[Equipment] Mask leaking due to opening mouth overnight

[klauskinski]

Hi, folks,

I'm new in this xPAP story... Have severe apnea (AHI = 54 during tests, oxygen went down to 73%). So I received an APAP machine about a week ago. I use full face mask Resmed F20 due to breathing through mouth. Based on measurements it is the correct size.

I set everything on "auto", min press = 4.4, max = 20. I got great AHI = 0.38 (34 sec with apnea) on the first night!   No leaks, no snoring, no breathing through mouth, woke up after baby sleep. I had 2 CA overnight. So I decided not to change any parameters and keep using it. 

But it went downhill from there . It seems like I'm getting used to the full face mask and simply ignore it during the night. I started to breath through mouth again. The problem is that when I open my mouth, the mask starts leaking. The machine is trying to keep the pressure pressure and raises the pressure which makes the situation worse because then I start getting apneas. After about a week of using the machine, my AHI is 10 and over 25 minutes with apneas. My typical pattern is "leak first, pressure up --> a mix of apneas after a couple of minutes that last several minutes". I usually wake up after this, get things under control and go back to sleep. This repeats now 2-3 times per night. I tested the mask and it's good if I don't move my mouth. However, if I start opening the mouth or even twist my cheeks, mask leaks. 

Any ideas how to keep my mouth closed and calm down my lower part of my face? Any other ideas? 

Thanks and happy Easter to all! 

Klaus

[ShaunBlake]

Hi, Klaus;
Since you haven't gotten any good advice I'll chip in and ask if you've considered a chin strap. I'm not typically a mouth-breather but have had issues with Large Leaks and dry mouth so I've looked into that remedy. It is a device that lots of folk here have found to successfully stop mouth-breathing while asleep.

Hope that helps.

[weiss27md]

There's also soft cervical collars. I plan to buy one of these. I have the same mask leaking too. Probably going to buy a nasal mask instead of the pillows I have now.

[Melman]

I use the F20 and had a problem with the bottom seal of the mask leaking when my mouth opened. A soft cervical collar fixed that. I still breath through my mouth much of the time but there are no leaks and my AHI is well controlled. The collar also eliminated obstructive events due to chin tucking. I suggest you post one or more OSCAR daily charts. There may be other issues that are contributing to you increased AHI but we can't tell without data. See the links below for how to organize and post your charts. Your minimum pressure, for example, is lower than we usually recommend. Are you using EPR?

[GuyScharf]

Another option is to try a different full face mask.  I tried the F20 for a few days but didn't like it.  I've been using the F30 for nine months, maybe more, and have only a few leaks. There are some usually small leaks when I move my mouth but overall I am satisfied with the F30.

[klauskinski]

Hi, guys, thanks for the ideas.

I guess I'll have to learn a couple of tricks before this is going to work properly . Melman, I have exactly the same problem as you do -- leaking at the bottom of the mask when mouth opens. Yesterday afternoon I also found another thread about taping mouth on this forum. I'll go step by step and try to find a solution that works best.

I have also changed the pillows in the middle of last night (thinner ones that allow my head to lay down more horizontally seem to work better) and the result was much better than the first half of the night. I'll keep playing with options and if nothing else I'll switch the mask as GuyScarf suggested.

Again, thanks a lot for ideas.

[klauskinski]

I wasn't able to add the graph to the previous post and now I can't edit it anymore, so it's here.

So this is the graph from last night that was much better (see the point in the middle when I swapped the pillows). AHI = 4.65 here... feel much better today in the morning.

[klauskinski]

And the current machine settings that I clipped off by mistake... sorry

My plan is to keep the settings as they are for another week or so and test other tweaks (neck support, taping mouth, etc) before starting to play with the pressure.

[KallyA]

I have this problem also with leakage at the chin area. I have had some success with the eliminator travel sleep pillow (search it on Amazon). They were previously marketed to stop snoring. It's basically a chin rest that straps around your neck. You may have to add a washcloth or something like that on top or underneath to raise it to the proper position for you. It does not have to be fastened tightly, just positioned so your chin can not drop down in front of it during night. I sleep only on my back on a wedge and don't move around much. If you toss and turn this might not work for you. If you sleep flat, also might not work.

Another thing I tried was an Aveela Premium Anti Snoring Chin Strap (also on Amazon). You can change the angle of the velcro attachment in the back and the strap on top to make it snug up on the chin. The edge of it comes right up against my face mask at the chin and helped stabilize the mask. I did not care for having two straps making dents in my head, though, so I gave it up. Since then, I found baseball cap liners (the plastic shell type) and plan to experiment with that to get rid of the denting issue.

Hope this helps, or gets you thinking creatively at least.

[mesenteria]

It's the least favoured remedy for what should be obvious reasons, but some of us, a few, have resigned ourselves to tape.  We tape over our mouths.

Before you discount this as far-fetched or desperate, it might be something you'll have to consider...or to reconsider.  Those of us who do use tape have found it to be a perfectly acceptable remedy to mouth breathing.  We tried a collar or a chin strap, and found them wanting.

If it turns out that you find yourself willing to attempt to tape over your lips, I use the 3M 'Water Resistant' white tape that comes in spools.  It is about an inch across the weave, and is easily torn, applied, and removed.  Fold over a small amount to make an easily grasped tab at one end of the tape.