Air Leakage From under the CPAP Mask: Causes and Remedies

Last Updated on March 30, 2021

An important step in CPAP therapy is the selection of airway pressure. Patients are helped in this by a somnologist after laboratory analysis of sleep quality. The strength of the air flow should be such as to prevent the relaxed structures of the pharynx from closing. But sometimes the device is set correctly, but you can not get rid of snoring and breathing stops. This may be due to air leakage from under the mask.

What are the Dangers of Air Leaks?

No mask is 100% airtight to the face for the entire duration of sleep. That is, occasional small air leaks are normal. And modern CPAPs are designed to automatically compensate for these losses without additional adjustments. But if the leakage exceeds an acceptable level, the pressure drops lower and lower, and at some point is not enough to prevent snoring and apnea.

The side effects of air leaks can be quite serious:

• Inability of the CPAP device to correctly analyze respiratory events and respond to them in a timely manner;
• Decrease in the therapeutic effect, recurrence of snoring and apnea episodes during nighttime sleep, as well as deterioration of the patient’s well-being;
• Deterioration of sleep quality due to the hissing and whistling sound of air leaking from beneath the contour of the CPAP mask;
• Irritation of the mucous membranes and eyes.

Leaks not only interfere with the treatment of complicated snoring, but also increase the discomfort of using the CPAP device. Therefore, if you find that the mask is leaking air, this problem should not be postponed.

Specifics of Air leaks from under Different types of Masks

There are three main types of masks for CPAP therapy – Nasal, Full Face, Nasal pillow. Each has its own characteristics in terms of the likelihood of leakage, as well as its nature and location.

• Nasal masks. Leaks often occur on the bridge of the nose, so it is necessary to adjust the mask so that it fits snugly on this problematic part of the face. The contour should not “dig into” the skin, as this can provoke skin irritation and inflammation. The nasal models have another problem: due to the strong air pressure, the patient involuntarily opens his mouth, which also causes a large leakage and lowers the therapeutic pressure. In this case, special chin straps can be used to hold the jaw closed.
• Nasal pillows. A pair of pads or rollers are inserted into the nostrils. They fit snugly, and therefore maintain an optimal seal, and direct the airflow precisely into the nasal passages. Consequently, the risk of air loss, and with it pressure, is minimal. However, the problem of leakage through the mouth is still an issue.
• Full face masks. There is no leakage through the mouth when using these models. But due to the large surface area of the contour, it is more difficult to achieve an airtight fit to the face. This multiplies the risk of air loss through the mask. Most often it leaks from the cheeks and chin. To eliminate this, adjust the fixation straps so that the mask clings tightly to the problem areas.

Different Causes of Leaks

Incorrect Fit of The Mask

The reasons for improper fit may be the improper size of the mask, as well as the peculiarities of the facial oval. If the mask is the wrong size, gaps may form where the mask fits against the cheeks, mouth or chin. This prevents the contour from sealing and leakage occurs. The risk of air loss is greater if the mask is large than if it is small. Additional accessories such as seals, liners, helium gaskets, etc. can improve the sealing. If you use dentures, keep them on overnight if possible. An intraoral device improves contour fixation and reduces the risk of leakage.

Quite often minor leaks can be repaired by following the recommendations below.

• Leak in the eye area. Pull back the mask and allow it to fill with air. Then lower the contour to your face just below the bridge of your nose, and then slide it slightly down to the bridge of your nose to make you feel comfortable. This helps to eliminate minor leaks, and it also helps to slightly twist the edges of the sealer so it doesn’t cut into your skin.
• Leak under the nose. Try moving your nose from side to side, moving your jaw back and forth a few times, and pressing your lips together and wiggling them. Often this will clear up small leaks.

Incorrect Belt Tension

Leaks from under the mask can be the result of poorly adjusted straps. They should be neither too tight nor too loose. It is important to ensure that the contour is pressed minimally against the face, allowing the model to operate without leaks. Minor air loss over the upper lip can be ignored, as it rarely leads to discomfort during sleep and does not affect the effectiveness of the treatment.

The Mask Is Too Old

If you use the mask longer than the manufacturer recommends, the product may show signs of wear: the silicone will thin and become softer, cracks and tears will occur, and the retainer straps will stretch. Manufacturers usually recommend changing the straps about every 6 months and buying a new mask once a year.

To extend the life of your mask, follow these tips:

• Avoid aggressive cleaning products for the care of the product, as it negatively affects the elasticity of the silicone. The best option is special formulas or neutral baby shampoo.
• Before removing the mask from the head, detach the fasteners. This prevents excessive stretching of the fixation straps.
• Do not overtighten the mask. If you find a leak, tighten the straps so that the pressure of the circuit is redistributed to the part where the air is leaking, such as the forehead, nose and chin.

Poor Mask Care

Any impurities destroy the silicone contour. Therefore, it is important to clean the mask as well as your face daily, especially if your skin is prone to oilyness. Adhering dirt breaks the seal. But remember that cleaning with aggressive compounds can also damage the product. The best option would be to wash with warm water and soap, dry, and then use the CPAP Cleaning Device.

Restless sleep

It’s hard to find people who lie still all night long. Any movement potentially results in mask displacement and depressurization. Therefore, patients who frequently toss and turn and sleep restlessly often experience a decrease in treatment pressure due to leakage from under the mask. In addition, it is worth mentioning that some patients even tear the mask off in their sleep, especially during the first few nights of treatment.

If you wake up at night and feel air escaping from underneath the mask, don’t rush to retighten the straps. First, make sure that the mask is exactly centered on your face. If it is not, center it. If that doesn’t help get rid of the leak, tighten the straps.

Too Much Treatment Pressure in the Mask

High pressure in CPAP therapy also increases the risk of leakage, as the mask is literally pulled away from the face. If you are prescribed high-pressure air to achieve a therapeutic effect, be especially alert to the readings on the machine, as well as the recurrence of symptoms. Renewed snoring, daytime sleepiness, and distracted attention should be alarming signals. If the leak rate or number of apnea episodes exceeds the acceptable range, see your physician to discuss options for resolving the problem. Air leaks sometimes disrupt the effects of treating complicated snoring and reduce comfort. But this is not a reason to get upset, it’s just a problem that needs to be solved. If you are having difficulty figuring out the cause of the air loss yourself, talk to your physician or treatment provider.

To Achieve Optimal Strap Tension, Use the Following Tips on How to Put on an Full Face or Nasal-type mask

Step 1: Sit up and fasten the mask loosely over your face without tightening the fixation straps.

Step 2: Lie down in bed in a comfortable sleeping position. Tighten the retainer straps to obtain the desired level of sealing. If you sleep on your side most of the time, the straps should be a little tighter than if you usually sleep on your back. Do not make them too tight. Many CPAP machines have a “pressure mask test” function. By turning it on, you will briefly increase the air pressure and be able to find the optimal tension in the straps.

Step 3: Pull the mask a few centimeters away from your face and hold it until its outer layer fills with air. Then gently release it onto your face.

You may need to make additional adjustments to the tension of the straps, and perhaps even a different size mask if you have lost a lot of weight or gained extra pounds. Gaining and losing weight changes the shape of your face, and this affects the tightness of the contour. You also need to tighten the straps if you have to increase the working pressure of the air supply. In addition, the tension of the retainers may change because the straps wear and stretch over time. As a result, the contour becomes less and less snug against the skin. In this case, the fixation straps will simply have to be tightened a little or replaced with new ones.