First 2 weeks of BiPap, looking to dial it in

[AFAIK]

I'll start with a bit of background. I'm a big guy with a thick neck. Even when I was fairly lean and my neck was at its smallest, it strained an 18 inch collar. I've probably been progressing towards sleep apnea since my mid twenties. When I started dating my current wife, she noted that I snored when I slept, and I started using breathe right strips, which actually helped the issue for a time. As I went through my thirties, I was gaining weight consistently, even though I wasn't drinking much and my diet was healthy. A few years ago I began snoring really, really loud. Like, strain my marriage loud. I got a device that sucked my tongue into it and that helped for a few years, but then my issues began to return. My general practitioner had been pressing me to have a sleep study for a couple of years and finally, my blood pressure just began spiraling up and I finally listened. My AHI? 89.

EIGHTY F*!#ing NINE. 

Turns out that tongue device (looks like a pacifier) had been saving my butt for awhile as generally people who have an AHI like that are a danger to themselves, falling asleep at the wheel and what have you. In any event, I got my titration study done and was prescribed a BiPap with a 14/19 pressure setting. Let me tell you, that took some getting used to. But one thing I noticed was that I was nearly manic the day after that, and I was sold. 

Now, I love my BiPap, even with all of its discomfort, and my AHI has come down to a range of .7 to 1.9. But there is one main issue I'm looking to address. Dry mouth. The air comes in from the back of my mouth and dries it out. Taping my mouth shut would not help, my mouth is shut the entire time. It puffs my cheeks out. The big issue is that it becomes painful and wakes me up. If not for the dry mouth I would sleep 8 hrs like a baby. I tried a chin strap, which doesn't work as, like I said, the air comes in from the throat. I also had a full mask and that didn't help either.

Oh, and I am attaching my most recent night's charts in case anyone wants to take a look and make suggestions. Like I said, I want to dial this in. Suggestions?

[Dormeo]

Wonderful to hear how well your therapy is going! There is variation in your leak graph—do you think you have mask leaks?

Try working on the position of your tongue inside your mouth. Place the tip of your tongue flat against the roof of your mouth just behind your top front teeth, then kind of plaster the rest of your tongue against the roof of your mouth by putting it in place and then sucking or swallowing a little.

I have found it especially helpful to practice this during the day. The more I do, the more likely my tongue is to stay in place while I’m asleep.

[sheepless]

apparently there's something called xylimelt (sp?) that you can suck on for dry mouth. there may be other similar brands.

generally the solutions to mouth leaks (and dry mouth) in no particular order are chin strap, soft cervical collar, mouth taping and the tongue suck method.

a properly fitting full face mask can reduce mouth leaks but not necessarily dry mouth.

[AFAIK]

Wonderful to hear how well your therapy is going!  There is variation in your leak graph—do you think you have mask leaks?

Try working on the position of your tongue inside your mouth. Place the tip of your tongue flat against the roof of your mouth just behind your top front teeth, then kind of plaster the rest of your tongue against the roof of your mouth by putting it in place and then sucking or swallowing a little.  

I have found it especially helpful to practice this during the day. The more I do, the more likely my tongue is to stay in place while I’m asleep.

So, that was a question I had as well. I've tested my mask -- a Respironics Wisp nasal mask -- at full pressure in different positions, trying to see what would trigger a leak, but I haven't been able to induce one. This makes me wonder if that's the air shooting out of my mouth and then, when I close it, the leak rate drops. I used a chin strap and not only did it not stop the dry mouth, it made the side of my head sore. Maybe I should experiment with another one?

[AFAIK]

apparently there's something called xylimelt (sp?) that you can suck on for dry mouth.  there may be other similar brands.

generally the solutions to mouth leaks (and dry mouth) in no particular order are chin strap, soft cervical collar, mouth taping and the tongue suck method.

a properly fitting full face mask can reduce mouth leaks but not necessarily dry mouth.

My mouth doesn't stay dry the entire day or anything, but having a dry mouth like that will absolutely destroy your teeth. That's why meth heads always lose their teeth - meth makes their salivary glands dry up. I still might look into it, however. I'm trying to do the tongue suck method, but I have a large tongue -- that's part of why I have apnea -- and I tend to find I hold my jaw in a certain way so my tongue can come forward and I can breathe better. So, it's a hard thing to train, but I'm trying.

[sheepless]

I can't manage the tongue suck for the same reason. just not enough room to move the tongue forward enough to be effective. chin straps tend to exacerbate the problem by pulling the lower jaw back. apparently taping is effective but some are reluctant to use it, feeling it might be dangerous (although there are ways to mitigate this); in my case a full beard makes it impossible. that leaves the soft cervical collar which has been pretty effective for me for about 2 years. $20 at walmart or the like. you might not think it'll help lip leaks (I didn't either) but it does. not 100% but best for me among the listed options.

[Dormeo]

Afaik, I do hav the suspicion that you are leaking more air out of your mouth than you might think. So I think taping would be worth a try.

Many find they can tape conveniently with multiple pieces of micropore tape. Myself, I prefer Somnifix, which does the job, is gentle on the skin, and is simple to use. Despite what the packaging suggests, you can unstick in at night, say, if you need to cough, and then re-stick it.

And I would suggest trying the tape along with a neck collar, as sheepless recommends. If that works, then later you can experiment with using just one of those aids.