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, 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 or BiPAP Auto adjusting pressure 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. 
Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 12.8 cmH2O (inhale and exhale pressure). This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. More details are on the blog post:
Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues    
Due to long COVID and bad flu in 2022, I had to increase the starting IPAP to 21.8 cmH2O and EPAP to 16.4 cmH2O. This was due to hypoxia and sleep disordered breathing reoccurring. The ResMed Mirage Micro mask that I use has worked great using very high pressure. To stop mouth leaks, I now tape my mouth using 3M Nexcare Micropore paper tape. The tape is much more effective and comfortable than wearing a chin strap especially during the summer.      

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

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