Identifying mouth breathing in data? Is it an issue? (PLUS an experiment)

[DiddyWolf]

I'm just shy of 1 months into starting apap therapy for severe sleep apnea. I'm sure I've got a lot to figure out, but let's start with a small (I hope), specific question.

I started out with a full face mask (ResMed AirFit F30i), which has given me all sorts of issues. One of the big ones is that it leaks like crazy at higher pressures (10-12), unless I tighten the lower straps to the point where they are uncomfortable. Either way it wakes me up. I'm sure this is largely because I have facial hair, even though I keep it short.

I've always considered myself to be a mouth breather, but after fairly constant issues with large leaks on the ffm, I decided to just try a nasal mask anyway and see what happens.

I switched to a ResMed AirFit N30i, and so far, I seem to have far less issues. Basically no large leaks, and I've almost never woken up due to leak issues of any kind, aside from a couple instances where I basically pushed the whole mask aside on my pillow.

So this is where I'm kinda stuck. If I'm not waking up due to mouth leaks, and I'm not experiencing symptoms related to mouth leaks (no abnormal dry mouth/nose), and my leak rate is lower over all, how can I tell if mouth leaks are happening and if they should be a concern? Obviously things feel ok after, but I don't know how to tell what's going on while I'm asleep.

I've been looking at my detailed data in Oscar, and I see variations on leak rate at different times. Is it possible to tell if this is some amount of intermittent and minor mouth leaks?

NOTE: I typed up all of the above yesterday, before I had a chance to pull screenshots of my Oscar data. I've since done a bit of an experiment last night and may have answered my own question, but I still wouldn't mind feedback.

First, here is an example of how bad my leak issues were with the ffm. This would be the "adjusted for comfort" tightness.
   

And here's last night where I ran my experiment.
   

So about my experiment:

The first longer session on the left is the nasal mask with nothing keeping my mouth closed. Those smaller variations in the leak rate, particularly the couple of times it spikes, were what I was thinking previously was my occasional mouth breathing or slight mouth leaking during the night.

The session on the right however, is my first time trying taping my mouth closed. I just got some mouth tapes to try a few days ago and this is my first time doing so. A few things that jump out to me about this is that I still see some of the same variations in leak rate, even some that were larger than with my mouth unrestricted, but these clearly can't be mouth leaks. I think some (most?) of them were position related mask leaks, as I did wake up slightly once or twice and needed to adjust my mask while changing sleep positions. 

I of course also can't help but notice that my mouth taped session dropped my AHI through the floor. It was a 23.90 for only the first unrestricted session and 3.03 for only the mouth taped session. It seems like I'm going to need to experiment with that MORE, regardless of all of my above concerns about if mouth leaks are an issue. That's not to say I haven't had periods of earlier un-mouth-taped sessions with low AHI, but far more of my earlier graphs look more like the first session than the second one.

One last bit of my experiment; Early last night I made a point of intentionally full open mouthed breathing for a good 30-40 seconds, just so I could see what that even looks like in Oscar. I think it's safe to say I was not seeing this level of mouth breathing elsewhere in my data.
   

I've rambled enough. Thoughts?

[cdplatt]

"If I'm not waking up due to mouth leaks, and I'm not experiencing symptoms related to mouth leaks (no abnormal dry mouth/nose), and my leak rate is lower over all, how can I tell if mouth leaks are happening..."  No evidence of mouth leaks = no mouth leaks (or at least no leaks that should concern you).  The tape experiment certainly seemed to help your results.  

[Deborah K.]

I see several things that should help improve your therapy and comfort and make the following suggestions:

Raise your starting pressure to 8.  This will better meet your pressure needs and help your EPR to work better.

Change your EPR to full-time, set to 3.  This will lower your flow limits, which is good for your therapy, and will make your breathing more comfortable.

You have Positional Apnea (PA).  This shows on your charts where you have lots of events clustered tightly together.  No setting can fix this. You have to make physical changes.  PA is caused by your chin dropping towards your chest, causing something like a kink in a hose.  With PA it blocks air flow instead of water.  To fix this there are a couple of things you can try.  Sometimes sleeping on a lower pillow will solve it, but yours are quite bad, so I think you will probably need to obtain and wear a soft cervical collar that is tall enough to hold your chin up no matter what position you sleep in.  Drugstores carry a few, and Amazon carries lots of them.  When I needed one I found the Caldera Releaf Collar the most comfortable, and for me, it worked as well as any of the others I tried.

Solving PA will cause a very nice drop in your apnea events.

And yes, mouth taping helps lots of us.

Best of luck with getting your therapy and comfort to a much better place!  

[DiddyWolf]

No evidence of mouth leaks = no mouth leaks (or at least no leaks that should concern you).

I'm overthinking it, got it. XP

Raise your starting pressure to 8.  This will better meet your pressure needs and help your EPR to work better.

Change your EPR to full-time, set to 3.  This will lower your flow limits, which is good for your therapy, and will make your breathing more comfortable.

This sorta of changes are on my list of things to bring up at my follow up appointment with my doctor.

You have Positional Apnea (PA).

I thought that was mostly a back sleeper issue? I'm primarily a side and stomach sleeper.

Caldera Releaf Collar

Their sizing tops out about 2 inches shy, unfortunately

[Deborah K.]

You can change your settings yourself.  It's easy and you are allowed to do it yourself, whether your doctor likes it or not.  Actually, it feels great to take charge of your own therapy once you have folks here to help you optimize things.

Positional apnea can occur in any sleep position.  You definitely have it.

If that collar won't work I'm sure you'll be able to find one that does.  I used one for a good while then tried something else that works well for me.  I assume it would work for others too, but I haven't heard anyone else say they do this.  I'm primarily a back sleeper (due to back pain) and once in a great while sleep on my side.  I bought a child-size pillow as they are smaller and flatter than regular pillows  Mine has a raised edge at both the front and back.  I use the higher edge, and it causes my head to tip back slightly, completely solving the PA.  My pillow is no longer made, but I've seen others I think might work.  Here's a link to one:

https://www.amazon.com/MLILY-Adjustable-...r=8-5&th=1

Good luck with whatever you try!