Mouth breathing question

Ok I hope this doesn't sound too stupid...

First a little background on me.
I haven't been given any information other than here's your machine and good luck basically. I like to be self sufficient and learn by searching when I am not provided with information, which is how I stumbled upon these forums. When I did the titration in the 2nd sleep study the gave me a nose mask (sorry if that's the incorrect terminology as I am still trying to learn all of this). I am a mouth breather so it didn't work out too well. I didn't sleep more than 1 1/2hrs during the first study and about 2 or 2 1/2hrs the second. I know I lost pressure through my mouth during the titration. When the tech came to my house to setup the machine he eyeballed my size and ended up leaving me a large mask which ended up leaking in my eyes. I now have a medium Quatrro and no matter how I adjust it I still get leaks up near the bridge of my nose thus getting into my eyes (which keeps waking me up). I have decided to try the Mirage Liberty which is one of the 3 ffm they offer.

adding more information

My pressure is 12 and I use the ramp feature. Other than that there are no other pressure settings. I don't have any software yet for getting more data. The longest I have slept with the therapy was 6hr one night. I believe the average so far is 3.6hrs. I don't have a problem falling asleep with it on, just when it wakes me up leaking in the eyes. From the limited time that I have used it I believe my AHI is between 5-6. During my test they said I was at about 11\hr. The longest apnic period was 39 seconds.

Now for my question.
I have read on here about people using chin straps or taping their mouths up. I thought I read about people doing that even though they use ffm. I have bad sinuses thus the mouth breathing. If I am using a ffm and mouth brething am I still getting sufficient treatment? I believe that I but after some of the things I have read I believe I have confused myself ...kind of information overload....along with feeling like I haven't slept in weeks.

I really want this to work as I realize how important this is. I was a medic for 13 years so have seen many people who were on CPAP and have seen plenty of people who went while they were sleepng. I don't want that or something else happening to me. Sorry for the long post. I figured I'd try and give as much info as possible as I am sure I will have other questions down the road. Hopefully someone doesn't point me to another thread where this was answered already as I did try using the search function and didn't find anything pertaining to this.

danimal71 wrote:Now for my question.
I have read on here about people using chin straps or taping their mouths up. I thought I read about people doing that even though they use ffm. I have bad sinuses thus the mouth breathing. If I am using a ffm and mouth brething am I still getting sufficient treatment?

Yes, you are, unless your mask is leaking too much. Opening your mouth inside of a full face mask is fine because the air is not going to rush out, given that the mask is pressurized.


I'm one of those who wrote that I tape even though I use a FFM. I do that because when my jaw relaxes it can easily disconnect from the mask and then I would lose pressure. I tape in lieu of using a chin strap, because I don't like chin straps and they don't work for me. I don't tape my mouth closed, however. I just tape my jaw shut by running tape from below my chin up onto my cheeks. I have sometimes done a similar thing by running tape from below my chin up onto the mask, but I have found that taping to my cheeks is more convenient.

If you look for a chin-up strip, either here or on google, you will see a very similar concept to what I do. I used to use chin-up strips (that I made from 2 inch tape) but they don't do a good enough job, so now I run longer pieces of tape as described.

Thanks for the quick response and confirming that my thinnking was correct. I figured that's what the ffm were for. I think I would suffocate if I tried to breathe through only my nose the entire night.

What determine's what's an acceptable amount of leaking? If I leak from the side or chin area and it's not gushing out is that acceptable to sleep with? From the reading I have been doing I now feel foolish to think that I would have a perfect seal all night long.

danimal71 wrote:Thanks for the quick response and confirming that my thinnking was correct. I figured that's what the ffm were for. I think I would suffocate if I tried to breathe through only my nose the entire night.

What determine's what's an acceptable amount of leaking? If I leak from the side or chin area and it's not gushing out is that acceptable to sleep with? From the reading I have been doing I now feel foolish to think that I would have a perfect seal all night long.

Actually, I don't think a perfect seal is impossible to achieve. I believe I used to get a perfect seal when I sealed my mask with silicone earplugs.

The acceptable leak rate depends upon the mask and the pressure. The higher the pressure, the higher the acceptable leak rate.

If you search, you can find a chart for the various acceptable leak rates at various pressures for the Quattro. Someone posted a link to such a chart the other day.

The literature you received with your mask may have that information.

danimal, Since you're using the ramp it is advisable to make your mask adjustments at full pressure. This might help with the leaks because if you adjust your mask at the ramp setting, everything might seem fine until the pressure starts to increase. My husband is a mouth breather and has a good leak rate with his FF mask.

I never used the ramp when I first started on therapy. Now I'm using it to help me resolve leaks, and I'm liking it a lot.

I'm using the Quattro mask right now, and I DO use the ramp on purpose to help me fix the leaks. It's easier to get the mask set at 4 cm than at my prescribed 9 cm. I set the ramp to start on 4, and the ramp only lasts 5 minutes. I spend that 5 minutes adjusting the mask in little micro adjustments. What I do is get the mask on and set at 4 cm, then lie down in the position I usually sleep in. As the pressure ramps up, little leaks develop, and they are much easier to fix when they are little. Most of the time it just requires me to turn the dial one click. This allows me to not over-tighten the mask. The Quattro is the worst I've had for leaving red marks. I don't want it any tighter than necessary.

Not everything works for everyone. To danimal71, I suggest you experiment with different ways. You might find that having the ramp on for a short while will help you with the Quattro to get it to stop leaking.

"Acceptable" leak rates vary, depending on brand/type of mask, and machine. I can only speak with ResMed products - the clinician manual provides information. I'm sure RemStar should have the same.

FFM work for some folks - I tried them at DME office but none of them appeared to fit well, and all of them leaked. So I gave up trying and went with tape and chinstrap options.

Chinstrap - papcap plus 4 is the top of the line. Works for some, not for others. I've got one but again, didn't work for me.
Tape - again some like it, some don't. I use 2 inch blue painter's tape, #2080, nightly for about 8 months now. I get occasional blow-out but by in large, my leak rate is quite low and acceptable.

The key is to experiment and see what works best for you. Once you've got the leaks down to acceptable range, then you will be in better position to tweak the right pressure, ramping, EPR settings, etc.

Well, here's my 2 cents.

I have similar issues as you do. I found by experimentation that using an APAP - I could raise my lower pressure to around 8.5 or 9 and my mouth stays fairly shut - anything above that pressure caused serious mouth breathing. But, since I use an APAP - the pressures go up when it thinks I need more. Apparently the baseline lower pressure at 8.5 or 9 is enough most of the night. When the machine kicks up the pressure - I don't seem to mind and still do not seem to open my mouth much. I apparently mouth breathe after a sustained amount of pressure, not the kind of "blip" that an APAP gives. So I can use a nasal mask, not tape, not use a chin strap - and mouth breathe minimally. This is only if I keep my minimum pressure below a certain point. But that point seems to be enough.

I never found a FFM that worked for me - the Quattro was one of them. They just didn't - so I gave up and continued to use the nasal SoftGel mask. If I run my machine in CPAP mode at ... say ... 10 --- I mouth breathe like you wouldn't believe. So It seems that APAP with a nasal mask works best for me even though my problem is in my upper airway (sinuses - my lower palate has been lasered out). This is the total opposite of what you'd expect, but it works. I optimized things further by settling on 12 as an upper pressure limit, and now average and AHI of about 0.3 usually less. One night this week my AHI was 0.0, but that was just luck.

You have an APAP - so is it set in CPAP mode for a pressure setting of 12? Have you entertained the thought of playing with the settings (titration in a sleep lab is never perfect - or even close)? Have you tried a range of pressures in APAP mode? It would really help to have software to do this, but I think you would benefit tremendously. All I know is no matter how much I try, my AHI is higher when I use a FFM even after playing with the setting to get it optimally set.

If not, it sounds to me like your mask is leaking a lot and it is making life difficult for you. I bet your AHI could get a lot lower than 5-6.

danimal71 wrote:Ok I hope this doesn't sound too stupid...

First a little background on me.
I haven't been given any information other than here's your machine and good luck basically. I like to be self sufficient and learn by searching when I am not provided with information, which is how I stumbled upon these forums. When I did the titration in the 2nd sleep study the gave me a nose mask (sorry if that's the incorrect terminology as I am still trying to learn all of this). I am a mouth breather so it didn't work out too well. I didn't sleep more than 1 1/2hrs during the first study and about 2 or 2 1/2hrs the second. I know I lost pressure through my mouth during the titration. When the tech came to my house to setup the machine he eyeballed my size and ended up leaving me a large mask which ended up leaking in my eyes. I now have a medium Quatrro and no matter how I adjust it I still get leaks up near the bridge of my nose thus getting into my eyes (which keeps waking me up). I have decided to try the Mirage Liberty which is one of the 3 ffm they offer.

The lab and the sleep doc you went to are suspect. If they were having trouble getting TST (total sleep time) from a titration study they should have drugged you. The fact that they were happy with the hour and a half they got for the titration makes me wonder about them. You can always find another sleep doc and redo the study. I would recommend that anyway.

Don't call yourself a mouth breather. That is fictitious terminology. The human body opens the mouth to double up on the airway when and only when blood oxygen drops. IE- you break into a sprint or in some way end up in respiratory distress. If your airway is clear and your sa02 is above 85% your body should not need to open the mouth for any reason unless of course you are having events or you are on too high a pressure. If you are on an optimal pressure and your mouth does come open for any reason the body will recognize that you are getting more than enough oxygen through the nose and it will close the mouth as easily as it opened it. Exceptions of course- if you have few teeth and not much jaw structure then any pressure will be too much pressure and the mouth will come open anyway.

Go to your DME company, tell them you want to see a medium Resmed Swift FX. It is a nasal mask however if you are set to an optimal pressure than you should be fine. Pressure test it with a CPAP machine there at the DME company to make sure you got a good nasal piece that seals around the nostrils and will not leak.

If you are missing teeth in the front of your mouth however, tell us and I'll give you another solution.

danimal71 wrote:adding more information

My pressure is 12 and I use the ramp feature. Other than that there are no other pressure settings. I don't have any software yet for getting more data. The longest I have slept with the therapy was 6hr one night. I believe the average so far is 3.6hrs. I don't have a problem falling asleep with it on, just when it wakes me up leaking in the eyes. From the limited time that I have used it I believe my AHI is between 5-6. During my test they said I was at about 11\hr. The longest apnic period was 39 seconds.

Don't listen to the AHI detector on the cpap machine. It is bogus information as it does not comply with AASM standards. Do not use the ramp feature either. It does not help you acclimate, all it does is hide leaks which will appear after it gets up to full pressure. As you were titrated with a nasal mask you should be using a nasal mask. The Resmed Quatro is a nice mask (it is actually what I use) however if the fibers below your jaw are atrophied it can cause more events than it fixes. We know the nasal mask works... use the nasal mask. Once again, unless you are missing teeth in the front of your mouth, in which case we will have to think of something else.

danimal71 wrote:Now for my question.
I have read on here about people using chin straps or taping their mouths up. I thought I read about people doing that even though they use ffm. I have bad sinuses thus the mouth breathing. If I am using a ffm and mouth brething am I still getting sufficient treatment? I believe that I but after some of the things I have read I believe I have confused myself ...kind of information overload....along with feeling like I haven't slept in weeks.

Listen to me very closely. Chin straps never worked. They were a bad idea from the start and people who recommend them have no idea what they are talking about. The sinus problems are probably caused by oral breathing which in turn were probably caused by respiratory distress. Do everything you can to make a nasal mask work and if your pressure is indeed 12cwp, you should overcome this in no time.

danimal71 wrote:I really want this to work as I realize how important this is. I was a medic for 13 years so have seen many people who were on CPAP and have seen plenty of people who went while they were sleepng. I don't want that or something else happening to me. Sorry for the long post. I figured I'd try and give as much info as possible as I am sure I will have other questions down the road. Hopefully someone doesn't point me to another thread where this was answered already as I did try using the search function and didn't find anything pertaining to this.

Resmed Swift FX, make sure you test it against 12cwp to make sure it doesn't leak out of your nostrils. Get the right size. If it still causes problems then your pressure is not 12cwp and you need another PSG from some one that knows what they are doing.

Since this is a mouth breathing topic, naturally I need to ask:

How likely is it that I could be mouth breathing or mouth leaking without it waking me up?

Many people on this forum say that I'm in denial about this. However, well, I guess you could say I'm in denial.

A cat jumping on the bed wakes me up.
Being thirsty wakes me up.
Having to pee wakes me up.
Changing positions in my sleep wake me up (because I need to re-adjust my mask).
The blanket being out of position wakes me up.
The cats doing "projects" downstairs wake me up because I hear the noises.
The start of a gentle rain wakes me up.
A sudden breeze from an open window will wake me up.
And, if i have a slight leak through my nasal pilows, the noise wakes me up.

So why do people on this forum say that my treatment is'nt working because I'm mouth-leaking?
I don't understand. I've intentionally opened my mouth a few times with the mask on, and nothing leaks unless
I make a consious effort to reposition my tounge from the roof (top) of my mouh, to the bottom.

In the one or two instances where my tounge I guess went wayward during deep sleep, the rush of air
leak is freaking loud, and of course I woke up immediately! Is it really possible that in deep sleep that some how my tounge changes position
so that air leaks out, and that I'm sleeping so deeply that the noise doesn't wake me up???

So, is it really possible that people could have a mouth leak with xPAP, and yet the noise doesn't wake them up??

That's my questions, and it's actually an important question because I need to know if I'm in fact mouth breathing,
and I don't know how to determine that. Any ideas? I really don't want to charge my insurance for a full face mask,
or even a chin strap, because from what I've read on these forums, neither of these solutions are all that
great.

(Full masks are leak-prone, and chin straps don't always work).

So really what I'm after is - how do I know if I'm leaking air from my mouth?
What's an easy way to find out?

I mean, people here describe how to tape their mouth closed, and describe how make dental appliances to keep the tounge in the right position to block any
air flow through the mouth ... but what if only want to at this state figure out it I'm actually leaking air through my mouth? Any ideas?

larry63 wrote:Since this is a mouth breathing topic, naturally I need to ask:

How likely is it that I could be mouth breathing or mouth leaking without it waking me up?

Happens all the time. It is really not as big a deal as people make it out to be. They are envisioning oral breathing as a serious loss of pressure which could ruin everything. This is mostly because they have never run a TPSG and they don't know. You could have a dream where you open your mouth to talk to some one, you could swallow saliva and momentarily let pressure escape. So long as the mouth closes on it's own after it has opened on it's own, it will not cause any problems. If it is causing arousals or events however, that is another beast entirely. That is you on too high or too low of a pressure.

larry63 wrote:Many people on this forum say that I'm in denial about this. However, well, I guess you could say I'm in denial.

A cat jumping on the bed wakes me up.
Being thirsty wakes me up.
Having to pee wakes me up.
Changing positions in my sleep wake me up (because I need to re-adjust my mask).
The blanket being out of position wakes me up.
The cats doing "projects" downstairs wake me up because I hear the noises.
The start of a gentle rain wakes me up.
A sudden breeze from an open window will wake me up.
And, if i have a slight leak through my nasal pilows, the noise wakes me up.

So why do people on this forum say that my treatment is'nt working because I'm mouth-leaking?

It is not due to oral leak. You are either on the wrong pressure or you have a serious mask leak going on- either way you need another titration. If you have had one recently and that is how you got on this pressure- you need to be titrated by another lab entirely. Bad titration are a good portion of the problems people have on this forum.

larry63 wrote:I don't understand. I've intentionally opened my mouth a few times with the mask on, and nothing leaks unless
I make a consious effort to reposition my tounge from the roof (top) of my mouh, to the bottom.

In the one or two instances where my tounge I guess went wayward during deep sleep, the rush of air
leak is freaking loud, and of course I woke up immediately! Is it really possible that in deep sleep that some how my tounge changes position
so that air leaks out, and that I'm sleeping so deeply that the noise doesn't wake me up???

So, is it really possible that people could have a mouth leak with xPAP, and yet the noise doesn't wake them up??

A person who is perfectly titrated should be able to sleep through an earthquake.... except if the earthquake cuts the power. Oral leak is not large enough (on any patient) to cause events. If you are still having problems then you need to see your sleep doctor or get a new one.

larry63 wrote:That's my questions, and it's actually an important question because I need to know if I'm in fact mouth breathing,
and I don't know how to determine that. Any ideas? I really don't want to charge my insurance for a full face mask,
or even a chin strap, because from what I've read on these forums, neither of these solutions are all that
great.

(Full masks are leak-prone, and chin straps don't always work).

So really what I'm after is - how do I know if I'm leaking air from my mouth?
What's an easy way to find out?

I mean, people here describe how to tape their mouth closed, and describe how make dental appliances to keep the tounge in the right position to block any
air flow through the mouth ... but what if only want to at this state figure out it I'm actually leaking air through my mouth? Any ideas?

Oral leak is irrelevant. If you are perfectly titrated and orally leaking then you would wake up after 8 hours of uninterrupted sleep feeling refreshed but with a dry mouth. Sleep fragmentation of any kind indicates that there is something else going on.

Calist wrote:

larry63 wrote:Since this is a mouth breathing topic, naturally I need to ask:

How likely is it that I could be mouth breathing or mouth leaking without it waking me up?

Happens all the time. It is really not as big a deal as people make it out to be. They are envisioning oral breathing as a serious loss of pressure which could ruin everything. This is mostly because they have never run a TPSG and they don't know. You could have a dream where you open your mouth to talk to some one, you could swallow saliva and momentarily let pressure escape. So long as the mouth closes on it's own after it has opened on it's own, it will not cause any problems. If it is causing arousals or events however, that is another beast entirely. That is you on too high or too low of a pressure.

larry63 wrote:Many people on this forum say that I'm in denial about this. However, well, I guess you could say I'm in denial.

A cat jumping on the bed wakes me up.
Being thirsty wakes me up.
Having to pee wakes me up.
Changing positions in my sleep wake me up (because I need to re-adjust my mask).
The blanket being out of position wakes me up.
The cats doing "projects" downstairs wake me up because I hear the noises.
The start of a gentle rain wakes me up.
A sudden breeze from an open window will wake me up.
And, if i have a slight leak through my nasal pilows, the noise wakes me up.

So why do people on this forum say that my treatment is'nt working because I'm mouth-leaking?

It is not due to oral leak. You are either on the wrong pressure or you have a serious mask leak going on- either way you need another titration. If you have had one recently and that is how you got on this pressure- you need to be titrated by another lab entirely. Bad titration are a good portion of the problems people have on this forum.

larry63 wrote:I don't understand. I've intentionally opened my mouth a few times with the mask on, and nothing leaks unless
I make a consious effort to reposition my tounge from the roof (top) of my mouh, to the bottom.

In the one or two instances where my tounge I guess went wayward during deep sleep, the rush of air
leak is freaking loud, and of course I woke up immediately! Is it really possible that in deep sleep that some how my tounge changes position
so that air leaks out, and that I'm sleeping so deeply that the noise doesn't wake me up???

So, is it really possible that people could have a mouth leak with xPAP, and yet the noise doesn't wake them up??

A person who is perfectly titrated should be able to sleep through an earthquake.... except if the earthquake cuts the power. Oral leak is not large enough (on any patient) to cause events. If you are still having problems then you need to see your sleep doctor or get a new one.

larry63 wrote:That's my questions, and it's actually an important question because I need to know if I'm in fact mouth breathing,
and I don't know how to determine that. Any ideas? I really don't want to charge my insurance for a full face mask,
or even a chin strap, because from what I've read on these forums, neither of these solutions are all that
great.

(Full masks are leak-prone, and chin straps don't always work).

So really what I'm after is - how do I know if I'm leaking air from my mouth?
What's an easy way to find out?

I mean, people here describe how to tape their mouth closed, and describe how make dental appliances to keep the tounge in the right position to block any
air flow through the mouth ... but what if only want to at this state figure out it I'm actually leaking air through my mouth? Any ideas?

Oral leak is irrelevant. If you are perfectly titrated and orally leaking then you would wake up after 8 hours of uninterrupted sleep feeling refreshed but with a dry mouth. Sleep fragmentation of any kind indicates that there is something else going on.

Interesting. Even though I supposedly have severe sleep apnea (AHI == 65 at the first study), and have always had symptoms of fatigue and severe inabilaty to concentrate, these symptoms have only got worse with treatment.

I'm starting to suspect that I over-estimated what my "sleep study" was truly trying to accomplish, other than to sell sleep apnea machines.

The summary report that was sent to my ENT basically mentioned nothing other than that I had a high AHI. No mention was made of whether sleep architecture was otherwise normal, or whether I had spontaneous arousles not due to respiritory events. IOW, the so called "sleep studies" seem to me to be really only to be studies to determine whether someone has OSA.

Titration by a sleep lab has its limitations. There is so much to be done, especially on a new patient, with getting an optimal pressure. For one thing, the mask used will affect what pressure is needed - unless you get a perfect seal all the time - which you never do. You do best sleeping as you do at home.

I contend that a sleep lab titration is only a starting point. It is best "optimized" by the patient (if they can) by "tweaking" the pressure and settings on their machine until they sleep the best over time. A few hours in a sleep lab is not going to cut it for anything but an approximation - unless you are so drugged out that they can do anything to you for hours and you will not know the difference.

Then the drugs will change what pressure you need at home and in reality. This is kind of like "in vitro" vs. "in vivo" when in a scientific study.

The empowered patient has the best tools available to help him or her self. The OP (who seems to have disappeared) is a good example of someone who could benefit from some self empowerment. If he had software, he would be able to see what was going on to a good extent - certainly enough to determine what is the best course to take.

The biggest issue in discussion here is whether mouth breathing of minor mask leaking causes arousals in itself. You'd need to take home a recoding EEG to figure out that one.

I haven't disappeared just a long day yesterday and didn't really get on the computer but for a few minutes.

I was diagnosed with a good case of post nasal drip years back. My nose is either stuffy or draining all year round. I have tried several medications to clear it up and nothing ever totally relieves it. This is why I have a hard time breathing through my nose. I probably should have been titrated with a ffm and not a nasal mask. The person who administered the test didn't seem as knowledgable as the person who performed my first sleep study.

I have a follow up appointment with the Sleep Dr int the begining of 2011. After I meet with him and get a better opinion of him. Right now it's not that high.

I have been having a couple better nights with the Quatrro. I actually slept for about 6 or 7 hrs with it last night and actually feel pretty good today compared to how I have been feeling. I still have the nasal mask that I used when I was titrated but haven't tried it in a while. According to the machine my AHI have dropped to 4.9 as of this morning. I know it's not a big jump from the mid 5's where I have been at since I started the CPAP. Based on all of the reading I have done on here I do plan on getting the software soon. Even though I have read about so many people on here changing their settings I still feel leary about trying it myself. Do the Dr's give you a hard time when they find out that you have done that?

Thanks for the responses\recommendations.

danimal71 wrote: Even though I have read about so many people on here changing their settings I still feel leary about trying it myself. Do the Dr's give you a hard time when they find out that you have done that?

If they do - you get rid of the Dr! Frankly I feel you can learn more from experimentation with the wonderful assistance of these board members than any sleep Dr can give you.

I know lots of people here do not like APAP - but I find it great (at least now) and think that it gives lots of room for self-improvement with software. If you have nasal issues, I bet they vary from day to day and therefore an APAP might get you closer to what you need at any one time.

Most importantly - without software and your own self-guidance - you will never know if your sleep study was done right and titration was even close. What if the pressure of 12 was totally wrong? It would explain why you can't seem to tolerate the machine for long and why your AHI doesn't get down a bit lower.

Your sleep Dr should ideally work with you and not tell you what to do. You've got a data capable APAP - what more do you need to make this work on your own? I personally don't think 15 minutes of thought (at the most!) from a sleep Dr. is going to get you that far. I doubt you will get more than 2 (of actual thought).