Please tell me it's going to be OK!

Think of the masks as shoes. You will be running a marathon, you need shoes that fit YOU, and you need to try them on and run with them, YOU decide if they fit and work for you. Anything else would be stupid - same with masks.

WilsonVilleUSA wrote: learned to not mouth breath and now use nasal pillow or cushion.

How do you learn not to mouth breathe?

I was wondering the same thing since it seemed from my observation that hubby was now sleeping with his mouth closed after all this time, so I experimented with a nasal mask we had and his mouth dropped open the minute he fell asleep. I guess the FF sitting on his chin keeps his mouth closed, no snores, no leaks low AHI. His Ultra MirageFF is very comfortable.

Thanks Dori, I think you got the gist of my question better than the others. It wasn't that I wished to breathe with my mouth open, just that having a pressure differential between my nose and mouth was uncomfortable and having even pressure felt more natural. This was minimum pressure because we were just trying the mask on for the first time. It was most evident when I tried to speak...not easy to do with the mouth closed. In reading the forum I noticed, perhaps in perceptive error, that there seems to be a big preference for nasal masks or pillows and was just wondering what the point was. So far I've got beards, comfort (personal preference), smaller mask = less leak potential all very valid and the last two good enough for me to remain open minded about exploring all mask types despite my initial middle of the night impression.

Quit the damned therapy and sleep on your side or abdomen.

I haven't started therapy and I can snore sleeping face down, on my side or flat of my back. If you had done me the courtesy of reading the thread you would know that I don't even have an official diagnosis yet. Thank you very much for the suggestion though.

After reading your first post, I was going to tell you "it is not going to be OK".

But then I read your second post,

snipsnsnails wrote: I'm very much a glass half full guy. I WILL be fully involved in my treatment cuz after the wedding I'll be living in a remote area of the world. Finding a cpap technician will require about 1100 miles of travel. That's one of the main reasons my fiance was so anxious that I get it checked. I'm not looking for an easy fix just assurance that A. this pap stuff is worth the trouble, B. I can learn to handle all this stuff myself, and C. that I can find a place online to go for help when I need it.

There is hope for you.

Don't worry about A, B and C. They are absolutely true.

I would be guessing what you mean by a "glass half full guy", but for CPAP to be successful, you will likely have to make a firm commitment to it. You say you will be fully "involved" in your treatment, but you need to be fully "in control" of your treatment. A pig is "fully involved" in bacon; Smithfield is fully in control. You want to be Smithfield.

Don't worry about 1100 miles. Many of us have doctors and DMEs within a mile of our bedrooms and don't rely on the b******s because they do such a sorry job - but you will need a prescription. An internet connection, a browser that will reach this site and DME sites, and a shipping lane for machines and supplies is enough.

To get off to a good start, read this document and be fully prepared and in control of your Thursday appointment:

Questions to ask about your PSG and Titration Study
by CPAPtalk member rooster

1. Did I have any central apneas? How many?

2. Were there any comorbidities? What were they?

3. Did I breathe or leak through my mouth? How often? What do you recommend to prevent it?

3. Did I exhibit Positional Sleep Apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.)

4. Is there anything else unusual about the results?

5. How will I know my therapy is preventing apneas?

6. I am determined to own a data-capable machine and software to monitor apneas, hypopneas and mask leak. This will allow me to call your office with specific questions if I have problems with the therapy. Will you help me with the appropriate prescription?

In addition to the questions:

1. Get a copy of your PSG. It is your legal right to have one.

2. Get a copy of your CPAP prescription.

3. Make sure the prescription calls for a humidifier with the machine.

Point number six is a critical one. Most people get screwed on their first machine and the insurance won't pay for another one for five years. Be prepared to refuse delivery of a machine if you are not absolutely sure it is the one you need.

If you don't understand everything in the document, ask questions here and get prepared in time for Thursday.

Good luck.

Snoring is not sleep apnea, millions snore and don't have sleep apnea.
Sleep apnea is when you wake up with a snort or gasp because your
air supply has been cut off by your tongue falling back or your soft palate
blocks your airway. CPAP therapy is pure hell. Try sleeping on your side
or abdomen.

SleepingUgly wrote:If you can breathe well enough through your nose AND keep your mouth shut so the air doesn't leak out of your mouth, a nasal mask is better. One reason is that full face masks tend to leak more than nasal masks just because there is more surface area for leaks.

I agree on both counts, SleepingUgly.

SleepingUgly wrote:One thing I've always wondered about personally is this: Nasal breathing is superior to oral breathing for a variety of reasons, including that opening your mouth (even without breathing through it) facilitates airway collapse.

Well, I know of one way that opening the mouth can facilitate airway collapse: loss of therapeutic pressure translates to a compromised airway stent. However, there might be yet other airway-collapse dynamics you have read about---perhaps occlusive anatomical positioning imposed by an open mouth. I haven't read about that collapse scenario yet, but I sure wouldn't be surprised if YOU have already read white papers about it, SU.

SleepingUgly wrote: So I've wondered, if opening your mouth, and if breathing through your mouth, are inferior to nasal breathing, why aren't full face masks inferior in that any oral breathing or mouth opening should facilitate more collapse, therefore entailing higher pressures?

If there are other "open mouth" collapse dynamics, then that just might be true. However, the loss-of-stenting-pressure scenario I had mentioned above shouldn't be an issue with a full-face mask---since the air pressure is already equalized at the nose and mouth, complements of the FF mask. However, mouth leaks are a genuine problem with a nasal-only interface as CPAP pressure attempts to equalize with ambient pressure at the open mouth-----hence loss of crucial stenting pressure in more severe leak cases, and sensory-based sleep disturbances are possible in less severe cases of mouth leak.

nosnore wrote:Snoring is not sleep apnea, millions snore and don't have sleep apnea.
Sleep apnea is when you wake up with a snort or gasp because your
air supply has been cut off by your tongue falling back or your soft palate
blocks your airway. CPAP therapy is pure hell. Try sleeping on your side
or abdomen.

Wow, did you read his post where he says he STOPS BREATHING FOR 90 SECONDS TO TWO MINUTES?

Sounds very likely that he does have OSA. Not sure about what therapy you've tried, but for me CPAP has been far from "Pure Hell". In fact, after being on CPAP for a short period of time I came to realize that I was far closer to pure hell BEFORE I started therapy.

Back tot he OP - sounds like you are willing to be involved in your care, that is good. Assuming you do in fact get diagnosed, get a second sleep study to be titrated and have the doc set a baseline for your pressure. Since you will be far from care, I would strongly suggest getting a machine with full data capabilities. That way you can either send the info to your doc instead of having to visit, or manage your care on your own. Get the software to be able to read your data. I have the Puritan/Bennett-Covidian "Sandman Auto HC" and love it. I have also used Respironics and they are good machines as well.

I think people should go APAP out the gate instead of CPAP. The APAP machines can run as CPAP, but I have had much more comfort using APAP. My initial prescribed pressure for CPAP was 12. On APAP I am set for 8-12 and spend far more time at 8-9 than I do at the higher pressures. Lower the pressure, generally the more comfortable and less leaks.

As far as "learning" to not breath through your mouth, having a good air flow through my nose reduced my urge to mouth breath. Without CPAP and having chronic sinus problems, I mouth breathed to get more air. Having been on CPAP I have no where near the sinus problems I used to have. I learned to keep my throat "closed" while using my mask, I can even have my mouth open and not have air leak. I don't what muscles are involved and it is hard to describe, but it is kinda like using the back of your tongue to close off your throat.

I had leak problems with every full face mask I tried. I have a Liberty hybrid that works pretty good, but I only use it if I h ave a cold or sinus infection and am stuffed up. Otherwise I use a Swift LT with nasal pillow.

Sure there are some people that can't adjust to CPAP. I think the majority that try it are able to find some relief however. It seems sill to me to give up before trying based on one or two peoples bad experiences. You certainly have nothing to loose by taking a chance, and a lot to gain if it works for you.

-SWS wrote:

SleepingUgly wrote:One thing I've always wondered about personally is this: Nasal breathing is superior to oral breathing for a variety of reasons, including that opening your mouth (even without breathing through it) facilitates airway collapse.

Well, I know of one way that opening the mouth can facilitate airway collapse: loss of therapeutic pressure translates to a compromised airway stent. However, there might be yet other airway-collapse dynamics you have read about---perhaps occlusive anatomical positioning imposed by an open mouth. I haven't read about that collapse scenario yet, but I sure wouldn't be surprised if YOU have already read white papers about it, SU.

http://erj.ersjournals.com/cgi/content/full/22/5/827

Mouth opening, even in the absence of oral airflow, has been shown to increase the propensity to upper airway collapse 20. The two most likely explanations for the latter finding are that jaw opening is associated with a posterior movement of the angle of the jaw and compromise of the oropharyngeal airway diameter 21, and that posterior and inferior movement of the mandible may shorten the upper airway dilator muscles located between the mandible and hyoid and compromise their contractile force by producing unfavorable length-tension relationships in these muscles 20

(This is actually a very interesting article that some of you will understand better than I do, but "OSA" was experimentally induced in healthy subjects by occluding their noses, but not by occluding their mouths.)

Here is an abstract that speaks to the same:

http://www.ncbi.nlm.nih.gov/pubmed/14665515

SleepingUgly wrote:

-SWS wrote: However, there might be yet other airway-collapse dynamics you have read about---perhaps occlusive anatomical positioning imposed by an open mouth. I haven't read about that collapse scenario yet, but I sure wouldn't be surprised if YOU have already read white papers about it, SU.

http://erj.ersjournals.com/cgi/content/full/22/5/827

Here is an abstract that speaks to the same:

http://www.ncbi.nlm.nih.gov/pubmed/14665515

Please see my red text above... Thanks for those citations!

Interestingly, right after my above post I tried an experiment. I breathed through my mouth only with lips slightly parted. Flow actually seemed pretty good and upper airway resistance seemed ordinary as far as I could tell. Then I very slowly parted my lips while still breathing through my mouth only. I was a bit surprised to notice that upper airway resistance seemed to progressively increase in my case, thereby requiring more and more more work to inhale. So, given my own anatomy, I might be better off with a chin strap and a full-face mask. I know that a chin strap alone doesn't work for me, and I don't like mouth taping.

Here's another one suggesting that nasal breathing is superior:

J Am Board Fam Pract 15(2):128-141, 2002. © 2002 American Board of Family Practice wrote:Another cause of OSA is nasal obstruction. The nose, best viewed as a variable resistor, contributes to nearly 40% of total airway resistance.[23] This resistance is greatly influenced by the vasomotor reaction of the nose to several factors, such as hormonal effects, metabolic changes, and numerous pharmacologic agents.[23] Olsen et al[24] measured the respiratory effort in a patient during sleep and suggested that the oral airway resistance was greater than the nasal airway resistance. With the nasal pathway being the preferred route for nocturnal breathing, an increase in nasal resistance will invariably increase the possibility of collapse of the nonrigid portion of the upper airway, namely, the pharynx.

snipsnsnails wrote: I meet with my doctor on Thursday. I'm scared, Somebody tell me it's going to be OK.

Better than just OK... Now that you know there's a problem to be fixed, addressing that problem can lead to a significantly improved life.

On that note, congratulations on your upcoming life improvements!

SleepingUgly wrote: So I've wondered, if opening your mouth, and if breathing through your mouth, are inferior to nasal breathing, why aren't full face masks inferior in that any oral breathing or mouth opening should facilitate more collapse, therefore entailing higher pressures?

That is a good question. But can it be assumed that "more collapse" actually occurs with mouthbreathing? I have some doubts that this is correct as a general rule. What I believe is happening is the same amount of collapse but into a slightly smaller airway. Maybe this is just a semantics difference.

I also question the advertising of dentists who claim MAD always results in lower CPAP pressures.

As far as the downside of mouthbreathing while sleeping, I note two important ones, but there are others.

One is drying of saliva in the mouth which then favors harmful bacterial growth which can lead to dental problems and gum diseases. This can be mitigated by impeccable mouth hygiene (flossing and thorough brushing) and use of Biotene gel immediately before sleep.

Second is,

In addition, the nose and sinus cavities make a gas called nitric oxide, which has two important beneficial properties. The first property is that nitric oxide is antimicrobial, both in the nose as well as in the lungs. This gas, when inhaled even in small amounts into the lungs, can increase oxygen absorption up to 20%. Not breathing through your nose for whatever reason has potentially detrimental effects on your health.
http://doctorstevenpark.com/index.php?s=nitric

There is a question of how damaging the second issue is to people who mouthbreath but not exlusively as they still have flow through the nasal passages. To assess this, it would need to be known what, if any, dropoff there is in nitric oxide reaching the lungs.

In any case, I spoke to Dr. Park and another doctor about concerns of mouthbreathing while using a full face mask. They both said with successful CPAP treatment so much good is being done for the patients health, that problems from mouthbreathing become minor.

snipsnsnails wrote:Hmm, something tells me Sleepy Tiger knows what a frozen chicken a la king MRE tastes like as well. Thanks folks! I'm reading and learning.

On a side note, I actually liked the Chicken ala king.