Day 3 on CPAP - Questions/Concerns!

Hi there,

I was diagnosed with sever sleep apnea in the beginning of May. I seen a respiratory therapist on Wednesday to setup a month trial of CPAP therapy. With much anxiety and apprehension I was quite nervous about starting this treatment, let's face it, having a mask pump air down your throat sounds pretty terrible.

The good news? After two nights of CPAP use I *feel* I am adjusting very well, very quickly. I am using a Phillips Respironics System One (it's an autoset) with a Respironics EasyLife nasal mask... from what I understand, I am pretty lucky to have gotten both a mask and machine that I am adjusting to so well so fast (almost too well if that makes any sense) The first night I had about 6 hours of sleep with the mask on, no major issues. I honestly woke up feeling very well, rested and energized, etc.. and that was only from 6 hours sleep.

Last night was good too, however I do have some questions and I'll try to make this brief. I noiced a few times I woke up because the air would leak through my mouth. I want to say I am 100% sure that this happened and woke me up right away, and there was no constant leaking (I hope) Anytime it happened my lips would smack together or I'd feel the air rush through my mouth which woke me up. So I am praying that this wasn't a leak so much, as I would close my mouth and fall back asleep no problem. I got ~7 hours and 50 minutes of sleep roughly. I woke up once again feeling very well rested.. but now at work I feel sleepy, but not naerly as fatigued as I would be when I wasn't on treatment. I am going to chalk this up as just normal tiredness and the fact that I work at a computer so I am not active, but what I am worried is that I was having mouth leaks and not just little leaks that woke me up. I am pretty positive I do not have mask leaks, it stays very well sealed to my face, haven't felt air blow on my eyes, lips, etc.. so I believe mask leaks aren't occuring.

My question is, being so new to this I am kind of confused. I checked the machine the first morning of use and it said I had it on for 6.6 hours with a pressuer of 11.5. I checked this morning (the night I had those little mouth leaks) and the pressure was 9.9 or 9.6... somewhere in around there. Why the sudden drop? Could that be due to the mouth leaks? Or is it possible that some nights you just don't require as much pressure as the last? ALSO, just to note as it may be important.. I woke up at 4am to have a drink of water, took the mask off for 20 seconds, put it back on and then used the ramp feature (so it ramped down back to 6 so I could fall back asleep without the high pressure) So I am not sure if maybe thats why I got a lower number last night as well?

Sorry this is so long! I have so many questions and need to provide as much info as I can. I expect a call from my therapist on Monday to follow-up so I'll be sure to ask him then as well, but thought I'd voice my concerns and share my experience so far. Like I said, so far I am very happy with how things are going after all the horror stories I have read with people having absolutely no luck with CPAP.

Thanks for reading.

Welcome to CPAP and welcome to the Forum! Please do register and hang around here, you can learn a lot!

First of all, if you have mouth leaking you definitely need to solve that. Some suggestions are mouth taping, a chinstrap, or a Full face mask (FFM). If you don't solve this, all the air will escape out of your mouth, disrupt your sleep, and the CPAP won't be doing its job. This will not go away on its own with more CPAP use!
All the info you could ever want about mouth taping, denture strips, and other fancy ways of keeping our traps shut at night:
Links to: Mouth leaks - Air Leaks - Tape - DIY Guard

At your followup on Monday, you should ask about a FFM and mention the mouth leaking. It's always good to have a FFM as a backup anyway (for colds, congestion, etc). I would prefer to use a FFM instead of taping, since I also mouth leak, but i haven't found one yet that fits me. Your best bet is to have your therapist bring over different FFM's to try - try them on with CPAP at your current pressure and lie down to test them. The Quattro, the Ultra Mirage Full Face, and the Hybrid are very popular FFMs, and there are many others of course.

Your other question, related to the pressure differences between nights: each night can be very different and affected by what we ate, sleep position, tiredness level, etc. So it's perfectly normal to have different pressure needs every night. The use of ramp or night-time wake-ups could affect those numbers too. However, your mouth leaking will skew all your results, so please fix that first!

Glad to hear you're adjusting so well and that you found a good mask! A good mask is more than half the battle!

Thank you for the quick reply.

I will have to monitor the "leaking". As mentioned I am very certain that I am not having leaks, just very minor bursts (kind of how you let the air flow out from time to time to "de-pressurize" I do this when I go to sleep as it's hard to get the nose only breathing at first so I let a little air out of my mouth to relieve some pressure) Would it still be a bad thing if my mouth only leaked for seconds, literally a couple seconds say 5 times a night? I don't see how this would affect things too much, but I could very well be wrong.

The next thing I would consider if this is a regular occurance is a chin strap? How uncomforatable is that? I was given a face mask as well for backup, but I can't stand it. I'd rather use a chinstrap, I like my mask very much.. it's super comforatable.. the full face mask is definitely not.

Thank you very much for all the info, I appreciate it. I kind of blamed the drop in pressure to my little mouth "leaks" last night, but that's good to know then. I will be monitoring the mouth leaks and even still, I don't think a chin strap would make things that much worse, so long as I can keep my mask!! I am very attatched to it already. The face mask puts 10x more pressure on my face and limits the positions in which I can sleep.

I'll be sure to register and stick around, it's always nice to get more information and talk with others who use it. I feel very lucky to have such success after only two nights.. I thought this was going to be months of adjusting and losing sleep. I might wake up a couple times throughout the night but it really has no effect on me and I wake up feeling good.

You might be doing more mouth leaking than you think. A chinstrap is a good starting point, but may not necessarily stop the mouth leaking (it does for some, but not others - i would venture to say it doesn't help most mouth breathers/leakers). A good way to know is if you have a really dry mouth in the morning. You don't always wake up when you mouth-breath.

I found the chinstrap to be very uncomfortable because it pulled my jaw back even more, but the pap-cap was very comfortable (but doesn't stop mouth-leaking for me either).

Yes, some FFM's can also be very uncomfortable, but there are many kinds in many sizes. Just because that particular one doesn't work for you, doesn't mean that another won't work! The Hybrid is a nice FFM.

I don't want to give up my nasal mask either, so I tape.

Good luck!

Interesting. I very well could be doing it more than I think.. however the first night I noticed nothing but last night there were a few times I woke up with leaking. Just when I thought I got off scott free and onto an easy treatment process... not so much.

A chin strap will be my first option before a full face mask. I know the one I tried wasn't comforatable but I don't think I'll like any of them, they are too big, take up too much space, seem to leak more easily, etc. The nasal one I have is great. I don't think I have the guts to tape my mouth shut, especially this soon into treatment.

Another question... when my therapist reviews the last 30 days of sleeping through the software, will it show if I am having apnea events ? So if I am having mouth leaks and so on, will that show in the software? It'd be nice to see how often mouth leaks happen, for how long, etc, etc.. not sure if software is that sophisticated yet?

I really thought I was going to be lucky and breathe through my nose only , having just little tiny leaks.. but now I don't think that's going to be the case. Damn mouth just needs to stay shut! My therapist even said after I addressed my concern saying "I am a nose and mouth breather, so I am worried about the nasal mask" He just said using a nasal mask will teach you to breathe through your nose only... apparantley not the case here is it! I can't control my trap when I'm in deep sleep.

Anyhow, I hope the software will show the leaks and so on... hopefully I wasn't having any apnea events last night either I don't need those anymore

Some machines can show mouth leaks - i think yours can but not sure. Also your low AHI can be misleading if you're mouth leaking.

It'll get better, if you're willing to work at it

Thanks for the reply.

One thing I just noticed upon doing some quick research on mouth leaks is the humidifier. Last night I turned mine down from 5 to 4... who knows if that's even enough to make a difference. I kept it at 5 on Wednesday with no leaks that I noticed anyways... then last night at 4 I noticed a few leaks. So I'll be keeping it at 5 tonight and from now on. Will be interesting to see if I notice anything.

On Monday I'll let my therapist know tha I think mouth leaking might be a problem. He may have to show me some more face masks. I might also try the one he gave me if I notice more "leaks"

Welcome and congrats on doing well. You're very early into therapy so there are so many variables to consider

Couple of suggestions:

1. post your equipment
2. i'm not familiar with your machine but if software is available, get it, learn to read it and post it for other's to respond to.
3. mouth breathing might actually be a sign that you're getting solid REM sleep - but it needs to be corrected ASAP

The easylife is a great nasal mask, i used it before migrating to nasal pillows and still keep at backup. If you do the tape method, highly recommend the #2080 3M blue painter's tape. You will need to be careful with the 2 inch wide tape, mask sure the inner cushion of the easylife does not come into contact with the tape or else your mask will leak.

Thanks for the suggestions.

After night 3 I have made the decision to try my full face mask tonight. I never realized it's a Resmed Mirage Quattro. I put it on and it's really not that bad, especially if I can breathe through my mouth!! I am coming to the conclusion that I am a mouth breather. When I drifted off to sleep last night I woke myself up twice because I started leaking through my mouth.

The equipment I use (bare with me.. I'm a newbie) I am not at home so i can't say exactly what I have but I am pretty darn sure it's a Philips Resperonics System One with A-Flex, it's an autoset with a heater humidifier. I am now using the Resmed Mirage Quattro FFM.

As for software I am not sure because I am doing a one month rental/trial with the sleep clinic. Either way, once my month is up I am going to seriously consider this CPAP machine, it's very quiet, user friendly, etc, etc. Seems like a great machine? And the way I see it, if I am having such success already with the equipment (and hopefully the new FFM) that I might as well use that same equipment.

I shall let you all know how the sleep goes tonight with the new mask, I am looking forward to breathing through my mouth

Welcome aboard

I too struggle with mouth leaking and now use a chin strap. I also use the polident strip trick to keep air from puffing out of my lips. That seems to help most of the time.
I am pretty new at the game myself. Hope to hear more form you as you progress

Welcome to the forum! It sounds like you're off to a great start--really, even with the mouth breathing. You're already sleeping better and feeling better. From here on, it's just tweaking to get the most benefit. Congratulations!