New CPAP user and suffering from mouth leak

[dloomis]

Hi everyone - new PAP user here (two weeks in). About me: 54 year old male, athletic build, 22 BMI, historic side sleeper due to nasal congestion. I have that under control with Nasacort so nasal pillows are working pretty well. 

I'd love some feedback on how to control my mouth leak which I believe is due to my soft palate relaxing and allowing air to enter my mouth. I've been using ResMed P30i nasal pillows with pretty good success but switched to the Bleep Eclipse last night as an attempt to isolate and control my mouth leak. I've been taping but with the mouth leak I'm getting the dreaded chipmunk cheeks. Like I said, when I do wake up I notice that my soft palate relaxes to the point where air starts leaking into my mouth. I'm trying a soft cervical pillow tonight.

Here are a few of my Oscar charts. I've been experimenting with various pressure settings; I *think* my CPAP setting should be 10 cm/H2O but I set it to 8 last night to see if excess pressure was the culprit. I still had the issue. 

Anyway, any feedback would be much appreciated! I truly believe solving these leaks are the last blocker to me *finally* getting a good night's sleep.

   
   
   

[dloomis]

OP here. I'm also setting Humidity to 1 tonight per Jason's recommendation on YouTube. My mouth tape isn't consistently sealing which could be to excess moisture. I'm using 2" Cover Roll tape.

[ChadBSr]

MouthShield/somnoseal may work better than tape. Chin strap or collar for mouth drop

[Expat31]

Try curling your lips inwards, before fixing your tape. You should get a much better seal. If still not enough, try in addition a chin strap. A ResMed minimalistic one is pretty good. I find it doesn't pull your jaw back.

[LaurenceShaw]

Try curling your lips inwards, before fixing your tape. You should get a much better seal. If still not enough, try in addition a chin strap. A ResMed minimalistic one is pretty good. I find it doesn't pull your jaw back.

I'd note that the ResMed is essentially the standard design of chin strap, which is problematic for most people.  It wraps around the tip of your chin and the top back of your head, and your jaw joint (which is right in front of your ear) falls almost exactly on that line.  Which means that design of chin strap is forcing the jaw almost directly into the jaw joint, which is the worst angle possible for effectiveness and comfort in stabilizing the jaw in the elevated position.  I'd suggest you look into the Knightsbridge Dual Band chin strap.  Its straps pass under the jaw and lift vertically.  We're Supplier 37.  (Use that link or you'll likely end up with a counterfeit.)  However, I'm not sure how a lifted jaw will affect your soft palate (but would be interested in learning/hearing if there is a connection) ...

[Expat31]

Hi, I think there is some confusion between two seperate subjects on two seperate posts.

I think you may have linked the two together.

Let's examine them in some detail:-

 1) New CPAP user and suffering from mouth leaks

My quotes:-

"Try curling your lips inwards, before fixing your tape. You should get a much better seal. If still not enough, try in addition a chin strap. A ResMed minimalistic one is pretty good. I find it doesn't pull your jaw back."
 
And

  2) RE: Request for help

"However in the deep sleep phase or REM sleep, when there is a semi paralysis of the muscles (loss of muscle tone), and the tongue and soft palate, under the force of gravity, can fall back against the phalanx wall, blocking the airway. See attached diagram of the upper airway for the zone concerned."

In this last post, you will find no reference to a chin strap whatsoever.

Obviously a chin strap cannot impact the upper airways with the tongue or phalanx wall. I think it is mechanically impossible!

But I guess what really has caught your eye is my statement "I find it (the strap) doesn't pull your jaw back."

I will try to explain:-

I have always been acutely aware of the jaw position impact on sleep apnea. For 2 years before having  a CPAP,  I had a mandibular device pulling my jaw forward. I stopped the mandibular device as the settings eventually got maxed out. So over to CPAP

Fast forwarding to a problem I had with leaks. Tape became no longer totally effective, as pressures increased over time, as I perfected my titration, getting to "the sweet spot".

After discussing with my equipement supplier on possible solutions, he came up with  the Resmed chin strap.

I was more than sceptical as I had read that would be useless as pulling your chin back. I had read, but never tried...

My arguement was, just look at the direction of force, it's all wrong, look at the straps pulling backwards on the jaw.

His answer was "have you ever tried a chin strap?"  My answer was obviously no,  he just replied "take it and let me know.

I sat looking at this ridiculous item for two weeks afterwards, left on the bedside table, not wanting to make things even worse, adding to the my already existing leak problems.

To end this long story, I altered the top strap forward as far as possible, nor completly in line with my chin, so as to be as directly in line as much as possible, for the line of force to keep the chin upright, not backwards.

The only modification was keep the top strap from slipping,  I just added some non slip tape. 

The result for me was amazing. I think the key may be the chin cradle in the design. Resmed designers cannot have totally ignored the risks of their chin strap pulling the jaw in the wrong direction.

However. we are all different. I have a normal head, no funny lumps or anythins on the top. This is why my quote was "I find it doesn't pull your jaw back."   Just an opinion, based on my own experience.

Concerning your product, it looks really good for getting the line of force directly above the chin. It is certainly the most effective and logical method.

I never considered it in the past, as being located in France it is more complicated with the add on for freight and import taxes.

What I have learnt is to try everything, leaving no stone unturned.

[Deborah K.]

It may be that you are using too short a piece of your mouth tape.  If I don't use a 5-1/2 inch piece I still leak.