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Joined Dec 2016
Joined Dec 2016

Hi Dr. Luisi,

Thank you so much for your response. I think you are right. I tried the Good Morning Snore Solution once again this afternoon for a few minutes with a chin strap which helped a little, but still had the facial fatigue.

The last few nights I have noticed that with the CPAP treatment, one piece of medical tape over my mouth, and a minimal chin strap, I seem to be learning how to keep the noises from happening as much and am starting to sleep better. And there is no facial fatigue with this method. I'm wondering if I'm starting to get better at keeping the "back door" into my mouth shut, but don't know enough to know if that was the problem in the first place.

I am not a newbie to CPAP therapy. I have been doing this for 4 years. I was successful the first 3 years with the Resmed P10 mask, a chin strap and tape and a pressure on my autopap of 10-13. I had no trouble with the noises and physical sensations in my throat. Then last fall, all that changed for some reason. I tried several FFMs, but my face is small and it has been difficult to find one that will stay sealed and with the pressures that high, my mouth is becomes unbearably dry because I am a mouth breather. The nasal mask seems to be the best option for me, and when I do sleep my AHI is great --- almost always under 2. So I am very grateful that my body/brain seems to be relearning what it needs to do.

Do you think it would be good to have an ENT or my sleep medicine physician look down my throat to see if something has changed over the last few months, causing the problem and the need to increase the maximum pressure to 20? A few years ago the doctor told me that my airway was narrow. I wonder if the tissue has gotten flabbier. I've not gained any weight. I'm small and weigh 115 pounds, but I do have the myasthenia issue.

Thanks again. I really appreciate your feedback.

Hi Dr. Tony,

I know you are waiting for your buddies to return from their conference but wanted to ask you a couple of questions. If you have any thoughts, I can wait until you hear from your friends so you are not having to write 2 replies.

I tried the "Good Morning Snore Solution," a tongue retaining device, last night. I was able to keep the tip of my tongue in the suction bulb but still had the problem with the noises and physical sensations similar to the sound one makes and the feelings in one's throat when imitating a pig. My lips will also start to sputter just a little so I'm assuming air might be coming into my mouth instead of it all going down my airway. It seems like the tongue is somehow losing suction, from the roof of my mouth, but I'm not sure that's the problem since the snore solution device didn't seem to solve the problem. As you may recall, I do use medical tape over my mouth and a chin strap.

I've thought about going to a different Sleep Medicine specialist and or an ENT specialist to see if there is something that is causing a structural problem. I am almost 57 and menopausal. I also have Myasthenia which causes the facial and throat muscles to be weak which is typically worse in the evenings. In fact, it is quite common for people with Myasthenia to have apnea.

I'm concerned about a mandibular device because both the snore solution and the boil and bite mouth guard (the one I bit with my normal bite and the one that I tried moving my lower jaw forward just a little) make the muscles in my face so tired that it's uncomfortable to have the devices in my mouth for more than a few minutes. My face ends up feeling the way most people would feel after blowing up balloons for an hour. I think this is because of the Myasthenia.

So my questions are these:

  1. Do you have any ideas what might be causing the problem?
  2. Do you think it would be a good idea to have a second opinion from a Sleep Medicine specialist? My doctor is wonderful but seems to be at a loss for what is happening.
  3. Would a mandibular device cause the same facial fatigue that the boil and bite mouth guard and the Good Morning Snore Solution cause?

Thank you for your help.