Sleep Apnea: How can naso-pressure NOT release from the lips?

In theory, the nasal-type CPAP headsets assume that the 5-15psi or so of pressure will not break the seal of your lips… Now, we all know that the weak seal of the lips could never hold back that much pressure, correct? Not a problem! Coincidentally, with the pressure going in on the nasal side of the soft palate, this creates a vacuum in the oropharynx, which brings the tongue up and back to the rook of the mouth and sides of the cheeks. So, now the pressure is ultimately being held back by the seal of the tongue against the insides of the mouth.

Now, my experience with the nasal headset is that, eventually, the pressure seeps around the sides of my tongue, blows it back down into its resting place, and SNAFU, the pressure releases from my mouth, there is a loud rushing sound of air, and I wake up, interrupting my sleep. This happens even when my jaw and teeth are properly clenched with a chin strap!!! :eek: THis happens time and time again.

Since then, I am trying to adjust to my new facial mask, which is a royal pain in the ass and bridge of my nose. But, is this nasal headset problem a common problem? My tongue is just relatively too small to occlude the pressure, how can this be happening!!!??? How does this not happen to everyone?

Wow - that’s a new one one me. I’ve used a CPAP for five years (11 pounds pressure) but never had that particular problem. When I first started, the technician said it would be easier to work with nasal pillows rather than a mask because I wear a moustache and he wasn’t certain the seal below the nose would work right.

I haven’t had a problem with the chin strap other than occasionally getting dislodged, sliding away. That wakes me up, but I’m able to slide it back in place without waking more than minimally.

Don’t know about the tongue problem (no doubt mine is too big, just as my teeth were for the size of my jaw, necessitating orthodontistry).

I wonder if you’ve tried talking to a lab tech. We have a sleep lab in our small town and they are usually very helpful. I’ll try to pass your question on to them.

In the meantime, good luck. Sorry I don’t have any immediate, concrete answers, but I’ll see what I can do.

THanks, *'boy. I am preparing an e-mail to send to a doctor whom I had a one time free of charge visit (and polysomnography) with. I’ll ask him about this problem. Maybe there is something I can do, because I’ll be damned if I am going to wear that god-forsaken mask my whole life!

I am looking into the Pillar procedure too.

Once I got used to it (and got out of the habit of sleeping with my mouth open!), I’ve never had a problem with the seal breaking through my mouth. My tongue just kind of…sticks…to the roof of my mouth when I’m sleeping with the mask on.

I’m sorry that you’re having difficulty adjusting to your PAP therapy! Unfortunately for a minority of patients, this form of treatment may take *months * to get used to!

I’m a registered polysomnographic technologist and although many patients can plop on a mask and sleep through the night on their first go, I have heard complaints similar to yours in about 15% of the cases CPAP is prescribed at our lab. My best advice to you is to use a “ramp” feature on your machine or speak with your doctor regarding a pressure change (this may result in a retitration).

A “ramp” allows the pressure to increase slowly to your prescribed pressure as you drift off to sleep. Say you’re on a pressure of 14cm: a ramp might start at 6cm and increase to 14cm over a half hour or more. Your body can easily ‘accept’ 6cm and the slow increase allows for a smooth transition into deeper sleep, cutting down on central apneas that might pop up if you were struggling with the high pressure.

Often patients who mouth breathe (aka “oral vent”) are on a pressure that is either too high or too low. Ask your sleep physician if a retitration would be appropriate. And while you’re at it, find out if Bilevel is an option. Insurances are loathe to pay for it, but you might find it quite a bit more comfortable than CPAP.

Other than that, be sure you’re using a heated humidifier, that can help significantly.

If you do decide for the surgery, it is generally believed that only about 30% of patients with sleep apnea can be fully cured with surgery, and some doctors consider that number to be optimistic. :S The Pillar procedure is the least invasive, AFAIK, however. :slight_smile:

Either way, good luck!

Eek…long first post. Sorry…

I am situated with an automatic PAP. Starts out at 5, jumps to whatever is needed. THe problem always happens just as I drift off to sleep, just when my tongue completely relaxes. This happens at the least amount of pressure (5psi), which is all the more curious. THe suction to pressure ratio just isn’t right for me.

I’m one of the people who had a horrendous time adjusting to the CPAP. The first time I tried I gave up after clocking 180 hours of miserable sleepless time, lying in bed feeling like someone’s hands were around my throat, my head was in a vice, and a flesh-sucking alien was lodged on my face. Eventually I was motivated to try again. It took months, but now I find the CPAP somewhat comforting, and I’m certainly grateful for the quality sleep. (Of course, I would prefer not to need the CPAP.) What helped me the most was that I quit using the chin strap; apparently I don’t really need it. YMMV.

I used to occasionally experience pressure breaking through the lips. I found it usually helped if I adjusted the mask a bit.

Auto-titrating devices are usually given out only temporarily until an appropriate pressure can be determined from the ‘log’ the machine keeps on your usage. Definitely call your physician; he can read the log a determine a permanent pressure for you. 5cm is a very low pressure, and it probably isn’t enough to treat your apnea.

Fuel Thanks to Happy Trees you’ve got serious professional advice. I screwed up and didn’t get this to the lab today, but if you like, I will pursue. Multiple viewpoints may provide some parallax on the situation.

Thanks, Happytrees for providing such excellent information. When my wife was first diagnosed, she use the nasal thingies, but they were way too noisy, so she got the new type of mask with a soft inner mask. It is comfortable enough, but in the morning it leaves a deep ring all around her face which does not go away for most of the day.

She stuck with it for about 4 months, but has given up due to this problem (vanity, vanity). Her sleep doc did not think there were any other mask types that would not do this. Do you happen to know of an alternative?

You could try a total face mask, though it’s pretty pricey.

Fuel, another thing that helped stop pressure releasing from the lips for me was to keep the hose positioned so that it goes from the attachment place on the mask up the center of my face and back over my head. I tuck the hose under my pillow a bit to keep it positioned like that.

KlondikeGeoff, My mask leaves marks, but they disappear within an hour. Perhaps your wife needs to loosen the straps a little.

I had that ring-face problem until I loosened up the straps, too.

Sometimes I’ll do that air-escape thing on purpose. It’s as close as I’ll ever get to circular breathing. :wink:

Good heavens - from the photo of that thing, I wouldn’t be surprised to see that fellow running around wielding a chainsaw!! I wonder if there’s a mouth-and-chin version that might be a good compromise for Fuel’s situation?

Fuel, if that mask is a pain in the ass, I imagine you’re wearing it wrong :smiley:

Duct tape? a mouthful of taffy at bedtime? Seriously I don’t have a clue but wanted to say I hope you’re able to get this sorted out - people I’ve spoken with who use CPAP tell me that once they get the issues dealt with, they sleep massively better and feel like new people.

I am figuring out these days on my own that I am suffering from some sort of hypopnea, not so much OSA. I am not sure if it is centrally originating, or if my laying on my stomach all night tires my diaphragm and intercostals out, but it happens towards last 3rd of my sleep time and I swear, I’ll wake up over and over again from no substantial physical obstruction at all. My body doesn’t seem to want to breath aggressively or deeply, so it seems to get obstructed that way.

As you can figure, this problem does not help my use of CPAP, breathing against any kind of pressure. My plan is to train myself to breath against the pressure while awake reading and such…