Replies to This Discussion

Permalink Reply by Kath Hope www.hope2Sleep.co.uk on November 9, 2010 at 6:48pm

Wow Neal - thanks so much for the explanation. Also, when you say you don't like full face masks, what do you suggest for people who just cannot breathe through their nose (like me)?


Neal Buckner, LRCP said:

Donna,

In regards to why increasing the humidification will reduce the mouth breathing. The nasopharynx is responsible for humidifying the air we breath in. By the time the inhaled air gets to the back of our throats it should be darn near 100% humidified. If the air coming into the nose is too dry the mucus membranes respond by producing more mucus to humidfy the air. In order to do that the blood vessels in our nose engorge to provide as much blood as possible to create the needed secretions. The end result is swollen mucus membranes causing the nasopharynx to swell shut. This will cause folks to open their mouth to breath due to the reduced air flow through your nose. When you open your mouth the air flows right through and out your mouth and causes the sore dry mouth. By increasing the humidification coming from the CPAP machine you reduce the chance of excesive drying and swelling in the nose. The upper airway loves warm moist air.

In regards to the mask fit. Nasal pillows tend to dry things out more so than a nasal mask. Reason: When we exhale we also exhale humid air. With nasal pillows there is little dead space for you to rebreath that warm moist air. With a regular nasal mask there is surface area and dead space for exhaled moisture to hang out and be rebreathed.

Personally, I'm not a big fan of the Opus Nasal pillow system. For newbies I tend to set them up with a nasal mask like the Activa LT with action cell cushion. It allows the frame to move independantly from the cushion and provides an excellent seal even when laying on your side. Plus, the rebreathing of exhaled humidification reduces the irritation of the mucus membranes. Especially for those who just start. There is an acclimation period that needs to take place. Right now you are experiencing hyperrhinorea do to the airflow irritation. The drooling and nasal congestion is in response to dry air. I don't like full face masks either. The area that needs to be sealed lends to increase leaks and sleep disturbances.

Try a nasal mask until you get good and comfortable with using CPAP. Then try the nasal pillows when your are due for another mask.

Neal

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Permalink Reply by Donna B. on November 9, 2010 at 7:08pm

Mike: I did adjust the humidifier to 3 but the dry mouth and drooling was worse then when it was set on 2. I warm up the machine for about 45 minutes before bed but I do not wear it while it is warming.



Mike Burns said:

It sounds like your mouth is opening during sleep so adjusting the humidifier may help [ 3-4 ] .what I teach my patients is to put the mask on with the cpap running for 1hr before bed watching tv in bed and no talking during this time the go to sleep that teaches the brain to keep the mouth closed this could take a few days buy it works. Or go to cpap.com and buy a chin strap call red ruby. Mike b RCP, psgt

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Permalink Reply by RockRpsgt on November 9, 2010 at 7:11pm

Wow Neal - thanks so much for the explanation. Also, when you say you don't like full face masks, what do you suggest for people who just cannot breathe through their nose (like me)?

The Remed Nasal Fx for her!

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Permalink Reply by RockRpsgt on November 9, 2010 at 7:15pm

If you do get switched to a FFM mask you might want to request some APAP time, or another titration to adjust your pressures. Titrated pressure settings for FFMs and nasal interfaces are not interchangeable. A full face mask typically requires a higher pressure than a nasal.

• ▶ Reply

Permalink Reply by Donna B. on November 9, 2010 at 7:16pm

Neal: That is quite the explanation ! Thank you. I will make some notes and bring them to my appointment with my DME guy tomorrow. I do have nasal irritation now, my nostrils are very sore. Even with a breath rite strip I still don't feel like I am breathing at 100%, my nasal passages are so swollen shut. It all makes better sense to me now. I wish my sleep doc would explain things to me the way you just did. Thank you so much !
Donna


Kath Hope www.hope2Sleep.co.uk said:

Wow Neal - thanks so much for the explanation. Also, when you say you don't like full face masks, what do you suggest for people who just cannot breathe through their nose (like me)?


Neal Buckner, LRCP said:

Donna,

In regards to why increasing the humidification will reduce the mouth breathing. The nasopharynx is responsible for humidifying the air we breath in. By the time the inhaled air gets to the back of our throats it should be darn near 100% humidified. If the air coming into the nose is too dry the mucus membranes respond by producing more mucus to humidfy the air. In order to do that the blood vessels in our nose engorge to provide as much blood as possible to create the needed secretions. The end result is swollen mucus membranes causing the nasopharynx to swell shut. This will cause folks to open their mouth to breath due to the reduced air flow through your nose. When you open your mouth the air flows right through and out your mouth and causes the sore dry mouth. By increasing the humidification coming from the CPAP machine you reduce the chance of excesive drying and swelling in the nose. The upper airway loves warm moist air.

In regards to the mask fit. Nasal pillows tend to dry things out more so than a nasal mask. Reason: When we exhale we also exhale humid air. With nasal pillows there is little dead space for you to rebreath that warm moist air. With a regular nasal mask there is surface area and dead space for exhaled moisture to hang out and be rebreathed.

Personally, I'm not a big fan of the Opus Nasal pillow system. For newbies I tend to set them up with a nasal mask like the Activa LT with action cell cushion. It allows the frame to move independantly from the cushion and provides an excellent seal even when laying on your side. Plus, the rebreathing of exhaled humidification reduces the irritation of the mucus membranes. Especially for those who just start. There is an acclimation period that needs to take place. Right now you are experiencing hyperrhinorea do to the airflow irritation. The drooling and nasal congestion is in response to dry air. I don't like full face masks either. The area that needs to be sealed lends to increase leaks and sleep disturbances.

Try a nasal mask until you get good and comfortable with using CPAP. Then try the nasal pillows when your are due for another mask.

Neal

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Permalink Reply by Neal Buckner, LRCP on November 9, 2010 at 7:27pm

Another trick is to get some nasal saline. It comes in a gel form now. You can either irrigate your nasal passages prior to bed time to pre-moisten your nassal passages and clear out any irritants that coolected during the day. (The nose is where all the filtration occurs as well.)

@ Kath Hope. Why can't you breath through your nose? Allergies? Chronic sinusitis? Mask that is too tight? What are your pressures at? If 12 cmH2O or less. Try going to the extreme end of things. Swift LT or Swift FX might be better. Get a nettie pot or nasal saline spray and irrigate your nose prior to bed time.

I will do everything I can to get a person back to nasal breathing. Here's why.

Donna B. said:

Neal: That is quite the explanation ! Thank you. I will make some notes and bring them to my appointment with my DME guy tomorrow. I do have nasal irritation now, my nostrils are very sore. Even with a breath rite strip I still don't feel like I am breathing at 100%, my nasal passages are so swollen shut. It all makes better sense to me now. I wish my sleep doc would explain things to me the way you just did. Thank you so much !
Donna


Kath Hope www.hope2Sleep.co.uk said:

Wow Neal - thanks so much for the explanation. Also, when you say you don't like full face masks, what do you suggest for people who just cannot breathe through their nose (like me)?


Neal Buckner, LRCP said:

Donna,

In regards to why increasing the humidification will reduce the mouth breathing. The nasopharynx is responsible for humidifying the air we breath in. By the time the inhaled air gets to the back of our throats it should be darn near 100% humidified. If the air coming into the nose is too dry the mucus membranes respond by producing more mucus to humidfy the air. In order to do that the blood vessels in our nose engorge to provide as much blood as possible to create the needed secretions. The end result is swollen mucus membranes causing the nasopharynx to swell shut. This will cause folks to open their mouth to breath due to the reduced air flow through your nose. When you open your mouth the air flows right through and out your mouth and causes the sore dry mouth. By increasing the humidification coming from the CPAP machine you reduce the chance of excesive drying and swelling in the nose. The upper airway loves warm moist air.

In regards to the mask fit. Nasal pillows tend to dry things out more so than a nasal mask. Reason: When we exhale we also exhale humid air. With nasal pillows there is little dead space for you to rebreath that warm moist air. With a regular nasal mask there is surface area and dead space for exhaled moisture to hang out and be rebreathed.

Personally, I'm not a big fan of the Opus Nasal pillow system. For newbies I tend to set them up with a nasal mask like the Activa LT with action cell cushion. It allows the frame to move independantly from the cushion and provides an excellent seal even when laying on your side. Plus, the rebreathing of exhaled humidification reduces the irritation of the mucus membranes. Especially for those who just start. There is an acclimation period that needs to take place. Right now you are experiencing hyperrhinorea do to the airflow irritation. The drooling and nasal congestion is in response to dry air. I don't like full face masks either. The area that needs to be sealed lends to increase leaks and sleep disturbances.

Try a nasal mask until you get good and comfortable with using CPAP. Then try the nasal pillows when your are due for another mask.

Neal

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Permalink Reply by Kath Hope www.hope2Sleep.co.uk on November 9, 2010 at 7:41pm

Thanks for replying and not meaning to hijack Donna's post. My ENT surgeon who did an SMD on my turbinates (which failed after initial positive results) said I have a deviated septum so need septoplasty and a turbinectomy as turbinates are swollen. I can't breathe through my nose hardly ever, but it's worse with the APAP. Pressures are set at 9-12.5. Have had to set a cap on the APAP as it runs at maximum without - possibly due to the nasal issues. O2 (according to my newly bought pulse oximeter, say I'm having several (I think at least 5) events at around 85 and never run above 95 (hope this makes sense??). AHI is between 5-10.
Strangely enough, I was given a SinuPulse last night for nasal irrigation. I will try it tomorrow. Do you reckon it may fix my problem without the dreaded operations?


Neal Buckner, LRCP said:

Another trick is to get some nasal saline. It comes in a gel form now. You can either irrigate your nasal passages prior to bed time to pre-moisten your nassal passages and clear out any irritants that coolected during the day. (The nose is where all the filtration occurs as well.)

@ Kath Hope. Why can't you breath through your nose? Allergies? Chronic sinusitis? Mask that is too tight? What are your pressures at? If 12 cmH2O or less. Try going to the extreme end of things. Swift LT or Swift FX might be better. Get a nettie pot or nasal saline spray and irrigate your nose prior to bed time.

I will do everything I can to get a person back to nasal breathing. Here's why.

Donna B. said:

Neal: That is quite the explanation ! Thank you. I will make some notes and bring them to my appointment with my DME guy tomorrow. I do have nasal irritation now, my nostrils are very sore. Even with a breath rite strip I still don't feel like I am breathing at 100%, my nasal passages are so swollen shut. It all makes better sense to me now. I wish my sleep doc would explain things to me the way you just did. Thank you so much !
Donna


Kath Hope www.hope2Sleep.co.uk said:

Wow Neal - thanks so much for the explanation. Also, when you say you don't like full face masks, what do you suggest for people who just cannot breathe through their nose (like me)?


Neal Buckner, LRCP said:

Donna,

In regards to why increasing the humidification will reduce the mouth breathing. The nasopharynx is responsible for humidifying the air we breath in. By the time the inhaled air gets to the back of our throats it should be darn near 100% humidified. If the air coming into the nose is too dry the mucus membranes respond by producing more mucus to humidfy the air. In order to do that the blood vessels in our nose engorge to provide as much blood as possible to create the needed secretions. The end result is swollen mucus membranes causing the nasopharynx to swell shut. This will cause folks to open their mouth to breath due to the reduced air flow through your nose. When you open your mouth the air flows right through and out your mouth and causes the sore dry mouth. By increasing the humidification coming from the CPAP machine you reduce the chance of excesive drying and swelling in the nose. The upper airway loves warm moist air.

In regards to the mask fit. Nasal pillows tend to dry things out more so than a nasal mask. Reason: When we exhale we also exhale humid air. With nasal pillows there is little dead space for you to rebreath that warm moist air. With a regular nasal mask there is surface area and dead space for exhaled moisture to hang out and be rebreathed.

Personally, I'm not a big fan of the Opus Nasal pillow system. For newbies I tend to set them up with a nasal mask like the Activa LT with action cell cushion. It allows the frame to move independantly from the cushion and provides an excellent seal even when laying on your side. Plus, the rebreathing of exhaled humidification reduces the irritation of the mucus membranes. Especially for those who just start. There is an acclimation period that needs to take place. Right now you are experiencing hyperrhinorea do to the airflow irritation. The drooling and nasal congestion is in response to dry air. I don't like full face masks either. The area that needs to be sealed lends to increase leaks and sleep disturbances.

Try a nasal mask until you get good and comfortable with using CPAP. Then try the nasal pillows when your are due for another mask.

Neal

• ▶ Reply

Permalink Reply by Mike Burns on November 9, 2010 at 9:27pm

If you have fax send it to me I have very good teaching guid that might help you with dry mouth, you can go on line to look at differnt types of chin straps that would work cpap .com is wear i send my cpap patients the chin strap is called a red ruby this one lifts the chin up not back like the other chin starps, The last thing i would try is a full face mask. if want to try them get a hold of your DME Co. and make sure they have a Rt that you could talk to.

Mike B RCP.psgt

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Permalink Reply by Donna B. on November 10, 2010 at 6:54pm

UPDATE !! I turned in my F&P Opus 360 nasal mask today because of all the problems I was having with it. According to my DME guy, Joe, the design is such that the seal at the base does not stay put and that's what was causing all my problems. I explained in great detail my frustration of not being able to sleep through the night and he suggested this new mask, it is a nasal only mask but it's design is much better. (I even got a pink head strap with it !)
So..., I now have a new mask and my very own CPAP machine. No more rental.

We also discussed starting a group for all the SA patients, they do not have one and I really think it is needed. I asked Joe how many new patients he sees weekly (they also have a sleep lab there) and he said the number is growing. There are 3 or 4? sleep doctors at this practice so you can imagine how many new patients a week they are seeing. We are going to work on putting this together. I am excited. I believe this will benefit so many others like me, especially those that are not aware of this wonderful website.

I will update tomorrow after I hopefully get a decent night's sleep.
Thanks to all who have replied, you keep me going when I want to give up.
Donna

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Permalink Reply by Kath Hope www.hope2Sleep.co.uk on November 10, 2010 at 7:03pm

Good news (hopefully) on the mask problem, and FANTASTIC hearing about you being willing to start up a group. Just think how much extra energy you'll have to run it once you get the treatment going properly :)
Good Night!

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Permalink Reply by Donna B. on November 10, 2010 at 7:44pm

Thanks Kath !
I hope to be Joe's sidekick, I am great at organizing and promoting but I will leave the technical stuff to him. He is also a SA patient so he can truly speak from experience. My Doc on the other hand does not have SA but I have been told he is the best in the field of sleep medicine.
Good night, sleep well.
Donna




Kath Hope www.hope2Sleep.co.uk said:

Good news (hopefully) on the mask problem, and FANTASTIC hearing about you being willing to start up a group. Just think how much extra energy you'll have to run it once you get the treatment going properly :)
Good Night!

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Permalink Reply by Sandra Ceslowitz on January 15, 2011 at 9:29pm

Mike Burns said:

If you have fax send it to me I have very good teaching guid that might help you with dry mouth, you can go on line to look at differnt types of chin straps that would work cpap .com is wear i send my cpap patients the chin strap is called a red ruby this one lifts the chin up not back like the other chin starps, The last thing i would try is a full face mask. if want to try them get a hold of your DME Co. and make sure they have a Rt that you could talk to.

Mike B RCP.psgt

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