Dry Mouth/Normal Leaks

DNAClone · Post by **DNAClone** » Sat May 23, 2009 6:33 am

I have been on APAP for several weeks. I have allergies and take nasal sprays, antinistamines and decongestants. I use a humidifier in my room along with the heated humidifier on my Respironics.
I have been experimeting with the following masks:
1. Quattro - leaks too much
2. Swift LT NASAL PILLOW- seems to move causing leaks during the night
3. Swift Mirage II Nasal Pillow - seems to be the best for me . I have minimal leaks (34-36 l/min) whcih falls inside the normal range for this mask at 13-15 cmH20. Chin straps have been a pain and I stopped using. Also, I have been waiting 2 weeks for a card reader so I can follow the data. CPAP-supply.com had it on back order for over 10 days. I expect to receive the card reader either today or in NEXT COUPLE OF DAYS.

Question: When I wake up my mouth is very dry. I can live with this but is it OK since my leak data on the LED display is within normal limits?
Any thoughts out there on this holiday weekend? Thanks.

Wulfman · Post by **Wulfman** » Sat May 23, 2009 9:31 pm

Did you do the "Teflon tape fix" to your Quattro?

Do you have Diabetes? (dry mouth can be a symptom of that.....there's a link between Sleep Apnea and Diabetes)

You didn't say what your pressure range is, but try switching to CPAP mode at your prescribed pressure and see if that helps with any of it......particularly the leaking.

Den

timbalionguy · Post by **timbalionguy** » Sat May 23, 2009 9:56 pm

You might also consider trying the hybrid mask. I just switched to it from a Quattro (which is a fine mask). Less leaks overall. Considerably less position-related leaks. And leaks tend to be minor in comparison to Quattro 'blowouts'. Slightly less comfortable than the quattro, but I sleep much better now. And of course, no issues related to mouth breathing.

DNAClone · Post by **DNAClone** » Sun May 24, 2009 6:42 am

Hi
To answer some of our questions, I finally have data from the smart card.
Titraton study 13.0
Pressure range 12.5-17.0
90% Pressure - 15
Average Pressure 13.4

Swift II Leak data appear to be approx 20% above the accepted rate which is about 41.5 based upon the Resmed chart.
Max leak 105
90% leak 60
Avg leak 48

No, I have not tried teflon tape but did try a tight chin strap that must have been removed while asleep. Ido have Dermicel tape which I may try tonite. However, since my titration was 13 and my 90% pressure is 15, is this increase in pressure compensating for the leak?
The AHI was 1.9 which is quite good and the events correlated with the high leaks.

Wulfman · Post by **Wulfman** » Sun May 24, 2009 8:10 am

DNAClone wrote:Hi
To answer some of our questions, I finally have data from the smart card.
Titraton study 13.0
Pressure range 12.5-17.0
90% Pressure - 15
Average Pressure 13.4

Swift II Leak data appear to be approx 20% above the accepted rate which is about 41.5 based upon the Resmed chart.
Max leak 105
90% leak 60
Avg leak 48

No, I have not tried teflon tape but did try a tight chin strap that must have been removed while asleep. Ido have Dermicel tape which I may try tonite. However, since my titration was 13 and my 90% pressure is 15, is this increase in pressure compensating for the leak?
The AHI was 1.9 which is quite good and the events correlated with the high leaks.

In the first place, the "90% pressure" doesn't mean diddly squat to me.....it's usually a moving target from night to night.
And, "average pressure" is statistically the single pressure where you spent most of your night and is probably too low when trying to determine your best fixed pressure.

With further analysis of your software reports, you should be able to figure out what's happening over time.
It's difficult to reply without actually looking at the Daily Details Report, but I'd say it's "probable" that the leaks are driving the pressure increases......because with an Auto, that's the way it has to work. With a CPAP (or an Auto in CPAP mode), the machine will (try to) "maintain" the pressure (by increasing the output pressure during a leak) that's set in the machine (provided it has "Leak Compensation" capabilities).

I'd say your numbers are still within acceptable limits and I doubt that the leaks are skewing the AHI. However, leaks are annoying and Autos WILL chase leaks (like some dogs chase cars).

My recommendation remains as before.......use CPAP mode. It's easier to figure out what's happening and get things under control when you're a new user. With Auto modes, trying to figure out the "chicken and egg" situation can be frustrating......which caused which?......leaks, other events or pressure increases. Besides, in CPAP mode, the pressure changes won't disturb your sleep.

Den

thinggtwoo · Post by **thinggtwoo** » Sun May 24, 2009 8:50 am

Hello, wife of a Newbie here! Hubs has a Mirage Quattro, and what is this "Teflon Tape Fix" that you mentioned in regards to this mask leaking? My husband has been using one for almost a week now, and is VERY Frustrated with the whole deal. I will start my own topic soon, but this "Teflon Tape Fix" caught my eye, and wondered if it could be explained, please?

Thanks!
Cori aka Thinggtwoo

Wulfman · Post by **Wulfman** » Sun May 24, 2009 9:21 am

thinggtwoo wrote:Hello, wife of a Newbie here! Hubs has a Mirage Quattro, and what is this "Teflon Tape Fix" that you mentioned in regards to this mask leaking? My husband has been using one for almost a week now, and is VERY Frustrated with the whole deal. I will start my own topic soon, but this "Teflon Tape Fix" caught my eye, and wondered if it could be explained, please?

Thanks!
Cori aka Thinggtwoo

Doing a forum search (above) on "Teflon" will give numerous references to it.
However, here is a thread with pictures from one of our forum members.

viewtopic.php?f=1&t=33452

Den

DoriC · Post by **DoriC** » Sun May 24, 2009 12:30 pm

Wulfman wrote:
DNAClone wrote:Hi
To answer some of our questions, I finally have data from the smart card.
Titraton study 13.0
Pressure range 12.5-17.0
90% Pressure - 15
Average Pressure 13.4

Swift II Leak data appear to be approx 20% above the accepted rate which is about 41.5 based upon the Resmed chart.
Max leak 105
90% leak 60
Avg leak 48

In the first place, the "90% pressure" doesn't mean diddly squat to me.....it's usually a moving target from night to night.
And, "average pressure" is statistically the single pressure where you spent most of your night and is probably too low when trying to determine your best fixed pressure.

With further analysis of your software reports, you should be able to figure out what's happening over time.
It's difficult to reply without actually looking at the Daily Details Report, but I'd say it's "probable" that the leaks are driving the pressure increases......because with an Auto, that's the way it has to work. With a CPAP (or an Auto in CPAP mode), the machine will (try to) "maintain" the pressure (by increasing the output pressure during a leak) that's set in the machine (provided it has "Leak Compensation" capabilities).

I'd say your numbers are still within acceptable limits and I doubt that the leaks are skewing the AHI. However, leaks are annoying and Autos WILL chase leaks (like some dogs chase cars).

My recommendation remains as before.......use CPAP mode. It's easier to figure out what's happening and get things under control when you're a new user. With Auto modes, trying to figure out the "chicken and egg" situation can be frustrating......which caused which?......leaks, other events or pressure increases. Besides, in CPAP mode, the pressure changes won't disturb your sleep.

Den

Den, I follow your logic about CPAP mode, so in this case what fixed pressure would you suggest DNA use? And why is the Avg Pressure "usually too low for the best fixed pressure"? Dori

Wulfman · Post by **Wulfman** » Sun May 24, 2009 1:01 pm

DoriC wrote:Den, I follow your logic about CPAP mode, so in this case what fixed pressure would you suggest DNA use? And why is the Avg Pressure "usually too low for the best fixed pressure"? Dori

I always recommend that a person starting out, use the titrated pressure.....unless or until they can prove with a data-capable machine and software that a different pressure will work better. In this case, it's 13 cm.

When using an Auto, the "Average pressure" is where a person is spending the highest percentage of the night.
In DNA's case, his minimum pressure is 12.5 and he's spending a good deal of time at about a full centimeter higher than that. That tells me his minimum is too low.
His 90% is reporting (for the data he posted) at 15 cm.
His AHI is good.....at 1.9. However, I would suspect that some of those events are occurring before the machine can respond (which is typical of an Auto's response). I believe he could get better AHI numbers with a single pressure.

I think DNA's titrated pressure is pretty close. Maybe 14 cm. could ultimately be the best single pressure, but 13 is where he needs to start and leave it there for about a month.......and monitor it with software.

As you well know, getting mask leaks under control should be one of the primary goals on the road to good therapy.
And, bed pillows can make a world of difference in that quest, too.

Den

DNAClone · Post by **DNAClone** » Tue May 26, 2009 7:45 am

Another night of data with mouth taped shut using Dermicel tape as advised by others.
AHI 1.9
Average Pressure 13.1
90% Pressure 14.0
Increased leaks corresponded to events
Average leak 47.00 (still 20% above normal leak rate at 14cm H20)
Average Max Leak 98
Average 90% leak 60

Pressure seemed relatively constant and required a mild increase following events.
The Swift II appeared to be moving around a bit in one nostril.
Previous attempts at the Lt Swift could not hold pillows in place when I tried medium and small sizes.

Although the AHI numbers remain well below 5.0, I still need to reduce leaks. I ruled out mouth breathing with the tape but still had elevated leaks. The AHI numbers did drop 1-2 with the taping and the pressure was more constant.
I must work on a better system for the mask or try another. The Activa and Quattro had leaks, perhaps because I needed a smaller mask. Currently have medium as recommended by sleep center.
I am concerned that a hybrid will have similar leak issues with varying pillow sizes.

My DME advised that I visit them and try on all types of masks. Since I never tried more than 3, perhaps they can size me better and find the best fit for my anatomy.

thinggtwoo · Post by **thinggtwoo** » Wed May 27, 2009 3:08 pm

Doing a forum search (above) on "Teflon" will give numerous references to it.
However, here is a thread with pictures from one of our forum members.

viewtopic.php?f=1&t=33452

Den

Thank You!

Thinggtwoo

Gerald · Post by **Gerald** » Wed May 27, 2009 3:58 pm

DNA.....

Thanks to Rested Gal, I migrated to the Aeiomed Headrest (Aura) mask.

I have conquered at least 95% of my leaks. I use blobs of Lansenoh Lanolin on each nare....and 2" wide Blue 3M #2080 Painter's tape on my mouth.

My AHI is continually below 1.0.....the last three nights were 0.1, 0.2, and 0.1

I can't find a more comfortable, easy system to accomplish excellent therapy.

You can do the same.........

Gerald

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