Need Help with SH Results and cheek puffing

[littlefatcat]

Hi, all.

I am so confused about my settings. It's been a while since I posted. I keep fooling around with my settings and don't know if I am way off the mark or what. With my setting of a high of 17, I am having real problems with cheek puffing and then puffing out air. It's annoying to say the least. I tried taping with Micropore tape. I remove it very carefully with a rolling motion, but still have sores and redness around my mouth so don't think this will work for me. Tried bite guard as well. May be headed for full-face mask if I can't change what is going on. I love my Wisp, but my cheeks always have deep lasting marks from the straps which are embarrassing. 

Anyway. am I way off on my settings? I don't know how to figure this out at this point. Suggestions about settings and cheek puffing would be appreciated!

Thank you!

[Gideon]

Your numbers are good and would be accepted by the medical community (<5 AHI)

You are on your minimum pressure for most of the night and because your cheeks are blowing out, I would think of lowering your minimum pressure to 14 and your Max to 16 for several days (1 day does not make a trend) and see how you do, lowering the Max to not puff your cheeks.  The idea is to lower your pressures slowly until you reach a comfort level.

2 years ago you were doing OK (slightly better numbers with a minimum of 10-11) so you have some safe room to work with.  

on taping, try a different tape, look for one that is for "sensitive" skin.  Also try to learn the "tongue trick" where you hold the tongue on the roof of your mouth.  This blocks the airway from the mouth.  It took me MONTHS to learn that.

Fred

[littlefatcat]

Thank you, Fred! 

I started raising the pressure because I was having so many nights over 5. I try to leave the pressure the same for a while before changing it. I just am not certain how to tell if I should go up or down. If I lower the max to 16 again and the graph spends a lot of time at 16, does that mean I need to raise it?

Micropore tape is supposed to be for sensitive skin. I’ll look around for another. Wonder if painter’s tape would be better. Not really sure about tongue trick. Air seems to find its way around sides of my tongue.

[mesenteria]

At your local pharmacy, look in the sports and medical tape section.  Find 3M Corp "NexCare" white tape 2.4 cm wide, the water-resistant kind.  It comes in a blue and white plastic spool with a cylinder cover.  Works really well for me.  I have it one at least 7 hrs each night, and have been using it for over 14 months without a hint of irritation.  Perhaps it will work for you.

[Gideon]

Thank you, Fred! 

I started raising the pressure because I was having so many nights over 5. I try to leave the pressure the same for a while before changing it. I just am not certain how to tell if I should go up or down. If I lower the max to 16 again and the graph spends a lot of time at 16, does that mean I need to raise it?

Micropore tape is supposed to be for sensitive skin. I’ll look around for another. Wonder if painter’s tape would be better. Not really sure about tongue trick. Air seems to find its way around sides of my tongue.

I don't recommend tape not intended for human use and the fact that you appear to be sensitive reinforces that thought.
Your numbers, say don't worry about it.  Right now your comfort is more important.
The human body is intended to breathe thru the nose.  As much as possible we should strive for that.
read this 5-important-reasons-why-you-must-breathe-through-your-nose

[Sleeprider]

The best strategy is to train yourself to contain the pressure in your airway, not in your mouth. People that use nasal therapy must do this, but even with a full face mask, you will be much more comfortable. It is the back of the tongue against the roof of your mouth that accomplishes this control, and you may need to practice until you understand how to keep the tongue along the roof the mouth behind your teeth and let the back of the tongue lie along the soft palate, blocking the pressure. For some people that tend to have a slack jaw, a soft cervical collar (preferred) or chin strap (less optimal) can help keep the tongue and jaw position closed to prevent the air from entering the mouth. If you can learn to do this, your problem will be solved without tape, and your results will improve tremendously. If you can't control the pressure, then nasal therapy is not your best choice, and it may be time to look at a full face mask. No defeat in using what works.

Your pressures are fairly high and you would be much more comfortable on bilevel (BiPAP or VPAP) therapy. Even the Resmed Airsense 10 CPAP allows up to 3-cm pressure relief on exhale. There is a lot of flow limitation in your results and a pressure difference (pressure support) between inhale and exhale pressure would probably improve that, along with increasing comfort. Your Philips Dreamstation will not do bilevel pressure. High pressure and intolerance of CPAP at those pressures are the medical reasons for switching a patient to bilevel therapy.

[Technopauper]

Many seem reticent to use a full face mask, I love mine.

If not clear from other response the issue is one of differential pressure - O cm pressure at mouth versus CPAP pressure in your airway so unless you can seal off your tongue then a FFM solves the problem.

Taping contains pressure in the mouth and puffing happens when your tongue releases pressure from your airway where because of taped mouth, your cheeks then blow up like a balloon.

Two fixes then - learn how to do the tongue thing or try a FFM

Rob

[littlefatcat]

I’m not certain which tape you are talking about, mesenteria. The Nexcare Gentle Paper tape is the same as Micropore tape which is used in hospitals as a surgical tape. That is the one I am having issues with. Looking online, I see there is a tan tape that is called absolute waterproof...is that the one? I also see that there’s is a blue Nexcare tape for sensitive skin.

[littlefatcat]

Sleeprider, I practiced with my tongue behind my teeth last night. I think perhaps the problem was that I was placing my tongue behind my dental retainer instead of behind my teeth. Will work on it.

I’m not sure what Bipap and VPap are. Sounds like I would need to have another sleep study. I have moved away from my sleep doc. Would need to find new doc. Ugh! I was hoping to resolve my problems with some settings adjustments. Might not be possible. Also may not be possible because I don’t know what I am doing.

[Sleeprider]

BiPAP and VPAP are both names for bilevel positive air pressure therapy that is based on different pressure for inhale and exhale. Imagine if your exhale pressure was 4-5 cm lower than inhale...When your inhale pressure reaches 17 cm, then your exhale pressure is a comfortable 11 or 12 cm. This contrast makes breathing easier and more comfortable, and it also increases your ventilation volume, helps you overcome flow limitation and hypopnea. Your pressures are relatively high, and you have marginally acceptable results, but quite a few remaining events. Bilevel does not require a new sleep study, it requires that you either are uncomfortable or don't tolerate your CPAP pressure, or CPAP pressure is greater than 15 cm, both of which are true for you. You should be able to talk to any doctor about your discomfort, high pressure and poor results and obtain a prescription for bilevel therapy. If you are not concerned with paying out of pocket, you can get a bilevel machine from many online vendors like Supplier #33, or used machines from Craigslist, Offerup, Letgo etc. We can help you to understand how the machines work and how to get them.

What we know is that in spite of high pressure you have flow limits and hypopnea as well as some obstructive apnea. I think the central apnea you have are a function of your sleep disruption from being uncomfortable and having leaks. With bilevel, your pressure would be lower and more effective.

In spite of the air puffing your cheeks, you have a low leak rate. Our main objective needs to be making you more comfortable, One way to keep air out of your mouth, is to encourage your jaw to stay closed, and a way to prevent your obstructive apnea is to protect your airway and prevent chin tucking. Both of these things can be accomplished using a soft cervical collar. Take a look on Amazon at the Caldera Releaf collar. If you use something like this, it is very likely your pressure will stabilize at a lower level, and events will be significantly reduced. Here is a link to an aritcle we wrote on that subject that is based on actual results from members of this forum. http://www.apneaboard.com/wiki/index.php...onal_Apnea