What causes "mouth leak?"

OK, I am not a CPAP newbie by any means. More the opposite. But I found out I am a severe "mouth leaker" early on and initially tried chin straps which were given to me by my DME at the time. I found chin straps to be TOTALLY worthless and I do mean totally worthless. I was then given a Quattro FFM, tried it one night, swore it off I'd never do it again and went back to the nasal mask. I then realized my back was to the wall after another night on nasal CPAP and gave up and went back to the Quattro FFM and have used it ever since. And that was late summer 2007. So, Ive been using that Quattro a LONG TIME.

But I'd kind of like to go back to a kinder, gentler form of headgear and mask. One where the straps are loose. One where the mask is loose fitting and does not leak despite being loose fitting. In other words, something COMFORTABLE. The Resmed nasal Activa fits that bill. Loose, comfy, does not leak at all even with a lot of movement and even with high pressures. The nasal Activa is a mask that is a work of art, IMO.

My problem is I cant use one. I totally lose therapy on it. Wake up with air rushing outta my mouth and my mouth will feel so dry it feels like Iraq after a napalm strike.

That brings me to ask. What exactly CAUSES mouth leak from CPAP? Is it nothing more complicated than the high pressure air going into your nose and thru your sinuses and has to go somewhere, so it bypasses your throat and goes out your mouth instead? Or are certain folks with anatomical weaknesses in the jaw or airway more prone to bad mouth leak?

Inquiring minds would like to know.

Eric

I can only state what caused my mouth leaks. I've been on CPAP for 13 years. For 12 years I was on CPAP with pressure of 10 and never had a problem with mouth leaks. Had a new sleep study a year ago and needed a pressure of 16 to start. I immediately noticed mouth leakage at 16 even with EPR set at 3. My pressure had to be adjusted up until my CPAP pressure was at 18 and still having obstructive events. The higher the pressure, the worse my mouth leaks and the higher my AHI. I just could not exhale against the high pressure, so opened my mouth for relief. So at least in my case, I can definitely say that higher pressures cause mouth leak.

This is a recognized fact in sleep medicine journal articles. I read one today online about how a standard titration is supposed to be done for both CPAP and Bilevel. The tech is supposed to carefully observe patient sleep if pressure gets to 15 on CPAP. If obstructive events still occur or obvious mouth leaks, they are supposed to switch to Bilevel titration which provides a lower exhale pressure.

http://www.aasmnet.org/Resources/clinic ... 040210.pdf

If my sleep study had been performed using the standard of practice, I would have been prescribed a Bilevel machine a year ago instead of one year of struggling to control my mouth leaks on CPAP at 18.

That definitely does make a lot of sense. For some, you can only get but to so high of a pressure before you begin to get mouth leak. Nothing you can do about it. It does sound like you got the short end of the stick not being titrated on Bipap at such high pressures. All too often in sleep medicine, if insurance is involved at all, it seems sleep docs and techs and RTs dont want to take the proper...and oftentimes more expensive route. I had a Bipap for about eight months and recently gave it back to my DME. It had about at most, a weeks worth of night data on it. I returned it, barely used. I did get to keep the humidifier with it, though.

My pressure situation is where I am pushing those pre-Bipap pressures. Im in the 14s thru the 16s for my 95th percentile. If I lost 30 lbs, my pressures would drop back to a consistent 12 to 14ish range. If I lost 50 lbs, I would drop back to about 10 to 11 range, topping at 12ish sometimes. I have not gotten under 204 since being on CPAP, so I dont know what my pressures would do if I got down to 190 or under. I suspect it would be very good though.

Beyond the rather obvious, the fact that pressures 10 and over basically induce mouth leak, I'd like to know if there are certain anatomical factors that contribute to mouth leak. Certain jaw types for instance. Today I was told by a sleep medicine trained dentist that I do not have a receding jaw or a "weak chin." I was told my jaw was pretty strong, even at age 44. I was told that I had a certain type of jaw, one that might respond well to an oral appliance combined with nasal CPAP. The dentist explained the anatomy of it, but he was talking a language I did not understand. Something about my jaw type being "high." And sometime to the effect that if I was able to get my lower jaw moved forward and open my airway some to begin with when I went to bed, the air from nasal CPAP would go right down my throat into my trachea and into my lungs like its supposed to. And not out of my mouth as in mouth leak.

I did not quite know whether to trust what he was telling me, as I know he makes some of his money by making and selling prescription oral appliances and not prescribing CPAP.

Eric

VikingGnome wrote:I can only state what caused my mouth leaks. I've been on CPAP for 13 years. For 12 years I was on CPAP with pressure of 10 and never had a problem with mouth leaks. Had a new sleep study a year ago and needed a pressure of 16 to start. I immediately noticed mouth leakage at 16 even with EPR set at 3. My pressure had to be adjusted up until my CPAP pressure was at 18 and still having obstructive events. The higher the pressure, the worse my mouth leaks and the higher my AHI. I just could not exhale against the high pressure, so opened my mouth for relief. So at least in my case, I can definitely say that higher pressures cause mouth leak.

This is a recognized fact in sleep medicine journal articles. I read one today online about how a standard titration is supposed to be done for both CPAP and Bilevel. The tech is supposed to carefully observe patient sleep if pressure gets to 15 on CPAP. If obstructive events still occur or obvious mouth leaks, they are supposed to switch to Bilevel titration which provides a lower exhale pressure.

If my sleep study had been performed using the standard of practice, I would have been prescribed a Bilevel machine a year ago instead of one year of struggling to control my mouth leaks on CPAP at 18.

Suddenly Worn Out wrote:Today I was told by a sleep medicine trained dentist that I do not have a receding jaw or a "weak chin." I was told my jaw was pretty strong, even at age 44. I was told that I had a certain type of jaw, one that might respond well to an oral appliance combined with nasal CPAP. The dentist explained the anatomy of it, but he was talking a language I did not understand. Something about my jaw type being "high." And sometime to the effect that if I was able to get my lower jaw moved forward and open my airway some to begin with when I went to bed, the air from nasal CPAP would go right down my throat into my trachea and into my lungs like its supposed to. And not out of my mouth as in mouth leak.

He was probably saying that your palate (roof of mouth) is high giving your tongue more room in your mouth. I have a very flat, barely arched palate so my tongue is really crowded and tends to fall back into my throat when asleep. A dental appliance would do nothing for me. It would just crowd my tongue more.

Whether to trust your dentist or not? I have a brother and brother-in-law who are dentists in California. They both have been on CPAP for 10 years. If they aren't using a dental appliance for OSA, it tells me I shouldn't.

I don't know what causes it. I just assume that my jaw goes slack due to atonia while I sleep. Why the air comes out my mouth... Why wouldn't it?

My mouth doesn't stay closed, it takes work and when I am asleep it just falls open. After fighting with the quatro I tried the Innomed/Respcare Hybrid. It took some work but I now use it all the time unless I have cold.

Hello Folks...

is my first week and last night my wife do not get sleep... Again !!!

she says I am doing a noise different my snoring before, but very audible...
my mouth continues dry, I am using a micropore tape to close..but without success. and with the tape now I am producing this noise.
she records and sounds like a blow....and a little beat of snoring...

this is my graphics for this night...

my cpap is auto then I do not set the pressure...maybe force the pression solves the problem ??? or auto configuration is the best option really ?

thanks for help...

screen1:
http://i1355.photobucket.com/albums/q71 ... 8ef10c.jpg

screen2:
http://i1355.photobucket.com/albums/q71 ... 663edb.jpg

piwtorak wrote:she says I am doing a noise different my snoring before, but very audible...
my mouth continues dry, I am using a micropore tape to close..but without success. and with the tape now I am producing this noise.
she records and sounds like a blow....and a little beat of snoring...

AHI 9.0 higher than we would like to see....like it to be less than 5
EPI 31 exhale puffs...puffs of air exiting the mouth...higher than we want to see..like to see single digits
dry mouth...means mouth breathing..now it doesn't always mean HUGE exchanges of air but some opening of the mouth and exchange of air.

All equal what you already know the tape is not doing a great job of keeping the mouth sealed. It's not sticking well.

Large leak % is 0....so must be some low level leaks going out through the mouth....we sometimes call that motor boat sound.
Could that be what your wife is hearing?

BlackSpinner wrote:My mouth doesn't stay closed, it takes work and when I am asleep it just falls open. After fighting with the quatro I tried the Innomed/Respcare Hybrid. It took some work but I now use it all the time unless I have cold.

Yeah? I am getting refitted for a Resmed Quattro FX FFM this week. I cant take the regular Quattro anymore. At least I wont have pressure on my forehead and will be able to sleep with my head tilted back in a normal position with the Quattro FX, even if I still have some straps.

You say you have had good luck with hybrid masks? The Innomed/Respacare Hybrid? I will look that up as a future possibility.

Eric

Eh...yeah that sounds something along the line he was talking about. What I went to him for was an OA to use with loose fitting nasal CPAP and do combination therapy. Im not ditching CPAP, just trying to really work the headgear part out in detail and to get the effect I am looking for, I might have to spend some $$$$$ on an oral appliance.

Or hell, maybe all these respiratory infections I have been having have been from tonsils that have gone bad on me, but I did not realize it. Combined with living in a house without central air for the past three years? I do know the strap on the left side of my neck is cutting into my eustacian tube though and I cant take it anymore. And that has zip to do with my tonsils.

Eric

VikingGnome wrote:

Suddenly Worn Out wrote:
He was probably saying that your palate (roof of mouth) is high giving your tongue more room in your mouth. I have a very flat, barely arched palate so my tongue is really crowded and tends to fall back into my throat when asleep. A dental appliance would do nothing for me. It would just crowd my tongue more.

Whether to trust your dentist or not? I have a brother and brother-in-law who are dentists in California. They both have been on CPAP for 10 years. If they aren't using a dental appliance for OSA, it tells me I shouldn't.

I read here somewhere, and have noticed with myself, that when my tongue is pressed to the top of my mouth air can't leak out of my mouth. But if I let it drop then my cheeks puff out and I imagine if I were asleep the lips would part!

Fortunately, tongue against the roof is my normal state ... it's even like that as I type this.

I don't know if that's why some people have leaks and some do not. I have pressures as high as 17 without any indication of leakage.

That sleep medicine dentist I saw yesterday talked about that. He mentioned some type of anti-snoring device that you suck on that forces your tongue against the roof of your mouth, said it creates a seal with your mouth. He said it is something called a "Tveo" or something along that line. He said I could try it but there is a poor compliance rate with it. But he never treated me before I can tolerate about anything as long as I get good sleep and does not cause infections or ear aches or whatever.

Eric

khauser wrote:I read here somewhere, and have noticed with myself, that when my tongue is pressed to the top of my mouth air can't leak out of my mouth. But if I let it drop then my cheeks puff out and I imagine if I were asleep the lips would part!

Fortunately, tongue against the roof is my normal state ... it's even like that as I type this.

I don't know if that's why some people have leaks and some do not. I have pressures as high as 17 without any indication of leakage.

He said it is something called a "Tveo" or something along that line.

Aveo TSD. See viewtopic.php?f=1&t=86511 and http://www.aveotsd.com/index.php

Air pressure in nose and throat is higher than room air pressure.
Equilibrium rules.
Lots of space with chipmunk cheeks, "Hey guys, there's room for more"
Oops! Lip leak! She doesn't know--she's asleep! We're FREE!
Loose lips sink cpap therapy.

chunkyfrog wrote:Air pressure in nose and throat is higher than room air pressure.
Equilibrium rules.
Lots of space with chipmunk cheeks, "Hey guys, there's room for more"
Oops! Lip leak! She doesn't know--she's asleep! We're FREE!
Loose lips sink cpap therapy.

LOLOLOL!!!!!!