Air leak from nose to mouth?

[Guest]

Lately I have been having a problem that so far has been happening in the morning hours like from 4:30am to 6 or so when I get up. It feels something like maybe air is going from the back of my nose to my mouth but not out my lips. It is so hard to say what is happening because I am more asleep than awake when it happens, so I know something is happening but I don't know what because I am not conscious enough. So my question is this what might it be and why do I notice it happening mostly toward morning? I normally hold the back of my tongue against the roof of my mouth (subconsciously) to keep air from entering my mouth.

Gary

[drubin007]

I am having a similar issue, sort of... For the past few days I feel increased pressure coming from my cpap. The first morning I did not know what to think, I woke up and my cheeks were filling up with air. I suspect I looked like a chipmonk.

From reading in here, I learned the tongue to the roof of your mouth trick and it helped... I could then hear more air gushing from the exhaust on my nasal headgear...

I made a post last week (or earlier this week?) with my numbers and looking for suggestions.. Never have figured out what caused it.

I have been playing with my pressure (from 9.6 to 10.2) but for a few days nothing different, now this? I lowered my EPR from 3 to 2 last night, but same results.

maybe we are being invaded by poltergeists?

[roster]

I am having a similar issue, sort of... For the past few days I feel increased pressure coming from my cpap. The first morning I did not know what to think, I woke up and my cheeks were filling up with air. I suspect I looked like a chipmonk.

........

Chipmunk cheeks is a common problem. Your particular anatomy allows pressure to leak from the airway into the mouth. The benchmark solution is a full face mask. That is why I use one.

Contrary to what is often said here, you can't try your tongue to stay on the roof of your mouth during sleep.

[twasbrillig]

I agree with Rooster - you can only train your tongue to stay at the top of your mouth when you are awake. It's not necessarily going to stay that way when you relax and go to sleep, because of the additional outward pressure during exhalation from the CPAP. With normal breathing while awake, it will stay there. However, if you try to exhale a large breath sharply through your nose, you can feel the seal being tested.

I have seen the term "velolingual seal" to describe what's going on with your mouth. It's actually made by the base of your tongue and your soft palate. If you use a nasal mask or pillows, you will find you can open your mouth and even wiggle your tongue without breaking the seal.

Rooster may disagree, but I think a chin strap can help. When your mouth falls open, it puts more stress on the velolingual seal. Having something keep your chin closed may help prevent the seal giving way.

If the seal breaks, your cheeks will fill up. It's only a matter of time before the air comes out of your lips.

The real question is, are you having higher AHI during those times in the morning when you wake up? From a general therapy standpoint, if you are half-awake, there is also something going wrong.

[roster]

........
Rooster may disagree, but I think a chin strap can help. ......

Twas,

It seems to work for, what, maybe one out of twenty? Good for that one!

I'm not counting people like Charles at the AWAKE meeting who brags about his homemade chin strap and then talks about using a rinse for his dry mouth. Now I wonder how his mouth gets dry with that chin strap holding it shut?

[grandmma]

by twasbrillig on Thu Jun 25, 2009 7:36 pm

I agree with Rooster - you can only train your tongue to stay at the top of your mouth when you are awake

I used polident strips for over a year and a half, and somehow during that time my tongue has trained itself to sit in the right spot, and I no longer mouth breathe at all - no chinstrap, tape or polident at night for some months now. Pure luck & side benefit, no self training involved, so you could be right!

However, just mentioned on a separate thread - my son has a new chinstrap, he thinks its a "Seanet", only purchased yesterday & trialled last night so he's a bit vague as yet.

It covers his mouth completely, but we were in no doubt his drooling if nothing else would scupper that. We were wrong - apparently it was a raging success.

Don't use a chinstrap myself, so not sure if this is a new design or not, but thought it was worth a mention here as well.

Now he needs to work on the strap marks, but that's another pain.....

[roster]

by twasbrillig on Thu Jun 25, 2009 7:36 pm

I agree with Rooster - you can only train your tongue to stay at the top of your mouth when you are awake

I used polident strips for over a year and a half, and somehow during that time my tongue has trained itself to sit in the right spot, and I no longer mouth breathe at all - no chinstrap, tape or polident at night for some months now. Pure luck & side benefit, no self training involved, so you could be right!

.....

Now here I would say something different. You kept your mouth closed all night long for 18 months, not by flexing muscles, but by mechanical means. IMO, that could create a habituation that would keep your mouth closed when the mechanical means is gone. If such a habituation came about, it would only involve a positioning of the head and jaw without any flexing of muscles.

Training the tongue is quite different. You can only do it for brief times each day when you are awake. More importantly, it requires that muscles are flexed to hold the tongue on the roof of the mouth. It is known when we fall asleep muscles relax so the tongue falls back.

[Muse-Inc]

...When your mouth falls open, it puts more stress on the velolingual seal...

Air leaking out thru my very slightly opened lips, chin up, teeth aligned, tongue to roof of mouth -- not the CPAP air which is very loud just a gentle puff now that leads to dry mouth & arousals & some startle reflexes. I find the effort required to exhale against CPAP (pressure 11) is still disconcerting. Thinking I may need exhalation pressure relief. Then, again, I might need to go to a hybrid mask...that's why I'll be getting an APAP & recording oximeter 'loaners' next wk to gather data.

[grandmma]

Rooster I agree in principal, and sorry I was not more clear - my mouth does stay closed thru the past 18 months training. However, also the tongue does sit in that 'sweet spot' that..I'm not sure of the correct explanation, but blocks the airway to the mouth? Down behind the throat. Don't know when it happened, it just did. It was not a conscious thing on my part, had to be whilst I was sleeping, I expect.

Whilst I am awake I can open my mouth wide as I like whilst on CPAP and no air escapes. Don't know what happens when I'm asleep, but leak #s are really good, so something's working there too, either the closed mouth, the tongue, or both!

Unexpected, but a nice bonus nevertheless!

[roster]

......... I find the effort required to exhale against CPAP (pressure 11) is still disconcerting. .........

Muse,

Many get a feeling of having difficulty breathing out against a moderate pressure. Typically this is because of an awareness and focusing on breathing while lying awake. They consciously breathe in and out. Once they are able to fall asleep, the automatic breathing function takes over and it is nearly effortless to breathe out. It is a "mind problem" not a "muscle problem". When that happens to us the solution is to distract the mind from breathing with relaxing thoughts until we fall asleep.

........
Air leaking out thru my very slightly opened lips, chin up, teeth aligned, tongue to roof of mouth -- not the CPAP air which is very loud just a gentle puff now that leads to dry mouth & arousals & some startle reflexes. .......

If you have air leaking out through your lips, it absolutely is "CPAP air". The only source of this airflow is your airway. No need to worry yourself with an oximeter at this point, you just need to adapt to a full face mask. I just awoke from a wonderful dream sleep with my full face mask feeling like a fine friend.

Good luck,

[drubin007]

I agree that I cannot control my tongue while sleeping, despite my repeated efforts!!!

The chipmunk cheeks for me at least is sporadic... I do not get it every night, so not sure why I do get it when I do.

I got iagain last night and when I noticed used my tongue to stop it and went back to sleep. Leak rate showed 0.08 L/s on my machine (no software yet to read into it further). I used a chin strap for the first time last night too (thanks Pugsy!)
so not sure if that helped with my numbers...
\a few more days will determine.

full face mask would not work for me. used one in my sleep study and was too uncomfortable. they are not for everyone!

[twasbrillig]

One thing about CPAP being continuous pressure and continuing to provide pressure as you expire ( and perhaps this is what you were getting at, Muse) is that it is working against the natural functions of your nose and throat. It feels funny in more than one way.

Your velolingual seal is designed to keep air going either from your nose down into your airway, or from your mouth into your airway; that way, when you create inspirational pressure from your diaphraghm, the pressure isn't wasted by trying to draw in air from all different places, which creates turbulence. The air is going to come in either through your nose or mouth, and that's that. IMHO, the main function of the velolingual seal for breathing is to make inspirational airflow efficient.(It has other effects on eating, speaking, etc)

When pressure continues in during exhalation (as it does with CPAP), you have two different air streams coming at the velolingual seal. One from the lungs pushing air out, one still from the nose pushing air in. While CPAP contributes a modest amount of pressure, it's still destabilizing to the seal, because it's not onlly adding pressure, but it's coming from the wrong direction.

I have found this all contributes to what appears to be a strange problem for me. I automatically breathe through my nose, and I can't switch to mouth breathing, even if I want to. I think the only time I can mouth breathe is when I have a really, really congested nose from a cold. (Since I seem to have some type of retropalatal problem, my sleep breathing problems might be solved if I could breathe through my mouth. Perhaps some type of long term training might work.) But nose breathing creates problems when the velolingual seal gives out. Sometimes I have a startle, but at other times, I just wake up with a fluttery feeling of my tongue and make some swallowing motions, as I unconsciously try to reset the velolingual seal. I did this a lot in my last sleep study late in the night, as (I assume) they were increasing the pressure.

I don't think the gross mechanics of the nose and mouth are much considered by the folks who are doing research on CPAP. In fact, I can't tell that there is much research done on CPAP at all, except in people for whom it works. Not much research into why some compliant folks get little or no benefit. The $$ seem to be going to the basic research on innervation, reflexes, etc. That's ok, but it means we have very flimsy evidence for how to get CPAP to work better.

[roster]

Twas,

Seems like you are really overthinking this. The seal you are referring to is nothing more than the meeting of the soft palate and the tongue. If they meet securely enough while you are breathing through the nose, then they will prevent pressure from leaking into the mouth. If the force of their meeting is at some point less than the CPAP pressure, then pressure will leak into the mouth.

.........
When pressure continues in during exhalation (as it does with CPAP), you have two different air streams coming at the velolingual seal. One from the lungs pushing air out, one still from the nose pushing air in. .........

That sounds highly unlikely. If you are breathing out, the direction of air flow in the nasal passage is also out. I would be surprised that one could exhale through the mouth while air from a nasal mask is moving through the nasal airway and then out through the mouth. Sounds like quite a trick that one would have to train for. Don't forget, when CPAP is not being used, the breathing process is still subject to pressure, the pressure of the atmosphere. CPAP only adds, I believe, about 1% to the existing air pressure. If you are curious, the calculation is made easily.

Advice to myself: K.I.S.S. and use a FFM.

Regards,

[Muse-Inc]

...I automatically breathe through my nose, and I can't switch to mouth breathing...

This is what I think is happening with me too, for some reason I just don't switch to mouth breathing even if necessary unless I make a conscious effort (for major congestion). While my outage alarm was in shipment, we had a power outage. I was breathing, gasping really, though the nasal pillow mask's exhaust vent; the struggling, strangled sound of my gasping finally woke me up. I never breathed through my mouth...weird.

Rooster, I fully agree that it's CPAP air but there's huge difference when that seal is fully breached and the air hisses out in rush through my mouth and the small puffs that escape periodically during the night -- I can't even confidently associate these puffs with my wakeups . I really wish I had a machine that could identify if this is the cause of my wakeups; I'm waking up 1-6 times a night now and this is as tiring as it frustrating...I can't associate it with anything. At least I get the APAP to collect nighttime data next Thursday. I might end up with a hybrid mask yet; doc doesn't want to change anything until he sees the data from the APAP & oximeter loaner. Maybe 50#s is enough tissue loss to have compromised the integrity of my seal.

I'm sure hoping some of you will be around over the holiday next weekend to help me get data from whichever APAP I end up up and to make sense of it. I am soooo clueless about these details...even tho my thinking is much clearer and sharper than immediately pre-CPAP (nearly 2 yrs ago), I still get confused easily and that never used to occur...I refuse to blame age .

[roster]

....... I'm waking up 1-6 times a night now and this is as tiring as it frustrating.........

Sounds like you are in denial about mouthbreathing/leaking. You can either do something about it or continue to whine. Suit yourself.