22 March 2019

Stop CPAP Mask Problems and Issues

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

To stop CPAP mask problems and issues, I went back to using an “old” nasal mask being ResMed Mirage Micro and to use a Bilevel or BiPAP auto adjusting pressure machine. It is an “old” mask as the mask is no longer manufactured by ResMed although the mask and cushions are available online. A picture of the mask is at the end of the blog post.  

Masks are very personal. A great mask for one person may be a terrible mask for someone else. No matter what mask you end up with, by stopping mask problems and issues in particular leaks and constantly waking up, you will not be losing quality sleep and waking up tired and unrefreshed each day. 

As noted in CPAP Air coming out of the Eyes, one of the hardest and most difficult aspects of using a sleep apnea machine is to find your “perfect” mask. A mask that is properly fitting and comfortable will strongly enhance a person’s experience, acceptance and long-term use of the sleep apnea machine. Otherwise you may end up being one of the 80% non-compliant, failing and non-successful people on sleep apnea therapy as detailed on Why is CPAP Compliance Rate Low? 

At the sleep medical specialist and equipment supplier, make sure they explain and you try the different types and brands of masks. Use a mask that is comfortable and suits your style of sleeping. This is critical as it is you who will be sleeping with the mask each day not the equipment supplier. It is best that the equipment supplier have a return policy should the mask not meet your satisfaction. 

The sleep staff need to ask you questions including what sleep positions you sleep in and whether you move from side to side and lie on your back, what pillow you had and whether you may need to change, are you claustrophobic wearing the mask and do you want to read a book with your mask on before going to bed? 

Due to smallness, I recommend you first try with nasal pillows and nasal masks. Generally, the smaller the mask is, the smaller the leaks. I look at leaks in an earlier blog post Stop CPAP causing Mask Leaks: Use Bilevel. 

Be aware, there are conflicts of interest in the sleep apnea industry. Avoid them at all costs as it may be to your detriment. The blog post details my first mask and personal experience and how I had no choice in selecting the mask.

There are many reasons for using an “old” mask and a bilevel or BiPAP auto adjusting pressure machine. 

1. To reduce mask leaks showing on my machine each morning to zero even though I use maximum pressure up to 17 cmH2O. For some of you, leaks from the mask are going to make you frustrated and drive you crazy. Just when you go to sleep as well as during the night, the mask may leak, waking you up constantly. 

Using a bilevel machine has assisted greatly in reducing mask leaks to zero. More details are at the above blog post and Guide to Success using CPAP and Bilevel. In these posts, I detail the 4 steps that I believe are The Secrets to Success to using a sleep apnea machine. 

2. For a ResMed machine, once leaks are constantly over a certain level being 24 litres per minute during the night, your sleep therapy will be less effective than it should be and may lead to sleep disruption and constant waking up during the night. Should this happen, you will wake up tired and not refreshed in the mornings. 

The ResMed machine will blow more air to compensate for the leaks and so you end up going around in a circle with mask leaks. More air may lead to more mask leaks and more waking up during the night. By using a bilevel machine, I have reduced substantially the likelihood of mask leaks occurring by reducing the median/ average pressure and tidal volume of air. 

3. The mask does not leak when the pressure moves from a low EPAP (exhale pressure) of 4.2 cmH2O to my maximum pressure of up to 17 cmH2O and vice versa. It does not lose its seal even though the range of pressure is quite large. 

An issue I found with other masks is that when the pressure went above 11 cmH2O, the mask would begin to leak. Once the pressure went above 12 cmH2O, the mask would leak badly. The bilevel machine allows me to have a large difference between inhale and exhale pressure reducing mask leaks and enabling me to optimize my sleep and wake up feeling energized and refreshed.  

4. As noted in the blog post Why NOT to use a CPAP Humidifier? by having zero or minimal leaks, even though I do not use a humidifier and have maximum pressure up to 17 cmH2O, I do not have a sore throat and dry mouth each day due to CPAP air. In addition, by not using a humidifier has simplified my sleep apnea therapy. I no longer need to obtain clean water and to remember to fill the humidifier with water.  

5. I have been using the same mask cushion with the sleep apnea mask for more than 5 years and still have Zero leaks showing on my machine each morning. This particular mask has saved me a lot of time and money as I do not need to regularly obtain new mask cushions. My first mask, the ResMed LT Activa would completely “lose” its seal after 3 to 6 months and leak badly. 

When a senior executive at ResMed asked me what mask I was using and I advised ResMed Mirage Micro, the reply was “That was a good mask!” Why is this mask no longer manufactured by ResMed? Is it because not enough patients needed to change their mask cushions on a regular basis and ResMed was not making enough money? 

6. When using the “old” mask, I stopped having skin rashes. My first mask, ResMed LT Activa would give me skin rashes from the mask cushion. Changing to an “old” mask stopped the rashes overnight. Did ResMed change the silicone formula in the Activa mask? 

7. The mask is very comfortable and seals easily. It is a small mask and not heavy and bulky making it comfortable to sleep with on a normal pillow. With the forehead support, the mask does not lose its seal and leak when moving a lot in bed such as side to side or lying on my back. The forehead support is of great benefit and you are able to adjust the support and together with the mask cushion have maximum comfort for you. 

8. For those people who have CPAP air through the eye tear duct and air coming out the eyes, the nasal mask allows me to cover a portion of both nostrils at the middle section of each nostril with medical paper tape. By doing so, I have reduced the volume of air coming out the eyes by an estimated 3% to 4% as well as to stop nasal congestion and nose bleeding

Whatever mask problems you are having including other CPAP side effects and issues, keep going and using your sleep apnea machine. Some patients on the sleep apnea forums have tried more than 10 different masks! There are hundreds of different masks available and there is a “perfect” mask for you to stop mask problems and issues. 

Below is a picture of the ResMed Mirage Micro mask.

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 21.4 cmH2O and EPAP to 16.2 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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