23 February 2019

Stop CPAP causing Mask Leaks: Use Bilevel


“If you are going through hell, keep going.”
- Winston Churchill (Former British Prime Minister – 1874 – 1965)

For some of you, how to stop CPAP causing mask leaks is going to make you frustrated and drive you crazy. Just when you go to sleep, the air pours out from under the mask waking you up. During the night the mask continues to leak and may wake you up continuously. No matter what you do, you just cannot stop the mask from leaking. Should CPAP be causing mask leaks, seriously consider using a Bilevel or BiPAP Auto adjusting pressure machine. From my personal experience using a bilevel machine, you will be able to get rid of mask leaks and have Zero leaks showing on your machine each morning! 

Later, in another blog post Stop CPAP Mask Problems and Issues, I provide details of why I use an “old” nasal mask being ResMed Mirage Micro. Even though I use maximum pressure up to 17 cmH2O and have used the same mask cushion for more than 5 years, Zero leaks are still showing on my machine each day!

Masks are very personal. A great mask for one person may be a terrible mask for someone else. My first mask, a nasal mask, ResMed LT Activa whilst liked by many people was to me a terrible mask. In fact, it was and still is the worst mask I have used. The mask ended up in the garbage bin. Why was this particular mask, my very first mask? I will cover this matter in the next blog post Conflicts of Interest. Avoid! 

The question is: How do you stop mask leaks and ideally reduce your leaks to Zero? 

By doing so, you may not need a humidifier as advised in the previous blog post Why NOT to use a CPAP Humidifier? More importantly you will stop interruptions to your sleep and constant waking up from changes in pressure caused by leaks. 

From personal experience, I can have up to an average of 1.5 litres/ minute of leaks before I need to look at using a humidifier even using average pressure of 17 cm H2O. Some days I can have 4 Zeros for leaks on the SleepyHead reports. I understand the average leaks for a person is 4 to 6 litres/ minute. 

The Secrets to stop leaks and ideally reduce your leaks to zero are: 

1. Have a mask that you feel comfortable with and suits your style of sleeping. 

For example, do you sleep on your back and/ or move from side to side. Due to smallness, I recommend you first try with nasal pillows and nasal masks. Generally, the smaller the mask is, the smaller the leaks. At the equipment supplier, make sure they explain and you try the different types of masks. This is critical as it is you who will be sleeping with the mask each day not the equipment supplier. 

2. Stop Mouth Breathing. Use a Chin Strap or as some patients are doing, I am not recommending this method, mouth taping. 

You may reduce the likelihood of using a Chin Strap or mouth taping by 3 and 4 below. 

3. Reduce your median/ average pressure for IPAP (inhale pressure) and EPAP (exhale pressure) as much as possible. 

The maximum or top pressure is only required as necessary to cover obstructive sleep apneas. Note the CPAP machine operates at maximum pressure all night; and 

4. Reduce median/ average Minute Ventilation (MV) to 6 litres/ minute or lower and keep the 95% to 100% rate “under control”. 

Normal MV rate is considered to be 6 litres/ minute per Medical Textbooks. “Under Control” means that you try and keep MV to a maximum 10 litres/ minute otherwise you may be considered to be hyperventilating. Hyperventilation is to breathe at an abnormally rapid rate or over breathe causing low levels of carbon dioxide in your blood. 

The Secret is to slow your breathing/ respiratory rate (RR) down and reduce the volume of air/ tidal volume (TV) that you are breathing in. Ideally, apply the principles of the Buteyko Breathing Method to your sleep apnea machine. Minute Ventilation is the total volume of air entering the lungs in a minute. 

Further information on Minute Ventilation and the Buteyko Breathing Method is at:

For the last two items, many patients may not be aware of. As detailed on the page The Secrets to Success, many patients may need to consider using a Bilevel (BiPAP or BPAP) Auto adjusting pressure machine to achieve 3 and 4 above. By using a Bilevel Auto machine, I have reduced median pressure of IPAP and EPAP by up to 20% to 25% and median Minute Ventilation (MV) by up to 10% to 15%. More details at CPAP Vs Bilevel Settings Example.

By reducing the volume of air and the median pressure and only using the maximum or top pressure as required, leaks will be substantially reduced. With the median pressure reduced, from my own personal experience, my maximum pressure of 17 cm H2O is rarely attained. Previously a few years ago, I was at pressure of 17 to more than 18 cm H2O on a regular basis. 

As mentioned previously, many of the sleep medical specialists do not truly understand how the sleep apnea machines and sleep therapy work in the treatment of obstructive sleep apnea. There is no doubt that the mask is important. However, what I feel the medical specialists are overlooking is the issue of what is actually causing the leaks in the first place. It is the air pressure and the volume of air that is initially causing the leaks. 

Get the leaks minimized and you are not under stress and losing quality sleep and wasting time and money finding a mask that “does not leak”! 

Increasing pressure and the volume of air can be likened to someone filling up a bucket with water. Turn the tap on more and more water comes out filling up the bucket at a faster speed. Increasing pressure and the volume of air will have the same result leading to more leaks especially at higher pressures. This is basic Physics which the medical specialists would have been taught at school. Yet, the medical specialists keep prescribing CPAP machines rather than seriously considering a Bilevel Auto adjusting machine for non-successful patients. 

Some medical specialists will argue that water and air are completely different. Whilst the density may be drastically different, the principles applying to each are similar in that both water and air are fluids. 

The issue of leaks together with the extensive list of CPAP side effects and issues that I overcame is the major reason why I believe Bilevel (BiPAP or BPAP) Auto machines should be prescribed for many of the 80% non-successful, non-compliant and failing patients rather than a CPAP machine. More details at Why is CPAP Compliance Rate Low? This is so you as the patient can wake up feeling refreshed and energized each day! 

Whatever issues you are currently having with your mask, keep going and using your sleep machine. Some patients on the sleep apnea forums have tried more than 10 different masks! There are hundreds of different and very “advanced” masks available and there is a “perfect” mask for you to stop leaks. 

Should you be having issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.

“Have courage. Be adventurous and Go for it! Overcome your fear.”
- Mrhelpful

12 February 2019

Why NOT to use a CPAP Humidifier?


“Don’t keep forever on the public road, going only where others have gone and following one after the other like a flock of sheep. Leave the beaten track occasionally and dive into the woods.”
- Alexander Graham Bell (Scottish Scientist and Inventor – 1847 - 1922)

When one sheep decides to go somewhere, the rest of the flock usually follows, even if it is not a “good” decision. If one sheep jumps over a cliff, the others are likely to follow.

Why use a Humidifier even though the sleep medical specialists and equipment suppliers keep recommending that you should use one? They have spent vast sums of money on research on how best to incorporate humidification with the CPAP sleep apnea machine. As previously advised on the blog page Why is CPAP Compliance Rate Low?, these sleep medical specialists do not truly understand how the sleep apnea machines work. They have made sleep apnea therapy for obstructive sleep apnea complex. It is SIMPLE! By learning why NOT to use a CPAP humidifier, you will simplify your sleep apnea therapy.

By truly understanding how the various machines and sleep therapy works, I believe there would be no need for many patients to use a humidifier due to the air from the machine. 

I have used average fixed pressure of 17cm H2O on a sleep apnea machine with no humidifier and I had no issues in doing so other than nasal congestion and nose bleeding. It made no difference what time of year it was or the level of humidity in the air. In a previous blog post, I outlined how to Stop CPAP Nasal Congestion and Nose Bleeding. I understand that some people will need to use the humidifier due to nose issues, however, what about the remaining majority of people who use the humidifier? 

The three main issues that require patients to use a humidifier are:
- Dry sore throat;
- Dry mouth; and
- Nasal congestion and nose bleeding. 

Is dry sore throat and dry mouth the only issues that you are having? 

Before advising from personal experience the Secrets to NOT using a humidifier, let me outline all the benefits of doing so:

- No more “rain out” issues and excess condensation 

- No need to add an extra piece of equipment like the ResMed S9 machine. You will only need one small box instead of two.   

- No need to find clean water/ distilled water especially when travelling away from home

- No more having the water chamber run out of water during the night

- No more forgetting to fill the water chamber before going to bed (Yes, I have done this! Had to disconnect the hose and get out of bed late at night)

- Taking less space on your bedside table

- No need to clean the water chamber due to residue build-up

- Saving money from using less electricity. It is estimated that using a heated humidifier uses 3 times more power when compared to not using the humidifier. The saving may not be much, maybe only $30 to $40 per year; however, this amount still buys a number of Cheeseburgers!     

- When travelling, going camping or in power blackouts, 3 times less battery capacity is required should you have no access to electricity. 

- Without a humidifier, the ResMed S9 can be used with a 30W power adapter. Originally it was half the size and half the weight of the 90W power brick. In addition, it came as a Travel Pack with 4 interchangeable plugs at the back of the power adapter making it perfect for when travelling overseas to various countries.        

- When travelling especially on short trips, as no humidifier, I put all the sleep gear including the machine in hand luggage on the plane. No need to carry an extra bag.

- No need to use XyliMelts or anything similar that you are using to keep the mouth moist

- No need to worry whether the air is too warm and there is too much or too little humidity depending on the season in the year and weather.  

- For those with air coming out of the eye tear duct issue, a major advantage was that I was able to increase the maximum pressure by more than 30% to 12cm H2O fixed pressure from 9cm H2O. More details of the air coming out of the eye tear duct and eyes are on the blog posts Air through Eye Tear Duct and Air coming out of the Eyes

After seeing all the benefits of not using a humidifier, why would you want to still use a humidifier? 

The Secrets for not using a humidifier are:

1. Minimize Leaks from the Mask and Mouth Breathing. Ideally reduce Leaks to Nil so that a Zero appears on your sleep machine every morning; and

2. Breathe through your nose. Breathing through your mouth using a Full Face Mask and a Total Face Mask will lead to dry sore throat and dry mouth and possible dental health issues such as bad breath.

The nose is like a humidifier whereby it will warm, humidify and moisten the air that you are breathing in. In addition, breathing through your nose kills deadly bacteria and viruses and traps dust particles. This is one of the reasons serious consideration should be given to using nasal pillows and nasal masks where possible.  
   
In relation to minimizing leaks, from personal experience, I can have up to an average of 1.5 litres/ minute of leaks before I need to look at using a humidifier. Some days I can have 4 Zeros for leaks on the SleepyHead reports. I understand the average leaks for a person is 4 to 6 litres/ minute.

The question is: How do you minimize leaks and ideally reduce your leaks to Zero? 

I will look at this question in the next blog post Stop CPAP causing Mask Leaks. 

Should you be having side effects and issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.

“Have courage. Be adventurous and Go for it! Overcome your fear.”
- Mrhelpful