First post- Leaking from mouth, using chin strap

[Rgn3]

After 3 years of CPAP use I just learned about the Apnea Board. I continue to have some degree of nasal stuffiness and episodes of leaking from my mouth. A previous trial of a full face mask was unsuccessful.
Background: 71 year old. My initial sleep lab study showed AHI range of 5-15
Nasal Stuffiness: My nasal stuffiness has decreased from my initial CPAP experience. I currently use nasal saline prior to sleep with reduction in my nasal stuffiness.I have previosly seen two ENT physicians and I do not have a correctable anatomic nasal obstruction.  
Resmed chin strap: I tighten my chin strap ever several weeks when my mouth leaking increases 
SleepyHead: Attached is a representative study when I experienced leakage.
Some of my parameters from the last 6 months: AHI 2.64, Obstructive index 0.17, Hypoxia Index 2.47, Average leak rate 4.31, 90% leak rate 14.0, % of time above leak rate threshold 2.68%, Average pressure 5 .
Questions: 1- Other approaches to the nasal stuffiness?
                2- Other approaches to use of the chin strap? Mouth guard and if so what type? Tape?
                3- What are the parameters I should be looking on the Sleepyhead readout and what are the desired ranges?
                4- The F & P Icon + is not one of the preferred CPAP machines in the Machine choice article on Apnea Board. What are the deficiencies of the F & P?
Thank you for your input.

[ShaunBlake]

Hi, Rgn3, welcome to ApneaBoard; I'm glad you found us, and like you I recently learned about the board after years of PAPing (and not).  Sadly, your SleepyHead (SH) report didn't make it through the ether.  I suspect that you may not have done the extra step of clicking the "Add Attachment" button — that's what I usually do.  So I can't offer any suggestions or advice about it or your therapy.

Last things first: I don't know anything about the F&P (although you'd think I'd be an expert since I've had a F&P washer & dryer for over 10 years ) so can't say why it isn't a preferred choice.  I do know why the ResMed AS 10 AutoSet is the overall 1st choice: comfort; quietness; and extremely quick, accurate responses to breathing changes.

I suppose you would see, if you bothered to look at my profile, that like you, I'm "too old".  Had time to wrestle with some of the issues you've encountered (sadly, not smart enough to solve them!)

1.  The best solution I've found for nasal stuffiness was nothing.  That is, I use a nasal pillows mask and it almost always overcomes my stuffiness enough that I can relax and sleep.  Nothing else I've tried is as effective.  (Never tried a FFM — hated the cumbersome thing when first offered one in the previous century.)

2. I haven't found a chin strap that eliminated my leaks.  I discovered that even with a chin strap I needed to sew my lips together to prevent blowing air — I tried taping my mouth, as many folks in the forum recommend but I'm too much a baby to remove the tape, and can't endure leaving the tape on permanently.  Currently I use a "cervical collar" (not really a cervical collar; designed for snoring or such) which dramatically reduced my leaks to a level that my software doesn't embarrass me.

3.  Well, the AHI you mentioned is considered very good, and the O and H numbers are pretty good and not too bad — good enough that you don't need to be frantic about lowering them.  Leak rate of 3% would possibly benefit from mouth-taping.


Hope that helps!  Try again to post two or three SH charts so the gurus have something to dissect.

[problemchild]

One of the biggest issues leading to tons of obstructive apneas for me was mouth leaking.  When I was obstructed, my CPAP would ramp up so high that it would blow my mouth open and breach the cushion around my mask.  It was seriously frustrating.

What I learned here from other members was that my pillow configuration was a culprit in all those obstructives.  I had propped up several pillows so that I could sleep at an angle with my shoulders and upper back supported (because of back/neck problems).  Unfortunately, doing so allowed my head to too easily roll forward, creating the obstruction that started the manic attempts of my CPAP machine to blast the obstruction back open. 

Worse, I wear a bite guard to keep from clenching/grinding my teeth at night, so that was also making it easier for my mouth to come open...something that was easy enough already.

By lowering my pillow pile and sleeping, basically, flat on my back, my obstructives cratered from the freakishly high levels where they'd been.  I propped up my headboard with a bricks to give me a slope that avoids reflux, so I didn't feel like I needed a lot of pillows anymore. 

The final catch, though, was that my mouth still fell open (or was blown open) at night.  Like so many others, the chin strap didn't work at all for me.  When it stayed on my head, it actually pulled my jaw back sharply enough to make it hurt, but it really didn't do much to keep my mouth closed.

What finally worked for me was a soft cervical collar.  I wear it every night, tucked in under my chin.  The collar is a more passive constraint on my mouth coming open, so it seems to do the job that chin straps never could. 

**Disclaimer** Keep in mind that I am not a doctor and none of the things that worked for me might actually work for you.  Any suggestions you get online, you'll be safer to run past your doctor(s) to make sure they won't do more harm than good.  

Good luck.

[Rgn3]

I have two representative nights with leaking loaded!

[jaswilliams]

Your only into large leak for 2% of the time not enough to worry about unless the leaks wake you up I would try increasing your minimum pressure to 7 that will have a more beneficial effect on your AHI as you seem to get hypopnea when the pressure falls back towards the minimum of 5. Also the increased minimum pressure may help reduce the flow limitations

[Cpapian]

I have two representative nights with leaking loaded!

So in the first screen shot, I notice that when your leak went up, your pressure went up and your AHI went up.  But not necessarily in that order.

I notice you machine is set 5 to 20.  Jaswilliams recommended your raise your minimum pressure.  I would also lower your maximum pressure.  Your current settings are almost wide open.  From the  screen shots, it looks like pressure goes to 11.  So set it maximum at 13 and keep an eye on it.  If you start to see it reach maximum pressure often and you see events, then you would increase it.
 
I haven't used a F&P machine, but based on the screen shots, you don't get as much information as my Resmed gives me.

F&P is probably the #3 brand in popularity.  The other two Respironics and Resmed have different algorithms.  Therefore they respond to events differently.  I assume your machine has another different algorithm also and it would also respond differently.  

In the end machines come down to price and personal choice.  I had a Respironics for a few months before I got my own machine.  For me, the Resmed was quieter, I needed lower pressure and my AHI dropped.  It was a win, win, win for me.  Not everyone has the opportunity to test drive a few machines prior to purchasing.  I was lucky I did.

[tedvpap]

Your only into large leak for 2% of the time not enough to worry about unless the leaks wake you up I would try increasing your minimum pressure to 7 that will have a more beneficial effect on your AHI as you seem to get hypopnea when the pressure falls back towards the minimum of 5. Also the increased minimum pressure may help reduce the flow limitations

This is good advice.

[matthewb]

I took a few months but found a full face mask that worked, and solved all my issues. Won't go back to a nasal mask or pillows now, much better sleeping now.

[Sleep2Snore]

It is very difficult to stop leaks from the mouth.
I use nasal pillows and even with a very good Chinese made chin strap and a collar I still get a mouth leak, or should I say a leak through the lips.
When this starts it dries out my mouth and the leak gets worse, it also makes my mouth taste like the bottom of a parrots cage!  

[Rgn3]

jaswilliams wrote:
I would try increasing your minimum pressure to 7 that will have a more beneficial effect on your AHI as you seem to get hypopnea when the pressure falls back towards the minimum of 5. Also the increased minimum pressure may help reduce the flow limitations

So the higher minimum pressure might prevent soft palate/tongue from obstructing the airway?

Cpapian wrote:
Jaswilliams recommended your raise your minimum pressure. I would also lower your maximum pressure. Your current settings are almost wide open. From the screen shots, it looks like pressure goes to 11. So set it maximum at 13 and keep an eye on it. If you start to see it reach maximum pressure often and you see events, then you would increase it.

Why might lower maximum pressure be better? Does this mean that higher CPAP pressure can "force" mouth to open?

ShaunBlake wrote:
Currently I use a "cervical collar" (not really a cervical collar; designed for snoring or such) which dramatically reduced my leaks
problemchild wrote
What finally worked for me was a soft cervical collar.

What brand of soft collar are you using?