a woman wearing a sleep apnea mask, but it is leaking air from the mask and the tube

How to Conquer CPAP Leaks: Tips and Tricks

A common checklist for the new positive airway pressure (PAP) user:

  • Confirm diagnosis
  • Meet specialist
  • Learn to use therapy
  • Receive therapy
  • Use therapy

Once here, you face 3 situations:

  1. PAP works! It’s easy, or gets easier over time.
  2. It’s uncomfortable and disruptive. Without support, you might give up.
  3. You think it’s working, but the mask leaks.

Your goal after this? Check this final box:

  • Perfect mask seal

Even people who use PAP successfully experience mask leaks. Let’s take a closer look at kinds of leaks and what you can do about them.

What causes CPAP leaks?

Potential leaks can be caused by:

  1. Poor mask seal
  2. Leaking tubing
  3. Oral leak
  4. Intentional leak

1. Poor mask seal

This is PAP’s biggest problem: the mask simply doesn’t fit. If it doesn’t seal to the landscape of your face, pressurized air will escape. 

Solution: Try new masks to find one that most closely and comfortably fits the contours of cheeks, bridge of the nose, and chin. Also, while trying on masks, recline in your favorite position. Your sitting or standing profile changes while reclining, especially the jaw’s position.

Other leak causes include:

A worn-out mask

The silicone may soften or grow thin, which can lead to holes, tears, or cracking that leaks pressurized air. 
Solution: Replace your mask.

Old headgear

Over time, headgear can stretch out. Always adjust it as you use it for this reason. At some point, it will finally stretch too much to be effective.
Solution: Replace your headgear.

A dirty mask

The silicone comes into regular contact with cleaners, skin oils or other facial residues, building up and compromising the seal.
Solution: Prioritize daily cleaning.

Pressure challenges

Certain kinds of masks work better for higher pressures. Nasal (over the nose) masks often work best for delivering higher pressures.
Solution: Discuss leak issues with your sleep specialist. Ask to try different mask types and sizes better suited to higher pressures.

Improper use of seal supports

You may use a fabric cushion liner or lotion approved for improving seal. However, you may still struggle with leaks. 
Solution: Make sure you need seal support; newer cushions provide better seals than older models. Then, check that you’re using your support correctly.

Sleeping position

Side and stomach sleepers may experience mask position torqueing. 
Solution: Pick a mask that most comfortably and reliably suits your sleeping position. Also, a side-sleeper CPAP pillow provides a cutout allowance for your apparatus. Finally, consider learning or relearning how to sleep on your back, if possible.

Sleeping behavior

Are you a restless sleeper? Each new movement risks breaking the seal. Also, some unknowingly pull the mask partly or completely off. 
Solution: Talk to your sleep specialist. They may want to check your mask settings or screen you for other sleep disorders causing this behavior.

2. Leaking tubing

Tubing that’s old or damaged (by pets, small children, or negligence) results in holes and cracks that leak. Those using humidification will awaken to damp spots on the bed. 

Solution:Replace your tubing. Meanwhile, keep it out of reach from pets or small children.

3. Oral leak

Also known as oral breathing or mouth breathing, this describes pressurized air leaking through your open mouth. When this happens, your therapy ceases to work. The brain, as a defense against blocked breathing, prompts you to breathe through your mouth to maintain proper oxygen and carbon dioxide levels in your blood as you sleep. Oral breathing happens due to a congenital problem or as a learned behavior for those unable to breathe nasally (awake or asleep).1
 
Solution: Use a chin support, which gently holds the mouth closed as you sleep. Or, consider a full-face mask if you regularly breathe through your mouth. Finally, talk to your sleep specialist about the causes of your oral breathing as you may need to address structural issues in the jaw.

About mouth taping

Some healthcare professionals suggest using medical tape to seal your mouth while using PAP. Be warned: Mouth taping is controversial, scientifically unproven, and potentially unsafe.2 While asleep, your taped mouth may lead to aspirating (breathing in) substances unintended for the respiratory tract:

  • Stomach acids (reflux)
  • Excess saliva
  • Regurgitation (flu, foodborne illness)

This increases your risk for aspiration pneumonia, lung infection, chronic cough, asthma, or bronchitis.

4.Intentional leak

This describes 2 kinds:

The first is through the exhale port, the vent in the space between the mask and tubing which releases carbon dioxide. It's normal and factored into the manufacturer’s pressure algorithm.

The other is normal leak coming from regular use. No mask is airtight; they’re all expected to leak a little during use. Your leak score indicates when your leak exceeds acceptable levels.

Intentional leak needs no fixing.

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