to keep the mouth completely closed. That's because it's actually the position of the tongue inside the mouth that stops (or doesn't stop) mouth air leaks or mouth breathing.
If the tongue is in a position that maintains an air proof seal even when the jaw is relaxed, it really doesn't matter if the lips/mouth are open.
The reason chin straps work to prevent mouth air leaks for some people is that their tongue can maintain a leak proof position in the mouth as long as their jaw doesn't drop tooooo much. The chin strap is not supposed to keep the jaw clamped tight shut. It's just to keep the jaw from dropping down so far that the tongue also drops away from the roof of the mouth.
The reason chin straps don't work for many people is that their tongue can't keep a seal inside the mouth when they are in the total relaxed state of sleep. Even if a chin strap is cinched so tight that the teeth are clenched, if the tongue doesn't "stay put" in a sealing position (usually up against roof of mouth, or flopped back at the entrance to the throat) CPAP air can detour into the mouth and gush out despite wearing a chin strap.
I had to use tape over my mouth for over three years before my tongue finallllllly formed the habit of keeping an air sealing position inside the mouth. For almost a year now, I've been able to use a chin strap. And it doesn't even have to be tight. Just has to "be there" to keep my jaw from dropping completely open.
To get an idea about what I mean when I talk about the tongue has to maintain a seal inside the mouth, try these four little experiments:
Experiment 1. Close your mouth and swallow. Where is your tongue when you START to swallow? Your tongue is probably flattened out and pressed hard up against the roof of your mouth.
Now keep your tongue pressed firmly in "swallowing" position (wide and up against roof of mouth) and try to breathe through your mouth.
If you can exhale some air out, press against your cheeks with both hands to keep your cheeks from ballooning out like a blowfish.
Experiment 2. Open your mouth and swallow while mouth is open. Aain, where is your tongue? Probably in exactly the same "roof of mouth, widened out at the back" position it goes to whenever a person swallows. That air tight sealing position.
Experiment 3. Clench your teeth tightly shut. Let your lips be slightly open. Let your tongue be relaxed down in your mouth... not pressing against roof of mouth at all. Breathe in and out through your mouth. You can do that easily as long as the tongue is not against the roof of mouth. That's why a chin strap doesn't prevent mouth breathing for many people.
Experiment 4. Repeat experiment 3, but this time take your finger and push your lower lip up. That's what tape or Polident strips can do -- keeping the lips firmly closed to dam back the detouring air.
If the tongue doesn't stay in a sealing position INSIDE the mouth, keeping the jaw up isn't going to do a thing to prevent mouth air leaks or mouth breathing.
Depending on the geometry of the inside of a person's mouth, simply keeping the jaw from dropping much will lessen the space inside the mouth so that the sleep-relaxed tongue will stay against the roof of the mouth. For them, a chin strap works.
However, for others, it doesn't matter how clamped shut the jaw is....the tongue will still drop down from the roof-of-mouth position, and CPAP air will detour into the back of the mouth and gush out from between loosely closed lips. That's when we reach for tape or polident strips, or make a "DYI" mouthguard thingy to dam the air back.
LINKS to: Mouth leaks - Air Leaks - Tape - DIY Guard
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