mouth leak driving me nuts

[Palmtrees]

Hello all.  I am a nasal mask user (narrow lower jaw and receding chin resulted in massive leaks with all the full masks I tried) and when I first started, I had a chinstrap, tape, etc.  Some dry mouth but nothing hysterical.  Eventually, I did alright with just the tape. (I found that the chinstrap was useless).

  I have switched over to the Brevida nasal pillows because they are more comfortable, and the strap doesn't slip around.  However... I am waking every couple of hours with a mouth like a desert.  Tape, and gel do not help.  I have noticed, while lying there getting ready to fall asleep that I will feel a bolus of air in my cheek that moves around my mouth and ....pfft...right out between the lips...sorta sneaks out the corner.    the machine reports no leaks beyond the usual 6lpm leak it has always reported.

Here are my questions:  1.  I have lost some weight and am using a steroid nasal spray and now I wonder if my pressure is too high (7 isn't very high from what I understand).  Do I need to lower the pressure a bit?  Would that help?  and lower it how much?

2.  I am using the blue medical tape.  Is there a best configuration to tape in? 

Forget the chin strap.  I tried several.... my lips seem to be the problem.  Leaky lips!  who knew?

[weiss27md]

Try correct tongue posture.  After a while you'll naturally start to do it.  It's impossible to breathe out of your mouth while practicing correct tongue posture. 
What about a soft cervical collar?
You might post a daily OSCAR, that would help also.

[Hydrangea]

I agree with the above. Do a search here for the tongue suck technique. It takes some time, but it is effective.

I do find it easier to keep that sealed with lower pressure. But a pressure of 7 is pretty darn low, so I wouldn't be inclined to turn it lower unless your doctor or others recommend it due to treating your apnea.

[hegel]

I recently started using a cervical collar and it really helps with mouth leaks. I had to give up using my P10 nasal pillows because of the same issue with pressure build u in my mouth and then farting out my lips. With a cervical collar, this issue is addressed and I'm able to go back to the P10.

I was showing massive leaks (from my mouth) with the P10--40 leaks per minute. Now I'm down around 15, which I think is acceptable if not as good as with a F20 full face mask. 

Chin straps don't work for me either and I find mouth tape too problematic. Many don't however.

[Palmtrees]

thank you all1

[mesenteria]

If you can't get a reasonable fit with a commercially available cushion, would you be averse to trying a modification?  If you already own it, and it won't fit as well as you need due to your facial geometry mentioned earlier, you'd have little to lose by trying 'something'.  Also, I'll make a small statement about taping after the following:

There's a pliable shoe sole restorer called 'Shoe Goo'.  You've probably seen it, maybe use it.

What if you were to carefully surgically remove a thin wedge of the seal material on the next best cushion that almost worked.  You'd snip out a thin wedge on either side of the cushion so that it could be folded a bit, or closed a bit, so that it would more closely conform to your face's surfaces.  It would 'cup' more if you forced the cushion, by bending it a bit, to close up those two new gaps.  It's just an idea, and I don't even know if it would work due to the supporting frame's prevention of the folding action.  But, if it could be folded slightly, you could then apply some of the Shoe Goo and see if it would hold both as a patch/filler, but also to retain the cushion in the new-folded shape.  


This would be pains-taking, and you might fail initially.  But once you figure out how to do it, and the Shoe Goo cures so that it doesn't adversely affect your facial tissues on contact, you may have a new BFF in things PAP.

I use a nasal cushion.  It was the first choice offered at the meeting with my RT, and I felt it was probably the least invasive or overwhelming.  I settled on it.  The first night was brutal.  Awful.  I called her the next day and asked WTF?!?  She replied that I have three options: another mask type, a chin strap, or taping.  I thought maybe 1.7 seconds and said I would try the tape.  From there, it's a long succession of great nights.

I use 3M Corp NexCare 'water resistant' white tape that is about 2.5 cm wide and that comes in a while spool enclosed in a white cylinder with decals.  It is only moderately sticky, but works better if you press it into place with finger tips after placing it across your lips.  With a folded over tab on one end, removal next morning is a cinch.  And, the modestly sticky adhesive is rather gentle upon removal.  And...it stays in place very well.  If you don't apply enough to have about 4 mm past the 'corners' of the mouth, it will probably leak there...so make sure to use enough.  Press, press, press, including those corners.

Don't forget to fold over another small tab on the free end before you put the spool away.

[PaulaO2]

I know you said you tried all the chin straps. But did you try the PAPCap? It is specifically designed to help with cheek inflation and lip leaks. I used it for a long while and reviewed it here:
http://www.apneaboard.com/forums/Thread-...-Pur-Sleep

[Palmtrees]

Thank you for the suggestions.  I went ahead and lowered the pressure to 6.0.   I also got one of those buckwheat hulls-filled pillows.  I find it very comfortable (which is strange because it is super firm), but it allows me to sleep on my back and this morning when I got up.... no dry mouth and AHI for the night was...0.3.   I was shocked.  I did tape my mouth with the blue Nexcare tape....and I think I wasn't taping it far enough past the corners of my mouth.  So, doing better.  I took a look at the PAPcap, and it just isn't for me.  The less gear on my head the better.  I did cut my hair very short and that seems to be a big help, too.  :igh::    What a life!