[Equipment] Massive leak rate, tape isn't helping

[Gronk]

Been lurking for a few months, finally decided to post. I've been on APAP/CPAP therapy for about a year and a half. 

My initial settings were horrible but the PA at the sleep clinic reviewed my data at my 6 month checkup and suggested a fixed pressure instead of variable. Things went really well after that until this spring when I started exercising and losing weight. Since then I've had mouth leak at 50%+ every night. I tried dialing the pressure down--about 0.2 at a time for a week--but the leak rate didn't go down and my AHI started going up. I went back to the original fixed pressure and decided to try taping. I've got a full beard and I know that complicates things. I'm trying to find solutions that don't require shaving it, so a FFM is my last resort. I sleep on my side so I don't know that a FFM is even a viable option.

So far I've tried SomniFix strips and Nexcare Sensitive Skin. The SomniFix was basically a joke--not only does it not stay affixed at the corners of my mouth, the hole in the center is big enough that I can comfortably breathe through it. That's not going to do anything to stop mouth leak. A very expensive lesson, for sure. The Nexcare tape seemed like was going to be better but it immediately lost seal at the corners of my mouth. By the time I got up this morning it was only attached in the middle of my lips, tenaciously so. I'll try wiping my mouth a little better tonight to see if that helps with adhesion in the corners.

I can't see any obvious difference between the two nights with tape vs any recent nights without it but that's probably expected given how ineffectively I applied them. I'm really frustrated that my health is improving so much in other areas (lost 75 lbs since my check up this spring and can now run 30 minutes straight) but suffering so much everywhere else because of apnea. I've even tried sleeping without it for short periods to see if the weight loss has improved things but it always results in waking up with that really heavy head fog/headache I associate with pre-CPAP nights, so presumably there are still a lot of events happening. I looked at buying a home sleep study kit to be able to monitor it without the CPAP machine but balked at the US$3000 price tag.

So, what say you, fellow apnea sufferers? Do you need closeups of any particular areas? Any nights on the summary that may be worth investigating?

[Canuck 2]

It might be worth your time looking at another mask that seals your mouth and nose(full face). I have the P10 and have used it for the last 5 years approx and it is my favorite but had to go through about 4 different masks until finding my mask(I have been using cpap for 12+yrs). I seal my mask by putting my tongue to the upper roof of my mouth and it seems to seal for me, it still leaks every once in a while usually when head gear weakens a little. It is a blessing when you find the mask quickly that works for yourself.

[mesenteria]

Some ideas I'll throw out there, and not because I have found they work.  My NexCare 'water resistant' (that's important) white tape works very well, now for three years:

a. Clean your mouth with a detergent and warm water, wipe dry with a clean dry towel, and then apply the tape;


b. Press the tape firmly into place all over its surface using the finger tips.  Press several times for a full second to get proper adhesion:

c. Ensure the tape is placed and oriented well.  It must extend at its extremes at least 6mm past the corners of your lips AND be firmly pressed at those two places.  Also, and I realize we're all built differently, the elevation of the tape matters.  That is to say, how much of the tape lies below your bottom lip and above your top lip matters.  At least, it does to me.  In my case, I need most of the width to lie over and below my bottom lip, with the top lip covered only barely to about 3mm above it; and

d. I think a change of mask, or learning how to sleep differently, maybe be viable options in the long run.

[Dormeo]

It's funny, but I couldn't breathe through the Somnifix slot to save my soul. I do purse my lips before I apply the strip, if that makes a difference.

To follow up on Canuck 2's suggestion, here's a little more information. Try putting the tip of your tongue behind your upper front teeth. Then position the main part of your tongue up against your upper palate. Finally, give a little suck or swallow to create a bit of suction. You should now be able to open your mouth while breathing entirely through your nose. Practice this during the day, and see if you can get it grooved in deeply enough to help while you are asleep at night. For some people, this is really all it takes to avoid mouth leaks.

If your jaw tends to drop down during the night, pulling your mouth open, then a soft cervical collar, or a firmer snore collar, can be a big boon. And recently some members have been having good luck with the Knightsbridge Dual Band Chin Strap, which involves a cap. It pulls the jaw up rather than back, which what is needed.

[edfreeman]

There was a recent thread about tape types here:

http://www.apneaboard.com/forums/Thread-...uth-taping

The sensitive tapes didn't work for me. Peel off too easy, a good thing after you've awakened for the day, notsomuch while you're sleeping.

[holden4th]

A suggestion that is outside the envelope - consider training yourself to be a nose breather. If you are actually a side sleeper this will be a plus. To achieve this you need to practice while you are awake. You use what is called the 'tongue suck method' where you put the tip of your tongue just above the line of your upper teeth. This pushes the back of your tongue up onto the roof of your mouth effectively sealing off mouth breathing. You can test that it works by trying to breathe through your mouth while your tongue is in this position - you can't!

I did this for six weeks and I am now a nose breather. I still keep reminding myself to check while I am awake.

The addition of a soft cervical collar to hold up my lower jaw completed the process. The air flowing up your nose from a nasal cushion or pillows also adds to the brain training.

[Gronk]

Thanks for the feedback. I've had a busy weekend, just now getting back to this.

I'm single, so I don't have anyone to monitor my jaw position while I sleep. I use a firm body pillow for support and have tried pushing it up to my neck to act as a jaw support--doesn't seem to be doing any good though. My sleep Dr. prescribed a chin strap but that was a complete farce: beard + chin strap = slides right off. I'll look into a cervical collar next. I recall seeing a few threads with discussion on how to select one on the forums here...

I read a few threads about tape brands and how to apply them before purchasing a few different types, including the one linked above. The supply of medical tape is very limited at my local retailers. Amazon isn't always very reliable for product descriptions so I'm not sure if what I've ordered is what others here are actually using. The US retailers only seem to have "absolute waterproof" tape. Searching for "water resistant" tape only shows results from Canadian retailers, so maybe it's a marketing difference?

I'm a nose-breather when I'm awake by default, only resorting to mouth breathing when absolutely necessary. I tried the "stick your tongue to your hard pallet" trick the last two nights as well without any noticeable difference. My sleep Dr. gave the advice of "learn to sleep with your mouth closed" when I told him about the APAP settings waking me up when they ramped up and blew my mouth open. I couldn't figure out how I was supposed to exert conscious control over voluntary muscles when my body is physically paralyzed during sleep. Not sure how that's supposed to work in his mind. His PA at my next checkup actually reviewed my data and changed me to CPAP at 9.0, which worked great for about 6 months.

While I realize it's in my best interests, shaving my beard is really the nuclear option in my mind. Seeing bonjour's avatar suggests that it's possible to keep it and be successful, but that's just a thumbnail on the internet.

I'll see how the cervical collar and some more experimenting with tape goes.

Thanks!

[Sleeprider]

The Knightsbridge dual chin strap from Supplier #37 won’t slip and fits under the jaw, not the chin.

[JJJ]

The Knightsbridge dual chin strap from   Supplier #37 won’t slip and fits under the jaw, not the chin.

Gronk,

The advice from others above helps a lot of people, but everyone's situation is different. For me I had a bit of leaking from the mask, but the big problem was my mouth falling open while I sleep. I have a private theory that as we age certain nerves stop doing what they used to do - the nerve that tells the base of my tongue to stay forward stops working as soon as I fall asleep, so the tongue falls back against the pharynx and I can't breathe - giving me an instant obstructive apnea event. Similarly, the nerves that keep my mouth shut stop working when I am asleep and my jaw falls down - causing a massive air leak. 

If you're like me, there are really three ways to deal with a mouth that doesn't stay shut: 1) a cervical collar (tried it, hated it), a full face mask that covers the mouth as well as the nose (can't stand that huge thing on my face), or a chinstrap. For me the chinstrap was the solution, although it took me a lot of experimentation to get success. I started by buying two or three commercial chinstraps, but none of them worked very well. I'm a side sleeper, and a very active sleeper as well, so rolling over tended to dislodge things. 

My final solution was a homemade chinstrap. I went to a fabric store and bought several meters of elastic designed for waistbands - about 3.25 cm (1.5 inches) wide. I cut off a length appropriate to go tightly around my head - under the chin and over the top of the head - and then I took a simple needle and thread and sewed the ends together to make a band. After a few trials I discovered my special secret - before putting on my mask I pull it through the chinstrap, then I put on the mask, and finally I pull up and adjust the chinstrap on top of the mask. The chinstrap not only keeps my mouth shut, it helps to hold the mask in position as well. 

Good luck to you, and don't give up. You'll solve your leak problem eventually!

[Gronk]

Good news everyone!

I ordered a few soft cervical collars this past weekend, got them on Monday. It felt really strange but I can't argue with the numbers. I'm still getting RERAs and some leak during the night but it's much improved. The Knightsbridge chin strap will be delivered Monday, I'll see how that goes and if there are any improvements over the weekend.