CPAPtalk.com

I use a modified PapCap. I use the cap itself, but instead of the strap portion that goes under the chin, I use a basic one which has more give to it, and which has a sort of "cup" of fabric, which I can bring over my lips: https://www.cpap.com/productpage/respir ... white.html I cut the chinstrap's ends shorter and use the little Velcro squares it comes with to Velcro the ends together on top of the PapCap. This has worked great for me.

I have tried taping, without great success, but I may try it again. I have never managed to train my tongue to stay on the roof of my mouth, although reading that someone managed this after 5 years gives me hope!

Jill

PS -

I thought that the whole idea of the red line is that the VPAP compensates for all leaks below the red line. If so, what is the significance if any in seeing a few minor spikes above it?

Also, I think it is even possible that the spikes were caused by me momentarily pulling the nosepiece of the Wisp away from my face to re-seat it.

Another, unrelated thought. On the subject of taping the authors of the above study also said this:

There is an urgent clinical need for a safe and effective
method for preventing mouth leaks during bilevel ventila-
tory support. Taping was used in this study in preference to
other ways of sealing the mouth such as a full face mask,
because existing full face masks have higher deadspace,
leak, and discomfort than nosemasks, and arousal data
would be uninterpretable. However, the authors do not at
this stage advocate taping the mouth for indiscriminate
long-term home use, because of the risk of asphyxia in the
presence of nasal obstruction, machine or power failure, or
regurgitation.

I'm not taking a position pro or con on any of the above remarks - just playing Devil'sAdvocate out loud with myself, and with everyone participating in this discussion, to try to reason it all out.

Regards, Nate

NateS wrote:I thought that the whole idea of the red line is that the VPAP compensates for all leaks below the red line. If so, what is the significance if any in seeing a few minor spikes above it?

Some people aren't happy unless they don't see any blips for leaks at all (Sheriff I see you rolling your eyes at me because you know I am talking about you ) and I guess if that makes them happy then that's all well and good. The mind is a powerful drug/tool.
Below the red line...I don't care where it is as long as I am sleeping well and leaks aren't disturbing my sleep.
Above the red line...well it all depends on how far above and how long and did it wake me up.
Brief spikes from mask reseating are insignificant but the fact that a person was awake to do the reseating may be more important.
15 to 30 minutes at 27 L/min is far from the end of the world if I sleep right through it. That's such a small time period our of 7 or 8 hours that it can't have a huge impact unless again..it wakes someone up.

Some people are just super sensitive to the slightest little leak. A leak that the machine can certainly compensate for in terms of therapy effectiveness but if we wake up 20 times a night fiddling with those little leaks then sleep quality is surely to be affected. So when sleep quality is affected we need to fix them no matter how small.
If someone doesn't feel like there sleep quality is being affected then I don't think there is a big deal if the leak line is less than perfect. My leak lines are sometimes perfect and sometimes not but I rarely get awakened by anything related to leak or mouth breathing. So I really don't care if I spend 15 minutes above the red line.

Now if my sleep was really fragile and the least little thing woke me up..yeah then I would work on the leaks but only because they were affecting my sleep quality and not because there was less than perfect straight line all night long.

Everyone has to decide where their own priorities are going to be.
Minor leaks that the machine can compensate for....as long as they don't disturb sleep aren't a problem because the machine can compensate in terms of pressure delivery.
Minor leaks above the machine's ability to compensate for adequately need to be evaluated on an individual basis..how big, how long and did it disturb sleep.
Massive leaks...again how big and how long? 5 minutes...far from the end of the world out of 8 hours as long as it doesn't disturb sleep.

Your leak line is not pretty but it is a lot better looking than what I have seen in the past when you spent half the night above the red line. For some people who might have a leak graph looking like yours it might mean that they battled leaks all night long and got horrible sleep quality. When that happens they need to fix it but unless something is creating a problem...there's no reason to go to drastic measures to fix a not so pretty leak line. IMHO
Sometimes the cure for the problem causes more problems than the problem is causing.

Pugsy wrote:

NateS wrote:I thought that the whole idea of the red line is that the VPAP compensates for all leaks below the red line. If so, what is the significance if any in seeing a few minor spikes above it?

Some people aren't happy unless they don't see any blips for leaks at all (Sheriff I see you rolling your eyes at me because you know I am talking about you ) and I guess if that makes them happy then that's all well and good. The mind is a powerful drug/tool.
Below the red line...I don't care where it is as long as I am sleeping well and leaks aren't disturbing my sleep.
Above the red line...well it all depends on how far above and how long and did it wake me up.
Brief spikes from mask reseating are insignificant but the fact that a person was awake to do the reseating may be more important.
15 to 30 minutes at 27 L/min is far from the end of the world if I sleep right through it. That's such a small time period our of 7 or 8 hours that it can't have a huge impact unless again..it wakes someone up.

Some people are just super sensitive to the slightest little leak. A leak that the machine can certainly compensate for in terms of therapy effectiveness but if we wake up 20 times a night fiddling with those little leaks then sleep quality is surely to be affected. So when sleep quality is affected we need to fix them no matter how small.
If someone doesn't feel like there sleep quality is being affected then I don't think there is a big deal if the leak line is less than perfect. My leak lines are sometimes perfect and sometimes not but I rarely get awakened by anything related to leak or mouth breathing. So I really don't care if I spend 15 minutes above the red line.

Now if my sleep was really fragile and the least little thing woke me up..yeah then I would work on the leaks but only because they were affecting my sleep quality and not because there was less than perfect straight line all night long.

Everyone has to decide where their own priorities are going to be.
Minor leaks that the machine can compensate for....as long as they don't disturb sleep aren't a problem because the machine can compensate in terms of pressure delivery.
Minor leaks above the machine's ability to compensate for adequately need to be evaluated on an individual basis..how big, how long and did it disturb sleep.
Massive leaks...again how big and how long? 5 minutes...far from the end of the world out of 8 hours as long as it doesn't disturb sleep.

Your leak line is not pretty but it is a lot better looking than what I have seen in the past when you spent half the night above the red line. For some people who might have a leak graph looking like yours it might mean that they battled leaks all night long and got horrible sleep quality. When that happens they need to fix it but unless something is creating a problem...there's no reason to go to drastic measures to fix a not so pretty leak line. IMHO
Sometimes the cure for the problem causes more problems than the problem is causing.

Thank you for that additional input, Pugsy.

Frankly, when I wake up during the night, I never get upset about it because I know I will easily fall back asleep. It gives me a chance to look at my clock on the nightstand and tell myself how many more hours I have until I need/care to wake up. It only concerns me when the wake up is caused by dry mouth, because I am concerned about excess mouth dryness, not because of loss of sleep or sleep quality.

If the latter, I pop the lozenge in and deliberately wait until it is fully dissolved so that there is no danger of choking on it, confident that I will fall back asleep almost immediately thereafter.

Otherwise, I really don't care about momentary wake ups. However, I really don't know what the quality of my sleep is following a wakeup. I do know I wake up almost every morning feeling happy and refreshed (unless I have a sore back from sleeping too long) but that doesn't really tell me much because I'm so dumb I used to wake up happy and feeling refreshed even before I was diagnosed with sleep apnea and centrals! If it wasn't for my girlfriend telling me I was scaring her to death every night with my long stopped-breathing episodes and my snoring, I never would have gone in and been diagnosed!

Regards, Nate

Nate, I'm not sure that xpap is designed to deal with mouth (soft palate) leaks. The study referenced in the preceding posts kind of implies not. Hypothetically, what if we have a situation as in the drawing below where an obstruction occurs at the base of the tongue, but the pressure is allowed to escape at the soft palate, before the obstruction? How can the obstruction be cleared? I don't know if this situation is possible, but it seems it could be and, if so, therapy would be lost.



I think Pugsy's comments are right on. I think leaks do bother some of us a lot more than others. I know, If my leak line looked like yours, I'd be awake all night. Now, if you are obtaining restful, restorative sleep and apneas are being successfully treated, then I agree that leaks do not matter. But, are apneas being reported correctly if there is mouth leaking? I don't know. I can sure see where they might not be - red line or not.

The bottom line for me is that leaks are disturbing and mouth leaks are the worst. As that is the case, I find a FFM to be far more comfortable than the tape, chin straps, etc. required for me to sleep with a nasal mask.

I just read your last post which mentions dry mouth and I have to say that a FFM will not necessarily prevent it. Occasionally, I find I need a modified chin strap to reduce dry mouth caused by mouth breathing (nasal congestion?) even with a FFM, but I know the therapy is still good. Oh well...

See here for ResMed's view and comments about bi-level and mouth leaks. http://www.resmed.com/us/clinicians/com ... clinicians

Jay Aitchsee wrote:Nate, I'm not sure that xpap is designed to deal with mouth (soft palate) leaks. The study referenced in the preceding posts kind of implies not. Hypothetically, what if we have a situation as in the drawing below where an obstruction occurs at the base of the tongue, but the pressure is allowed to escape at the soft palate, before the obstruction? How can the obstruction be cleared? I don't know if this situation is possible, but it seems it could be and, if so, therapy would be lost.



I think Pugsy's comments are right on. I think leaks do bother some of us a lot more than others. I know, If my leak line looked like yours, I'd be awake all night. Now, if you are obtaining restful, restorative sleep and apneas are being successfully treated, then I agree that leaks do not matter. But, are apneas being reported correctly if there is mouth leaking? I don't know. I can sure see where they might not be - red line or not.

The bottom line for me is that leaks are disturbing and mouth leaks are the worst. As that is the case, I find a FFM to be far more comfortable than the tape, chin straps, etc. required for me to sleep with a nasal mask.

I just read your last post which mentions dry mouth and I have to say that a FFM will not necessarily prevent it. Occasionally, I find I need a modified chin strap to reduce dry mouth caused by mouth breathing (nasal congestion?) even with a FFM, but I know the therapy is still good. Oh well...

See here for ResMed's view and comments about bi-level and mouth leaks. http://www.resmed.com/us/clinicians/com ... clinicians

Jay, I checked that reference, and here is how I fit:

What criteria chould I consider before prescribing a full face mask for a patient?
Take a few minutes to ask all patients these questions:

Do you often wake up with a dry mouth and/or throat? YES BUT ONLY UNDER THERAPY
Do you tend to breathe through your mouth (rather than your nose)? NO
Do you suffer from allergies or hay fever? NO
Do you have a blocked nose/congestion at certain times of the year? NO
Have you ever had a broken nose? NO
Do you have a deviated septum? NO
Have you had previous nasal surgery? NO
Are you currently using any nasal therapy or medication? NO

In addition, for patients already using therapy with a nasal mask:

Are you continuing to snore even when using therapy? NO
Do you use a chin strap with therapy? YES
Is leak indicated by your flow generator data? SOME

One question I believe should be also included would be:
How likely is it that you would continue to be therapy compliant if it required wearing a FFM?
… to which my answer would be: MY HUNCH IS IT WOULD BE LESS LIKELY

Regards, Nate

NateS wrote:

SleepingUgly wrote:I would be a complete disaster after a night of leaks like yours. I guess whether your leak situation is considered a success or failure depends on whether you are disturbed by all those leaks. You're obviously partially disturbed (sleeping people do not suck lozenges). If you aren't tired during the day and can tolerate it like this, I guess that's success.

Could you post a typical chart?

Thx.

Nate

SleepingUgly,

I apologize if my response seemed flippant. I did not intend it to be. I should have simply said that I don't think that the experiences of patients on bi-level and those on ASV are comparable. The pressure on inspiration on ASV is constantly jumping up and down, so it seems to me to be entirely logical that the leak number would be in constant change even though the minimal extent of the leak could be constant.

Regards, Nate

Has anyone here used the Breathe Mate oral appliance? It looks interesting.

http://shop.breathecleanerair.org/produ ... tegoryId=8

I have only found one full-face mask that works comfortably on my unique face;
and it not only leaks horribly, but has been discontinued.
Therefore, I am forced to adopt one or more of the alternatives.
I refuse to allow the laziness and greed of mask manufacturers to stand between me and quality sleep!

Lot's of questions lately about mouth breathing, leaks, etc. Maybe this old thread will have answers for some.
(My personal answer was a full face mask)

Hmm, I didn't see this thread a few months ago... must have been when I was out of town with no net access.

Nate asked if it was possible for an ASV to have a flat leak line. Answer is, yes. My EPAP is 6, my MinIpap is 10 and my MaxIpap is 14.



Now, if I've done this correctly, that should be a shot of my leak for the other night. The line before the break is with the Headrest. The line after the break is with the Tap Pap.

If I haven't done it correctly, I shall have to try again....

Kiralynx wrote:Hmm, I didn't see this thread a few months ago... must have been when I was out of town with no net access.

Nate asked if it was possible for an ASV to have a flat leak line. Answer is, yes. My EPAP is 6, my MinIpap is 10 and my MaxIpap is 14.



Now, if I've done this correctly, that should be a shot of my leak for the other night. The line before the break is with the Headrest. The line after the break is with the Tap Pap.

If I haven't done it correctly, I shall have to try again....

That's very interesting - do you have the accompanying Pressure graph for that same night?

Thanks, Nate

NateS wrote: That's very interesting - do you have the accompanying Pressure graph for that same night?

Posting now.... I'd post the whole page, but I've got it saved as a PDF file, and have to do screen shots.



As you can see... my ASV controls events for me extremely well.

Kiralynx wrote:

NateS wrote: That's very interesting - do you have the accompanying Pressure graph for that same night?

Posting now.... I'd post the whole page, but I've got it saved as a PDF file, and have to do screen shots.



As you can see... my ASV controls events for me extremely well.

That is wonderful!

I've never been able to achieve a flat line like that.

Here is the best I get:



Happy New Year,

Nate

NateS wrote: That is wonderful! I've never been able to achieve a flat line like that. Here is the best I get: <snip>

Happy New Year,

Happy New Year to you also, Nate.

That variability on the mask would likely drive me nuts. But I will note that the differences between our charts may stem from the fact that mine is set to a pretty narrow range (which is what works to control my events), whereas you appear to need somewhat wider a range. Plus, what controls your events does seem to be a pretty widely variable pressure.

I do use a homemade "brandy keg" chin strap. Well, I suppose it's a chin strap. It's a 4" diameter cylinder of hard foam that I bored a hole through, wrapped it in fleece, and added a strap to. (Half of a dead CL2 strap.) Strap goes around my neck, and the cylinder tucks under my chin to hold it up. Much better than more straps over my head.

(I also have to wonder what the same data would look like in the same software. We could be comparing apples and oranges here. Oh, well, have to wait until I can get a newer machine that Sleepyhead works with.)