Forum · Cheeks full of air. Like a Chipmunk

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[-] Baba +0 points · 10 months ago

I use a AirSense 10 Cpap for women and a nasal mask. During about the last two hours of sleeping, I awake with air entering my mouth. I squeeze my cheeks together and it disappears. Yes, I start by positioning my tongue to the roof of my mouth but I think during the night it relaxes. This happens over and over until I finally get up. I am losing sleep almost every morning. My pressures setting are 5-15. I have resorted to using paper tape each night over my lips as the air would puff out of my mouth if I didnt. I have seen this done by other people and it works in my case. Air does not escape my mouth thru my lips doing this. I have tried a chin strap before using tape but when this happens early in the morning, it can still puff air thru my lips (ie: the paper tape}.

I have told my health provider and she is in the process of sending me a new mask that covers the mouth and still has holes so the air streams upwards and enters my nose. It is a very new mask, small, and jell like so I will as always be able to sleep on my side. This I think will eliminate the use of the paper tape. Yeah!

BUT, I think I will still have that high pressure entering my cheeks in the morning. Do you think the pressure is set too high? I just finally contacted my technician that sets the Cpap up. She says my usage is no higher than a 9.8 pressure .. This complicated and she will contact my Dr. about lowering the level of pressure. I won't know if this helps but if I am using tops of 9.8 pressure, how would this be too high in the morning because it isn't at night? Strange or my lack of understanding.

My Cpap is Wifi connected and my reading daily are right on the mark except for a lack of morning sleep from the puffy cheek thing.

*By the way, this is my first post.

-Baba

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[-] wiredgeorge +1 point · 10 months ago Sleep Enthusiast

Guess the nasal mask and puffy cheeks means your mouth is shut but air is escaping into your mouth rather than the exhaust holes in the mask. I can't use a nasal mask as this is one of the problems I have as well. I tried a WISP nasal mask and even with my mouth shut, exhalations blew into my mouth. My pressure is MUCH higher than yours at 21/25. In any case, agree with the med supply place that the full face mask might help.

As far as your pressure setting, the sleep study you had to get a prescription for the CPAP machine was likely much more accurate a gauge than anything else, Would be best to talk to your sleep doc rather than a DME tech if you are considering altering the pressure. In any case, I would wait till you get comfortable with the new mask before looking at pressure changes. Welcome to the forum!

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[-] DanM +0 points · 10 months ago Sleep Commentator

Welcome, Baba! Welcome to the Forum! It sounds like your machine is set for a range of pressure with a low of 5 cm and high of 15 cm. The machine detects your breathing and adjusts the pressure accordingly, and it looks like 9.8 cm is the most you are getting at any given time. This means the machine is sensing that your breathing is normal at pressures between 5 and 9.8 cm, so it is not delivering higher pressures. Even if your doctor approves the change in pressure and your machine is set for 5 to 10 cm, you will likely still experience the same pressure setting and the same experience of "puffy cheek" when using treatment. This is not uncommon or abnormal. It is simply a side effect of the treatment. Some patients actually do better on a mask that covers the nose and mouth (full face mask) because it allows air to enter and exit through either the nose or the mouth. There is no need to keep your mouth closed with a full face mask, so you may not continue to experience the puffy cheeks. Please let us know how you progress, and best wishes!

[+] [deleted] +1 point · 10 months ago
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[-] Baba +0 points · 10 months ago

So what I understand you saying, it doesn't matter if my Dr. approves that my pressure is changed down to 10 or just left at 15 because I am only using 9.8 of it anyway which is not the cause of the air in the cheeks puffing them out in the early morning. It is "simply a side effect of treatment" then. They ordered me a full face mask which I should receive in a few days. I am hoping the "side effect" will disappear and Yeah, no more tape at least. I also assume that the other settings are not the cause of my problem then like "Ramp off, EPR off" and a few others that I don't know what they mean. I feel better just from your response.

Baba

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[-] wiredgeorge -1 point · 10 months ago Sleep Enthusiast

My guess is that the puffy cheeks is because your mask doesn't allow for enough exhale capability. The full face mask will likely have better exhale capability. As far as keeping your mouth open with a full face mask, this is OK as long as your jaw doesn't drop and break the seal but it sounds like you already keep your mouth closed while sleeping.

Not sure why ramp and EPR are turned off on your machine. Ramp is a function which is present to allow a little slower transition from start up to full pressure to sort of ease you into use. Some folks don't much care for full pressure at startup and like to ease into it and ramp is a length of time where the machine starts at a low pressure and builds up to full pressure. The EPR is is your exhaust pressure which is one of the two settings in a BIPAP I think. BiPap allows for a little lower pressure than the inhale pressure to allow easier breathing. If your machine is in CPAP mode, the pressure is constant so EPR is likely not used. I use a BIPap at 21 EPR and 25 inhale pressure.

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[-] Baba +0 points · 10 months ago

Res Med Air Sense 10 for her CPAP. Well, I received my new Full Face Mask. They say that people like it. Note- It is my first full CPAP mask. Before this one, I've had two nasal masks. My CPAP machine is a Res Med Air Sense 10 Auto set for her. Last night for the first time I used the new Amara View CPAP mask first time last night. It covers just the mouth and your nose sets on a shelf where the air enters your nose and it doesn't cover the nose completely. This was WORSE. I loved the freedom of nothing in my nose or tape being placed over my lips although I still don't open my mouth. Once again the air was so violent that I could not control the mask from leaking all night. The air blew out from under the mask at any point it could. I opened my mouth next just to test what would happen and the air rushed out of my mouth like Old Man Winter. I adjusted the straps over and over and even pressed the mask to my face. It was a short night

My technician said she would contact my MD. about pressure changes. I am not sure that he was the one that set the perimeters in the first place as I took the original test at home per my MD and thought the results might have gone to a sleep Dr. that I never did see. Perhaps in a different town. The original report stated I had a mild to moderate apnea. I remember a number of 15.

The real reason I am concerned is that I have Afib and knowing that sleep apnea could be a trigger that may set it off. I will probably have Afib the rest of my life but it is not constant. Between 2003 and 2014, I've had 4 ablations for it at a University hospital. They lesson the beast but most likely there is no complete cure.

Back to the nasal mask tonight. oooeeeeeoooo

-Barb age 76

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[-] wiredgeorge +0 points · 10 months ago Sleep Enthusiast

A technician hooked you up during your study. The results went to a monitoring gizmos and a doctor read the results and came up with the numbers used in your prescription. The numbers MAY have been passed to your primary care physician for ordering the equipment and the set up or they may have come directly from the sleep doc; depends on your insurance. I am in a managed care HMO so the prescription came from my primary care doc with the concurrence of my insurance. In any case, you had best look into who wrote the prescription for your equipment and the set up. Just call the sleep place and ask firmly. The tech you mention may be OK, but I think you would be well served to find out who wrote the prescription and discuss your issues with that doctor and not rely on a technician as your interface with the doctor. If your primary care physician wrote the prescription it was based on the sleep docs recommendation.

Not sure who came up with the mask you tried but you may want to visit the med supply place and let you examine various masks and perhaps try them out and get one fitted there. You can try looking at reviews on masks but every mask has folks that both love and hate it as they work differently for different people. The Amara mask shows this plainly in its reviews.

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[-] Baba +0 points · 10 months ago

No response from my CPAP tech on my issues plus she is so busy that she doesn't answer my message calls. Last time I talked to her I said "firmly" to contact my MD which is within feet of her office. She said she would but she didn't.

I returned to my old nasal mask last night. The Amara mask was sent to me by mail from my local hospital's medical supply office. It's going back. Total leaks all night.

Here are my results of my sleep last night after I entered the "no zone" of the technical menu.

Events hr.9 Pressure Used 9.4 Leak 6L/min AHI 1.3 Total AL 1-1 Central AL 0-7

I do not know if these results are good or bad but by tweaking my numbers, I SLEPT GREAT FINALLY!! Res Med Air Sense 10 for her plus nasal mask.

-Barb

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[-] wiredgeorge +0 points · 10 months ago Sleep Enthusiast

I am not sure where you are getting your results you posted. The events per hour is excellent at .9. The pressure used? I personally wouldn't care as long as the pressure is what is needed to stop the obstruction of your airway. The leak rate of 6 L/min is excellent and the AHI 1.3 number seems at odds with the events number you copied at .9. The AHI is the number of events per hour.

Either number is pretty good. I think there is a link between low leak rate and good AHI number.
Wikipedia defines AHI as: The Apnea–Hypopnea Index or Apnoea–Hypopnoea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep.

I have no idea what Total AL 1-1 means but Central Apneas at are those that are not caused by obstructions but you also stop breathing and I have no idea if the numbers you posted are good or bad but I am sure someone will come along to discuss the issue.

OK, back to the mask. From your numbers, it looks like your nasal mask is working just fine. Looks like you are figuring things out and good night sleep is always a great reward! Keep us posted.

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[-] Baba +0 points · 10 months ago

That's all I will request of the tech is that she says my numbers look good now that I tweaked the settings myself. So let them put me in jail. I will have to take my CPAP with me. Thanks to you knowing most of the number, I feel better. I certainly have read everything I could get ahold of on internet about these values. Tonight will be the real test. Instead of taping my mouth with my usual paper tape, I have made a head band type band to go around my mouth. I made it out of stretch surgical tan tape. I saw a picture of what some woman made and it worked for her. Somehow I lost that picture on internet and I will have no way to thank her now. A chin strap just doesn't do it for me. I can still puff a little air outside my lips let alone a hurricane.

Thanks again, Barb

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[-] Baba +0 points · 10 months ago

wiredgeorge- I learned how to get into the tech. settings on my CPAP. That's where I got these readings. It was easy. Internet tells you almost anything. I am soooo illegal.

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[-] PatientVioletBear0961 +0 points · 10 months ago

One thing you can do to reduce how often your tongue falls down off the roof of your mouth, allowing air to get into the mouth, is to do tongue strengthening and training exercises during the day. Be sure that during the day your mouth is closed and your tongue is positioned against the roof of the mouth, all the way from front to back, as much of the time as possible, so as to train it to maintain this rest position. Strengthen the tongue by pressing it against the roof of the mouth and holding for several seconds before releasing. Repeat this 30 times, or so, each day with the tip of the tongue, the middle of the tongue, and the back of the tongue. A few weeks of doing these daily exercises should reduce how frequently you get air in your mouth, but with the caveat that it is rarely perfect due to the way that the muscles go mostly limp during REM sleep.

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[-] Baba +0 points · 10 months ago

It wakes me up from Rem sleep and even though I do the tongue thing it doesn't stop it completely and although now that I am awake, it just keeps a blowing. I thought my smart Res Med Air Sense 10 when on auto knows when I am awake. Well, it failed I tweaked my tech. settings and hoping tonight to get to sleep all night. Ha, they will put me in jail for doing that but It beats trying to get their help. They suggested a full mask that I received in the mail from the med supply office and that was worse than the nasal. That tongue just relaxes in Rem sleep.

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[-] PatientVioletBear0961 +0 points · 10 months ago

You could get help with more effective tongue training by seeing a myofunctional therapist: http://myofunctional-therapist.com/

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[-] wiredgeorge +0 points · 10 months ago Sleep Enthusiast

I went for about a year with high leak rates before I figured out that my jaw was relaxing at night and dropping and the leaks were from my mask coming up over my mouth a bit. Seems simiple now but I have almost no leaks now that I have figured it out. I use a martial arts mouthpiece that you fit to your bite and this keep my jaw from sagging/dropping at night. I am also careful to place the bottom edge of my full face mask in the groove between my lower lip and my chin. I also have tightened the lower straps a tad and the mask stays where it should now. The mask is also comfortable used like described.

It isn't hard to figure out how to modify the settings on a PAP machine as you have figured out but I figure I paid an expert to determine what would work best for me and it is done by prescription so best I leave it alone since my therapy has proved pretty effective. I still haven't figured out what a CPAP technician is. Does this tech work for the sleep study place or the med supply place? Either would not be able to change machine settings without the sleep doc's direction/prescription I think.

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[-] Baba +0 points · 10 months ago

My CPAP technician works for the med supply place. She has been able to change my machine settings with the approval of a sleep doctor, which I have never seen, and onto my MD for the prescription write up.

She probably has extensive training because the other med supply gals don't know as much and their tech rotates her office and hours. She is extremely hard to get ahold of. Maybe everyone is on her for answers.

I've had my machine for almost two years now and have changed masks 3x. only by visiting the med supply place and requesting another one. I now own the machine. I can sell it or toss it.

I have studied extensively tech subjects on this certain machine. I now changed my setting myself. It's perfect now and I am down to AHI 0.9. I will go to the med. supply and have them print out my test results and have them give it to the tech to see if I am on the mark. As usual, she probably won't even answer me. I know she is by prescription only but she did once long ago. Hmmm? The med supply girls can also read print outs of my readings.

I know I should have, by law, keep trying to aggravate the tech gal to get my prescription changed but she has had several chances.

7:35 usage hours 70 Good mask seal 20 0.9 events per hour 5 1 mask on/off 5 Total myAir score 100 -Barb

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[-] wiredgeorge +0 points · 10 months ago Sleep Enthusiast

Geez, you are doing great. I have NEVER had a score of 100. In the past 14 days, I have only slept past six hours three times (twice barely). I find it hard to understand how folks can sleep for 7 hours... (well except my wife who likes to sleep 8 hours). hehe

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[-] Baba +0 points · 10 months ago

Fearless-And I have always been a somewhat light sleeper before. Remember, though, at the beginning, I only had a mild to moderate apnea.

My husband that has near your pressures, sleeps like a log all night long and on his back. His apnea was off the charts at the beginning. He does not have a Res Med Sense 10.

Perhaps because you don't know when you remove your mask, you could be one of those unconscious deep sleepers. I still think that somehow that mask bothers you for some reason during perhaps REM sleep and you toss it away because it does bother you. Perhaps the pressure of air blows you silly and that would be the time your mask might leak or you feel you are in a hurricane.

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