Taping

First of all, I want to thank everyone on the forum--I have learned so much just from reading the posts. I have gained a lot of knowledge and am tryiing to take control of my relatively new (started apap on August 29 of this year) diagnosis and my treatment.

I have a question about taping your mouth. I use the Zest Nasal Mask. Some mornings when I wake up, my throat feels dry. I'm not sure if I am mouth breathing or not. DH is no help--he sleeps so soundly he told the sleep doctor at my first appointment that I didn't stop breathing in my sleep. (Yeah, I got to really rub that in when we got the results of the sleep study and my AHI was 31!) My humididty is set on 3.5 on my ResMed Autoset APAP. My AHI is really good (less than 0.5 on most all nights). I must confess I don't really know how to read the leak statistics on the ResMed software.
I thought I might try taping at first to see if that helped my dry throat and if it did, I would get a chin strap of Papcap. The problem is, what type of tape do you use and do you put it horizontally or vertically on your mouth, chin or lips?

Thanks for all your help!

On the software...leak line...does it often go above the red line or stay there a long time?
I have found it doesn't take a lot of mouth breathing to dry the mouth out and yet still not hugely impact the leak line.
If it doesn't impact the leak line I figure it won't impact therapy all that much. So I don't worry so much about it.
A few spikes to the red line and even above for really short periods of time probably won't impact therapy all that much.
Now of course if you spent a lot of time over the red line...well your know what that means.

Tape...blue painters tap 2 ".. delicate kind if your skin is fragile.
Horizontal cross the lips though some people do a vertical adaptation.

I taped early on in therapy because I had some massive leaks..after a couple of months I quit and leak line stayed stable except for occasional blips we all have. Sometimes I wake up and have a bit of dry mouth and my mouth is open...... so I look on the reports and I don't see a thing pointing to a massive leak. I can only surmise that the time was brief and probably not long enough to hurt anything and I shrug it off. You may or may not be mouth breathing enough to seriously impact your therapy. Just look at that red line and see how much time you spend there or above.
Don't look at the overall numbers...look at the leak line on the graph itself.

ccu nurse wrote: I must confess I don't really know how to read the leak statistics on the ResMed software.

You didn't post the leak numbers from your data. So, let's make some numbers up so that you can see what they mean.

Lets suppose your leak numbers are: Median: 1.4, 95th% 6.4 and Maximum 20.4 What do these numbers mean?

Since you are using an S9, the numbers represent your UNINTENTIONAL leak rates.

In other words, ResMed and ResScan subtract off (an estimate for) the intentional leak rate for your mask at your pressure setting. So all the leak that is reported is UNINTENTIONAL or EXCESS leak---the kind you want to minimize.

Median: 1.4
This means that for 50% of the time the S9 was running, your unintentional leak rate was AT or BELOW 1.4 L/min. It also means that your unintentional leak rate was AT or ABOVE 1.4 L/min for 50% was running. If these are overnight figures, that's 50% of the night with leaks AT or BELOW 1.4 L/min and 50% of the night AT or ABOVE 1.4 L/min.

95%: 6.4
This means that for 95% of the time the S9 was running, your unintentional leak rate was AT or BELOW 6.4 L/min. It also means that your unintentional leak rate was AT or ABOVE 6.4 L/min for 5% was running. If these are overnight figures, that's 95% of the night with leaks AT or BELOW 6.4 L/min and 5% of the night AT or ABOVE 6.4 L/min. And how much is 5% of the night? Well, 5% of one hour is three minutes. So you can get an idea of an upper bound on how long your worst leaks (the ones above the 95% leak figure) lasted by multiplying the usage (in hours) by three minutes/hour. For example, if your machine was running for 7.3 hours and the 95% leak figure is 6.4, that means your leak rate was AT or ABOVE 6.4 L/min for a total of (7.3 hours)*(3 minutes/hour) = 21.9 minutes

Maximum: 20.4
This means that at some point when your S9 was sampling the leak rate it detected a leak of 20.4 L/in. We know you could not have been leaking at this rate for more than 5% of the night because your 95% is much lower than 20.4. When the max leak rate is this much higher than the 95% leak rate it could simply be that the S9 happened to sample the leak rate just as you were making a major adjustment to the mask and you knew the seal was broken because you'd pulled the mask away from your nose in order to reseat the mask. Or it could be that you had a 15 minute leak that was really, really bad. Only the leak line tells which case is more likely.


Are the leaks really a problem?

Leaks come in three basic varieties:

• Leaks that are LARGE enough and LONG enough to adversely affect your therapy. These obviously have to be dealt with. Are your leaks in this category? Well, the Resmed engineers believe the machine is capable of compensating for leaks up to 24 L/min as long as they're not too long lasting. The infamous Mr. Red Frowny Face shows up when the Resmed engineers believe your leaks are both LARGE enough and LONG enough to compromise both your therapy and the data the machine records. Mr. Red Frowny Face shows up when your 70% leak rate is AT or ABOVE 24 L/min. In other words, the Resmed engineers believe that if your leak rate is AT or ABOVE 24 L/min for 30% (or more) of the night, there's a real leak problem that the machine cannot cope with. And at that point, you really do need to do something to address the leaks.
• Leaks that are LARGE enough and/or LONG enough to adversely affect your comfort. These are leaks that are either not large enough or not long enough to clearly adversely affect your therapy and the data. But if a leak wakes you up, it's a problem. If you wake up with dry eyes from leaks causing air to blow in your eyes, that's a problem. If you wake up with a dry mouth, that's a problem. If you can't get to sleep in the first place because every time you move in bed the mask springs another leak that makes you more alert, that's a problem. And if you can't get to sleep because the leaks simply annoy you and keep you from drifting off into slumberland, that's a problem. In other words, if the leaks are causing you discomfort, they're a problem and they need to be dealt with so that you'll be more comfortable, and hence, sleep better.
• Leaks that are NOT large enough and/or long enough to adversely affect your therapy AND do NOT cause you any discomfort. My advice on these leaks is to not lose sleep over them. No one is going to have 95% leak rates equal to 0.0 L/min night after night after night. If that 95% leak rate is below 10 or 15 and you're sleeping through the leaks and not waking up with any problems caused by the leaks, then don't get too worried about working excessively hard to eliminate the last bit of leaking.

Welcome from one nurse to another. Former CCU nurse too! Now Clinical Documentation Improvement Specialist.
I use Nexcare paper tape. I tape horizontally from one side to another. I have heard others tape vertically. Try different things to see what you like best. Chin strap did not suit me as well as taping. I was shocked to find that out because I thought taping your mouth shut sounded so barbaric to me. Do you use software to view your data? With ResMed S9, leak rate should stay under 24L/min and you should try to prevent long leak times. Leak spikes for brief periods of time and minimal leaks in terms of volume can be normal.

Thanks Pugsy!

I must not be doing something right on the software. The only thing I see is a daily graph of the leak. Some nights it looks good, some nights it looks up to the line. I'm not even sure how to download the data to a screenshot so I can post for others to see???

The worst tape I sed was paper surgical tape. It leaves a large amount of adhesive residue that's difficult to remove. I was visiting with a nurse and told her about the residue and she recommended J&J cloth surgical tape. It was good. No residue at all. However, I could only find it in 3/4" rolls and it took a minimum of four 5" strips a night, so I was ripping through a whole bunch of it at about four bucks a roll. Then someone on here recommended 3M painter's tape, No. 2080 EL. It's adhesive will not come off on your skin, not harsh, but strong enough to do he job. It's available at Wal-mart or Lowe's. About 10 bucks for a 60 yard by 2" roll. It will last a long, long time and is the best I have found. No more dry mouth for me. Good Luck!

Several ways to post your reports if you want to.
Here is how I do it.
BTW the single daily leak graph is all we need to see...no need for summaries and trends and all that.
Best to see what happens in a single night.


Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

Got it! Thanks everyone!!!!

When you are doing your download of data are you choosing to change the default of summary to all detailed data?
I forget the exact wording. Looks like summary here. I don't use this machine or software so I don't remember the exact wording. I know if you don't change the default you don't get individual nightly details.
There is a video explaining how to use the software. Have you seen it?
http://montfordhouse.com/cpap/resscan_tutorial/

That said. I can see from this that most nights your leak was well within acceptable limits.
8 nights it reached the red line. All the others are fine. From this report we can't see just how much time you spent at the red line during the individual nights. It might not have been nearly as bad as you might think.

Here is one night's data. Oct 16, one of the nights that the first chart showed at the red leak line.

ccu nurse wrote:Here is one night's data. Oct 16, one of the nights that the first chart showed at the red leak line.

Well..... I certainly don't see it. Looks remarkably good to me. Perhaps that last little spike before you woke up.
That line doesn't need taping as far as leak itself is. Nothing there bad enough to impact therapy.

Looks pretty darn good. Nothing there needs improvement at all.

Actually, your leaks look great compared to mine....but I use the wide blue painters tape. I use two strips horizontally and one strip vertically to keep it in place...i have been using it for a month now with no problems. I do not like the chin strap so this has been great for me. One day i took a nap and put nothing on...i guess i forgot. my mouth was dry as cotton....so yes this helps me. Give it a try...

Taping your mouth risks suffocation if the machine quits blowing and you don't wake up. You will be rebreathing your own exhaled air. Oxygen will decrease and CO2 will increase. This can cause you to sink deeper into unconsciousness and stop breathing. This is why the FDA requires all full face masks to have an anti-asphyxia valve.

Most people will wake up and be able to take the mask or tape off, but it's not a sure thing.

Another risk is aspiration pneumonia if you vomit before you can get the tape off. Aspiration pneumonia is very bad. Google it.

Many people tape anyway despite the risks. The risk may be small, but you'll probably be doing this for the rest of your life so risks add up.

archangle wrote:Taping your mouth risks suffocation if the machine quits blowing and you don't wake up.

How many friends did you loose this week?

Give it a rest, please.

ccu nurse,

First, the leak line on the night where you posted the detailed data looks quite good.

Second, that summary data of your average, 95%, and max leak data looks far, far better than you think it does.

ALL those nights where the leak is at or approaching the red line? It's the maximum leak that's the one that's touching or over the Red Line. And remember that the maximum leak rate is just that: The biggest leak the S9 detected all night. If it sampled the leak rate at a time when you were tugging on the mask (perhaps to scratch you nose for example), then that maximum leak rate can easily be way higher than what was happening all during the rest of the night.

On ALL of the days with posted data, the median leak rate is invisible. That means that your median leak rate is consistently down close to 0.0 L/min. In other words, the S9 is detecting NO unintentional leaking for at least 50% of the time it is running.

Moreover, on the vast majority of your nights, the 95% leak rate bar is also invisible and even when it is visible it is very small---as in well less than 5 L/min. This means that on MANY nights, the S9 can detect no UNINTENTIONAL leaking going on for 95% of the time the machine was running. In other words, on many nights, your S9 is detecting a measruable unintentional leak for no more than 5% of the night. Indeed, the night with the largest 95% leak rate (the 5th night from the end) has a 95% leak rate of only about 5-7 L/min. That's exceptionally good leak data.

So whatever is causing the dry mouth, it's not leaks that are big enough to adversely affect your therapy. Pugsy is right several posts back when she said that it's possible to have a very tiny, itsy-bitsy leak that doesn't show up in the leak data, but still manages to dry the mouth out.

Or another possibility is that air is getting into your mouth and drying it out, but you're swallowing the excess air or breathing it instead of leaking it. This can happen to me when my tongue drops from its normal place up against the roof of my mouth. In my case, this results in a dry mouth combined with chipmunk cheeks (if I wake up in time) or aerophagia (if I don't wake up in time).