Hi Dr. Luisi,
That makes so much sense and clears up the confusion I have felt as to why I can do well for a few weeks and then all of a sudden start having trouble again. Changing my expectations will bring me more peace.
Thank you again.
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:
Thank you for your help.
Great. Thank you Dr. Tony. I'll wait to hear from you. Take care.
If I use the Narval, does that mean if I have to have a filling, I will have to get a new Narval?
We live in Las Cruces, NM which is an hour from El Paso, TX and 3 hours from Albuquerque. Thanks again.
Thank you Dr. Tony. I really appreciate your advice, including the suggestion about the Narval. We live in Las Cruces, NM. El Paso, TX is about an hour away, and Albuquerque, NM is about 3 hours away so if you know a dentist you could recommend here or in those two cities, that would be great.
Thanks again for all of your help.
I am a mouth breather and use a pressure range of 15-20. I am currently trying the Dreamweaver under the nose mask (which I love) in hopes to avoid a severe dry mouth when I use a full face mask. I have had trouble with my tongue coming away from the roof of my mouth when I use a nasal mask, causing air to enter my mouth, chipmunk cheeks, and all sorts of noises, despite the use of a chin strap (I've tried several brands) and taping my mouth shut with medical tape.
Last night I tried another boil and bite mouth guard in hopes that I could determine whether or not a dentist-made oral appliance may be worth a try. I did not set my jaw forward when I molded the first guard, and it didn't work at all.
But molding the guard with my lower jaw forward last night seemed to solve the problem. I could see how having the tongue in the right position kept the air from entering into my mouth. Unfortunately, as I relaxed, my bottom lip slid off the mouth guard. I tried using a chin strap to keep it in place, but this did not solve the problem.
Could I have set my lower jaw too forward?
I forgot to mention that I do have TMJ issues in case that makes a difference in your recommendation.
Of the three dental appliances you suggested, is there one that would be better for a small mouth? Also, how Dio I find a good dentist who can help me with an oral appliance? I think there is only one dentist in our small community who does it, and I am not sure how good she is.
I thought I would try the cheap boil and bite mouth guard again. When I tried it before, I did not set my lower jaw forward. Is this why it didn't work If so, how much forward does my lower jaw need to be before I bite down?
And I figured out what was causing the "pig noises." It's my tongue coming away from the roof of my mouth, and air filling my mouth despite the tape and chin strap.
Thanks for your help.