Any mouth breathers successfully use nasal mask?

[plr66]

The way I use the tights they don't even touch the frame so they can't "mash" it hard against the face. As far as the mouth cushion floating, this is too loose. I like a snug (but not tight) adjustment of the mouth cushion against the face.

Anyway, here is the link to the techniques I use: viewtopic.php?t=14422&highlight=

Thanks, Rooster! I'll spend a bunch of time using your experience over the coming week.

[briank]

My observations on fitting the Hybrid are here (and include a "see also" link to Rooster's post):
viewtopic.php?t=44457

[Velbor]

This question poses a number of issues.

First issue, what is meant by "mouth breathing?" The phrase has been used in many posts to mean many things, and the imprecision causes misunderstandings and errors. Inhaling and exhaling through the mouth? Inhaling only? Exhaling only? Exclusively through the mouth, or is there some distribution between mouth and nose? How do we KNOW what's going on while we're asleep. Most of the time, we are really talking about "mouth leak" rather than "mouth breathing" (though either or both can occur.) When using a nasal mask, any airflow through the mouth will result in a "leak" of the machine's air output.

Second issue, is "mouth leak" and different from or "worse than" cushion-to-skin "seal leak?" Yes and no. In terms of pressure loss, NO. The dynamics of a small-volume pressurized system such as xPAP are such that, in terms of the effect on PRESSURE maintenance, a leak is a leak is a leak, wherever it occurs. The machinery will, or will not, be able to compensate for the leak in terms of pressure, depending on its size, regardless of its location. But in terms of clinical effects, possibly YES. Since mouth leak likely involves pressurized air which is already entering through the nose, it has the effect of increasing airflow into the nose and out of the mouth. This can cause dryness in both locations, and nasal congestion, either or both of which can be problematic.

Third issue, what is the EXTENT of mouth leak? Just because it occurs, all is not lost. The key questions are, to what extent is it occuring, and how often is it occurign? If the mouth leak is small, under 0.40 L/s or 24 L/m, it may not present any major problems; the machinery can easily compensate for the air loss and maintain the pressure. Even if the leak is large, if it occurs only sporadically and intermittently, and if it occurs for only a relatively short duration (e.g. less than 5% of the night), again it may not be problematic. Data is needed to evaluate the extent of the "problem" and its significance.

It is always desirable to minimize mouth leak (or any leak for that matter). Chin straps may work if the problem is that the jaw opens. Taping and/or "Polident" gluing will almost always eliminate mouth leak, but it may also cause paridoxical INCREASES in sleep-disordered-breathing, which defeats the purpose of taping. Again, without being able to monitor your own data, it is very hard to know what is going on.

The simple answer to the posed question is, YES. I have periodic exhalation mouth leak, I use a nasal mask (much of the time), I do not tape, I do not use a chin strap, and I do receive successful and effective CPAP therapy. But the combination of actions, and the degree of problem, and the degree of success, will be different from person to person. So for any particular person, the answer may depend on many factors. Velbor

[roster]

..............I do receive successful and effective CPAP therapy. ..........

Velbor,

By what method do you propose an individual using a nasal mask while mouthbreathing/leaking judge the effectiveness of CPAP therapy?

What method do you use?

Regards,

[Velbor]

By what method do you propose an individual using a nasal mask while mouthbreathing/leaking judge the effectiveness of CPAP therapy?

Insightful question. Thank you!! The two key factors that I look for in my own data are:

1) Comparability of nasal mask performance with full-face mask performance in terms of respiratory event indices over time. This comparability is not identity: I find that my nasal mask provides "better numbers" than does a full-face mask, under the same settings and conditions (and in fact across different machines), which is one of the reasons that I do not abandon the nasal mask despite the known mouth leaks. (Another reason is that the Activa nasal mask is the singularly most comfortable mask I have encountered, with the least "seal" leak!) There are some other stastical characteristics I use as well which demonstrate comparability. The important concern, which has been suggested by a highly respected poster on this forum, is that the mouth leaks may be severe enough to disable the machine from sensing and reporting respiratory events. There is no evidence that this is in fact occurring, but this leads to factor two:

2) An acceptable leak profile. As noted in my earlier post, I would not want to see leak (adjusted for mask venting) in excess of 0.40 L/s (= 24 L/m) occurring other than sporadically, and ideally not constituting more than 5% of total therapy time. (Even these numbers are "conservative" in terms of machine ability to sense events and maintain pressure. With Respironics machines, there should be NO "Large Leak" indicators.) This concern leads me at times to use somewhat lower pressures than might otherwise be ideal, since increased pressure is often associated with increased leak. Still, results are well within accepted "goal targets" of xPAP therapy.

Clearly, this approach calls for a good deal of user involvement, and data access, at least during the early weeks of therapy, when user involvement and data access should ideally be present in any case.

[roster]

Velbor,

In comparing the effectiveness of nasal versus full face masks, is it intentional that you do not mention subjective (or objective) measures of "how you feel"?

[Velbor]

In comparing the effectiveness of nasal versus full face masks, is it intentional that you do not mention subjective (or objective) measures of "how you feel"?

Again, a very insightful question. And yes, it is quite intentional.

I am unable to identify any objective measures (e.g. respiratory event indices, %-time-in-apnea) or quantifiable clinical factors (e.g. mask, number of times up) regarding my sleep experience which correlate with "how I feel" (e.g. energy, awakeness, alertness, sharpness) the following day. My OSA has rarely been "symptomatic" on a day-by-day basis, and so is not subject to tracking day-by-day differences. My diagnosis was based on my wife's observation of my sleep-breathing patterns, and by sleep study.

I am also unable to find any metric (e.g. the Epworth scale; I inherently distrust unquantified global subjective self-evaluations) which is objective and sensitive enough to identify day-by-day changes. I certainly have days during which I feel more "foggy" than others, but they tend to run on for multiple days, and I have not yet been able to correlate them with any other factors.

In addition, I find startlingly large night-to-night variation in my own objective numbers, which do not correlate with "changes" in CPAP. The inherent biological variability overwhelms the effect of intentional variations in therapy, and I can detect differences only with MANY nights of very careful data collection, adherence to protocols to minimize variables, and statistical review.

I envy the folks for whom CPAP is a life-changing therapy. For me it is simply a life-preserving therapy. I have nothing upon which to gauge the effectiveness of therapy, other than the numbers which the machinery grudgingly gives me. I don't rule out the possibility that some people are able to "titrate" aspects of their own therapy simply based on how they feel. But I can't do it myself, and perhaps therefore tend to be more than a little doubtful of claims that others can.

Regards, Velbor

[Mouchet]

Last night I use nasal pillows and a chinstrap, and it may have worked . I still woke up about three times since they fell out but it appears I got my app meals down 2.4 the lowest I’ve ever seen in four years.

I’m a huge mouth breather and so much so that for mass just keep waking too much what’s the best post the kids so that they don’t fall out so much

[zorki1c]

I use pillows and don’t have a problem keeping my mouth shut when in bed. But a while back I had an injury thatforced me to sleep in a recliner for a couple of weeks. I discovered that in that position i could not keep my mouth closed and my AHI went through the roof. When i was able to go back to a bed the problem went away