Chin strap over or under? With P10 Nasal Pillows.

[brightcrow]

I've been swallowing air recently, using my P10 Nasal Pillows. Tonight I will try my first solution, to replace the pillows with fresh ones and see if leaking is the cause of the swallowing. In case that doesn't work, I'm considering buying a chin strap but I'm not sure if that would throw off the sizing of my non-adjustable P10 headgear which is pretty snug. Would a chin strap be worn over or under the P10 headgear? Over my shoulder-length hair? I'm a side-sleeper in case that matters. The chin strap I'm looking at is the Ruby-Style Adjustable Chinstrap, but it looks so big in back. Thank you in advance.

[IslandSunshine]

I use the Ruby chin strap UNDER the P10. Works great for me. See what works best for you.

[OkyDoky]

The chin strap is to keep you from breathing out of your mouth and causing leaks. I don't think it will prevent you from "swallowing air". You could search above for aerophagia and see what others have tried.
A soft cervical collar might hold your airway in line.

[brightcrow]

@OkyDoky: I've noticed when my seal is not great, the machine seems to push air harder, so figured it might be collecting in my belly. You may be right that the chin strap might not help.

[OkyDoky]

Are you having symptoms? Belching, abdominal discomfort, passing gas?

[brightcrow]

Yes, wake up with a bloated belly, all of the above. Sometimes it lasts for hours. This has only been for the last several days, during which time I've also had trouble with my nasal pillows losing their firmness and not sealing as well as usual.

[dcheddar]

I use a Ruby-style adjustable chinstrap OVER the P10 straps.
The chinstrap keeps the P10 straps from moving around on my hair. I'm a side-sleeper.
However, the chinstrap doesn't fully prevent me from leaking air out my lips, so I also tape my lips with paper bandage tape (CVS store-brand).
I saw a big drop in leaks and AHI when I started taping. Almost every night AHI is "0.something", and 0.0 is common.

[OkyDoky]

What pressures are you using? Are you monitoring your therapy with Sleepyhead? What has your AHI been and is it obstructive, hypopnea, or central? Are you using EPR?

[brightcrow]

I like the tape idea. Last night I observed myself breathing softly out of my mouth when I'd rolled onto my back in the morning hours. I had a much better seal with new nasal pillows too.

What pressures are you using? Are you monitoring your therapy with Sleepyhead? What has your AHI been and is it obstructive, hypopnea, or central? Are you using EPR?

I'm interested in having better access to my data, since my providers have everything auto-set and the clinical data hidden from me. I use My Air to get a sense of things. Part of me thinks I'd start over-thinking every detail if I had more data. My primary use for this auto-cpap is to counter my shallow breathing and low oxygen saturation when I sleep. I have low to moderate obstructive apnea too, with a huge amount of Periodic Limb Movement controlled by Ambien, which is the likely cause of the shallow breathing. Since a good night sleep is my goal and better oxygenation is my doctor's goal, I don't know if more data would be useful to me. What I know for sure is that the idiots who sold me this truly miraculous equipment know not a thing about it.

[OkyDoky]

The reason I asked about your pressures is that sometimes a small adjustment may help the aerophagia, but if it's not that big of a problem and doesn't last long that's your call.
I do like to have all of the information no mater if I use it or not, so I will give you that option. Here is the Clinical manual that tells you how to access your pressures and other options. https://sleep.tnet.com/home/files/resme ... -guide.pdf
This site has lots of info including how to download and post Sleepyhead. https://sleep.tnet.com/main
If this is something your are not ready to do now, I would still bookmark them for later.

[brightcrow]

Thank you, OkyDoky for your interest and support. I will keep that info at hand.

I believe I do use EPR and am told that the 95 percentile pressure is 9.2. My limits are 4 to 16 but I don't think I ever get that high.

[OkyDoky]

Thank you, OkyDoky for your interest and support. I will keep that info at hand.

I believe I do use EPR and am told that the 95 percentile pressure is 9.2. My limits are 4 to 16 but I don't think I ever get that high.

What the 95th percentile means is that you were at OR BELOW so it isn't a good measure of what your were at most of the time. The median maybe a closer guess. That's where the graphs are helpful, but if you are doing well no real hurry on that.
If you have a continuing problem with gas let your doctor know and they might do a pressure change if you don't feel comfortable or know enough yet to do it on your own.

[brightcrow]

It took me 10 minutes to explain to him that I wanted to know what my typical night's highs were, and all he could come up with at first was the most recent single night, which I suspected was high as a result of leak. Eventually he found monthly data, and when I asked what specifically the 95th percentile meant in this instance, he told me it was at 9.2 95% of the time. My median was around 6. So I inferred incorrectly that the median was the average between the starting setting 4 and the highs of 9. You're right, I should have my own source of data for future reference, so I'll work on that once I'm less anxious and frazzled. Thank you again.

[brightcrow]

OkyDoky: An update in case you're still interested. It does seem the problem is that the pressure gets too high. It woke me at 5am REM sleep at 11.2 pressure. I woke because my cheeks had puffed out and my lips stayed closed, then the air went down my esophagus. My fresh mask cushions were well sealed, I was sleeping on my side, and the hose was positioned well. I have to wonder if I'd be having this problem if they'd given me the "For Her" model of this unit. Do you know if it's possible to download the women's algorithms onto my machine? Now I'll have to wait out the holidays in order to get a call in to my doctor, who I'm hoping will know how these things work and can make informed adjustment recommendations.

[Jay Aitchsee]

Hi, brightcrow.
I don't know specifically how to help you, but I'll offer some of my observations.
Generally, higher pressures are more apt to cause aerophagia. Duh, makes sense, right? So if you can limit your machine from going to higher pressures that could help. Lowering your max pressure or going to CPAP mode could be beneficial. It's kind of a trade off between the pressure needed to take care of obstructive apneas and hypopneas and aerophagia. But you really need to see your data to make an informed change.
Aeropahgia could be exacerbated by improper alignment of the airway/esophagus. Have you done anything different lately that might cause this? New bed pillow, or something like that? Here, a soft cervical collar could help.
If you are going to tape. you might want to think about not completely sealing your lips. If you tape horizontally, you could leave a small slit to prevent the pressure build up. Vertically, a strip centered might allow some air to escape around it. As long as the leak from your mouth is not too great, doesn't cause dry mouth and doesn't disturb you, it should be OK. Again, a trade off.
Some have found side sleeping to help, others have not and maybe one side better than the other. Again, I think it's an alignment issue. If you find one way better than another, you might try pillows to help you maintain that position.
In my case, a switch from a FFM to nasal pillows has almost completely eliminated any aerophagia, but I do allow some air to escape from my mouth (no tape). My leaks are acceptable and essentially non-disturbing and improving as I practice holding my tongue in position to stop these leaks as I fall asleep. This practice seems to be teaching my brain to do this while asleep.
So, pick and choose. Maybe something in the above will be helpful.