The Blowfish Follies: Adventures in Taping

xenablue wrote:As much as I hate the thought of taping, I tried it ONCE, and unless I use industrial strength duct tape, completely covering my mouth, there is NO WAY taping stops ME from expelling air that the XPAP pushes up my nose.

I'm sure it stops mouth breathing, but that doesn't seem to be my problem as much as air in my nose, same air out my mouth without being used as it should be.

I'll stick with the chinstrap and 'willing' my tongue to stay put on the roof of my mouth behind my teeth

Cheers,
xena

This is definitely one area where individual tastes vary as much as individual anatomy and needs. I apparently have either a weak-willed tongue, or a tongue with a mind of its own (more likely ), and I do catch myself mouth breathing. Perhaps if I had been experimenting with better chinstraps to date, I might like them better than the Rube Goldberg setups I've inflicted on myself so far. But the times that I've gotten a secure seal I've had my best nights since being on CPAP. It's not my intent to be a taping evangelist, but I think I'll see how taping plays out for me.

As I see it, I have two main and entirely distinct challenges now:

(1) Maintaining a good seal--I think I'm almost there, just have to be more careful with tape placement; and
(2) Not destroying my skin in the process of meeting challenge #1.

How I'm doing with #2 will become clear only over time. I should say that I have always had very sensitive skin, although (especially in my younger days) quite pretty, and it's one of my few vanities. One loses so much over the years, I hate to see my skin sacrified to the gods of ill health unless absolutely necessary. I'm not wild about the divot in my nose, and I can only imagine what a FFM might do <shudders delicately>.

DD

DD
That leak line with overall average of 32 is really quite acceptable. Just some minor blips but not huge ones. With time and experience it will level out more.
I used to have some pretty good zippers going and large zippers at that. On occasion still yet one will sneak by but at least it doesn't last the whole night like it used to.

Pugsy wrote:DD
That leak line with overall average of 32 is really quite acceptable. Just some minor blips but not huge ones. With time and experience it will level out more.
I used to have some pretty good zippers going and large zippers at that. On occasion still yet one will sneak by but at least it doesn't last the whole night like it used to.

According to this vent flow rate chart (p. 5): http://www.resmed.com/us/assets/documen ... er_eng.pdf it seems pretty darn good. And did you notice how few events I had once I settled down for the night?? I would be very disappointed if I couldn't use my nasal pillows.

DD

Drowsy Dancer wrote: did you notice how few events I had once I settled down for the night?? I would be very disappointed if I couldn't use my nasal pillows.

I did notice and I do remember what your other reports looked like. This one is great. If the leak line never improves from last night, it is still great. It is a PITA sometimes to tape but I always felt that using full face mask was more of a PITA so I chose the lesser of the demons. Rested Gal has been taping for 6 years and still prefers to do that rather than mess with full face mask. I got lucky and learned to keep my mouth shut without the tape but if I hadn't I would stock up on that blue tape for sure. I tried the poligrip stuff, yucky and messy. I hated chin straps, too hot, too confining and didn't help me all that much for the effort it took. Don't mean to scare the newbies away from chin straps but remember I am menopausal woman and don't need anything to create extra heat. I sweat enough all by myself.

Will you have some nights where things get "off"? Sure you will but even full face mask users have bad nights too.
I see no reason why you can't continue using what you want to use.

DD....

I think you're now on the way to making things work............

2" tape is the way to go......arrange the 10" strip so that you have 1" above your mouth line...and 1" below.

Sorry you couldn't find the "Edge Lock" variety......I'm finding it to be much better than the previous model.

One thing I didn't mention...is my use of Lansenoh lanolin on my nares. Sometimes the lanolin gets under the tape that's just under my nose.....and sometimes...I have a slight leak there. However, the comfort and extra sealing for the nosepiece is worth it. I'm able to keep my AHI below 1.0 all the time.

G

Oh, I haven't given up on finding EL tape quite yet. Just haven't had time to go to the really good hardware store south of here. The #2080 will have to do for now.

Second night with the #2080:

(1) I took a little more care with centering the tape on the vertical axis (looking in the mirror as I did it), and that sucker didn't budge all night.
(2) Nevertheless, I woke up briefly at 4 a.m. with a dry mouth. Huh? It appeared that the tape was still sealed across my mouth.
(3) No skin irritation so far. Milk of mag has little to recommend it as a beauty treatment.

Leak line 29 (better), AHI 2.5 (slightly worse, except falling asleep wasn't the cluster of events it usually is).



Uploaded with ImageShack.us

DD

DD.....

Your leak line looks great for the first three hours....but it shows there's a problem later. If Your mouth is dry, that pretty well means that air is escaping through your mouth.

However, I wouldn't be surprised if the leaks experienced in the last five hours were caused by a poor seal around the nares.

If you think about it, there are only two places that we can experience leaks...the mouth or the nares (I'm disregarding the two "tear ducts" ...called "punctum" I think). You could be leaking pressure in both areas....mouth and nares.

When I think about it...as I just wake up...I hold my nose....and I do a "pressure test" in the mouth-tape area....just to see if the tape let loose during the night. Another thing I haven't mentioned is that I actually use (3) pieces of tape. Two are 3" long...and the other one is 10" long. The two short pieces are applied vertically on either side of my nose in the cheek area...and extend down to the chin. The purpose is twofold....act as a sort of "chinstrap" to help support my jaw....and also to better seal the age related crevaces on either side of my nose that extend to the mouth area. I put the short pieces on first...then, overlay the horizontal 10" piece.

Even with all that tape, I have zero discomfort during removal....because I DO NOT pull the tape away from my face.

Finally, I find no need to uses a coating on my lips. My gentle tape removal technique causes no damage or discomfort to my lips.

G

Gerald wrote:Finally, I find no need to uses a coating on my lips. My gentle tape removal technique causes no damage or discomfort to my lips.

My lips weren't irritated by my band-aid setup. It was the skin on the rest of my face. I am following your slow tape removal technique meticulously at present, but think I will stick with the milk of magnesia also.

Will try the vertical strips tonight, although I don't have "marionette lines." I find nasal leaks very noisy, so unless I roused slightly and adjusted the pillows (seems unlikely unless the leaks and events match up better than they seem to at first blush) in the night to alleviate the leaks, I'm thinking mouth leaks are a better explanation. It is curious how the line drops way down again and stays beautifully flat after the bumps--like a good seal was re-established. Which makes me wonder, contrary to what I just wrote, if it wasn't nasal leaks after all.

I may look for some Ayr gel today. I'm reluctant to use Lansinoh for reasons too tedious to explain here.

I should also note that I have no idea whether I will ever get my AHI under 1.0. It was 71+ at my sleep study, 9.0 at the end of titration, and I've been working hard to get it under 5.0. If I can't get it any lower than it is now, so be it. I do want to make sure that it's as low as it can go, and a part of that is making sure all the pressure from the blower is directed where it's supposed to be, whether through taping, FFM or sleeping standing on my head if that's what it takes.

Note that my leak line is displaying TOTAL leak--which as I understand it includes the vent rate. See this thread for a spirited discussion of the difficulties of evaluating leak rates as reported on Respironics machines: viewtopic/t62590/Someone-splain-thisLar ... -read.html

The adventures continue!

DD

Last night: leak line better (until I started experimenting with other sleeping positions), leak line worse:



Uploaded with ImageShack.us

I think that's a nasal leak, not a mouth leak. I don't think I ever got it properly seated after I got up and came back to bed around hour 5. Another trip to the hardware store tonight for O-rings: viewtopic.php?f=1&t=45777&p=411389#p411149

My AHI expectations are incremental. I do feel pretty good. No rash from the tape so far.

DD

Difficult night last night, although probably not as bad as it looks.

AHI 10.8, average leak 31.0:



Uploaded with ImageShack.us

I was awake for most of hour 1, which inflates my AHI for that stretch of time. The mask leaks started when my poor spouse started having a nightmare after watching the last episode of "The Pacific" and whacked me pretty soundly in the nose in his sleep around the end of hour 3. When you're wearing nasal pillows that doesn't work too well. Yeeks.

So the tape came loose towards morning after I got whacked in the nose. It looks pretty good until then. I think it was hard to get to sleep because I had too many caffeinated sodas too close to bed.

I'm using O-rings tonight and may try the microfoam tape. So far the milk of magnesia is protecting my skin very well. I try to tell myself it's a beauty treatment.

DD

DD..............

Your attitude is fantastic! My compliments.

Looking at your charts, I think you probably have the mouth leaks fairly well under control. I suspect, however, that your pressure is not high enough. You might try bumping it up 1/2-cm at a time......testing each small pressure increase for a week before you make another change. Nosepiece sealing is critical. Your internal pressure must be as constant as possible....to push open your airway to prevent hypopnea (an apnea wanna-be) or a real apnea where you cut off your air supply.

I know you said you were reluctant to use Lansenoh....so, I suggest that you find something else to help seal the nasal bellows. Also, you might use a magnifying mirror to help with adjustments to your nosepiece.

I found that I was able to determine the best angle and best nare fit by removing the nose piece....applying it to my nose at various angles and positions....while pressurizing my airway with my diaphragm muscle. I used my thumb to seal the nosepiece hose connection while I pressurized....forcing air backwards into the nosepiece. I could make the nosepiece leak more...or less....depending on the "nosepiece-to-nares-angle" and how much hand pressure I used to push the bellows against my nares. In this way, I was able to adjust everything for maximum comfort, maximum seal, and lowest AHI....the Holy Grail....the "sweet spot".

Nasal masks can handle higher pressures with more comfort...than can FF masks. It's a simple matter of Physics.....so you're going in the correct direction.

G

Last night AHI 2.5, average leak 35.0 (the hard way)

This was a little weird.

Used O-rings on the nasal pillows (liked), used the microfoam tape. I liked the microfoam tape a lot BUT--discovered that I took it off in the middle of the night for reasons that are unclear to me. I don't remember when but I can speculate from my leak line when that might be.



Uploaded with ImageShack.us

Thanks for the compliment, Gerald! I figure whining won't make this work any better. If it did, I would.

DD

You're right.....Whining won't help.

Only good, solid reasoning works. It helps if you turn the process into a sort of "game challenge"......with happiness gained with small successes...one at a time.

G

While you were not leaking, you didn't have many events. The fact that more flags appear after leaking started makes me wonder how valid those flags are. Once you solve that problem, your numbers should be much better. Of course, the real question is whether YOU are better.

Gerald wrote:Only good, solid reasoning works. It helps if you turn the process into a sort of "game challenge"......with happiness gained with small successes...one at a time.

Fortunately I am a logical person with a good basic understanding of the scientific method, and mature enough to cultivate enjoyment of small successes (I've lost a great deal of weight that way ). My minigoal for tonight is to see if I can keep the microfoam tape on. While I was still awake it seemed much more comfortable and pleasant than the #2080 painter's tape. If, however, I am prone to tear it off in in the middle of the night (which I haven't done yet with the #2080) it is obviously a poor choice.

Gerald, I actually went in search of Lansinoh today but was stumped so will have to look online. I did find some Ayr gel so I'll give that a whirl also.

M.D.Hosehead wrote:While you were not leaking, you didn't have many events. The fact that more flags appear after leaking started makes me wonder how valid those flags are. Once you solve that problem, your numbers should be much better. Of course, the real question is whether YOU are better.

I noticed that myself, but I don't think I have enough data to suss it out quite yet. I could be that I was sleeping more restlessly because my blowfish routine was waking me up, so those are sleep-onset events. Or I could be having more events because I wasn't having an adequately therapeutic level of pressure delivered to my nose. Or it's just suspect data (although I would think larger leaks would lead to more false negatives?).

ETA: here's a thread where a user looked at five months of his own data and did not feel that there was a clear correlation between his leak rate and event rates: viewtopic/t62752/Does-leak-rate-affect- ... ws-no.html

DD