The Mouth Leak Cycle

[zonk]

Just in case the link become invalid, here is the full information
http://www.resmed.com/au/clinicians/comp...clinicians


Mouth breathing
* is a common problem for CPAP and bilevel therapy users.
* is commonly caused by chronic nasal disease
* is usually intermittent
* can be exacerbated by:
Colds
Allergies
Alcohol consumption
* causes high unidirectional airflow and prevents moist air from the lungs passing over the nasal mucosa. This results in mucosal drying, nasal congestion, and flu-like symptoms on awaking in the morning.

Is mouth leak a common problem for patients using CPAP therapy ?
Yes
Mouth leak is experienced by around 40% of CPAP users1,2,3

Is mouth leak a common problem for patients using bilevel therapy?
Yes.
Mouth leak is experienced by almost all bilevel users1,2,3



Increased nasal symptoms can worsen OSA and lead to increased nasal airway resistance. This in turn leads to further mouth breathing, thus perpetuating the cycle.

The result is loss of therapy effectiveness, loss of comfort, and disrupted sleep4 – all of which can lead to loss of compliance, and ultimately loss of patients on therapy.

What makes a full face mask a good solution to mouth breathing and mouth leak?
A full face mask covers both the nose and mouth so that effective therapy can be delivered even in the presence of mouth breathing and leak.

This makes it different to a nasal mask.

Many people may need to use a full face mask all of the time. Others may find they only need it from time to time as an alternative to their nasal mask.

Full face masks are just one of a range of solutions that we offer to help you identify and manage mouth leak

What criteria should I consider before prescribing a full face mask for a patient?

Take a few minutes to ask all patients these questions:
1- Do you often wake up with a dry mouth and/or throat?
2- Do you tend to breathe through your mouth (rather than your nose)?
3- Do you suffer from allergies or hay fever?
4- Do you have a blocked nose/congestion at certain times of the year?
5- Have you ever had a broken nose?
6- Do you have a deviated septum?
7- Have you had previous nasal surgery?
8- Are you currently using any nasal therapy or medication?

In addition, for patients already using therapy with a nasal mask:
* Are you continuing to snore even when using therapy?
* Do you use a chin strap with therapy?
* Is leak indicated by your flow generator data?

Patients who answer YES to one or more questions may benefit from using a full face mask.

Prescribing a full face mask can prevent patients from suffering mouth leaks and loss of therapy. They are less likely to return with problems, and more likely to be satisfied and compliant with therapy.

References
1 Richards et al. Am J Respir Crit Care Med 1996 Jul;154(1):182-186
2 Lojander et al. Acta Otolaryngol 1999;119(4):497-502
3 Meyer et al. Sleep 1999 Jul; 20(7):561-9
4 Teschler et al. Eur Respir J 1999 Dec; 14(6):1251-1257

[justMongo]

A FFM was the answer for this knuckle dragging mouth breather!

[eviltim]

Interesting about the CPAP vs bilevel distinction. I wonder if switching to straight CPAP mode would help my mouth breathing, although I seem to be getting along alright without the chinstrap these days.

[ShelaghDB]

A FFM was the answer for this knuckle dragging mouth breather!

But don't you wake up with an open mouth and the driest one you could imagine, as if it is stuffed full of cotton wool?

If not, any idea why you don't?

[robysue]

Interesting about the CPAP vs bilevel distinction.

My guess is that the patient base for bilevel has some statistically significant differences from the patient base for CPAP/APAP.

In particular:

Most (but not all) people using BiPAP are at high pressures---IPAP > 15 is pretty common. And high pressures can make it more difficult to simply keep your mouth shut when sleeping.

Many (but not all) people using BiPAP are people who have "failed" at CPAP/APAP. And by "failed at CPAP" I mean that one or more of the following problems is still in evidence even though the patient has been compliant with CPAP/APAP therapy for several weeks to a few months:

• Severe discomfort with CPAP/APAP that has not been relieved with the usual changes to therapy including: Mask changes; use of a chin strap; changes to the humidity setting; use of a heated hose; changes in the heated hose temperature; change from CPAP to APAP or vice versa; and pressure changes.
  
• A treated AHI that remains above 5.0 even after several weeks or months of CPAP/APAP therapy.
  
• Daytime symptoms of OSA such as excessive daytime sleepiness, micronapping, and daytime fatigue have not improved or have gotten worse while on CPAP/APAP therapy even if the treated AHI is consistently below 5.0
  

It is quite believable that people who habitually mouth breath may be a much higher risk of running into one or more of these problems even though they consistently use their CPAP/APAP as prescribed: Mouth breathing can increase the chances of developing aerophagia and mouth breathing leaks can be both long enough and large enough to adversely affect the efficacy of CPAP/APAP therapy.

Hence it's easy to believe that a habitual mouth breather may be at (much) higher risk of being moved to a BiPAP because of serious CPAP/APAP adjustment problems than a non mouth breather has. And that in turn would mean that the BiPAP patient pool may indeed have a much higher percentage of habitual mouth breathers in it than the CPAP/APAP pool does.

I wonder if switching to straight CPAP mode would help my mouth breathing, although I seem to be getting along alright without the chinstrap these days.

Maybe, maybe not. If you can tolerate your 90% or 95% pressure level as a full time pressure setting, you may indeed find that you'll have less mouth breathing and better sleep in straight CPAP mode rather than APAP mode.

[eviltim]

That makes sense and is probably the reason why. Indeed my immediate thought was whether I'd be willing to put up with the straight CPAP. I've only ever tried it once and that was at my sleep study, which I failed so poorly I was given the S9 VPAP.