problems with sleep appliance & BiPAP combo

[elocin71]

I was diagnosed with severe apnea and have gone through CPAP and am now on BiPAP due to burping issues.  My max pressure is currently 15 although from my latest study, I would benefit from 18 were it not for the darn burping.  In attempt to reduce my required pressures, I now have a sleep appliance.  Of course the dentist wants me to use only the sleep appliance but since I have severe apnea, of course it can't do the job alone so I am trying to wear the BiPAP and appliance together.  Unfortunately because the appliance keeps my mouth open, air is blowing straight into my mouth and blowing up my cheeks.  I could probably manage to fall asleep like this but it would be murder on my already dry throat (even with max humidity).  Sleep doctor of course frowns on mouth taping but I tried anyway but with the Medipore being too porous, the air still manages to get in.

Has anyone out there had success with wearing both and if so, how did you do it?  I currently use an AirTouch mask and have also tried with a FitLife.

Thank you

[Walla Walla]

I would dump the mouth appliance and post some sleepyhead charts here so someone can give advice on proper BPAP settings. There's a lot of ways to set pressures to help with swallowing air.

[Sleeprider]

Mandibular advancement devices are pretty useless for moderate and severe obstructive apnea. I would bet good money you could do better with a soft cervical collar and optimized settings on your bilevel. What are your current settings...EPAP, IPAP, PS? Is this an auto, or fixed BiPAP Pro?

[HalfAsleep]

I'm sorry, I can't picture this at all. The appliance thingy is in your mouth, correct? And you have a full face mask, correct? How is that making your cheeks puff out, but you don't have puffy cheeks without the thingy?

I can't see any reason why it would make a difference whether you wore just a full face mask, or an FFM and a thingy together. I could do that with a bite guard and an FFM, no prob.

And I sleep all the time with a FFM and my mouth flopped open, but it certainly doesn't ever give me chipmunk cheeks. I'm not sure I even have pressured air blasting into my mouth.

On an F20 the air gets dispersed inside around the rim of the cushion, correct? I have an F10, and that's what it does, but I've also tried an F20.

It sounds like the air input from the hose into the mask is not lined up with your nose and it's all blasting into your mouth. Mine blasts about at my upper lip. Is your mask maybe too big? Or not right for your face?

I agree with above posts. How about getting some help here without the thingy, so everything is optimized, and then try to do them both at once?

The burping might be from a sleep position? From more pressure than you need?



IMO The biggest hazard from wearing an appliance thingy that advances the jaws and an FFM together is that the FFM headgear will pressure your jaws AND the appliance pressures the jaws. This might be a very problematic situation. It could exacerbate the physiognomy of the back of your throat and/or cause hideous and permanent jaw problems.

[elocin71]

OK so my sleep specialist thought the sleep appliance could, at a minimum, keep my jaw from falling back even if I didn't use it to advance my jaw.  Of course now I'm wondering if my orthodontist couldn't make a a positioner that would have done the same thing and have been less bulky.

Thanks for the suggestion Walla Walla, I will give uploading my data a try in a new thread.

Sleep Rider:, I have a Dream Station on:
Auto BiPap
Auto Bi-Level
min EPAP: 11
max EPAP: 15
PS: 2.0-4.0

I actually bumped it up to 12-16 last night.  Sometimes I can get away with this (although with an increase in gas the next day) and other times I wake up burping and have to turn it back down.

My AHI actually looks pretty good but it turns out that this machine doesn't "read" me all that well.  Before I was able to get a titration paid for, the auto settings put me at 11 on CPAP.  Obviously insufficient and I thought that once I got my higher numbers that I would stop being tired.  I'm still tired and hence the experimentation with the sleep appliance.  (And yes hormones and iron/B12/vitamins are where they should be)

So I paid attention last night Half Asleep and I think the air is actually not being blasted into my mouth but escapes into my mouth when my throat opens from my nose?  (Sorry there must be a term for this but I don't know what it is.)  This problem popped up once I went from 11 to 15.  Actually it used to be worse so I guess I've adjusted something that mostly has fixed it.  As long as my lips can seal, I'm not awoken abruptly by my cheeks puffing up.  With the sleep appliance, I can't seal my lips at all so now I'm stuck.  (I also wear a chinstrap FWIW.)  I do have a horseshoe nightguard that I've had for years and am able to wear with the CPAP without problems.  I clench much less after getting the nightguard and  from treating my apnea of course.  Luckily I haven't had jaw pain in my joint, just resulting headaches.

I am forced to sleep elevated on my back (I know-the worst possible position) because I get raging eyeball headaches when I sleep on my sides or stomach thanks to scoliosis

Despite what the dentist says, I don't believe that I could ever get off CPAP, so I won't be attempting to do the sleep appliance without the CPAP.  Just wish I could figure out how to put the two together and not create more problems!

Thank you all for your input

[Sleeprider]

Your auto bilevel with t3ose settings can range from 13/11 to 15/13 at PS 2, or would be nearly fixed at 15/11 at PS 4. It's not much range, and if you would be willing to post some data, we could probably prioritize some settings for comfort and efficacy. You seem to have some aerophagia, and are using a mandibular appliance and chin-strap that work at odds to each other. The Chin strap pulls your jaw back that you are trying to advance with a device. A more comfortable and effective option may be a soft cervical collar that encourages your jaw forward, helps with leaks and keeps your airway open. There is no doubt in my mind, that we could find some better options for you in terms of pressure and the devices you are using.

[elocin71]

P.S.  Actually I think my initial CPAP setting was 7.  My memory's shot :/

[elocin71]

Hmm now I can't remember if I was wearing the chinstrap at the same time as the sleep appliance, only that I tried it without my CPAP (for an hour before going back to my old setup).

Thanks, I did just post some data here: http://www.apneaboard.com/forums/Thread-...elp-please.  Hopefully it makes sense to somebody out there!

[HalfAsleep]

I, too, have to sleep on my back (last time I rolled sideways, I folded in half a couple of years ago and messed up the muscles and nerves in my shoulders and down my arms) and I also sleep with my upper torso on an incline.

It's important to be careful in that sleeping position as the head can nod forward and impinge on the throat. That position also gives me the headache from hell because the muscles at the back of then neck get overstretched.

You might have to experiment a bit with how you arrange the pillows so your head doesn't nod forward. I'm organized so my head is tipped slightly back. My FFM also stays in position better that way.