Blow by after ramp ends

I am a recently diagnosed 62 y/o female. My machine is a ResMed A10 AirSense Autoset with pressure settings from 8-15. Using a Brevida nasal pillow that was given to me after the titration was completed. Ramp is set at 4 and 15". Humidfier with heated tubing. I live in Colorado and the humidity is around 25-30% in my house. I was having mostly CA so turned down the EPR to 2 and that seemed to help.

My issue is that when the ramp completes and pressure rises, air blows out of my mouth. Mouth is closed tight. This happens while I am awake or asleep, sitting or lying down in any position. My mouth will be tightly shut and POW out comes the air. Generally the pressure is around 10-11 when this occurs. If I manage to go to sleep, it wakes me multiple times during the 4 hours sleep I get. I am at my wit's end.

My DME clinician has not responded to my issue. I see a Pulmonologist certified in Sleep Medicine and have not been able to talk with him.

Help please! Any ideas?

Thank you for any suggestions.

Sounds like you need a full face mask. If not, a chin strap or surgical tape on mouth is my only suggestion. Been there, done that. I use a nasal pillow with chin strap that works for me. A little air still escapes at the corner of my mouth sometimes, but not enough to worry about.

I am currently having the same problem so I hope you get some suggestions that are the silver bullet!

I have tried 4 different types of chin straps and while they help, none seem to solve the problem completely. The best one so far was the cheapest. You can find them on ebay for as little as $2 each. They are just an elastic strap with two holes for your ears, and a Velco fastener at the top.

I have tried the paper medical tape over the mouth, and it does work too if you can keep the tape on. I was a bit reluctant about taping my mouth shut, and you will read warnings about how it could be dangerous if you throw up during the night. But how often does that happen, and is tape any worse than having a full face mask if that occurs.

This is an ongoing project for me, and my attempt tonight is to combine a chin strap and the tape to see if that works.

As for the full face mask solution, I tried the Mirage Quattro and couldn't tolerate it for more than a few hours. It seems to leak and make rude noises that wake me up, and I just couldn't get any sleep. I've also tried the AirFit F20. It was better and I lasted 4 nights with it before I gave up on it. I wouldn't rule out a full face mask solution as many tolerate them. If you are paying for them, try to get one that is returnable if it doesn't work for you.

One minor change that you could try that may help a little is setting your EPR to Ramp Only. That way you get the benefit of the exhale pressure reduction when you are going to sleep, and then it discontinues when you are asleep. With no EPR your treatment pressure may reduce a little - perhaps by 1-2 cm. That could delay the onset of when you start to have a mouth leak, but probably will not eliminate it. To do this you need to set the Ramp Time to Auto. I would set the start pressure higher than where you are now (4 cm), and increase it to 7 or 8 cm. This can be more comfortable when you are trying to go to sleep. Then finally set the EPR to ramp only. This will require access to the Clinical Menu. It is easy to get into. Just hold the bottom Home button down and the round button down at the same time for 3-4 seconds, and you will be into the Clinical Menu. But, like I say, it probably will not be the silver bullet.

Edit: One more trick I intended to mention. Some find it possible to hold their tongue at the top of their mouth, and pushed up against the back of the top teeth. I find it does stop the blow by effect, and you can do it when you are awake. The trick seems to be doing it when you are sleeping, and I can't claim to have that part figured out...

I believe most mouth leaks are caused when the jaw relaxes at night and slides back a bit and the mouth opens as a consequence. I use a full face mask for a couple reasons but also use a "boil and bite" mouth guard and it keeps my jaw from sliding back and I have virtually no air leaks. The first full face I used for a couple years had small leaks that blew air into my eyes and made a noise or two once in awhile. I fixed this by using mask pads. The mask still had minor leaks but they didn't get in my eyes and no noises. I then tried an Amara View and need no mask pads and have no leaks generally. The material is much more pliable in the cushion and it fits up under my nose with no large center pillar.

I found the "pow" feeling to be so uncomfortable that I was willing to try anything to get it to stop. The tongue trick worked for me. I add it as the last step in masking up each night. I rest my tongue against the roof of my mouth with the tip of my tongue against the backside of my upper front teeth and then close my lips. When I was first doing this, I would "talk" to myself with thoughts like this: "This feels comfortable. I like sleeping this way. Everything is where it is supposed to be. I can shut my eyes now with my tongue this way and will be able to sleep through the night because my mouth will stay closed all night long. When I wake up in the morning, everything will be right where I left it. I will sleep this way all night. It's safe for me to go to sleep now.....etc." until my thoughts drifted off into sleep land. It's all automatic for me now...I hardly even notice what I'm doing. And I do wake up with everything just as I left it before I fell asleep. And there is no waking in the night with a "pow!" anymore. The power of suggestion is pretty incredible. It's like a night time hug or a kiss on the check before bedtime - very comforting and powerful when you believe what you are saying to yourself. This works....try it!

I have done two nights now with a nasal pillow mask + chin strap + tape over mouth. It seems to totally eliminate the mouth leak issue. Does not help with the mask dislodging during the night (probably side sleeping) and causing a leak. Surprisingly the tape on the mouth is about the least invasive feeling part of the whole setup.