Oral appliance

[Am943di]

Hi. I've been using a CPAP machine (Respironics Remstar Pro CFlex +) with a full face mask, and was doing fine. Now I can't exhale fully through my nose. I had a sleep study and it seemed that switching to a nasal mask solved the problem. When I got home I used the same settings and same mask as was used in sleep study but had the same exhale problem. I saw the Dr. who handled the study but no luck figuring it out. I then saw an ENT. Still no help. After research I discovered that the problem is that my tongue falls back at night and blocks exhale. So I put my finger between my teeth while wearing the nasal mask and, bingo, I could fully exhale. Apparently I need something between my upper and lower teeth. In my ideal universe it would be a very thin "appliance" that does not move my jaw forward (I have mild TMJ which I'd not like to worsen). I've tried a bunch of products which require me to boil and fit to my bite, but they were primarily for eliminating teeth grinding. Has anyone else had this problem...and solved it? Thanks in advance for anyone's help..Amanda

[Pugsy]

How about a nasal mask that incorporates a mouth guard into the design?
https://www.cpap.com/productpage/tap-pa ... roved.html

[chartle]

Hi. I've been using a CPAP machine (Respironics Remstar Pro CFlex +) with a full face mask, and was doing fine. Now I can't exhale fully through my nose. I had a sleep study and it seemed that switching to a nasal mask solved the problem. When I got home I used the same settings and same mask as was used in sleep study but had the same exhale problem. I saw the Dr. who handled the study but no luck figuring it out. I then saw an ENT. Still no help. After research I discovered that the problem is that my tongue falls back at night and blocks exhale. So I put my finger between my teeth while wearing the nasal mask and, bingo, I could fully exhale. Apparently I need something between my upper and lower teeth. In my ideal universe it would be a very thin "appliance" that does not move my jaw forward (I have mild TMJ which I'd not like to worsen). I've tried a bunch of products which require me to boil and fit to my bite, but they were primarily for eliminating teeth grinding. Has anyone else had this problem...and solved it? Thanks in advance for anyone's help..Amanda

I doubt you would find anything over the counter* would be available. I would go back to the ENT and or the Sleep Dr and see what they say.


* I have the same item and not sure why you have bought that. I've never seen anything about them that would make me think it would work for your situation. My dentist insists I should wear one because he thinks I grind my teeth at night. I've been trying to tell him my teeth are ground down because 40 years ago my orthodontist fixed my crooked teeth but really messed up my bite.

[chartle]

This device that you boiled was it for teeth grinding or specific to sleep apnea. I did a quick google search and found this below. Seems like most are devices that are used instead of a cpap not with. Ones my Sleep Dr did not even think would work for me.

https://www.google.com/search?rlz=1C1GG ... CexT9Pc278

[Julie]

I think they're referring to the 'boil and bite' device made for grinding.

[RogerSC]

How about a nasal mask that incorporates a mouth guard into the design?
https://www.cpap.com/productpage/tap-pa ... roved.html

Not a full mouth guard, just the top part. If that would do it for you, then this seems like a good possibility.

[chartle]

How about a nasal mask that incorporates a mouth guard into the design?
https://www.cpap.com/productpage/tap-pa ... roved.html

Not a full mouth guard, just the top part. If that would do it for you, then this seems like a good possibility.

But the "mouth guard" is not there to control a tongue or protect your teeth its there to affix the mask to your face without straps (need to keep this in the in my head if my wife ever needs one since she is highly allergic to anything touching her skin).

I'm still wondering why the OP thought its would help.

[Am943di]

I really appreciate all your thoughts and suggestions. I'm looking into the Nasal Pillow with stabilizing mouthpiece. I'm using terms such as appliance, mouthguard, etc interchangeably...I know they're not the same, but I don't know what else to call a piece of thin plastic between my teeth. I only need to keep my mouth open a half inch or so to make a big difference in my breathing. In any event I've got another round of appts, with dentist, ENT, otolaryngologist, pulmonologist, and supervising doctor for my sleep study. Thanks again all...Amanda
,

[chartle]

I really appreciate all your thoughts and suggestions. I'm looking into the Nasal Pillow with stabilizing mouthpiece. I'm using terms such as appliance, mouthguard, etc interchangeably...I know they're not the same, but I don't know what else to call a piece of thin plastic between my teeth. I only need to keep my mouth open a half inch or so to make a big difference in my breathing. In any event I've got another round of appts, with dentist, ENT, otolaryngologist, pulmonologist, and supervising doctor for my sleep study. Thanks again all...Amanda
,

So its just to keep your mouth open. I thought you were looking for something that somehow keeps your tongue not in the back of your throat.

Also i thought with any nose mask pillows that you had to keep your mouth shut.

[Pugsy]

So its just to keep your mouth open. I thought you were looking for something that somehow keeps your tongue not in the back of your throat.

Sounds like a nasal pillow mask to be used with the cpap machine.
You may not know about it but it uses a mouth guard to stabilize or hold the nasal pillows in place. The part of the device that is the mouth guard might just keep that tongue from moving around. Worth looking at.
Called the Tap Pap.
https://www.cpap.com/productpage/tap-pa ... roved.html
It's a nice little mask. I used it for a little over a year until the P10 was released and I switched to it.

[kteague]

the problem is that my tongue falls back at night and blocks exhale

A few thoughts... The tongue is commonly a culprit in sleep apnea events. There are a few things you could try to see if they might mitigate the issue. Are you back sleeping? That position allows gravity to pull the tongue backward. Think carefully about the sleep position of your head. Even if side sleeping, a soft pillow that allows the head to sink can be a recipe for getting into a compromising position with gravity again working against you. A firm flat pillow, with your head positioned at a slight downward angle can keep the tongue from falling backward. (Don't bend the neck to get the head forward, keep the spine and neck aligned and accomplish it by body angle. The main thing that helped me was mastering the technique of suctioning my tongue to the roof of my mouth just behind the front teeth. Kept at it until it became 2nd nature. Good luck with figuring out ways to help yourself. BTW, I love the TapPap mask.

[chartle]

So its just to keep your mouth open. I thought you were looking for something that somehow keeps your tongue not in the back of your throat.

Sounds like a nasal pillow mask to be used with the cpap machine.
You may not know about it but it uses a mouth guard to stabilize or hold the nasal pillows in place. The part of the device that is the mouth guard might just keep that tongue from moving around. Worth looking at.
Called the Tap Pap.
https://www.cpap.com/productpage/tap-pa ... roved.html
It's a nice little mask. I used it for a little over a year until the P10 was released and I switched to it.

Yes I've looked at and already commented about this "interesting" bit of kit. My point is the how is any mouthguard, for grinding teeth, or mouth guard like appliance, used to hold the nasal pillows in place, going to keep your tongue from prolapsing back into your throat. I've wore a mouth guard and I think it would make the situation worse because there is more stuff in your mouth that may push your tongue back. I looked at devices that were to keep your tongue from not doing that for snoring purposes and they looked like, well frankly torture devices.

But isn't keeping your mouth open using a nasal type mask or nasal pillows a bad thing?

[ChicagoGranny]

After research I discovered that the problem is that my tongue falls back at night and blocks exhale.

That's pretty much the definition of obstructive sleep apnea. Add "inhale" and you have it covered.

[Pugsy]

But isn't keeping your mouth open using a nasal type mask or nasal pillows a bad thing?

It can sometimes be a bad thing but sometimes not. The TapPap mask...the mouth isn't necessarily open. Not any more than with any other mask anyway.

Not all mouth opening equals mouth breathing of a magnitude to cause a huge problem. Been there and done that and proved it by looking at the leak line on the software reports. Anytime there is a question about just how much mouth opening/breathing is going on a person should first look at the software reports to help them determine just how bad or not things are.

As for a mouth guard of any sort affecting tongue falling back...maybe it can help...worth trying. The tongue will do some funny things when it has something in the mouth to mess with. Just ask anyone who has had any sort of dental work done.
I have used the TapPap mask...for well over a year and it didn't push my tongue backwards at all. Or at least didn't seem to change my pressure needs which I would assume that if the tongue fell back into the airway that more pressure would be needed to keep the airway open.

Actually the TapPap was quite nice...I would often wake up in the mornings and not even notice the mouth guard at all and/or the air pressure. Everything sort of just disappeared and I would briefly be thinking that I wasn't even using cpap.

Anything is fair game to try in the battle to keep the airway open. We won't know if something will work or not unless we actually try it.

[Am943di]

Again, thanks for all your replies. I am ordering the TapPap as several suggested. As for the issue of whether I'm looking for something to keep my tongue from "falling backwards" or for a way to just keep my mouth open, I'll say it could be either, or both. I have noticed that if my mouth is slightly open my tongue seems to not fall back. I'll try the pillow adjustments kteague described and let you know how that goes. I also came upon a cpaptalk thread from 2012. Apparently this is a very common problem. Naturally everyone's different...I just gotta find my particular cause. As I've said before: Sleep should be a given...one thing we can all just enjoy...Amanda