Addressing Mask Leaks

[wullybully76]

Hello all,

I have been on my therapy for almost one year. Overall, I feel pretty good; I no longer have daytime sleepiness or feel fatigue. (So thankful I can sit through a movie without falling asleep now!) No more morning headaches either. However, I'm trying to work out the mask leaks I experience in order to improve my therapy; this week I had one good night and the other 2 nights not so good with mask leaks. It seems each week I have a mix of good and bad nights with regards to mask leaks.

I currently have 4 full face masks (Fisher Paykel Simplus, PR ComfortGel Blue, Resmed Quattro FX for Her and Resmed AirFit F20.)  I mainly use the Simplus FFM as I feel it is the most comfortable one for me. I did purchase the AirFit F20 recently and will be giving it a try soon.

I have read other forum posts and articles online on how to correct mask leaks but the mask leaks still continue for me. 

My most recent SleepyHead screenshots for this week are here: https://imgur.com/a/GiFZP

Any tips or insight would be greatly appreciated.

Thank you in advance,
wullybully76

[Gideon]

It's kind of hard to offer specific suggestions without a specific issue. How is your leak manifesting itself?

For general information please refer to the mask primer.

[chill]

Yeah, mask leaks.  I hate them.  I am ok with the pressure, I am OK with the noise.  But those leaks...  The first question is do you need to use a full-face mask, or can you do something so that a nasal mask or pillows work for you.  The problem with the full-face masks is that they have a lot more area to leak from.  So right off the bat you have more of a potential for problems.  Most people use full-face masks as they mouth breathe.  A chin strap or a soft cervical collar is potentially another way to address mouth breathing.  Wearing a soft cervical collar allowed me to switch from the Simplus to the Eson.  That reduced my leaks from an all night annoyance to an occasional one.  Others have resorted to taping their mouths.  Some have been successful in training their tongue to block off their mouth (the tongue-suck technique).  That worked for me at lower pressures, but my tongue gets lazy.  So that is one direction to consider.

If you really need the full-face mask, then a mask liner is worth considering.  They don't eliminate the leaks but they diffuse them so you don't have the cooling or disturbing effects of a steam of air on your face or in your eyes.  I've tried a few and did not get on with them.  I am a bit of an active sleeper and kept dislodging them.

That is my two cents on the matter.  For now.

[Melman]

Welcome to the forum. Everyone struggles with leaks, especially at first. I have used the Quatro FX but had to much leakage at the bridge of the nose into my eyes. I now use the F20. It took a little fiddling with the adjustments to get it right but now for about a month it has been both the most comfortable and leak free mask I have used. Hopefully you will have a similar experience. One problem I had was that my jaw would drop while asleep to the point that the bottom seal would be at my lower lip resulting in horrible leakage. The fix was a $10 Avalon Aire chin strap from amazon.  I thought it would be uncomfortable but it's not. Before you do anything else, however, you should read the mask primer which contains guidance on how to reduce leaks.

http://www.apneaboard.com/wiki/index.php...ask_Primer

I hope you find this helpful.

[wullybully76]

I apologize for not going into further detail. Yes, I am a mouth breather. I have tried mask liners in the past and dislodged them so they would bother me and I'd wake up in the middle of the night; still experienced mask leaks.

I will order a chin strap and the soft cervical collar this weekend and give them both a try to see the results. I am a little hesitant to wear the collar because I can get claustrophobic but I am willing to try; it was difficult to use the FFM at first but realized my therapy was very important and learned to adapt to the FFM.

[wullybully76]

Thank you everyone for the responses so far. I had read the mask primer when I started my therapy almost a year ago and will re-read it; might provide some insight on something I may have overlooked.

[PaytonA]

First, can you put your finger on anything that was different between the 17th and the 18th,19th? The 17th looks pretty good.

I have the Simplus and the F20. I am not sure if you are aware but the Simplus is meant to be worn a little low on the nose. I also found that with the Simplus I would don the mask and turn on the machine. Then I would pull the mask away from my face a little to ensure that the cushions got inflated. Your pressure is fairly high so the lower straps will need to be fairly tight. The upper straps should not hold the forehead stabilizer hard against your forehead. Do you feel the leaks or is it what you see on Sleepyhead?

I like the F20 even better than the Simplus. With the F20 you need to slide the nasal bridge portion of the cushion up your nose until it rests against your brow. It makes a lot of its seal against the brow. Then put the rest of the mask against your face and fasten the headstraps. The lower straps will probably need to be tighter than the upper straps. It took me a little while to get the F20 set up properly and it seemed to work better the more that I used it.

I still get the best leakage results with the Resmed Mirage Quattro but a lot of people can not stand the mask. I get excellent results with it. In fact two nights this week I got four zeros for leak rate for the night. That is min=0, median=0, 95%=0 and maximum=0 for the night.

If you can feel your leaks, let us know where you are feeling them.

Best Regards,

PaytonA

[wullybully76]

First, can you put your finger on anything that was different between the 17th and the 18th,19th? The 17th looks pretty good.

I have the Simplus and the F20. I am not sure if you are aware but the Simplus is meant to be worn a little low on the nose. I also found that with the Simplus I would don the mask and turn on the machine. Then I would pull the mask away from my face a little to ensure that the cushions got inflated. Your pressure is fairly high so the lower straps will need to be fairly tight. The upper straps should not hold the forehead stabilizer hard against your forehead. Do you feel the leaks or is it what you see on Sleepyhead?



I like the F20 even better than the Simplus. With the F20 you need to slide the nasal bridge portion of the cushion up your nose until it rests against your brow. It makes a lot of its seal against the brow. Then put the rest of the mask against your face and fasten the headstraps. The lower straps will probably need to be tighter than the upper straps. It took me a little while to get the F20 set up properly and it seemed to work better the more that I used it.

I still get the best leakage results with the Resmed Mirage Quattro but a lot of people can not stand the mask. I get excellent results with it. In fact two nights this week I got four zeros for leak rate for the night. That is min=0, median=0, 95%=0 and maximum=0 for the night.

If you can feel your leaks, let us know where you are feeling them.

Best Regards,

PaytonA

Thanks, PaytonA, for your detailed response. Good to know how both the Simplus and F20 should rest on my face.

I honestly cannot recall anything different from the 17th compared with both the 18th and 19th. I was wearing the Simplus FFM all 3 nights and like you, I place the mask on prior to turning on the machine and pull the mask away to inflate the cushions. Perhaps my lower straps are not tight enough, given my high pressure. 

Once I get the mask adjusted, I do not feel any leaks when I go to bed; I tend to fall asleep fairly easily and quickly. I wake up feeling rested and the large leaks do not wake me up during the night so I am a little frustrated in the morning when I see leak rates like the 18th and 19th. I will add that in the past (say 6 or 7 months ago) I would remove my mask off in my sleep, not even knowing I was doing this and I would wake up seeing the mask besides me on top of my machine. I wonder if the large leaks back then would cause me to remove my mask in my sleep.

The only time I feel the leaks are when I'm barely waking up and my alarm is going off; I do feel the leaks near my eyes. At this point, I am turning off my machine, removing my mask and getting out of bed.

I tried the F20 for the first time last night so here are the results: http://imgur.com/ET1LYbI

I  plan on wearing the F20 tonight and making some adjustments to the straps; hopefully I'll see improvement!

Thanks again, 
wullybully76

[PaytonA]

I would recommend one thing for getting the mask adjusted. If you wake up and are feeling leaks in the morning, take the time to adjust the straps to fix the leak before you do anything else. During the night, the pressure from the mask moves the tissues around and your facial muscles relax. presto amazo....leaks. The time to fix them is right then because you can not approximate that condition of muscles and tissues.

One other thing. Are you adjusting your mask at your max pressure? What is your min and max PS (Pressure Support) set to? It looks like your machine is running in auto bilevel mode. Is that correct?

I looked at your charts. The leak rate pattern for the last night looks similar to the bad nights but the leakage is not as bad. I am beginning to think one of two things is happening. I would like to have you get the mask adjusted to avoid leaks at your highest pressure which is where your IPAP is running all night long.

Best Regards,

PaytonA

[wullybully76]

I would recommend one thing for getting the mask adjusted. If you wake up and are feeling leaks in the morning, take the time to adjust the straps to fix the leak before you do anything else. During the night, the pressure from the mask moves the tissues around and your facial muscles relax. presto amazo....leaks. The time to fix them is right then because you can not approximate that condition of muscles and tissues.

One other thing. Are you adjusting your mask at your max pressure? What is your min and max PS (Pressure Support) set to? It looks like your machine is running in auto bilevel mode. Is that correct?

I looked at your charts. The leak rate pattern for the last night looks similar to the bad nights but the leakage is not as bad. I am beginning to think one of two things is happening. I would like to have you get the mask adjusted to avoid leaks at your highest pressure which is where your IPAP is running all night long.

Best Regards,

PaytonA

I'm about to head to bed but wanted to respond. 

My Dreamstation is currently on a fixed bilevel mode but I believe it is capable of auto mode as well. I try to make adjustments to my mask as the pressure goes from EPAP to IPAP when I'm ready to go to bed; I probably spend several minutes doing adjustments. 

I will try to make additional adjustments when I feel the leaks in the morning. We'll see how tonight goes. 

Thank you,
wullybully76