How to Troubleshoot & Improve Leak Performance?

[MikeekiM]

Hi All,

After 18 months of absolute struggle, I have finally turned the corner and am now able to wear my mask all night long!

Check out my OSCAR chart for my usage trend from June 2022 to present. As you can see, I absolutely struggled for a year and a half, but the last 90 days has been super! And yes, I am pretty proud of myself for this achievement!



So now, my big battle is addressing my leak problems. I have heard that EPR can solve some leakage issues. I turned off EPR a long time ago (over a year ago) on my ResMed AirSense 11 and now I am wondering if turning it on will improve my leak performance.

I've tightened my mask, but realized that "tight" isn't always the answer and have also loosened it. I can't seem to get the right tension on my mask to get my leakage numbers under control. Here are my leakage numbers over the course of the same time period (June 2022 to present).



Any suggestions on what I can try? Any way for me to troubleshoot this? Any tips and tricks?

Thanks all!

BTW, I am using an AirFit N20 along with my AirSense 11.

[LSAT]

Are you mouth breathing? If you are, consider a full face mask or a chinstrap. With leaks that high, your AHI may be under stated.

[Pugsy]

To fix any problem you first have to try to identify the cause of the problem.

There are 2 main reasons for leaks....
1....mouth opening/leaking/breathing leaking
2....mask movement leaking.... which can be from less than optimal fitting or even the wrong size mask cushion

Have you taped your mouth shut (and that tape stayed put and didn't come loose) to see if the leaks are mouth opening leaks or not?

Obviously the fix for the problem is going to depend on the cause of the problem and you first have to figure out where or why that leak is happening.

Maybe the N20 simply isn't for you. Have you ever tried anything else?

[MikeekiM]

I don't THINK I am a mouth breather. But I guess I wouldn't know for sure. I figured the air from the CPAP would wake me up if it were rushing out of my mouth (or that my mouth would be terribly dry from the air output). And I don't find my mouth super dry in the morning, and I am not being woken up.

But I guess taping my mouth shut would answer that question once and for all. OK, maybe I have to try that.

[Pugsy]

I don't THINK I am a mouth breather. But I guess I wouldn't know for sure. I figured the air from the CPAP would wake me up if it were rushing out of my mouth (or that my mouth would be terribly dry from the air output). And I don't find my mouth super dry in the morning, and I am not being woken up.

But I guess taping my mouth shut would answer that question once and for all. OK, maybe I have to try that.

Tape for one night and make sure you don't scrimp on the tape because you don't want it coming loose or off.

Got any facial hair that might get in the way or affect the seal of the mask cushion???? Usually not that big of a deal with nasal masks but can definitely affect some of the other masks.

Then you can check the leak line....if it is still ugly then you have your answer.....your mask is moving around a lot for any number of reasons.

If the leak line cleans up a lot then you are likely experiencing some mouth opening leaks and then you can decide the best way for you to deal with the mouth opening. Don't think for one minute that you aren't mouth breathing or opening your mouth just because it's not waking you up or you aren't having a dry mouth. I can attest to the fact that sometimes our mouth opens and we don't ever wake up and we don't always get dry mouth either.

My best guess... mask movement is likely your problem but we have to rule out mouth opening first and that's actually the easiest experiment to make first.

[MikeekiM]

I don't THINK I am a mouth breather. But I guess I wouldn't know for sure. I figured the air from the CPAP would wake me up if it were rushing out of my mouth (or that my mouth would be terribly dry from the air output). And I don't find my mouth super dry in the morning, and I am not being woken up.

But I guess taping my mouth shut would answer that question once and for all. OK, maybe I have to try that.

Tape for one night and make sure you don't scrimp on the tape because you don't want it coming loose or off.

Got any facial hair that might get in the way or affect the seal of the mask cushion???? Usually not that big of a deal with nasal masks but can definitely affect some of the other masks.

Then you can check the leak line....if it is still ugly then you have your answer.....your mask is moving around a lot for any number of reasons.

If the leak line cleans up a lot then you are likely experiencing some mouth opening leaks and then you can decide the best way for you to deal with the mouth opening. Don't think for one minute that you aren't mouth breathing or opening your mouth just because it's not waking you up or you aren't having a dry mouth. I can attest to the fact that sometimes our mouth opens and we don't ever wake up and we don't always get dry mouth either.

My best guess... mask movement is likely your problem but we have to rule out mouth opening first and that's actually the easiest experiment to make first.

Thanks! This is very helpful. Looks like I have some "homework"!

I'll procure some mouth tape and do some troubleshooting as you've suggested above and will report back!

I love that I have a path forward, thanks again.

[MikeekiM]

I just bought some tape. Someone recommended the Nexcare Strong Hold Removable Tape, and the reviews seem indicate that it is good for the mouth taping application.

https://www.amazon.com/Nexcare-Strong-P ... 220&sr=8-5

Quick question. How does one position the tape? Across my entire mouth/lips in a "landscape" positioning? Or a 2" strip of tape in a "portrait" positioning across the center of my lips to simply keep my lips from parting in the center?

[Pugsy]

Quick question. How does one position the tape? Across my entire mouth/lips in a "landscape" positioning? Or a 2" strip of tape in a "portrait" positioning across the center of my lips to simply keep my lips from parting in the center?

Landscape position and be generous with the tape because you want to make sure that there is zero chance of any air exiting your mouth.

[Miss Emerita]

Be sure to fold the tape back on itself at one end to make a tab for easy removal. And purse your lips a little bit before applying the tape.

[MikeekiM]

I always wash my face, shave and put on some lip balm to prevent cracked and dry lips. Can I maintain this routine, or will I need to skip the lip balm to ensure good adherence? Not sure I can go long without some chapstick.

[ozij]

I always wash my face, shave and put on some lip balm to prevent cracked and dry lips. Can I maintain this routine, or will I need to skip the lip balm to ensure good adherence? Not sure I can go long without some chapstick.

A long time mouth taper, I always use - even need - chapstick when taping.
I put on the chapstick, fold my lips in, then put on the tape 3M Kind Removal Silicone Tape.

[MikeekiM]

I always wash my face, shave and put on some lip balm to prevent cracked and dry lips. Can I maintain this routine, or will I need to skip the lip balm to ensure good adherence? Not sure I can go long without some chapstick.

A long time mouth taper, I always use - even need - chapstick when taping.
I put on the chapstick, fold my lips in, then put on the tape 3M Kind Removal Silicone Tape.

Good to know. Thanks!

[MikeekiM]

Used the mouth tape for the first time last night.

I think it made a difference, but the jury is out.

My 30 day average 95% leak rate is 43.2 L/min. Last night was 27.6 L/min (which is still high, but quite a bit lower than my average).

The day before was 52.8 L/min, but the day before that it was 33.6 L/min.

So with the mouth tape, I definitely am running lower than average. I am going to use it for a few more days to see how things go and will report back.

BTW, it was super uncomfortable on my first night to tape my mouth shut. Part of it is definitely "mental". Because I know my mouth is taped shut, I start to develop a tickle in my throat and have the urge to cough and clear my throat. For those of you who have been doing this long term, how do you deal with the urge to cough (and what do you do when it is more than an urge and you actually have to cough)?

[Pugsy]

Did the tape come loose at all last night?

We need to see last night's leak graph from OSCAR but if the tape didn't come loose and was still stuck this morning and you still had a 27 L/min 95% number....most likely mask movement and not mouth breathing.

[MikeekiM]

I hadn't looked at my OSCAR data until now. And now that I have had a chance to look at it, it is clear that the mouth taping did work for most of the night.

Leakage was very low when I fell asleep, and sometime around 3:30am-4:30am the leakage suddenly spiked (causing the evening average to come in at 27 L/min).

I was too tired and sleepy to be able to remember everything that happened, but here is what I remember:

- Woke up around 1am, looked at my watch and went back to sleep
- Woke up around 2:30am, looked at my watch and went back to sleep
- Woke up around 3:30am, took the tape off my mouth due to comfort issues, went to the bathroom and went back to sleep
- Woke up around 4:30am, consciously realized that I took the tape off and went to the medicine cabinet to re-apply tape across my mouth
- Woke up at 7am to start my day

These are very rough times and very rough memories. But I think that this is what explains that "blip" between 3:30am and 4:30am.

I think having my mouth taped shut was causing me some comfort issues, which explains why I kept waking up over and over again.

I'll try it again tonight, hopefully at some point I'll be able to sleep through the entire night with the tape over my mouth.

Again, for those that are long time mouth tapers, how do you deal with things that cause discomfort or inconvenience when your mouth is taped shut? I am talking about things like a stuffy nose, a tickle in your throat that makes you want to cough, or an actual cough that you cannot suppress?

Will keep reporting updates moving forward! Thanks everyone!