mouth leak solution, cheap DIY oral appliance

[frequenseeker]

Here it is, the result of months of experimentation!
First, the background on the principle involved:
The air is not going down the airway, it is
detouring into the mouth and forcing its way out. If you sleep on your back with a rolled up towel or sock filled with rice at the level of your shoulder blades, this will straighten the airway and help the air go all the way down. You can try it side lying, use the "bump" just below the top of your shoulder, might work ok. This method also helps air swallowing (aerophagia).
If you have a retainer, put a rubber band between the clasps between your first molars and biscuspids. Or fill the center of the
retainer with orthodontic wax or ear plug silicone.
The rationale behind the above is that the back of the tongue can seal off the mouth so rubber band or wax into place, it will keep your tongue forced backwards a bit, and the back part will fan out and form the seal. This method completely eliminated taping and dams for me and some others here. In fact, I can have my mouth wide open and still have a seal that keeps the pressurized air going down the airway properly.
Some people have had luck training their tongues to do this without any guiding appliances. Just having the tip of the tongue on the roof of the mouth doesn't really do it. You need to put the tongue back from the front teeth somewhat so the rear part fills the back of the mouth to seal.
The mouth leaking not only loses the pressurized air that could be preventing apnea/hypopneas, it also wakes you up each time especially if it puffs or explodes out. This prevents you from getting real rest in the deeper stages of sleep since it keeps arousing you, even if you don't wake up enough to realize it. It is very worthwhile to get this problem fixed, it will improve your results greatly.
Now, for those who would like to try an oral appliance that can guide the tongue into position so it can seal properly, here are the directions:

Buy 2 boil and bite mouth guards (available widely, used for protection for sports).
Follow directions. You heat one up and briefly cool it down, then put it into your mouth and bite so it forms to your mouth. Take the other one and heat it more and get it straightened out.
Here is a photo of my custom dentist made appliance which has the tongue guide, and each of the the boil and bites.

Next, take the straight one and cut it in half. Heat one half again and then fold it into a "U" shape, but unequal lengths of the "legs" of the U:


Then you are going to attach it to the middle of the regular shaped mouth guard. Heat it again first and "fold" it into postion. Use the longer end to fix it onto the arch of the other guard, on the inside (the side facing up in the following photo). In order to get them to adhere, you can put a knife blade into a flame or otherwise get it hot, then touch it to the two surfaces and then bond them together with pressure.

Here is another image, I am not sure which will show the details best:


The end result might be a bit bulky in the mouth and keep your lips from closing well. If you want it less bulky, the bottom, or bite surface, of the arched guard is fairly thick. You can soften it by warming in shallow hot water and then try to get more of your lower teeth biting into it, you can shave it off with a sharp instrument, or you can freeze the guard first and then shave it down, which may be the best method. I have not tried any of these yet. Even if my lips are open this appliance works for me.
Your tongue base needs to seal the back of the mouth, and you might have to adjust the middle guide piece back or forward to get it right. The back of the guide being at the level of the first molar/bicuspid junction seems to be a good spot. You can put the mouth guard into your mouth when you are first biting on it, and look into a mirror and make a mark on the plastic at this location so you can plan for where to have the center guide meet your tongue, and use this to guide your placement of that part.

Good luck, and post your results!

[ December 01, 2004: Message edited by: frequenseeker ]

[<Airhead>]

Hi Frequent! Well, I was trying mouthguards too, wishing that I could get them "fixed" to be able to keep that tongue up. I tried my dentist, but he's too afraid that I will suffocate or something and wants a doctors rx before he can try to make anything. I wonder if there is any kind of non-toxic putty and cement you can get without the heating and cooling thing. Surely, some cpap company can do up something, can't they? I can't use my bipap because of that air blowing out my mouth bit, and I need it to keep the pulmonary hypertension (which I got from sleep apnea) from progressing. Pretty frustrating! Thanks for the description, instructions and photos!

[Luvsbettyboop]

Just a quick note, I have tried the normal boil and bite mouth guards and for some reason, it (dont ask me why have not figured it out yet) it caused major rainout. I tried for several days to figure out why all of a sudden I was continually getting rainout after never having it before. Narrowed it down to the boil and bite, that night I did not use it and had no rainout. Have not put it back in since. Hope this might help if it happens to any of you.

Wishing you all a happy restful sleep.

[frequenseeker]

Airhead, one problem is the material that is safe to have in the mouth, not many options that are workable. I have tried just a ball of wax but there is the risk of it dislodging and suffocation. With this appliance it is going to be firmly in place. If you get it so your lower teeth push depressions into it also, this could create a more "locking" appliance for upper and lower jaws, further helping to keep the mouth closed.
Luvsbettyboop, I wonder if you had your mouth more open when using the boil and bite. Straight out of the package it is very thick and could promote open mouth. Which then would create leaks and the machine would increase output to compensate, leading to rainout...or something creating greater flow = greater amount of water.

[snork1]

could you post a side view pic of the device pictured above? I think its a creative use of easy to obtain and safe amterials and the heat welding avoids all the toxic issues of a glue. I will probably give it a shot for the $6 investment.

[frequenseeker]

Thanks Snork! I worked closely with a dentist friend who knew the materials that were safe and available to try, and the pitfalls of screwing up teeth, bite and/or TMJ with the wrong approach.
The goals were: affordable, accessible, individualized fit, effective design. Any 3 of the 4 would have left out substantial numbers of potential users. It's great that this scores well on all.
I will get you the photo soon.

[<pinetree>]

So this thing is like a shelf, and the end of your tongue rests on it?

[frequenseeker]

In my acrylic one, there is a shelf for the tongue to rest upon and simultaneously the tip is not able to come as far forward due to the barrier between it and the back of the front teeth.
In the boil and bite version, it could be possible to replicate this. But I am not sure it is necessary. The most important principle seems to be the pushing back of the tongue and broadening of its base as a seal. The B&B pictured does this just through having the mass that is in the way of the tip. There is a little space for the tip to make it to the roof of the mouth between the mass and the palate though not as much as an actual shelf. Too much shelf and you have eliminated the basic guiding principle of getting the tongue pushed back. That happened with my acrylic one and I ended up using wax to fill in the shelf somewhat, to push the tongue back further.

[<pinetree>]

My apnea is due to the tongue being back too far and blocking the airway at the back of your throat. Wouldn't this device make that worse?

[frequenseeker]

I'd be interested in how this was determined so conclusively. I know it is a theory, and likely true for some people. Maybe a swallowing x ray would show it?
But I think if you have to use xpap to combat it but are defeating that by mouth leaking, you have to do something effective. If you prevent the mouth leak you will have more effective pap air going down the airway properly which in turn will splint the airway open, is my reasoning. The seal the tongue makes to prevent the mouth leak is not so far back into the throat. I think it could seal in the back of the mouth and further back it could still be kept free of the throat by the pap.
At least you have a cheap way to try this out. Your xpap should get you through the first experimental hours okay. If you have results available on your machine, even better for monitoring how you do. You should notice if it prevents the mouth leaks anyway..
Let us know how it goes! Or post more questions

[snork1]

It does seem ironic that pushing the tongue back would help. But I know I stop mouth leaks by shutting off air at the BACK of my mouth without an appliance...which unfortunately doesn't work in deep sleep.

My GUESS is that this works by sort of squishing the tongue back so it spreads out to do the same thing as you would do shutting off air while allowing CPAP to work without a device(while awake). But yes, tracking to make sure your therapy is working would be an important part of it. Although I would think you could figure out pretty quick if the shutdown moved far enough back to be a problem.

[frequenseeker]

I'm bumping this topic up to the top for those who have been asking about it.
Has anyone tried it, please post your results!
Pouses, this one is for you and your husband!

[<dfudd>]

IT WORKS - IT REALLY WORKS !!!!!!! Thank you so much for posting your mouth breathing solution & pictures. I have been on cpap therapy for 1 ½ years, and mouth breathing has been a major problem from day one. Chin straps are useless for me (I can clench my jaws tightly together and still blow air through my lips). Paper tape? Didn’t work. Would have leaks after 1-2 hours. Full face mask? Tried one without much success - I just didn’t like the full face plus too many mask leaks almost every night & would wake up every day with dry mouth from the mouth breathing. Only solution I found was taping my mouth shut with 3 inch wide masking tape (don’t laugh - I’m serious). I still would frequently have leaks around the tape edge after a while from the pressure in my mouth, so the taping has not been a total solution to the problem. Also, the nightly ritual of mouth taping has been a major, major hassle. Saw your post and thought I’d give it a try. Spent part of yesterday making a modified mouthpiece per your instructions. Used it last night and it worked - NO MOUTH LEAKS. I can say, after one night, that this is the solution I have been waiting for. Thank you so much. Merry Christmas !!!

[frequenseeker]

That's great!! Thanks for trying it and posting your results! Hope many more will follow.
I used to put a piece of silicone between my teeth and lips PLUS tape outside to keep the lips closed PLUS find just the right support of neck and back with no variation permitted. And still would wake myself wth the the pushing of the air on the inside. So I was motivated by similar desperation as so many of us
Help is possible!

[<Pouses>]

Thank you so much for all of your efforts, Frequenseeker. I am very excited you have finally been able to share this with all of us.

I have not been online much recently as I caught a cold a little over a month ago, that turned into Asthmatic Bronchitis. Definatley knocked the wind out of my sails for a while. Of course this has had my Sleep Apnea and allergies, and the Asthma going round and round. The allergy shots I give myself twice p/w do not seem to be helping as much as before.

I too, have tried Ultra Mirage FF, and the new Fisher Pykel FF with no success. Both leaked quite a bit, in part due to my mouth still coming open which moved both masks, thus I was not able to get either one resealed unless I pulled them so tight that that I would have deep ridges in my face all day. Went back to the chin strap again last night, but I started choking as my tongue seemed to stick to the roof of my mouth and my mouth and throat would become so dry that I could not stop the situation until I took off the chin strap. Of course I do not feel rested.

I am really anxious to try the appliance you have made. I have already made a mouth piece with the impressions from the teeth. My husband is very good at making things, and he is going to help me with the remainder of mine. I will go back to the store for more materials tomorrow.

Next week, I am going to a Dr. in Lansing for my breathing problems. This Dr. specializes in Allergies, Enviromental Medicine, and Otolaryngology. I am hopeful he will be able to help me as I realize that I can not successfully use the machine for the remainder of my life, until I can stabilize or repair some of my other problems. I try to do as many natural approaches such as a clean home, watching the many small details of allergies, etc. But in the last few months, I have been having so many problems with all of these situations, that I am at a lost to know how to help myself and still support my husbands problems as well. This is one of the reasons that I fought and resisted taking care of my own problems of having the OSA formally diagnosed and getting the machine for so long. My researh told me that is was going to be very difficult. It is a very large challenge when both husband and wife have this situation. My husband has been very supportive and helpful since my diagnosis, but the problems are still there. If I may also mention, we celebrated our 36th wedding anniversary this week. And yes, he is still very handsome. I am such a lucky and blessed person.

I do so much hope this appliance is going to work for me, and then we will make one for him. I was glad to see someone else say it was successful for them. I am anxious to complete it before this new Dr.'s appt.

Thank you again.
Devoted Wife