Finally!

Thank you for the help and support you have all given me over the last few weeks. I literally could not have gotten everything straight without you! Last night I had the best night using CPAP. Resmed sent me a shallow attachment for my Activa mask, and it was awesome! It is perfect for someone like me without much of a nose bridge.

I have two things that I need to tweak, and I am just sure you have some great advice.

1) I guess because the Activa has such a good exhaust system, I have not had any problems with rainout. That is GREAT! However, I have awaken 3 nights with such a dry mouth and throat that I could not swallow. I guess in that delirious half asleep/half awake state it causes me to panic when I can't swallow, so I awake ready to chunk the mask. I get up and go to the restroom, get water, and go right back to sleep without any problems the rest of the night.

With the other masks I tried, I couldn't have the humidity above 1. Right now with the Activa, I am on 3. I am going to go to 4 tonight and see if that helps any. Did you Activa users find that you needed more humidity with this mask?

2) I am on an auto-titrating setting between 5 and 10 cm. When I adjust the mask when going to bed so that it doesn't leak while on 5 cm, I think it gets too tight in the night when the pressure adjusts up. I wake up with a mask mark next to my nose. Is there anything that can be done about that?


Thank you again for all of your help and for being patient with my kajillion questions.

If you aren't tapeing or sealing your lips shut, you dryness is probably mouthbreathing, it could be puting any treatment at risk. Jim

SuzieQ wrote:However, I have awaken 3 nights with such a dry mouth and throat that I could not swallow.

I agree with Jim:

Goofproof wrote:If you aren't tapeing or sealing your lips shut, you dryness is probably mouthbreathing

Suzie, I'd bet dollars to donuts that you're mouthbreathing in your sleep... a lot.

I looked at one of your previous posts and saw this, back in Sepember:
viewtopic/t35515/viewtopic.php?p=301065#p301065

SuzieQ wrote:I have never been one to sleep with my mouth open unless I have a seriously stuffy nose. I don't have a stuffy nose right now, but this morning I woke up with my mouth open and a very dry throat and mouth.

I think many (not "all", but probably many) people who don't have their mouth open when they first go to sleep, do have it drop open when the jaw, tongue, etc., get totally relaxed during sleep. Sure sounds like that's happening to you. Dry throat and mouth when you're using heated humidification is almost always a telltale sign of mouthbreathing during sleep. Or at least of treatment air detouring into the mouth from the back of throat and gushing out the mouth instead of being breathed down to hold the throat open.

If you have a machine that can give you leak rate info, you might want to really check that.

Almost certainly mouth breathing. Keep a water bottle at bedside. I use Propel. When going to bed adjust mask at highest pressure. The Activa you can leave very loose w/o leaking.

Thanks to you all. I will up the humidity tonight. Tomorrow I will check on leaks and figure out how to tape my mouth to see if that helps any.

Rested gal, you said: Or at least of treatment air detouring into the mouth from the back of throat and gushing out the mouth instead of being breathed down to hold the throat open.

Why does this happen? Does taping prevent that? I had that happen while I was awake when I used the CL2, but it hasn't happened while I was awake with the Activa.

The problem happens when you are asleep, because then your mind is on autopilot, that's also why you don't realize it happened. Jim

By tapeing or using a FF mask, You bypass the problem, as the air can't escape your airway, before it holds your airway open. At worst it causes "Blowfish Cheeks, or excessive Gas, if the Valve in yous stomach is damaged.

SuzieQ wrote:Thanks to you all. I will up the humidity tonight. Tomorrow I will check on leaks and figure out how to tape my mouth to see if that helps any.

Rested gal, you said: Or at least of treatment air detouring into the mouth from the back of throat and gushing out the mouth instead of being breathed down to hold the throat open.

Why does this happen? Does taping prevent that? I had that happen while I was awake when I used the CL2, but it hasn't happened while I was awake with the Activa.

It happens when the tongue doesn't maintain a leakproof seal (leak proof from either direction) inside the mouth. It's not really a matter of whether the mouth is open or not. What prevents mouth breathing, or air detouring into the mouth from behind, is the tongue being in a position that doesn't allow air to enter the mouth from the front (mouth breathing) or from the back of throat (cpap air detouring into the mouth and gushing out.)

During the full relaxation of sleep, if the tongue relaxes enough and if the geometry of the inside of the mouth allows gaps between a relaxed tongue and roof of mouth....WHOOSH. One way or the other.

Taping will prevent a person from breathing in through the mouth. Taping can't prevent cpap air from detouring into the mouth from back of throat, but the tape will act as a dam across the front of the lips to keep the cpap air from gushing on out. The cpap air can fill the mouth and balloon out the cheeks (the "blowfish" effect that Jim mentioned), but the cpap air will be contained (not allowed to leak) from the mouth and the sleeper can continue to breathe through the nose.

The ballooning out cheeks can be bothersome to some people if the air takes a detour and fills a taped mouth. Ballooned out cheeks can make the tape loosen and leak. A chin strap or homemade strap that goes up along the side of the face can aid in keeping the cheeks flat and minimize the amount of "detouring" air that gets into the mouth.

For that matter, just a chin strap that keeps the jaw from dropping tooooo much (and no tape over the mouth) can be enough for some people's tongues to stay in a sealing position inside the mouth.

You might want to try a chin strap (commercial or homemade) first. If that doesn't get the job done, then dig into the tape topics. Remember, it's not just whether the jaw stays up or not, or whether the lips are open or not. It's the position the relaxed tongue stays in, inside the mouth, that controls whether there will be mouth leaks/mouth breathing.

LINKS to: Mouth leaks - Air Leaks - Tape - DIY Guard
viewtopic.php?t=8011

It definitely shouldn't be an issue with the mask. I use the Activa and use passover humidification on most nights. I can successfully use no humidification for a couple of nights without drying out too bad. I agree with the other posters that it is air escaping from your mouth that's the most likely cause.

Rested Gal, you said:

" The cpap air can fill the mouth and balloon out the cheeks (the "blowfish" effect that Jim mentioned), but the cpap air will be contained (not allowed to leak) from the mouth and the sleeper can continue to breathe through the nose.

The ballooning out cheeks can be bothersome to some people if the air takes a detour and fills a taped mouth. Ballooned out cheeks can make the tape loosen and leak. "


Rested Gal, when I read this, I thought, "I posted this exactly, but it was happening to me while I was awake!" I mentioned in my posts that I was having trouble keeping my mouth shut before I even went to sleep. The air would come rushing out (instead of having to be brought forward from the back of my throat) when I opened it.

When the air fills the mouth, is that what causes some people to have such problems with intestinal gas on CPAP? Is it because the air that makes the mouth balloon out ends up going into the stomach instead of the lungs?

When I told my new Doctor about my problem keeping my mouth closed sometimes, he said that it could well be a digestive issue. I could see that since it doesn't happen to me all of the time.

Today I looked at the nights that my throat was really really dry. There was an instant spike in the leak graph one time on each of the nights. I am guessing that is most likely the major leak of my open mouth, huh?

Thanks again for the help.

SuzieQ wrote:When the air fills the mouth, is that what causes some people to have such problems with intestinal gas on CPAP? Is it because the air that makes the mouth balloon out ends up going into the stomach instead of the lungs?

Could be, but the more usual problem that causes people to get aerophagia (gassy, abdominal bloating from cpap) is a damaged or weak LES (lower esophageal sphincter muscle) from untreated or undertreated acid reflux disease. If the LES doesn't close well or stay closed well, some cpap air can gets shoved down past it into the stomach.

SuzieQ wrote:When I told my new Doctor about my problem keeping my mouth closed sometimes, he said that it could well be a digestive issue. I could see that since it doesn't happen to me all of the time.

I've not heard about a "digestive issue" causing a person to not be able to keep their mouth closed, but I'm not a doctor...and I don't have any digestive issues.

SuzieQ wrote:Today I looked at the nights that my throat was really really dry. There was an instant spike in the leak graph one time on each of the nights. I am guessing that is most likely the major leak of my open mouth, huh?

Probably. But the more important thing about your leak graph would be how the leak line looks throughout most of the night. One brief spike, no matter how high, wouldn't matter much if the rest of the night showed a nice low leak line. If you're getting a jagged, Rocky Mountains style leak line most of the night, then the leaks are bad.

By the way, it's impossible to tell from the leak graph where leaks are coming from. Could be from a mask getting dislodged or leaking badly, or from the mouth if not wearing a Full Face mask (FF mask cover mouth and nose together.) If you have a high leak rate, you have to be your own detective to figure out if the leaks are from the mask not sealing well, or the mouth, or both. You already have your main clues to guide you... the extremely dry mouth you get so often, and the fact that you already know you have a tendency for mouth opening.

Gotta control those mouth air leaks and/or mouth breathing during sleep to get good treatment. A Full Face mask is going to be the answer unless you want to try other measures, perhaps starting with a chin strap to see if just keeping the jaw from dropping might allow your tongue to maintain an airtight seal inside the mouth. If a chin strap doesn't get the job done and if you don't want to go the FF mask route, then dig into the topics here:

LINKS to: Mouth leaks - Air Leaks - Tape - DIY Guard
viewtopic.php?t=8011

Thanks Rested Gal for your help. I will peruse those forum topics.