Need help with dry mouth, waking up & fatigue

[IslandGal2009]

I know this topic has been covered before but I can't seem to find a reason or solution to problem with dry mouth, etc.
EVERY night, I wake up several times with an extremely dry mouth and I need to sip water and/or spray my mouth with MOISTIR, a saliva 'substitute.'
I also am STILL waking up EVERY morning with either a slight headache, or sometimes worse. I also have morning nausea.
What have I done to try and fix this?
- increase the humidity and it's at 5.5. No change in my dry mouth, etc.
- checked the leak level. It's well within the cut off level for my Resmed S9 Elite. But I have taped my mouth a few nights to see what that would do. For example, two nights ago with a taped mouth, my leak level on Sleepyhead data was Avg leak: 0.75 and 95% leak: 2.40. STILL, a problem with parched mouth during the night. Note, I don't have a dry mouth during the daytime but do drink water fairly often.
- checked my medications. Before starting CPAP in February of this year, I was on thyroid meds and a half tab of zopiclone. I had dry mouth but I only woke up a few times (although I did wake up more frequently because of nocturia which seems to be better.) I stopped the zopilone for two weeks to see if THAT was the culprit but no change. It's just that over the past few months, I have been waking up more often with a parched mouth, continued morning headaches, nausea ... so am thinking that it has something to do with the CPAP therapy. ???? I have been a very low dose of beta blocker and Ca channel blocker for the past month but it hasn't made the dry mouth worse.
- I hesitate to not use the CPAP because even if I lay down in the afternoon to read, and start to 'nod off', I wake with a start and choking or feeling like I can't get air in.
Finally, I don't have obstructive apnea in the 'normal' sense, but rather airway restriction since a Lyme Disease infection 8 years. It has been that long for doctors to figure out that yes indeed, I DO have a problem with sleeping and getting enough air! UARS seems to be the diagnosis.
Note: my AHI is well within normal limits but there is a trend upward for the past two months. I seem to FEEL better and more refreshed, if the AHI is below 1.0.
Any suggestions?
Thank you.

(Note: for some reason, I couldn't log in under my regular user name, which is CoastalSun. I use a ResMed Elite S9 with humidifer, and WISP mask with pressure setting at 7. EPR setting at 1.)

[Todzo]

One thing I have noted over the last couple of years is that if my breathing becomes excessive for several minutes my mouth will become dry. Please understand, I am NOT a mouth breather. This was tracked to happen with mouth closed. Apparently the circulatory and metabolism changes due to less carbon dioxide in the blood are enough to change the workings of my salivatory systems. Sometimes I wake up with dry mouth. Consistently I am over breathing. Consistently reducing the breathing brings wetness back into my mouth. I do not drink water to do this. It seems to be related to the state of my body from over breathing.

Last summer I did a self titration (new city – doctors scarce). I was having problems with breathing stability which I attributed to weight loss. My pressure went from 15 cm/H2O down to 8 cm/H2O and has changed little since then.

So this summer I see problems with breathing stability? Apparently hot weather, known to cause more OSA, causes my breathing to become more unstable. Most often I suffer breathing instability in the winter time during those times close the the anniversary of a severe assault upon my person. The stressed nerves drive up the breathing levels and it becomes unstable. So this summer I added back into my CPAP therapy what works to stabilize my breathing in the winter. I added a bit of with enhanced expiratory rebreathing space (EERS)[1] back into my CPAP therapy. You should talk with your doctor about EERS and also ask him if dynamic CO2 therapy[2] has become available in the U.S. (it is rumored to be available in the EU).

I am suspicious that as the weather pattern moves more toward fall your problem will go away.

I believe that reducing stress in your life if you can may help.

I have found it useful to spend quality time with the machine during the day, re-learning to breath gently with it on my bed and just getting used to it while watching light TV, reading a book, listening to music or the radio – that getting used to the pressure in the current conditions is helpful to keep things a bit more stable at night.

I have found that aerobic exercise helps.

I have found that pulse oximeter guided eucapnic breathing helps.

HTH,

Todzo

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

[SleepWellCPAP]

Just a quick suggestion.

Have you tried a climate line tube by chance? Though you are increasing your humidity, I wonder if a heated tube would help. I had a client a while back with issues similar to yours and he ended up using a climate tube with the temperature set quite low.

Hope that helps, good luck!

[BlackSpinner]

The wisp is a nasal mask and if your mouth feels dry it is because you are mouth breathing.

You will have to find some way to keep your mouth completely closed or use a full face mask.

[CoastalSun]

SleepWellCPAP: forgot to mention that I DO USE A CLIMATE LINE hose ... current temperature is set at 67 F. Where I live, I don't need air conditioning; i leave a bedroom window open 100% of the time and the outside temperature at night is around 60 F with room temperature probably around 70F. Not sure what else I could do with temperature/humidity settings.....

BlackSpinner: I have discussed with my respiratory tech who is looking after the CPAP therapy about the possibility of mouth breathing. She doesn't think so because my leak levels are so low and there are not that many at that. ALSO: when I tape my mouth, I STILL wake up and have to take the tape back so I can sip water or use the spray. IF I am mouth breathing, than how else can I check it or stop it? I do know that I USED to mouth breath before CPAP therapy because I felt like I wasn't getting enough air. It took a few weeks, but now my tongue does rest on the roof of my mouth and even during the day, I notice that my tongue is up against the roof my mouth but my jaw is relaxed.

Thanks!

[Julie]

What your tongue does during the day is not necessarily what it does at night when you're not conscious. And you owe it to yourself to try a FF mask all things considered at this point. I don't think your taping system is ideal. The only other thing I can think of is that you might have Sjogren's disease ('show-grens'), an autoimmune disorder related to arthritis, lupus, etc., but it seems unlikely as your dryness is related to Cpap and you haven't complained of very dry eyes all day long.

[CoastalSun]

Hmmmm ... actually, I have had dry eyes and this dry mouth problem for a few years. I have been told that the dry eyes are because of cataract surgeries but they were dry BEFORE the surgeries. In fact, dry since the Lyme Disease 8 years ago. I just never complained to my docs about the dry eyes before. As far as the mouth dryness at night, I just figured it was 'getting older' syndrome. lol! Just like my mother, who used to get ready for bed and get a glass of water for the night table, I find myself doing the same thing. Oh boy
I see my sleep doctor later next week, so I will discuss getting a full face mask. The respiratory tech didn't think it was a good idea considering my history of Lyme neuropathy. I tend to lose my voice very easily if there are strong odours, I try to sing, or I am very fatigued. Alcohol does it too.
p.s. not overweight and I don't smoke.

[Julie]

Great ... there's a simple blood test (Google ANA test) for autoimmune stuff though I'm not sure if there's a specific one for Sjogren's or not, but ask your MD for a referral to a rheumatologist - nothing to lose after all.

[Sir NoddinOff]

I currently use ResMed's ClimateLine hose and a chinstrap, however I found myself still waking up with a dry mouth. Not every night but a couple of times a week. What I do now, and it seems to work, is place a 3/8" strip of 3M NexCare tape VERTICALLY on my lips. This seals my lips adequately but still allows me to sip water or take pills or whatever from the corners of my mouth. Yes I still use the chinstrap. Leaky lips sink ships and CPAP therapy (my paraphrase from the WWII slogan)

Regarding my last sentence above: Check out this info. Go to the bottom of the post and read "How to make a chinstrap", especially taking note of the part about preventing ones lips from parting while asleep:

http://www.sleep-apnea-guide.com/cpap-c ... z2a7sqwrgz

EDIT: I also just had the ANA test done to eliminate auto-immune diseases. It came back negative. I used to get flights of various tests done because I was always getting bitten by ticks quite a lot and was concerned about tick borne diseases (don't ask why I get bit so much ). The ANA test is a lot simpler, tho I don't yet know how effective it actually is? Early medical reports seem good, and my GP trusts it.

[SleepWellCPAP]

Thanks for clarifying.

Have you tried going back to "auto" on the climate control and maybe setting it to the factory default of 80?

Very few people I have found, tolerate low temp settings. Warm and sticky is terrible for weather, but most people like it in their pressure therapy circuit.

Good luck, please keep posting progress. It will be interesting to see how you resolve the situation.

[DJD52]

Hmmmm ... actually, I have had dry eyes and this dry mouth problem for a few years. I have been told that the dry eyes are because of cataract surgeries but they were dry BEFORE the surgeries. In fact, dry since the Lyme Disease 8 years ago. I just never complained to my docs about the dry eyes before. As far as the mouth dryness at night, I just figured it was 'getting older' syndrome. lol! Just like my mother, who used to get ready for bed and get a glass of water for the night table, I find myself doing the same thing. Oh boy
I see my sleep doctor later next week, so I will discuss getting a full face mask. The respiratory tech didn't think it was a good idea considering my history of Lyme neuropathy. I tend to lose my voice very easily if there are strong odours, I try to sing, or I am very fatigued. Alcohol does it too.
p.s. not overweight and I don't smoke.

Your issue sounds a lot like a few of mine. I had dry eyes and mouth before CPAP and before cataract surgery 24/7 also. After starting therapy I found a constant issue with a feeling of dry throat lump that inhibits easy swallowing. Higher humidity (room humidifier or CPAP humidifer) helps the dry throat irritation as well as keeps my mouth a "little" less dry. I told the sleep Dr that I do not mouth breathe so the Sjogren's test was the first thing my Dr ordered, but it was negative. After that I tried a FFM and his chin straps because he insisted. I also used layers of tape that were easy to peel back. (my way of testing) All were just uncomfortable and none of it helped me. My sleep DR told me AFTER he insisted I try the FFM, and the chin straps that mouth breathing wouldn't keep my mouth dry 24/7 anyway and he would have seen that kind of mouth breathing/leaking in my leak line when he checked my data for a week. He also said that this dry mouth does happen more often as we age.

Right now I have a new machine and the humidifier is not working. (waiting for the RT to check it Friday) I'm seeing just how much that lack of dependable humidity is adding to my dry throat issues, but my mouth also feels much drier. It is, at the least, very uncomfortable all day and night.

I hope you find some help. The mouth washes for dry mouth didn't help me. I keep sugar free candy of some sort in my mouth through the day when I can, drink lots of water, avoiding salty and acidic foods, caffeine, alcohol, nuts, etc.

I wish I had found a real solution, and I sincerely hope you do.

[CoastalSun]

Thanks DJD52. I woke up 5x last night with extremely dry mouth, dry eyes, dry sinuses, sore throat, and on and on it goes! Same symptoms during the daytime but I don't notice the dry mouth as much because I am drinking lots of water.
Lots of blood work this week and will be having a biopsy next week. I also saw my sleep doctor. Both docs assured me that my symptoms are NOT b/c of CPAP therapy .... the symptoms were there long before I started this new relationship with my 'face friend' back in February. In fact, I can't sleep without it now. or is that ??
My 'numbers' are excellent and there's nothing I can change with the settings at this point. Just have to figure out what else is going on.
Cheers!

[Artcarved]

Sinus problems can also cause dry mouth, as well as Reflux. My throat gets soar occasionally so I have a hot drink or chew sugarless gum which helps. A med I am taking gives me dry mouth, so having a drink or chewing gum (which my hubby hates) soothes.

[CoastalSun]

If only I could sleep through the night without waking up several times with a parched mouth!

Some nights, my mouth is so dry, my lips are stuck to my gums and my tongue is stuck to the roof of my mouth ...
Every night, I wake up b/c of the dry mouth and sip water and spray my mouth with Moistir. I am usually back to sleep within minutes.

CPAP therapy is going really well otherwise, sleeping better, getting up less to use the washroom, etc, and have no problem falling asleep with my new 'bed mate.' I still have morning headaches but they are less painful than pre CPAP. (Doctors are still are puzzled so far.)

But like I said, if I didn't wake up so damn much with the dry throat, I would be one happy camper! Seven months ago, I dreaded the idea of using a CPAP every night but now, I 'crave' it and realize that yes, I DO NEED IT.

Current Leak rates:
Sleepyhead numbers show over the past week numbers such as leak 1.27 95% leak 9.60; leak 4.60 95% leak 19.20; and Leak 2.31 95% leak 12.00
I taped my mouth the past two nights: Leak 0.59 95% leak 4.80; and last night Leak 0.25 and 95 % leak 0.00. I STILL woke up several times with a dry mouth even though I had a taped mouth.

I DON'T have sinus issues. I breathe through my nose easily.

SO: I have had blood work done to rule out Sjogren's because I also have dry eyes, and a few other symptoms that might suggest this autoimmune condition. The blood work came back negative but my ENT is going ahead with a salivary gland biopsy next month because of my various symptomsg.

In the meantime, I am using Biotene toothpaste for dry mouth (can't say that I notice any difference except in my wallet), Biotene mouth gel (tastes nice but again, not sure it's doing anything), drinking lots of water (always have so this isn't a big deal), using MOISTIR mouth spray when I wake up at night. It seems to work in that I go right back to sleep but wake up again within an hour or two with parched mouth.

Any thoughts, ideas, suggestions?? Thanks!

[Julie]

I heard you when you said you taped, but it's not ideal, and if there is any way you can try a full face mask (well fitted in your size) please do it. I feel you are going around and around it, but not at it and that's not helping. You may have Sjogrens, you may not, but while you're waiting, having already tried other things, why not try this? You can either go to Cpap.com (tho' can't be fitted there) and pay $25. (refundable if you keep the mask) for 'return insurance', or a local DME where you can try masks out properly (hopefully lying down). But it's a classic fix for your problem and shouldn't be avoided.