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Hi everyone - this is Mel. My friend, Cameron (aka "CAM") is new to the group and has some questions I wanted to post to the group, as I do not have the answers for him.

Maybe SleepyCarol, Mike, or anyone in the group can help with Cam's questions............

Cam has moderate sleep apnea and is using a C-PAP. Right now he is having a very hard time adjusting because of some other medical problems and is waking up choking and with his tongue stuck to the roof of his mouth because his mouth is so dry. His mouth has actually bled from this. He just got a call from his sleep doc who is calling him in a new "hybrid" mask that he said covers both the mouth and nose, but not as a whole unit. It supposedly has 2 parts to it and is open in the middle. Does anyone know anything about this kind of hybrid mask?

Cam currently is using a saliva gel before bed and still has the dry mouth problem and cannot utilize his mask because of this, as he is still waking up in the middle of the night from the severe dry mouth - not the sleep apnea. Can anyone help with solutions for his dry mouth problem?

Cam and I would both appreciate any kind of help, suggestions, or other information anyone in the group can offer.

Thanks everyone! I look forward to any help any of you can give.

Melodie (Mel)

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glad to have Cam here. dry mouth is often caused by mouth breathing, which also undermines CPAP therapy by letting the air pressure meant to keep the airway open escape through the mouth. does he have a data capable machine that will give us numbers on his leak rate?

his sleep doc is trying to fix the problem by using a hybrid mask --- i haven't tried that myself, but the alternative, full-face masks, do solve the dry mouth problem for some. also, would he be willing to try a chin strap? that might help to keep his mouth shut while he sleeps.
Hi Mike thank you for replying. I do mouth breath and have tried the chin strap but it gives me a headache and causes bruising. I have some Autoimmune disorders, Lupus/Anitiphospholipid Antibody Syndrome/Sjogren's I get the brusiing because I'm on major blood thinning medication and the dry mouth is from the Sjogren's because I lack enough saliva. I currently have the full face mask and this is what I'm getting the dry mouth from. I've tried the nose mask and the nasal pillow but those don't work because I guess I'm a mouth breather although that is not how I usually breath while awake. The machine I have is a Respironics REMstar Plus M series with a humidifier. Plus when I wear the mask I cannot turn my head at all or lay on my side because it causes it to leak, so I have to lay flat on my back with my head straight and you can imagine how uncomfortable that can become. I would like to know if anyone here has used the hybrid mask and has it worked or does anyone have the same problems I have ie the AI disorders. Thanks
1) Crank up the humidifier as warm as you can go without condensation
2) There are currently two masks on the market that fit the description. The first one on the market was The Hybrid. It has a small chin cup on the mouth cushion, which comes in three sizes. There are also three sizes of nasal pillows that connect to the mouth cushion at one of two heights.

While this mask has worked well for some people, maintaining a good seal can be difficult. ResMed came out with their own version of this concept - the Liberty. While the Hybrid is packaged with one frame and all the cushions together, ResMed packages the Liberty in either Small or Large. These two size mouth cushions and frames come with three different size nasal pillows. The measuring Guide says the critical factor is the height of the space between the bottom of your nose and the crease above your chin, which is where the bottom of the mouth cushion rests. There is no chin cup.
The nasal pillows on the Liberty are unique. There look like mushrooms on springy stems and are self adjusting in height.

Headgear for both masks is less than ideal, but the Hybrid's headgear is truly terrible. All four connection points are identical and swivel 360degrees. This means that the headgear easily gets all tangled up when it isn't on your face. I find the only way to undo the tangles is to detach the entire headgear and start again.

While I prefer the Liberty to the Hybrid, each has its fans. Given your troubles, either one may reduce leaks since they cover a smaller surface area than a traditional full face mask. They may be worth a try, but don't expect miracles.
I have used the Hybrid and find it is a tad more durable than the Liberty. The Liberty has a habit of leaking around the swivel hose piece on the front. Although some teflon tape will help.

What are you doing to help the Sjogrens syndrome. My son-in-law's aunt has this and she uses special mouthwashes and medication from the doctor to help with the dryness. Since you have tried the full face masks, I am unsure if the Hybrid or Liberty will help much with the dry mouth. Like Dan suggested turn up your humidifier and see if that helps.

Do you know if you have any large leaks during the night? Your machine doesn't record data so that isn't going to help determine if you are. Does your mask make lots of noise? To help seal your mask you might try a thin roll of Mack's silicone ear plugs around the edge of the mask where it touches your face. You can buy Mack's at Walmart, Walgreens, many drugstores and grocery outlets. They cost about $4.00 for a set. You can reuse the Macks a few times before you need to replace it. If you can cut some of your leaks it might help your humidity level and dry mouth.
Hi Daniel and SleepyCarol,
I have my up as high as it goes and still have the problem. In fact there isn't even any condensation inside the mask with it up all the way. I did try my wife's nasal pillow last night and I didn't open my mouth! I never tried the nasal pillow because the tech at the sleep lab said it wouldn't work because my nares were too small. Well it does fit but it is really tight and I ended up waking up very early in the morning needing to remove it because my nose hurt. The main thing was I DIDN'T OPEN MY MOUTH! I was never tested with anything but a full face mask from the get go. I think I am going to see if I can get a super small nasal pillow. Right now I believe my wife's is a small and it is tight inside my nose but it didn't leak. Do you know if they make a pediatric size of this? I guess I was just made with small nares and throat. My uvula hangs down very low and my throat opening is extremely narrow. God I hope I don't end up having to have the surgery. Thanks so much for your suggestions.
Oh and I think mine does record because it has a disk in it they said recorded things and every so often I'd need to bring it in so they could see the readings. Is there a way I could look at that on my Mac?
We need to know the specific name of your machine. It should say on it, probably the top. Just because it has a disk doesn't mean it records useful data -- there are machines that record strictly compliance -- meaning how much you use your machine for insurance purposes. As far as I know all the software is geared for Windows and am unaware of any that will work on a mac.

How do you know for sure you didn't open your mouth during the night? Did your mouth not dry out as much? Many times we are unaware of our mouths opening at night and not realize that it has opened -- even parted lips can ruin your therapy. If your machine does record data then it will show in as a large leak if you leaked from your mouth.

Your nose will hurt and be tender for several days when adjusting to nasal pillows or prongs. Just because your nares are tender doesn't mean that the size is wrong. If your nares are slotted, that might present a problem but I haven't heard of anyone's nose being so small they are unable to use nasal pillows (unless of course they are really young).
Which mask -- the name -- is your wife using? If the mask came from a DME then only one size of pillows are usually given so you may have to investigate to make sure your wife truly has the small size. If you order on line you usually receive all size pillows. A few masks only come with medium and large pillows, others are more flexible.

Once we know the full name of your machine and the mask we can provide more help.
Sounds like chronic mouth leaking to me.

Does he have a data capable machine?
The OptiLife from Respironics has Petite size nasal pillows available, and the ResMed Swift LT has XSmall pillows available. They may help. You might also benefit from a non-petroleum based cream, such as RoEzit/CPAP Moisture Therapy to ease a sore nose.
I already said it is a Respironics REMstar Plus M series with a humidifier and the nasal pillow is from ResMed Mirage Swift ll. After reading all of these posts I checked the sizes of the pillows because there are 3 of them and the one I used was the largest! I am going to try the smallest one tonight. I know I kept my mouth closed because when I open my mouth it sends the loud sucking air sound with a weird feeling and that would wake me up. I am a very light sleeper. My mouth wasn't as dry but still dry. I have an Autoimmune disease called Sjogren's. My antibodies attack my mucus membranes and therefore I have no tears, saliva or mucus to protect my organs. This is one of the main reasons I am having the horrible dry mouth. I usually don't wake up with the dry mouth if I don't wear the C-Pap. I don't want to not use it as I have moderate sleep apnea but I have to figure out how to get past the dryness issues. I have an appointment for a fitting to get the hybrid mask. I'm sure that one of the masks I have will work eventually. I have a full face mask, the nasal pillows and a nose mask with a chin strap. Thank you for all your comments.
Your Respironics Remstar PLUS M series does NOT provide useful data -- it only provides compliance data -- meaning the number of hours and days you use your machine. It does NOT provide any other data -- such as leaks, AHI, etc. It is useless as far as determining what problems might be hindering treatment. Compliance data is needed for some insurance companies and Medicare and thus the reason for the data card.

If you haven't had the machine very long (less than 30 days typically) you could switch it out by talking with your doctor have him or her write a script for a data capable machine. Explain that you are having trouble with your therapy and having a data capable machine would help him or her determine what might be going on with your therapy.

Once we get into deeper sleep it is still possible to leak without the air making a loud sucking noise. Your lips parted slightly will still allow leaks to occur that probably will not wake you. Just because you experience this loud sucking sound while awake doesn't mean that the same is happening while asleep. This is not a good comparison to see if you are leaking.

I have used full face masks and I know that my mouth will dry out with a full face mask, even with the humidifier, if my mouth drops open even slightly. Same goes for the nasal pillows.

I am familiar with Sjorgren's Syndrome as my son-in-law's aunt has it (we all live in the same small community and socialize on occasion). She is on a cpap as well -- has been for about 6 months. So I know it is possible to have Sjorgrens and still use a cpap. Like I said in my previous post she uses special mouthwash and gels as prescribed by her doctor to help with the dryness. I will try to find out from my son-in-law the names of the ones she uses but it will probably be the week-end before I see him.

Let us know how you did with the smaller size pillows.
If you have had this Plus CPAP for less than 30-45 days, call your insurance, ask what local DME CPAP suppliers they are contracted with. Hopefully you have the option of more than one as that will give you more bargaining/negotiating room. Then take that Plus back to your local DME supplier and tell them it is NOT ACCEPTABLE. Insist that they provide you with the Respironics M Series Pro w/C-Flex. If you do have the option of more than one local DME supplier use that weapon as well. All of your current equipment will be compatible w/the Pro. The Pro is fully data capable. The Plus should be taken off the market as should all less than fully data capable CPAPs in my not at all humble opinion.

If you've had it more than 30-45 days then it might pay to start w/your sleep doctor. DIPLOMATICALLY lay a guilt-trip on him that he's making therapy/equipment changes "by guess and by gosh", that the Respironics M Series Pro w/C-Flex will provide the data on your nightly leak rate, AHI, AI, etc. and you want a Pro in place of this bare bone, compliance data only Plus, that your insurance DOES cover the Pro, that the Pro and the Plus are the exact same HCPCS code for reimbursement purposes. Push for a new script for a Respironics M Series Pro w/C-Flex (x ressure setting, x C-Flex setting); Show AHI/Leak feature On; Full face, Nasal cushion, Nasal pillows or "hybrid" style mask of patient's choice".

Good luck!

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