Leaks, drooling, and swallowing, oh my!

[tmoody]

Hello boys and girls.
For about the past month, I've noticed an increasing amount of the things mentioned in the title. I'm drooling profusely (only when asleep!), and my "mask fit" numbers have been dropping, as reported in DreamMapper, often in the 80% range. I'm also swallowing air quite a bit. My wife complains that I sometimes make some sort of popping sound with my mouth, which wakes her up.

My AHI numbers haven't been terribly high, but there is a rough inverse correlation between mask fit and AHI. Last night, for example, my mask fit was only 78% (the worst I can remember), and my AHI was 3.6 -- somewhat higher than normal but not excessively so.

My medical situation hasn't changed, but I have dropped 30 lbs of weight in the past 70 days, more than half of it in the last month. This is a result of strict dieting.

Normally, aerophagia, mask leaks, and drooling would jointly be indicators of too much pressure, right? But in an ASV machine, the pressure shouldn't go any higher than it needs to, to correct breathing events. So the only variable I should have to consider adjusting is IPAPmin, I think. That and EPAPmin have been at 8.5 for as long as I've had the machine. Doesn't seem terribly high.

It could also be that the apnea is getting worse and the machine is having to blow harder to correct it, causing the leaks etc. I use nasal pillows, but maybe I need to switch to something else. Any thoughts about this?

[sheepless]

congratulations on your weight loss. if you're lucky your obstructive events have declined. that would enable you to reduce pressure, starting with epap min.

there's less chance of a nasal mask fit change due to weight loss than with other masks but you could try a smaller cushion.

for mouth & lip leaks & drooling, I have to wear a soft cervical collar. others use a chin strap, the tongue suck technique or tape their mouth shut. some kind of pacifier might also do the job.

[SarcasticDave94]

It's possible the weight loss skewed your pressure needs but I'm picking that as the only variable mentioned historically speaking. I suppose you can modify IPAP to put a limit but that depends heavily on if you have room to do so according to your data. I know how to suggest an edit if it were an ASV like my ResMed 10 but I'm not armed with the how-to on your PR.

Drooling seems to signify open mouth to me. You probably know the drill on open mouth stuff, decide what's best for yourself.

Aerophagia and mask leak could mean pressure reduction to help some. Mask leaks could also be from old parts or less than ideal adjustments or changing mask type could be another option.

Since you're invested into it with the time and effort, I'd eliminate easy mods first, such as trying pressures edits and mask adjustments per it's what you feel comfortable doing.

PS congrats on weight loss.

[tmoody]

Thanks for the input. The weight loss has been a battle, but worth it, I think. Five more pounds and I'll be merely overweight, not obese! Dream big, right?

My titration study, from three years ago, was interesting anyway. The prescribed EPAPmin was 8.0. There's no mention of IPAP, oddly, but I guess that's down to the PS, which was prescribed as 0. I've had EPAP set to 8.5 for a while, because the titration study showed a curious increase in spontaneous arousals at 8.0, but not higher or lower. On the other hand, spontaneous arousals were lowest at EPAP=7. I don't know if these data are still relevant, but I think I'll follow the suggestion of reducing EPAP back to 8.0 and go from there. I do have one of those collars, but I might see if I can improvise a chin strap, if I can find something suitable.

[SarcasticDave94]

Sounds OK from all that as I see it. Any chance you looked at an OSCAR or SH chart to see how much wiggle room you have for EPAP settings? Just mentioning because if your EPAP Min is borderline low already (not saying that it is), AHI may go up somewhere.

[tmoody]

Here's my update:

I tried reducing EPAPmin to 8.0 from 8.5. I've left PS at .5. The results have been more dramatic than I expected from such a small adjustment. The aerophagia and mask fit issues appeared to be mostly resolved. The mask fit number went back up to 97% or so. AHI dropped to below 2. The only thing that didn't improve was the drooling.

So I ordered a chin strap, which I tried for the first time last night. That fixed the drooling, and I also had 100% mask fit and AHI = 0.1, which is pretty exceptional. Even though I wore the Swift FX nasal pillow gear over the chin strap, I had the feeling that having the chin strap there helped to secure the nasal pillow. I can't really explain that, but it was my subjective sense that everything felt a bit more secure.

Well, that was just one night, so we'll see how things go from here. But it's pretty encouraging.

[SarcasticDave94]

Congrats on the upswing on the stats. Hope it continues for you.

[mesenteria]

The pooping noise...oops, I mean the popping noise (    ) is quite likely drool or moisture, both?, getting in the way of air attempting to vent, perhaps at the vent itself with them tiny little holes.  The reservoirs for our humidifiers also knock or pop if not seated firmly.