By Anne - Registered Polysomnographic Technologist
Mask leak is one of the largest complaints from CPAP users. It is noisy, disruptive, uncomfortable, and it can drastically lessen the effectiveness of your therapy. Many things can cause a mask leak, but we’ll address a few of the main culprits here and how to fix them.
For a quick overview of fixing mask leaks, please watch this video below:
Determine the Type of Mask Leak You Have
Firstly, there is intentional leak and unintentional leak. The intentional leak is air that comes from holes that are designed in your mask to allow for carbon dioxide to vent out so that you get clean air with every inhale. If the source of your leak is coming from these holes, it is supposed to be there, and you have nothing to worry about.
If the air leak is coming from between the mask seal and your face, out of your mouth, or from a tear in your equipment, that leak is unintentional and needs to be remedied.
If your leak is coming from between your mask and your face, the first thing to do is to try pulling the cushion away from your face and then allowing it to re-seal against your skin. Often, the silicone can wrinkle or bend, and doing this will allow it to settle back into the proper positioning.
This is something that you may have to do once or twice throughout the night, particularly as you are getting used to therapy or a new mask or if your equipment is starting to wear out.
If resetting the mask does not alleviate the issue, try tightening it slightly. If your mask has four anchor points, tighten the two closest to your forehead if the leak is near your eyes, or the two closest to your jaw if the leak is near your mouth.
If the leak persists, or if your mask feels excessively tight, it is possible that you may have overtightened your mask, which is causing the seal to curl and allowing air to escape.
The seal should be blown against the skin by the air pressure. In this case, loosening the mask may allow for the seal to fall correctly against your face and to end the leak.
Q: What is an acceptable CPAP leak rate?
A: 24 lpm (liters per minute) or lower.
Masks of Different Brands Fit Differently
It is important to be sure that you are following the directions for the mask that you have as they may vary. For example, the instructions for Fisher & Paykel’s Eson 2 recommend that you place the headgear on first and then move the cushion to the face.
By contrast, the instructions for ResMed F30i recommend holding the cushion to the face and then pulling the headgear on. You will also want to consult the size guide for your mask to ensure that you have the correct size of mask. Masks that are too small or too big will leak.
You want to find the best fit. Much like clothing, the sizes are not necessarily standardized between mask styles or brands. Wearing a medium in one mask will not guarantee that you are a medium for another mask.
Always check the size guide or select a fit pack where applicable so that you may have the freedom to try all the cushion sizes to find the best fit for you.
Your Face Will Change Shape When You Lie Down
One consideration that many CPAP users forget to account for is that your face will change shape when you lie down as gravity pulls it in different directions. When fitting the mask, try to do so in the most common sleep position.
If you sleep on your back, fit your mask while lying on your back. If you sleep on your side, fit your mask while lying on your side. If you lie on your side, it may be beneficial to tighten the straps on the side you lie on so that the mask does not shift off your face when pressed against the pillow.
You can also check this by pressing on the side of the mask with your hand to ensure that it does not shift off your face significantly.
Facial Hair Is Another Consideration
Many CPAP users enjoy having a mustache, goatee, or even a full beard. There are some masks that are better suited than others for these patients. In most cases, a nasal pillow mask that seals directly onto the nostrils will be a great fit for patients who have facial hair.
Masks like the ResMed AirFit P10 or the Philips DreamWear Nasal Pillow will not be affected by facial hair as they go slightly into the nose to create the seal.
If you need a full-face mask, a softer sealing mask like the Fisher & Paykel Vitera will often work as the cushion is slightly more malleable and can compensate for the looser seal from the facial hair.
If you are in love with another mask and really want to try to make it work, it may be beneficial to tighten the mask a little more than you might otherwise do to try to mitigate some air loss.
You can also confirm with your therapist or doctor that the air loss is being compensated for by the machine and is not affecting your therapy significantly. The machines are designed to compensate for some air loss, so yours may be within the acceptable range to continue therapy. It is very important to confirm that this is the case before ignoring a poorly sealing mask.
Oil Build-Up and Silicone Damage
Another problem which can be harder to pin down is when your mask used to fit just fine, but now it is leaking or rubbing in places that makes it very uncomfortable. Many people are confused by this as getting a different size wouldn’t fix the issue because the issue is new, but the mask is not.
Often this comes from needing to either clean or replace your mask due to age. Oil build-up on the mask from your skin can cause the seal to relax and not get as tight a fitting against your face.
This can also occur if you use a soap with moisturizers in it when washing as these can be deposited onto the mask causing a build-up and damaging the silicone.
The headgear can also stretch over time when not washed regularly. Imagine a pair of jeans that comes out of the dryer 2 sizes smaller than when they went in. Hand washing the headgear in warm/hot water will tighten the fibers back together and rejuvenate your mask.
It is generally recommended to replace your mask cushion every 3 months as the silicone will degrade from the oils on your face and from wear and tear from rubbing on your skin. The headgear and the rest of the mask typically should be replaced every 6 months.
If your mask is still within that time frame, it likely just needs a thorough wash with mild soap – we typically recommend a mild dish soap as it will cut through oils without leaving moisturizer residues – and warm/hot water.
It is also important to remember to only use water that is as hot as you can tolerate with your bare hands. Using boiling water or excessively hot water will damage the mask, mask cushion, and elastic in the headgear.
Mouth Leak Is Another Common Issue
This occurs when you are wearing a nasal or nasal pillow mask and your mouth falls open allowing all the air to escape out of your mouth. There are a couple options if this is the source of your leak.
First, check that the humidity level of the machine is set sufficiently high. If the humidity is set low or if you do not have a humidifier on your machine, the dryness of the air can cause you to open your mouth to ease the discomfort of breathing through your nose.
Turning up the humidity or adding a humidifier to your machine may resolve this. If it does not, it may be worth looking into a small pressure change on the machine. If your apneas are not being sufficiently treated, your brain may prompt you to open your mouth to get more air.
If neither of these options resolves your mouth leak, adding a chin strap to your mask will support your lower jaw so that it does not drop open. It is important to make sure that the chin strap is pulling the jaw upwards and not back as it will cause more apneas if it is pulling back.
Another important reminder is to be sure that you do not wear a chin strap without your CPAP machine. The mouth typically opens in response to lack of oxygen, and applying a chin strap without having the CPAP to ensure sufficient respiration is very dangerous.
If the chin strap is not for you, you should consider moving up to a full-face mask. This will allow you to breathe through either your nose or your mouth without losing the pressure of the machine.
While there are many different sources of leak, there are also many solutions to these issues. If you are experiencing a leak that is not resolved by these tips or is caused by something else, do not hesitate to reach out to our professional staff.
We would be more than happy to help you troubleshoot the cause and offer suggestions to remedy the leak so that you can have the best sleep possible.