In this page you will learn about the most common CPAP mask problems that can be found in CPAP treatment for sleep apnea.You will also learn how to overcome these problems:
Leaks are important. A cpap is simply a way to use air pressure as an internal splint to keep the airway open. Pressure that is insufficient to do this renders the cpap ineffective.
The various cpaps, autopaps, etc. may not have sampling rates that are sufficient to detect some apneas or hypopneas. Also desaturations can be taking place that affect your brain but do not meet the official definitions.
Whenever there is a leak your brain tries to compensate with biochemical responses that are not beneficial but are simply desperate measures the brain is attempting to take.
Remember that a sleep study is a very small sample and your home sleeping environment is usually quite different from that in a sleep lab. So if you are having leaks at home even rather modest ones it can still be affecting the quality of your sleep.
There are two types of CPAP mask leaks:
seal leak - air from the blower leaking between the "mask" and you face,
mouth leak - air from the blower exiting from your mouth rather than being exhaled into the mask. (Full-face masks by definition eliminate mouth leaks.)
Each of the two sources of leak can be "bad" for two reasons:
significant leak may exceed your blower's ability to maintain the prescribed pressure, may impair the machine's sensors ability to detect what's going on, and may thereby prevent an AutoPAP's algorithms from properly responding to whatever is going on,
significant leak may disturb YOU, by blowing in your eyes or making noises or causing arousals or - for mouth leak - producing increased airflow though your upper airway and drying out your nose and mouth with a variety of resultant problems.
CPAP Mask fitting suggestion 1:
If you are not the bashful type, take a blanket or sheet and a pillow w/you your next mask selection/exchange visit to your DME supplier if they don't supply a bed for you to lay on during the mask fitting. Ask to see a variety of all three types of masks: full face, nasal cushion and nasal pillows. Just to look at. Narrow the field to a couple you want to try.
Do one of those sitting up, adjust the headgear loosely, the mask should still feel like it is a fraction away from falling off.
Now lay down on the bed or cot or your blanket/sheet on your back. Adjust your pillow comfortably. If the DME supplier doesn't provide a CPAP at your pressure to fit masks, bring your own CPAP with you. Plug it in, attach to this mask and turn it on. Ideally at your scripted pressure or 10 cms whichever is the greater.
Lift the mask from your face just a skosh to let it fill with air. Let it lay back down on your face and make any adjustments to the headgear straps you need. The mask should fit comfortably, NOT tight.
Don't worry about minor leaks at this point. For them you don't tighten but rather you run your fingertip along the seam between the mask's outer cushion cover and your facial skin. That should eliminate the minor leaks.
For leaks near the eyes (NEVER tolerate eye leaks!) lift the mask from your face a skosh, once it refills w/air let it lay back down on your face a trifle low on the bridge of your nose. Now slide the mask just a skosh up to the bridge of the nose to where you want it. That should both seal any minor leaks AND turn the edges of the mask cushion cover UNDER so it doesn't cut into the skin.
For leaks under or around the lower part of the nose try twitching your nose, or wagging your jaw back and forth or screwing your lips up every which way. Often that's all that is needed to seal those minor leaks.
Now flip over to one side and make any necessary minor adjustments for leaks as above. Then flip over to your back and to your other side making any necessary MINOR adjustments. AT NO TIME should the mask fit too tight or uncomfortable. The longer you wear the mask like that the tighter and more uncomfortable it is going to feel.
If none of this works, forget this mask and try another until you find one that seems like it is gonna work for you. THAT is the one to take home.
Its gonna take another week at home for you to be sure you can live (sleep) with this mask for sure.
When you find a mask that almost works be sure to look it over good and compare it to the next one you are interested in trying.
Look closely at the distance between the nose cushion inside top of nose area and the cushion at the inside bottom of the nose (or chin or lower lip if a full face).
Had the one you tried felt like it was too long or too short? How does this other one compare in that length?
The same holds true for the width distance both at the bridge of the nose and lower at the cheeks and around the mouth. Its the inside opening of the cushion that is important, not the outside measurements.
Many of us need to be able to adjust the angle between the forehead and the bridge of the nose. The wrong angle can account for a lot of the discomfort at the bridge of the nose. Generally, the top straps looser than the bottom straps will help to avoid the discomfort at the bridge of the nose.
CPAP Mask fitting suggestion 2 (for CPAP full face masks):
Do your final mask fit when you are laying in bed, with machine turned on to your full pressure. Lay your head on your pillow in your normal sleeping position, then slowly pull the straps JUST until you get a good seal.
After you have the straps adjusted, life the mask off your face an inch or so and then position it back on your face for optimum seal.
For patients with
ResMed Quattro
full face mask - dual wall cushion masks are extremely high quality, and can be worn surprisingly loose. Make sure you are not overtightening - and make sure you are "seating" the cushion!
Think gravity when you adjust your mask. If you side sleep, it will be a bit tighter. If you sleep on your back, you will find a looser fit. If you toss and turn and sleep in all positions during the night, realize that gravity takes over and your mask may need readjusting to accommodate your different sleeping positions.
Full face masks are large in size, and when you side sleep, the frame may be pushing up in to your cheek area and moving off center causing pressure point soreness or leak. That would be enough for anyone to take the mask off during the night!
Having the mask sink in to a regular bed pillow can also block the exhalation ports and then we run the risk of co2 rebreathing which can be dangerous.
So...if you think you have chosen the best mask, yet still have leaks or comfort problems, consider the papillow.
They are purposely filled at a medium to medium/firm weight in order to provide the support and keep the unique shape stable.
The pillows have a bottom curve the allows support for neck and head and then offers a curve on left and right side to allow the positioning of our head so our mask can literally suspend off the edge of the pillow.You can see and learn more about this pillow here.
Taking the mask off subconsciously is a tricky one. There's isn't a lot of formal advice for this but it has been surmised that subconsciously you haven't really accepted the mask. Here are a few ideas to try and solve this:
Wear the mask for the last waking hour, disconnected from the machine. Watch TV, listen to some music, have a bath etc. Stuff you enjoy. If the brain links wearing the mask with enjoyment, chances are it'll be better during the night too.
Using tape or women's hair clip tools (whatever they're called) fix the mask or headgear to your head. Now when you rip it off, it'll wake you up so you can correct yourself. Reactive instead of preventative.
Aromatherapy scents can also help associate good feelings with wearing the mask. Trick the brain into good associations.
If you are using a nasal mask, you could use a
CPAP chin strap
over the headgear, which will also help with keeping it on.
Many of the masks offered for CPAP users now have dual cushions. ResMed comes to mind with their Mirage line which includes Quattro, Activa LT, Micro and even their Swift and FX nasal pillow systems.
EasyLife, ComfortFull and ComfortGel are just a few of the fantastic Respironics dual cushion interfaces. See all these CPAP masks here.
What’s the big deal about Dual wall cushions? Dual wall cushions are gaining popularity because they are more comfortable and they seal better. They are the latest and greatest in engineering innovation offered to us patients.
Is your dual wall cushion mask working for you or are you one of those patients who spent a lot of money and is wondering what all the hype was about because it’s not working for you? Maybe you have a dual wall cushion mask but are not even aware of it.
It's sad to know so many people have great masks that would work if they knew the proper fit, adjustment and seating techniques. Their providers never discussed fit and seating.
Here is what you should know:
Dual wall cushions need to be inflated to seal properly to the face.
Put your mask on your face with straps loose.
Turn on your machine to full pressure.
Lay down in your bed with your head on your pillow in your normal sleeping position.
Then and only then, gently tighten the straps JUST UNTIL you get a good seal. With dual cushion masks, there should be no reason to over tighten the straps. In fact, one of the best features of dual wall cushion masks is that they seal well even when worn loose!
Once your mask is properly fitted for your sleeping position, you need to “seat” or inflate the cushion. Pull the mask straight out from your face about an inch or two to let the mask inflate, then gently lay it back down on your face. You may have to repeat this until it feels comfortable on your face, but you WILL KNOW by feel, when it has inflated and seals.
Smile, fall asleep and wake up refreshed several hours later.
It is also important to know that no mask is perfect or leak free. But taking the time to fit your mask to your face and seat it properly is important and a good start, to avoid CPAP mask problems.
When you change sleeping positions during the night, gravity takes over and you may experience mask leak. If you originally adjusted it for side sleeping and then you roll on your back, you’ll probably experience leak. It will have to be readjusted to eliminate that leak.
I wish I could tell you that there is a mask out there for you that will fit perfectly all the time, never leak or hurt and that sleeping position doesn’t matter. Wouldn’t that be great?
There ARE GREAT MASKS available for sleep apnea patients - YOU have to take responsibility for correct fit/adjustment/seating.
Here are five steps to help you eliminate claustrophobia and anxiety when you use a CPAP mask:
Wear the mask at home while awake for one hour each day.
Attach the mask to the CPAP device, and switch the unit "on". Practice breathing through the mask for one hour while watching TV, reading or performing some other sedentary activity.
Use the CPAP during scheduled one hour naps at home.
Use CPAP during initial 3-4 hours of nocturnal sleep.
Use CPAP through an entire night of sleep.
Remember to advance by one step after each five days, once the step can be carried out without anxiety.
The Mirage Liberty
Full Face CPAP Mask would be a much less claustrophobic mask than any of the other FF masks. Once the air flow starts it should feel more natural as opposed to sitting in a store trying it on for fit.
How do you solve long hair issues with masks? Here are some tips:
You can put your hair in a pony tail and pull it under the top strap of your mask. When you secure the bottom strap of the mask, the hair is held in place along the back of your head.
You can put the straps over your hair while you're laying down, flip the hair up to get it off your neck and then adjust the pillow so it also helps with the bottom strap.
Occassionally, you'll have to adjust the strap or mask.
Pay attention to what cleaning products you use for CPAP mask. All of the mask manufacturers say to use MILD soap products when GENTLY washing our mask cushions and frames. Many specifically say NOT to use harsh or anti bacterial products.
If you have sensitive or allergic skin to a lot of soaps, you can use Ivory Dish Soap liquid. If you have soap residue left in the mask or the humidifier chamber, you can do the vinegar water rinse. The vinegar rinse is the only thing that helps cut the murky residue left over time.
just turn down the humidifier down a notch or two. Natural humidity in the home varies, so your humidifier needs can vary.
Try a hose cover. Resmed's tube cover runs about $15 and it is made from a nice slippery material so it slides over the covers, etc. easily and doesn't tug on your mask.
Move your CPAP back up to just below your mattress level and hang your hose above your head. Any moisture then has to run back down the hose to the humidifier rather than into your mask since more of the hose is running uphill than downhill.
Make sure you note the FILL LINE on your humidification chamber. If you fill even a hair above the line, it gurgles and brings water in to the tubing and your mask. Generally, filling 3/4 of the water chamber should get you through the night. No wasted distilled water that way either.
Cover your tubing with our insulated tubing cover - this will also greatly reduce or eliminate the "rain out" effect. Insulated CPAP Tubing Cover
has a full length zipper, so its VERY easy to get on and off. Easy to machine wash and I even add a drop of bleach to keep it sparklin' white and sanitary.
If your sleeping environment is cool at night and you are getting "rain out" - try turning down the heat/temp setting on your machine.
Another tip - make sure when you add water, you do not go over the FILL LINE. Occasionally, if you go right up to the line or a tad bit over, you may get water in your mask.
The drooling means yuo have your mouth open. Perhaps the mask isn't ideal for you.
You can keep the mouth stable with a
CPAP chin strap
CPAP chin strap, or pick a full face mask with a chin cup, such as the FlexiFit 432, the Joyce Full Face Plus and the Hans Rudolph 7600 V2 mask. Those cupping bits of plastic help prevent the mouth from opening too far.
is very comfortable for stomach and side sleeping. These nasal pillows are leak-free at high pressure and work well with Bi-level PAP. You can also wear glasses with this interface - handy if you read yourself to sleep, or during recovery from surgery if you want to watch TV without worrying about nodding off from medications.
You can see the Mirage Swift here.
Another mask that many people like is ResMed's Activa.
This one works particularly well at high pressures, but people like it at lower pressures.
ResMed's Activa has an "active cell", which is like a single bellows on an accordion. The active cell does two important things. You fit it loose on your face and the pressure from the cpap will "push' the cushion against your face. If you use an autopap and the pressure is increased the cushion pressure is increased to avoid leaks.
The other benefit for you is that the active cell allows the cushion against your face to stay in place when the hard part of the mask moves. You can put it on, turn on the cpap and wiggle the main part of the mask around - and the cushion stays in place. It can be a blessing with all of the tossing and turning you probably do.
A special pillow can help you with your Resmed Mirage Swift. If you sleep on your stomach and prefer little to no elevation, consider the Mini Edge Pillow.
If you like more elevation, the Double Edge is what most cpap users prefer.
Both pillows can be place on your reguar pillows if additional elevation is needed.
Choosing the best mask is the first step to avoid CPAP mask problems.
Find out what DME (Durable Medical Equipment supplier, the place where you get your CPAP and masks) stores your insurance covers. Call the stores and ask if they have a mask exchange policy. Most of the mask manufacturers allow a 30 day return/ exchange. Confirm this is something the DME you choose participates in.
When it comes the time to get your equipment, request from your DME that you go into their place of business.
Try on several masks (don't hurry) you HAVE to try them with the machine running on your scripted pressure and you need to be laying down in your typical sleeping position.
Do NOT choose a mask for looks, but one that does the best job for your needs - the least likely to have leaks and comfort.
During the sleep study, choose the mask that will do the job the best. The sleep technician will help you.
Buying shoes, if they are not comfortable in the store, they will not be comfortable later on.
Same thing with the mask. You won't be stuck with something you can't tolerate. When you first get your equipment set up, make sure to have a good long talk with the DME who does it. Hopefully, they'll bring several masks for you to try, so you can get a feel for how they work for you.
Make sure to try them at your full pressure, whatever that turns out to be, and lying down if possible, since masks will fit differently in your sleep position than they do when you're standing.
Check with your DME to be sure, but most have a 30 day return policy, if the mask doesn't work for you.
Some are not quite that patient, but they should be willing to work with you to find what is best. It's in their best interest to do so - they do not want to lose business, and do not want patients complaining about them to doctors, as that is bad for business, too.
Do not let the DME leave you with a mask that is uncomfortable and/or leaky. If it's not good when they are right there with you, believe me when I say it certainly won't be any better in the middle of the night when you're trying to sleep with the thing.
Also, it is better to get a mask/interface that works with the way you sleep, than to try to change the way you sleep to work with the mask. If the mask you have doesn't work with the way you sleep, you have the wrong mask.
Your DME probably doesn't want to provide you with a wide range of choices, because it costs them money. The insurance pays them with a set amount of money for an interface whether they give you a $20 mask or a $120 mask, so they want you to use the cheapest they have. You have to be very firm, maybe even aggressive with them about what you need.
One tip - if nasal pillows leak, you probably have the size too small, so go up one size.
If your nostrils are getting irritated, you probably have the pillows "forced" into the nostils - remember, they should just barely slip in to the nostrils, NOT be shoved in too far.
The Breeze CPAP Mask
has an angle adapter to allow for a custom fit. If your nose is being pushed up in any way, you are wearing the interface wrong.
Occasionally, your nostrils do get slightly irritated and so you can use a tube of Neosporin handy...just a little dab will lubricate and heal at the same time.
Many of the masks offered for CPAP users now have dual cushions. ResMed comes to mind with their Mirage line which includes Quattro, Activa LT, Micro and even their Swift and FX nasal pillow systems. 
Here are five steps to help you eliminate claustrophobia and anxiety when you use a CPAP mask:
People who read about CPAP Mask Problems also read about:
liquid. If you have soap residue left in the mask or the humidifier chamber, you can do the vinegar water rinse. The vinegar rinse is the only thing that helps cut the murky residue left over time.
handy...just a little dab will lubricate and heal at the same time. 
