Not mouth breathing but air leaking between lips

[Roy289]

Using nasal mask (F&P 405) since April 2016 at start of therapy. Recently purchased a F&P Simplus with goal to stop mouth breathing. Found I'm in a Catch-22 situation. Not a mouth breather but instead air leaks between lips due to loss of tongue seal.

Also the Simplus ffm causes aerophasia (swallowing air) and which causes a lot of discomfort and results in poor sleep architecture. Much worse tiredness throughout day i.e. not getting enough sleep!

Went back to nasal mask but leakage from my mouth as loose tongue seal causes very high LL (20% of time in LL).

Plan to return Simplus ffm tomorrow and try chin strap under nasal mask.

APAP hasn't been a solution to improve sleep for me but instead has made sleep MUCH worse. Prior to APAP my sleep was good with mild sleepiness during the day.

[FrankNichols]

I tried numerous things to solve the air leaking through the lips and aerophagia. With me when I did manage to get the P10 (Pillows) to work and sealed my lips (glue for example) the aerophagia was very bad. So, I ended up back on the F10 (FFM) and that helps in my case.

You could try taping your lips closed - there is a 3M surgical tape (I forget the name right now) it is paper and I tried it in 1 inch and 2 inch widths. It holds well, will seal your lips and is not hard to get off. In my case it made the aerophagia worse.

[Roy289]

Frank, thanks for response. I have a reel of the 3M 3/4" paper tape previously used to hold muscle stimulator pads on my wife's leg as part of her MS treatment. Will give the tape a try.

I've never been so bone weary in my life after using the APAP with ffm. Just not getting enough sleep. Also I think the volume of dead space inside the ffm mask changes the maximum airflow required. My setting was 7-14 l/m but most nights was just under the 14 upper limit using the ffm. On the nasal mask average was around 11 l/m. Net affect is leakage around the eyes using ffm.

I've followed your journey through different masks with quite a bit of interest.

[PaulaO2]

I dislike the use of tape. It is a dangerous practice, IMO.

There are a few things you can do. First is to keep using the Simplus and wait for the stomach air to settle. You can raise the head of your bed slightly to help with that.

Second is to try a chin strap with the nasal mask. But most of them don't help much with lip leaks. The one that does is the PAPCap. It helped me but didn't work well when I had to sleep on my back (it moves the cap).

Third is to give it time to see if the lip leaking stops. Determine if the leaking is bad enough to even worry about. How often does it wake you, how high are the leaks, how long, etc.

Fourth is to work on the tongue seal technique. For those that can do it (and most people can), it works.

For me, the lip leaking was fairly bad and continued to wake me. i could not master the tongue trick. The PAPCap worked for a while as did the fake Ruby chin strap if I kept it tight enough that it did not allow my cheeks to puff up. But I hated the fake Ruby and the PAPCap often came loose when I slept on my back. Eventually, I got tired of all the dang gear and switched to a FFM. I recently went back to the Nuance and have discovered I do not lip leak nearly as much. I check the data and the leaking is no longer high enough to worry about. So I don't. If it ever gets high enough again, I'll go back to the Simplus.

[robysue]

I'm going to suggest something that may be somewhat controversial: Mr. Red Frowny Face show up in the the Resmed's LCD data only when leaks are in LL territory for at least 30% of the night. So if you're in Large Leak territory for only 20% of the night when using your nasal mask, you might want to not worry too much about the leaks, or rather not worry too much about the leaks provided that:

1) Your leaks for the other 80% of the night are usually well below the Red Line.

2) The leaks are not waking you up OR you are waking you up less than using the FFM did.

In other words, could you post some data that shows what your leaks usually look like when you use the nasal mask without taping your mouth?

As for the aerophagia: That's a bummer that I know all too well. I do agree that poor sleep architecture makes aerophagia worse---it certainly does for me. But aerophagia also makes for poor sleep architecture: There's a nasty feedback loop that can set up between fractured sleep and aerophagia: The more arousals you have, the more you swallow. The more you swallow, the worse the aerophagia gets. The worse the arerophagia gets, the more arousals you have. ....

In my case I've found that if I can prevent the aerophagia from setting in, the sleep architecture improves because I have fewer CPAP-related arousals. So if you are getting better sleep even with the leaks, I'd suggest going back to the nasal mask.

[Roy289]

Paula, thanks for your suggestions. Very helpful

RobySue, attached is last nights screen shot using F&P 405 with large leakage around 20% of the time.

1. The pressure max never becomes close to 14 max. (as is typical with Simplus)
2. Mouth open likely when very large leaks that last long time (31min)
3. This afternoon felt tired but not "bone weary"

Hope this is enough detail.

[attachment=2969]

[PaulaO2]

If you are wearing the Simplus and getting those leaks, it is the mask, not your mouth. Since a FFM covers the mouth, lip leaking isn't "leaking" since the positive pressure isn't affected.

Look into mask liners such as Remzzz. The Simplus works best when it is sitting low on the face.

[FrankNichols]

The tape is not dangerous, it is extremely easy to open your mouth with the tape on it. In fact, that is one of the reasons it didn't work for me, I would open my mouth (to yawn I think) and the tape no longer was sealed. The point of the tape, I believe, is to "remind" you that you don't want to open your lips, by providing enough resistance to get your attention. Didn't work for me, but I did ask my sleep doctor and he said that it was safe and like most things worked for some and not others.

There are videos of making chin straps with non-stretchy velcro which some people find work much better, but they simply hold your jaw closed, and do nothing for leaks through your lips.

It's a real chicken and egg problem of leaks vs AHI. Since the machine has trouble properly detecting events during large leaks - I am not sure if they means above the threshold. I expect it does, but I KNOW that when I was having a lot f leaks just below the threshold, I would get a Green Smiley and my AHI was running around 6.5 to 9.0, which I tamed the leaks so it only occasionally went "high" (say 10 to 12) running mostly down around 5 to 8, my AHI dropped to hanging around 2.0 every night.

On the pressure with FFM, yes, I believe it is "common knowledge" that the FFM requires higher pressure than nasal pillows or mask to achieve the same therapy. So, if you switch to a FFM you will probably need to raise the pressure a few. I did that by raising it 1 every couple nights and monitoring the pressure wave form. When it looked like yours, I was happy - ie. it runs up to or just below max pressure, then decays right away. When it would run up to max pressure and stay there, I kept raising it. My thought being it was staying at the max because it needed more and wasn't allow to increase it. That procedure worked to get me down from 6.5 to 9 AHI to 1.0 to 3.5 AHI normally.

Good Luck

[Roy289]

Paula, the screen shot is for the nasal mask and represents a night were leakage was above 24l/m for 20% of total time. The leakage from the Simplus mask is similar and has leaks near the eyes. (very annoying). My Simplus is a size S and attempt always try to keep it low on my nose i.e. help reduce leakage around eyes by inflation of pillows. Always a struggle to balance pillow inflation vs mask seal.

Frank, my experience with the Simplus (or any of the ffm) is pressure would go quickly to the max limit and stay there a good portion of the night. Another catch-22, raising the max setting results in more leaks as pressure rises in response to flow limits. Using the ffm there are more OA than CA with nasal. My AHI is always below 5 with the nasal mask (between 0.46 and 2.5 most nights). The ffm has higher AHI but CA is reduced vs OA events.

What a struggle!

[FrankNichols]

You are experiencing exactly what I went through. I finally managed to win the struggle with the F10 leaks above pressure of 15, I now run with settings of 16 low and 19 high.

But, yes, if your pressure is too low the machine will ramp up and sit at max the whole time and you are not getting good therapy.

It took me almost a month to solve my leaks problem with the FFM. My solution, was to put non-stretchy velcro in place of the head gear that comes with the F10 - stretchy stuff. My theory was that when I moved (turned on my side mostly) the stretchy straps allowed the FFM to be pushed off to the side, and it stayed there until I woke up enough to move it back.

With the non-stretchy velcro I adjust the FFM for no leaks laying on my back at pressure, and the it doesn't change when I move around, the non-stretchy straps hold the mask in place. It is not as uncomfortable as it sounds. And I was blaming "old" headgear being worn out, until my new head gear came in and I tried it and my big leaks shot right back up around 75% to 90%. I put the non-stretchy back on, and my big leaks are back down to around 5% to 10%.

So, that works for me. If you want to try it, you can get the regular two sided velcro at Amazon - or other places - then just lay it over the head gear, wrap it over the end and back against it self. There is a thread here someplace with I posted photo of it - if a photo would help, I can did it up and post it here.

Frank