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+--- Thread: leak rate with nasal cushion (/Thread-leak-rate-with-nasal-cushion)
leak rate with nasal cushion - renoir - 11-15-2019
[attachment=17061][attachment=17061]I had been using a Dreamwear full face mask for the past month. It's okay, but I wanted to give my resmed nasal cushion mask another try. I taped my mouth twice in the night because I needed a drink.
Initially, the tape was disconcerting, but I got over that fairly quickly. The 'Cpap experience' through the night went well. It was easy to breathe and the mask was not cumbersome.
I was disappointed to see my leak rate in the morning. Part of me hopes it was due to the type of (cloth) tape I used the second time. I'd like to stick with the nasal cushion and work on the leaks.
My question... does the leak rate throw off the AHI score? During large leaks, is the therapy not working?
Thanks as always for your comments.
RE: leak rate with nasal cushion - Gideon - 11-15-2019
Your numbers are great, except for your leaks. This means, looking at the areas of the chart that don't have large leaks. You have few events, which by implication means that you would have relatively the same frequency of events during the large leaks, basically none, That said it is still important to manage the leaks, but you have less 'urgency' to do so because of your numbers.
Large leaks impair the ability of the machine to recognize and respond to events. You are lucky in that you do not have a large number of events. Still let's work on resolving this mouth breathing.
The leak chart, both in areas with and without large leaks shows 'mouth breathing'.
From the Wiki on mouth breathing
Quote:Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With OSCAR look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In OSCAR right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, not overnight, but it works for some.
Cervical Collar. A "soft" Cervical Collar (Releaf is popular). This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occurred when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues. An Anti-Snoring collar, which has a small strap in back (Dr. Dakota is popular)
It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw-dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, the Ultimate Chinstrap, Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose is to maintain a proper head and neck alignment while allowing for the mask maintaining the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks/mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask.
- Many users use a product called Biotene to get relief from this symptom.
The tongue trick is where you want to be but it takes a lot of time and some people just cannot get it. Place the tongue on the roof of your mouth and breathe with your mouth shut. Breathing thru your nose, right? Now leaving the tongue where it is open your mouth, you should still be breathing thru your nose. Now that you have that down move your tongue, breathing thru your mouth right? OK, put your mask on, under pressure, and repeat the above. Expect to need to turn your machine off when you start to repeat. Add talking while under pressure, It takes a while to get any of this down. It took me months. The exercises above are to help you understand the positions that cause the issue and how to correct it. For all this to become automatic will take a while.
RE: leak rate with nasal cushion - renoir - 11-15-2019
Thanks for the tips. I have a cervical collar which has really helped. I also know about tongue placement, but I wasn't aware of the exercises. It probably
can't hurt, also, to maybe even double up the tape and make sure it is secure.
RE: leak rate with nasal cushion - Gideon - 11-15-2019
(11-15-2019, 10:48 AM)renoir Wrote: Thanks for the tips. I have a cervical collar which has really helped. I also know about tongue placement, but I wasn't aware of the exercises. It probably
can't hurt, also, to maybe even double up the tape and make sure it is secure.
Note what I said about taping in the wiki article.
RE: leak rate with nasal cushion - renoir - 11-15-2019
Re:
I make sure that I can easily open my mouth when taped, if I need to.
How is it possible to do that? Do you just put a piece of tape vertical in the middle of the mouth?
RE: leak rate with nasal cushion - Gideon - 11-15-2019
Your jaw is one of the strongest muscles in the body. You can open it. Add a tab for easy removal and I just taped my lips. just to keep them from leaking.
RE: leak rate with nasal cushion - renoir - 11-15-2019
thank you