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Working through mask leak issues
#1
Hi All,

My first week of CPAP therapy has gone quite well! Still a bit groggy on waking up, but there's much less need for coffee, and what I do drink acts more like rocket fuel! Smile

As the thread title suggests though, I need to work out some leak issues with my mask.

The mask itself is a ResMed Quattro Air. I've managed to work out the solutions for almost all the little leaks except for one:

I'm very much a mouth breather - hence the need for a FFM. As the night rolls on, I open my mouth so wide, that my lower lip ends up sliding down and out from the lower end of the mask. This obviously causes a major leak, and I end up snoring.

The cause of this could be as simple as the fact that I have a large head/face, I was given a size medium mask and it's too small. I was presented with my equipment in person, so I'd think the DME would've taken sizing into account, but who knows...

This issue doesn't happen every night, but it does happen often enough that I'd like to address it. On nights when it doesn't happen, and I merely sleep with my mouth open, I wake up with THE WORST cotton mouth ever. Since the first night, I've had to keep a water bottle at my bedside. The humidifier level is already maxed out.

I'm sure it also doesn't help that my prescribed setting is 18cm.

Fellow mouth breathers, are these things common? and more to the point, is there anything I can do, short of using a chin-strap, to keep my mouth closed during sleep?

Thanks!
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#2
The difference between S, M And L sizes is each is 1 cm longer. I have a big head and face, and wear an M size (although I need a Large headband.) I too wake up with a dry mouth. If you go one mask size larger, you may find you cannot get a seal because the lower seal is too low on the chin. You might try a chin strap to gently remind your mouth to stay closed.

I run up to 19 cm-H2O and am able to keep a seal.
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#3
What Mongo said.

Been there. Done that. Have the battle scars to prove it. I use a FFM and my pressure is 20cm.

When you say your humidifier is maxed out, do you mean that the setting is as high as it will go or it is set as high as it will go without rainout? Is your humidifier empty when you wake up with cotton mouth? Is it almost empty?

I too have a large head but I was fitted with a medium mask and told that i was right between a medium and a small. The differences are in the measurement from the depression below the lower lip and some point on the bridge of the nose and I do not think that it takes into account the width of the face. With my Mirage Quattro mask I can slip my lower lip out of the mask and back in without any trouble. Are you sure that you are not doing this in your sleep? This brings up the question of what your leaks are like on the nights that you do not wake up with the bottom seal in your mouth? Do you have low leaks except at times during the night?

The chin strap would be one potential solution. There are FFMs that go all the way under the chin. I do not remember which they are but there are at least one or two.

Brdt Regards,

PaytonA
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#4
(07-02-2014, 12:23 PM)fotoflojoe Wrote: As the thread title suggests though, I need to work out some leak issues with my mask.
The mask itself is a ResMed Quattro Air. I've managed to work out the solutions for almost all the little leaks except for one:
I'm very much a mouth breather - hence the need for a FFM. As the night rolls on, I open my mouth so wide, that my lower lip ends up sliding down and out from the lower end of the mask. This obviously causes a major leak, and I end up snoring.

Full face masks are famous for being hard to keep from leaking. The reason is just mechanical - there is a lot more surface contact with your face, so more places for it to leak.

I found that a chin strap with a simple nasal mask works far better for controlling leaks, and is much more comfortable to boot. I would suggest you give a chin strap a try at least. Instead of going through the hassle and expense of buying a ready made chin strap from a DME ($20-40 or so), you can just visit a fabric store and buy a meter of elastic about 4 cm wide (or a yard about 1 1/2 inches wide). Ask for elastic that is used for waistbands. It shouldn't cost more than a couple of bucks. Now all you need is a scissors and a safety pin and you can make your own. Better yet, fabric stores don't require a prescription. Smile

If it doesn't work you're out only a couple bucks.
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#5
I too am a mouth breather. A chin strap works for me (not tight) + a homemade mask liner. On the liner I just
leave space for my nostrils - my mouth is covered. That way I never wake up with a dry mouth.


2010 sleep study 63 AHI, 2014 3.0
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#6
(07-02-2014, 12:23 PM)fotoflojoe Wrote: . . .
The mask itself is a ResMed Quattro Air. I've managed to work out the solutions for almost all the little leaks except for one:
. . .
Fellow mouth breathers, are these things common? and more to the point, is there anything I can do, short of using a chin-strap, to keep my mouth closed during sleep?

Thanks!

Hi fotoflojoe,
Welcome to the forum!

I'm also a mouth breather and FFM user. My initial mask (in my profile) was a ResMed Mirage Quattro. I found it livable, but didn't really like some things about it. I finally got a copy of my PAP prescription, and am now using a F&P Simplus. I'm also testing the Remzzzs mask liners.

The Simplus will be my new main mask - I like it very much. I had a good purchase experience with Supplier #26 (Suppliers link near top of page). I also believe the liners are of benefit. Although the leaks have been minimal with the Simplus, I sometimes have some seepage up near my eyes, which I hate. The mask liners seem to minimize this, or to help diffuse the seep - don't know which. The Simplus without liners was already much better than the Mirage, and the liners have improved that. If you don't find a means to tame the mask you have, I would encourage you to look at the Simplus. Note that F&P provides a sizing guide in .PDF format, which you can print out and use - worked well for me.

I have not yet tried a chin strap, even the elastic & safety-pin version, but I expect to do that, as I sometimes wake up with a dry mouth. Also, my most common seal issue occurs when the cushion gets wet with drool. Hopefully some form of chin restraint will improve both issues.

A benefit of using an online supplier: I checked with my DME (Apria), and found that to try a different mask, you get to return it for EXCHANGE, ONCE. My online supplier allows returns within 30 days for FULL REFUND. Considering that most PAP users end up trying a number of masks, this can be an important issue

There are a few suggestions you will read over and over on this forum:

1) If you don't have a hard copy of your PAP prescription, then get one. There are numerous reasons for you to have this document. You can't do business with most online suppliers without it. This puts you at a disadvantage, mostly dependent on your DME for whatever they choose to sell. I ended up asking for a fax of my prescription from my DME, which they provided.

2) Get a copy of your Sleep Study - as much data as you can get. NOT just the summary report - you need everything. In my case, the Summary report omitted the most significant finding of the sleep study. They may tell you that "You wouldn't understand it", or charge a copy fee, but tell them you want it anyway. Once you progress further with this therapy, there may arise some question that will only be answered by the sleep study itself.

I'm sure there are other recommendations, can't bring any to mind at the moment.

Good Luck with your Therapy!


A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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#7
Got busy with other (non-health related) issues, and lost track of this thread...
Whoops!

Thanks for the replies all!

Over the past weekend, I sucked it up and fashioned my own chinstrap from a length of four-inch ace bandage. This solution is working pretty darn well. The thing is fairly comfortable to wear, and it keeps the lower lip from having a slip!

One thing I noticed though: my AHI seems to be slowly rising. During the first week, it fluctuated while getting used to the process, but at times was as low as ~1.5.

Weirdly however, in the past few days, since starting to use the chin strap, my mask fit is right around 100%, with no large leaks, but my AHI is floating between 5.5 and 7.0. My guess is that the increase is due to the fact that I'm forcing my mouth to stay closed, but my sinuses tend to become congested overnight.

Last night, I tweaked the chinstrap tension in order to let my mouth open just a bit. When I woke up this morning, my mouth was wide open, but completely contained/sealed in by my mask. I haven't yet looked at last night's data, but I feel pretty great this morning! :grin:

The only other issue is that I'm convinced the actual pressure is dropping in my machine. It still lists 18cm, but the pressure absolutely feels lower now than it did when I first started all this. I also notice that the machine is louder than it used to be - it whines as I breathe. I've cleaned the filter and also started it with no filter. There is absolutely a whining sound coming from the air inlet. I'm going to give my DME a call, but I'll also probably build a manometer and check the machine's pressure myself - just to guard against having them try to BS me.

Thanks again all!
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#8
Great job!!!
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#9
(07-08-2014, 10:10 AM)fotoflojoe Wrote: Got busy with other (non-health related) issues, and lo
The only other issue is that I'm convinced the actual pressure is dropping in my machine. It still lists 18cm, but the pressure absolutely feels lower now than it did when I first started all this. I also notice that the machine is louder than it used to be - it whines as I breathe. I've cleaned the filter and also started it with no filter. There is absolutely a whining sound coming from the air inlet. I'm going to give my DME a call, but I'll also probably build a manometer and check the machine's pressure myself - just to guard against having them try to BS me.

it's more likely that you're just getting used to it, that's very common.

what feels like an insurmountable pressure at first becomes the norm after a while.

the prs1 isn't silent.

you might be getting a hose resonance, I've had it with some hoses on some machines. I had an elbow on my prs1 machine, and a hose that had more ridges than most, (I'm guessing) and when I'd take the mask off, and the machine would eventually stop blowing (auto on/off turned on) there'd be a five note scale of notes the air coming out would go down... I watched it on an audio spectrum analyzer!
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#10
To remove the possibility of other items having an influence, I "noise-tested" the unit in as stripped down a configuration as possible.
No hose. (and no mask obviously)
Humidifier removed.
Air filter removed.

In that state, I turned the unit on, and slowly moved around it for a few minutes. The noise I'm hearing is coming from the air inlet and fairly loud. as a final test, I breathed directly from the air outlet. The whining noise spools up and down with my breathing. This noise was absolutely not there on the day I started using the unit.

At any rate, I've got an appointment with my DME tomorrow to get the unit tested. I'll also be trying out other masks.

I don't know, we'll see. At the end of the day, if this is the worst issue I have to deal with, I'd say things are going pretty darn well.

Thanks!
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