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Audacity17
Unread post  Post subject: Air coming out mouth...pressure too high?  |  Posted: Thu Jun 25, 2020 1:58 pm

Joined: Mon Dec 05, 2016 2:14 pm
Posts: 6

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My dad just got a Remstar Auto A flex and I set his initial settings at 'auto' with a minimum of 6, and maximum of 12. He is using a DreamWare nasal trench. Laying down, he said air was trying to come out his mouth, so I moved the minimum to 4, which he said was better. He had a bad night of sleep, waking up in the middle with air coming out his mouth again. Looking at his numbers in Oscar, his 95 percent AHI number was 6.5 cmH20. It looks like he had a bad leak during the middle of the night, which might have resulted in a big ramp up in pressure. I don't want to make multiple changes at once, so I've brought the maximum down from 12 to 6. My next step might be to change it from 'auto' to 'cpap' with a pressure of 4, and then possibly turn on the A-flex. Any thoughts are appreciated, thanks.


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LSAT
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Thu Jun 25, 2020 4:43 pm

Joined: Tue Sep 05, 2017 9:40 am
Posts: 589
Location: WI
PAP Mask: F & P Vitera
PAP Machine: Airsense 10 Autoset
Pressure Setting: 12-20

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If he is opening his mouth, he is losing his therapy. If he can't keep his mouth closed he will need chinstrap, tape his mouth or use a full face mask.


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Respirator99
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Fri Jun 26, 2020 8:49 am
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 76
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Playing around with the pressure setting is not a satisfactory way to control leaks, especially at relatively low pressures such as these. What is the prescribed pressure, or doesn't he have a prescription? The prescribed pressure is the place to start. Get the leaks controlled, then you can fine-tune pressures.

If he doesn't have a prescription, start with a range such as 6 - 15, try that for a few nights then adjust the minimum to the median as determined by the machine.

But first you need to stop the leaks. You could try a chin strap or soft cervical collar to support the lower jaw. Alternatively you can try taping his lips - however I'd be reluctant to try this if he is infirm. Maybe the best solution is a full face mask.

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Audacity17
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Sat Jun 27, 2020 11:15 pm

Joined: Mon Dec 05, 2016 2:14 pm
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Sorry I wasn't clear in my first post. When he first tried it on 6, he was laying down and awake. He said it felt like it was forcing his mouth open. I then moved the min to 4, and max to 6. He woke up in the night with his mouth open. Last night I put it in CPAP mode, with a setting of 4, and used the C Flex, to take pressure off on exhale. His AHI has come down each night, now at about 3.5.


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tomkatt
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Fri Jul 03, 2020 3:55 pm

Joined: Wed Jun 24, 2020 2:12 pm
Posts: 6
PAP Mask: Dreamwear nasal cushion
PAP Machine: Respironics Dreamstation
Humidifier: Respironics Dreamstation
Pressure Setting: 8 - 14

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Audacity17 wrote:
Sorry I wasn't clear in my first post. When he first tried it on 6, he was laying down and awake. He said it felt like it was forcing his mouth open. I then moved the min to 4, and max to 6. He woke up in the night with his mouth open. Last night I put it in CPAP mode, with a setting of 4, and used the C Flex, to take pressure off on exhale. His AHI has come down each night, now at about 3.5.


Those are some of the lowest pressures the machine can do. It sounds like he's just a mouth breather (no offense intended, not like the insult but literally). Happens to many of us under CPAP therapy. Am I right in thinking he snores heavily without the CPAP treatment?

I've found success sleeping with a soft cervical collar to keep my jaw up. Chip straps and tape didn't work for me since I'm a beardy dude. But for issues like this, a chinstrap, taping the lips together, or a collar are generally recommended.


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LSAT
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Fri Jul 03, 2020 7:21 pm

Joined: Tue Sep 05, 2017 9:40 am
Posts: 589
Location: WI
PAP Mask: F & P Vitera
PAP Machine: Airsense 10 Autoset
Pressure Setting: 12-20

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Audacity17 wrote:
Sorry I wasn't clear in my first post. When he first tried it on 6, he was laying down and awake. He said it felt like it was forcing his mouth open. I then moved the min to 4, and max to 6. He woke up in the night with his mouth open. Last night I put it in CPAP mode, with a setting of 4, and used the C Flex, to take pressure off on exhale. His AHI has come down each night, now at about 3.5.


With a fixed setting of 4, the flex will do nothing since the machine does not go lower than 4. By lowering the pressure that low, he is probably not getting the therapy he needs. He should be using a full face mask so if his mouth opens he will still get the therapy he needs.


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Pugsy
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Fri Jul 03, 2020 7:29 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1725
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto
Humidifier: ResMed AirSense/AirCurve 10
Pressure Setting: Depends on the machine as I actually have more than one

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Flex exhale relief doesn't even engage or work at all until the pressure is at least 6 cm. Anything lower than that and it won't even come on.


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DeltaBravo3.8
Unread post  Post subject: Re: Air coming out mouth...pressure too high?  |  Posted: Sat Jul 04, 2020 2:22 pm
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 19
Location: Pennsylvania, USA
PAP Mask: ResMed F20 N30i P30i
PAP Machine: ResMed AirCurve 10 ASV
Humidifier: 10 Series HumidAir
Pressure Setting: EPAP 8-15 PS 4-12

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Personal opinion here is that adjusting pressures downward like that is the wrong way to address the mouth leak. You've taken away most of the therapy pressure by the setting edit. I would put the pressures back where they were and go about addressing mouth leaks by either a chin strap, tape, or a full face mask.

I have a chin strap on my wish list called Knightsbridge Dual Band. Get Google to look it up to do a bit of research. It's touted as not pulling the chin back but upwards only. That's positive IMO. Maybe try this or a full face mask like ResMed F20 or something similar.

BTW I am not against you changing pressures, it's just for the wrong reason given this scenario. My opinion of course. Best of luck.


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