Full face mask pressure issues

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I have always been a serious mouth breather, and therefore am stuck with using a full face mask. My question is directed to pressure related leaks with that type of mask. It seems that I ALWAYS have serious leak issues at pressures of 13/14 and up. I am currently in the process of evaluating 3 different masks, both ResMed and PR, and it does not seem to matter who the manufacturer is, or the shape or size - they all leak like sieves at higher pressures, at least for me. While I can go for a period of time - perhaps up to 1 or 1.5 hours - with no significant leaks and no events, then the leaks begin, and nothing seems to resolve it, other than what I do - take the mask off for the remainder of the night. When I have the uninterrupted periods, I start and then wake up on my back. While awake, I can never sleep on my side (my preference) without a leak. But I need to determine what I have to do to make this therapy work. While using at least one of these masks at 12 cmH2O straight CPAP, I have little leaks, 7+ hours sleep, but an AHI in excess of 30, as reported by both ResScan and SleepyHead. I have no Dr appt for another 4 weeks, and would like to have better results then I am currently getting before then. I can strap them down tighter, but that causes other issues. Any suggestions from full face mask users would be very much appreciated.

[zonk]

When used full face masks got better result with the Quattro FX than the standard Quattro.
Have you tried the Mirage Liberty (nasal pillows full face mask)
In the old forum some members recommended Fisher & Paykel full face mask it,s more stable as goes under the chin.

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Thanks, zonk. When I use the Quattro, I need to "dial in" the forehead adjustment to avoid leaks in my eyes. I need the same type of adjustment procedure on the Respironics ComfortGel. How do you avoid eye leaks on the FX? Seems like it would require a really tight strap in the absence of the forehead support. I am ending up in my current efforts with a really tight strap, leading to headaches and facial marking.

As to the Liberty, I have no source to try that mask. It would just be a shot in the dark. My DME really is not worth the powder to blow it to h***. They only have Respironics masks, all other manufacturers are special order without a return option, and they have no measuring devices for anything at all. I can try some Respironics and ResMed through the hospital sleep study dept where I did my original test. I will ask about it there, and who knows?

[iSnooze]

I also have a full face mask and mine leaked a little until I replaced the insert and the flap. If you're trying the masks, they should be relatively new but find out if they aren't. I've noticed that my replacement flap now not sealing as well as when I got it a month or so ago.

On the old boards there was a person who recommended a FitLife Total Face CPAP Mask. This mask covers the entire face and he said it didn't leak for him. You'd have to do some searching on the supplier's sites to read the reviews.

Good luck finding the mask that works for you at the higher pressures.

[JumpStart]

Hi, iSnooze. Thanks for the input. How often do you replace the cushion or flap or whatever it is? And if your mask has another replacement part, like the PR Comfortgel does, how often on that? It sounds like the best way to insure a seal (if it will seal at all!) is to keep those parts new.

[Netskier]

It seems that I ALWAYS have serious leak issues at pressures of 13/14 and up. I am currently in the process of evaluating 3 different masks, both ResMed and PR, and it does not seem to matter who the manufacturer is, or the shape or size - they all leak like sieves at higher pressures, at least for me. While I can go for a period of time - perhaps up to 1 or 1.5 hours - with no significant leaks and no events, then the leaks begin, and nothing seems to resolve it, other than what I do - take the mask off for the remainder of the night.

Try tightening the straps. Put bandaids on the bridge of your nose to prevent the mask cutting it.

When I have the uninterrupted periods, I start and then wake up on my back.

Tie a tennis ball to your back. Duct tape it. Or put something else on your back so that it is too uncomfortable to sleep on your back. Anything to keep you off your back.

While awake, I can never sleep on my side (my preference) without a leak.

I sleep with the back of my head on my pillow, with my ear on the pillow, but the rest of my face, and most of the mask, off of my pillow to decrease leakage sometimes. I have a Costco shaped memory foam pillow, actually two of them, that I use.

The more upright your head is, the less Obstructive Sleep Apnea (OSA) you will have. Also less comfort. But I seem to sleep pretty well now with the two firm pillows. If you sleep straight up, as in tied to a post, you will have zero OSA but really poor sleep. Somewhere in the middle you may find a solution.

But I need to determine what I have to do to make this therapy work. While using at least one of these masks at 12 cmH2O straight CPAP, I have little leaks, 7+ hours sleep, but an AHI in excess of 30, as reported by both ResScan and SleepyHead. I have no Dr appt for another 4 weeks, and would like to have better results then I am currently getting before then. I can strap them down tighter, but that causes other issues. Any suggestions from full face mask users would be very much appreciated.

Can you lower your max pressure and still stop OSA? I am down to between 2 and six OSA events per night using a pressure range of 6-14 cm/h20. I test my mask fit every night which takes me to 14 very quickly. I lay down on my side, and make minor adjustments to stop the leaks, first on my preferred side, and then on my unpreferred side.

I use a full face mask, a Quatro I think, and I now install it as high on my face as I can, with the seal just below my lower lip, this to get the mask above the bridge of my nose, which it used to cut when it was lower. Basically, I suggest a lot of experimenting in the Mask Fit setting of your Resmed.

I would never take off my mask for the rest of the night. I would always reduce my max pressure before taking off my mask.

You only need high pressures during REM sleep, so that is only every 1.5 hrs. And you need less pressure on your side than on your back.

One thing that would work, albeit a little radical, would be to just let you mask leak every 1.5 hours during you REM sleep so that it wakes you up, and THIS stops your OSA. Then just go back to sleep again for another 1.5 hrs and repeat all night. This will give you your deep delta wave sleep, but will deprive you of most of your REM sleep.

[iSnooze]

Hi, iSnooze. Thanks for the input. How often do you replace the cushion or flap or whatever it is? And if your mask has another replacement part, like the PR Comfortgel does, how often on that? It sounds like the best way to insure a seal (if it will seal at all!) is to keep those parts new.

I've only replaced them once. My DME technician said that silicone wears down and the seal isn't as good. My insurance will cover part of the price for the gel inset and "flap" once a month but I didn't ask for a replacement until 7 weeks after I started using cpap. That's when I noticed more and more leaks.

Oddly the last 2 or 3 nights I've had more leaks and noticeable "face farts" with the replacement parts. I decided to put the original gel inset and "flap" back on to see if it made a difference. It did. I'm going to give both the old and new items a thorough cleaning and see if that helps. Usually I wipe the mask down every day but only clean it thoroughly once a week.

"Flap" is an odd name for the part of the mask that touches the face. The European Respironics website has a picture of it seen below.

The comfort gel in the middle is blue and the SST (no clue what that stands for) flap is clear.

We don't have the same mask but perhaps a change in your mask cushion would help.

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Try tightening the straps. Put bandaids on the bridge of your nose to prevent the mask cutting it.

I tried tighter straps last night, and it was a significant mprovement on leaks, a pain otherwise. I will try the bandaid approach. We shall see what tonight brings.

Tie a tennis ball to your back. Duct tape it. Or put something else on your back so that it is too uncomfortable to sleep on your back. Anything to keep you off your back.

Don't misunderstand me. Sleeping on my back seems the only time I (1) avoid major leaks, (2) have uninterrupted sleep, and (3) limited events. Not really logical, but I assume the graphs are accurate in this regard. However, your comment regarding REM sleep was new information to me, both that the increased pressures are only needed then, and that it occurs approx every 1.5 hours.

Can you lower your max pressure and still stop OSA?

I suppose I could try reducing from 15 to 14, and see if that might give some change, but it appears that the lower pressures (such as the 12 straight CPAP I tried) fail to give any reduction in events (either apnea or hypopnea). Of course, I admit I am not doing well in reducing these at higher pressures either (at least up to 15, which was the max prescribed setting). I would try to show a copy of my Leak graph, but unfortunately I do not know how to add that to a forum reply.

Netskier, I do very much appreciate your input, and the time you took to address my various issues. Thank you. I will report on my progress.

[JumpStart]

Hi, iSnooze. Thanks for the input. How often do you replace the cushion or flap or whatever it is? And if your mask has another replacement part, like the PR Comfortgel does, how often on that? It sounds like the best way to insure a seal (if it will seal at all!) is to keep those parts new.

I've only replaced them once. My DME technician said that silicone wears down and the seal isn't as good. My insurance will cover part of the price for the gel inset and "flap" once a month but I didn't ask for a replacement until 7 weeks after I started using cpap. That's when I noticed more and more leaks.

Oddly the last 2 or 3 nights I've had more leaks and noticeable "face farts" with the replacement parts. I decided to put the original gel inset and "flap" back on to see if it made a difference. It did. I'm going to give both the old and new items a thorough cleaning and see if that helps. Usually I wipe the mask down every day but only clean it thoroughly once a week.

We don't have the same mask but perhaps a change in your mask cushion would help.

iSnooze, the picture you included looks very much like the Respironics ComfortGel Blue I am testing. However, you answered my question that it is both of those items which you replaced. Seems strange (and unfortunate) that it didn't work better for you, and disappointing for me that such a simple process would not be a solution. Let us know if the thorough cleaning has better results. I just acquired mask wipes, and anticipated fewer mask washings. That may not work out as planned, either, depending on what you find. Anyway - thanks for your help.

[Netskier]

Tie a tennis ball to your back. Duct tape it. Or put something else on your back so that it is too uncomfortable to sleep on your back. Anything to keep you off your back.

Don't misunderstand me. Sleeping on my back seems the only time I (1) avoid major leaks, (2) have uninterrupted sleep, and (3) limited events. Not really logical, but I assume the graphs are accurate in this regard. However, your comment regarding REM sleep was new information to me, both that the increased pressures are only needed then, and that it occurs approx every 1.5 hours.

Can you lower your max pressure and still stop OSA?

I suppose I could try reducing from 15 to 14, and see if that might give some change, but it appears that the lower pressures (such as the 12 straight CPAP I tried) fail to give any reduction in events (either apnea or hypopnea). Of course, I admit I am not doing well in reducing these at higher pressures either (at least up to 15, which was the max prescribed setting). I would try to show a copy of my Leak graph, but unfortunately I do not know how to add that to a forum reply.

Netskier, I do very much appreciate your input, and the time you took to address my various issues. Thank you. I will report on my progress.

I suggest a bunch of fully awake experimentation to explore leakage as a function of max pressure. I would begin by just running Mask Fit tests starting at 12 cm/h20, and progressing to 13, 14, and 15, using the minimum tension possible for each, and using a standard posture for each test.

If you can find some combination of pillows to sleep on your side, you will be way ahead because OSA is far more severe on your back, and I think on anyone's back, than on your side. For example, my sleep test was AHI = 40 while on my back, but only seven on my side, which was more than five times worse on my back.

If your leakage was reasonable at 12 while on CPAP, I would consider trying that in APAP mode for a night. That would surely be better than taking off your mask for the rest of the night.

I am sure that leakage must be controlled to get meaningful measurements. Resmed even provides this number which I forget just now.