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Permalink Reply by Karen Moore www.padacheek.com on February 4, 2009 at 5:17am

Hello Royalty,
This CPAP therapy does take patience and a bit of tweaking to get it just right. At first there are so many things to get used to. Of course you know that you have to find someway to keep your mouth closed or else use a full face mask. There are full face masks that have good success, you may even try a hybrid type, which is a nasal pillows and the mouth is also covered. With a great attitude like yours to make this work, you will do well with time. I am also a stomach sleeper and I am able to maintain the seal by letting the mask hang off one side of the pillow. But to tell you the truth, I did not have all the kinks worked out for at least 3 months. Keep working at it, you will get it.
A couple things helped me.
One is to suspend your hose over your head, with a hook on the headboard, or wall and then put a scrunchy, or elastic band around the hose there and hook it up. Another thing that helped is to take a pony tail holder, or a rubber band, and put it around the forehead post of the mask as well as the hose to keep the hose oriented upward. That helps keep it out of your way.
As far as humidity, if you are not keeping your mouth closed, the air pressure from your CPAP is going out your mouth and no amount of humidity will keep your mouth moist, and worse than that, you are not getting a treatment for your apneas.

I hope this helps you some.

Karen

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Permalink Reply by sleepycarol on February 4, 2009 at 8:23am

You are going to have to remedy the mouth breathing before things will turn around.

Many patients go through several masks before finding the one most comfortable for them. Even if you were fitted for your present mask doesn't mean that it is going to be the one best suited for you.

Since you are mouth breahting try some options to prevent that from happening.

A full face mask will allow you to open your mouth and shouldn't affect your treatment. If this option is not for you one of the following might work.

Many find that a chin strap doesn't always keep their lips sealed and air can escape between the lips. There are different types of chin straps and not all chin straps work for everyone. If you can afford it, you might try different chin straps and see if you can find one that works for you.

Other options include sealing your mouth with a strip of tape. Many use the blue easy release painter's tape. Others use the various medical tape. You will need to use one for sensitive skin as you don't want to irritate your lips and mouth area. If you try mouth taping apply chapstick to your lips, turn your lips in. place tape on the mouth and turn over the edges to form a quick release tab and relax your mouth. You will need to make sure the tape is wide enough to stick without gaping open in areas.

Others use polident strips to seal their mouth.

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Permalink Reply by Daniel on February 4, 2009 at 1:00pm

At SomniHealth, I don't like to put patients into Full Face Masks until we've tried all other alternatives. Re-reading your post, I think the most imprtant clue is your runny nose. Sounds like your body is fighting off the invasive air pressure by sealing your nose off via congestion. When you can't breathe through your nose, your mouth pops open, and you've seen what happens after that.

My suggestion is to try increasing the heat level on the humidifier. Hopefully, the extra moisture will fool your body into being more comfortable with the pressurized air, congestion will be relieved, and you won't need to breathe through your mouth. I presume you are already at heat level three if you are contemplating 4 or 5. It's fine to go up that high, but you've got to be aware of the possibility of condensation building up in the tube. If you hear clicking, popping, gurgling, or slurpy sounds at night, that's condensation. The previous posts about positioning the tube so that it feeds from above is sensible, but if there's condensation in the tube, it will only add to your woes, because the water will run down the tube and into your face. That's called "rainout" in the CPAP industry, but I refer to it as "waterboarding," since it is a form of torture, and will most definitely wake you up.

If you are getting condensation, there are alternatives to turning the heat down on the humidifier, which reduces the overall moisture level. Consider making the bedroom warmer (few people want to do that, but it works). You can also reduce condensation by insulating the tube from the cooler bedroom air by putting it under the covers with you, or by purchasing or creating a tube wrap.

If extra humidification doesn't do the trick, the next step is to try a chinstrap. Sometimes, people only need the chinstrap for a month or two in order to retrain themselves while the body adapts to breathing pressurized air.

If the chinstrap doesn't solve it, then it's time to look at a mask that covers your mouth. Since full face masks cover a larger surface area, they can open up a new can of worms in the form of incessant leaks.

The truth of the matter is that if you can get to the point where you can sleep through the night, and dry mouth and/or leaks don't bother you enough to disturb your sleep, you may be able to declare victory. Some people, especially in online forums, get obsessed with statistics and want their AHI less than 1 event per hour and their leak rate at zero. The fact of the matter is that if you are using your CPAP every night, sleeping the desired number of hours for you, and you feel refreshed when you wake up in the morning, you can declare victory over your sleep apnea.

Keep at it. These are normal problems you are facing. The first few months are the toughest, and then your CPAP will become your best friend.

Good luck,

Daniel

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Permalink Reply by Judy on February 4, 2009 at 7:05pm

If it makes you feel any better, Royal, you are doing better at 2 months than I was. My first 30 nights on CPAP were THE WORST SLEEP of my life (other than my two titration nights). Things GRADUALLY got better after that, but it sounds like things are improving faster for you than it did for me. So there is hope. Hang in here w/us!

What brand and model CPAP do you have? Which nasal mask are you using? Check your mask literature or for a label on the headgear or on the mask frame.

Depending on the brand and model CPAP you have there are some suggestions we can make, but we need to know which CPAP first.

The suggestions of hanging the hose over your head, or taking it under the covers w/you, or buying a hose cover (try making one by cutting the toes out of a couple, or however many are needed, thick hunting socks and securing them on the ends w/velcro or duct tape, placing your CPAP and humidifer LOWER than the level of your mattress will all help to avoid "rain out" (condensation) in your CPAP hose.(I like Daniel Levy's "rain out" description of "waterboarding"!!!)

You might give some serious consideration to trying the "hybrid" style of full face masks such as the Liberty, etc. that have both nasal pillows and a "mouth cushion" of some sort to stop the dry mouth. Meanwhile, some Biotene saliva substitute from the pharmacy will help somewhat. While taping your mouth might be cheaper to try, the "hybrid" style mask might well be the more comfortable option. If you do opt to try a "hybrid" style mask pick up a small tube of Ayr Saline Nasal Gel or bottle of Ayr Saline Nasal Spray. Sometimes we get irritated, dry nasal passages which can quickly become tender and sore due to the more direct pressure w/nasal pillows rather than nasal cushion to help the nasal passages toughen up faster. NEVER use a petroleum based product in or real close to your nose.

W/a pressure of 16 cms do you have an EPR or C-FLEX option on your CPAP (the brand and model would tell us that)? EPR or C-Flex can reduce your pressure as much as 3 cms during exhalation but still provide 16 cms on inhalation. And it might even be necessary to drop your pressure a few cms and build up to your titrated pressure gradually. Its too bad you found us so late, during the first 30-45 days you might have been able to switch to a BETTER local DME supplier. The one you have is obviously failing you miserably as is your sleep doctor.

I would be inclined to request a copy, not only of the doctor's dicated results (1-2 pages each) AND the full scored data summary report w/condensed graphs (5+ pages each) from BOTH your sleep evaluation and your titration studies (or maybe you had a "split night" study? Half the night w/o and half the night w/mask and CPAP? Whichever, I'd be inclined to request full copies of both dictated and scored data summary reports. They don't always get our pressure right, especially if a split night study. They can only get as good as the amount of sleep we get so that's not saying anything against the RPSGT(s) (sleep tech) who did your studies. I often think of the RPSGTs as the true heroes of the sleep profession w/the local DME suppliers and sleep doctors at the bottom of the "food chain" (except when it comes to money).

Some few of us do better w/LESS humidity to prevent or reduce the runny nose even w/the presence of a dry mouth. But MOST of us need the extra humidifty from the CPAP humidifier.

AND, you can always try a cheap, home-made "chin strap" by cutting the leg off a pair of panty hose tights, placing your chin in the middle and tying the ends at the top of your head. It will help stabilize your mask as well and might reduce the tummy sleeping caused leaks. It might take a little more time for acclimation to be able to sleep on your tummy but many are able to do so and so will you eventually. One step at a time. Patience, Perseverence and a Good Sense of Humor will get you thru the rough steps of acclimating to CPAP therapy.

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Permalink Reply by Gene on February 11, 2009 at 6:53pm

I use a full face because I simply cannot keep my mouth shut at night! I use a Fisher Pykel model that not only uses heated humity but also the tube that connects to the mask is also heated. So there is little loss of heat from chamber to mask.I don't know what your medical coverage allows for outside referrals, but mine let's me self refer to the clilic of my choice (within the network of course).
It's critical that you get to a clinic that can provide the most treatment options so you can try different things.
I know that a nasel mask for me just won't cut it, at least I can sleep through the night now.

Hang in there.

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Permalink Reply by Gerald Allen on March 23, 2009 at 11:10pm

Royalty, Hi, I'm working on mine too. I was given a hose cover as my DME that work for me as a friend. Sharie is an LP.Well anyway, My mouth was so dry my tung was over size. After 3hours of sleep. I have taken my full mask off and started using my nose mask. I did better after I turn my humidity down to two. I thank I'll do like Mr Levy said, I'm go to 3(humidity). I'm still forming and justing. I've start at 14 on my air, but it's auto and I only get to 9-10. Good luck Royalty. G

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Permalink Reply by Heather Meadows on March 24, 2009 at 8:09am

I concur with Daniel. After months of successfully using my CPAP, I all of a sudden started finding my mouth falling open every night. It was terrible. Eventually I realized that it was because my nose was stopped up. Find a way to solve that problem and your mouth may stop opening. What I did was flush my nose out with salt water before going to bed each night.

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