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Hi there,

Thank you for reading this, I have a bit of an urgent mask leakage issue that I am trying to solve for my mother, I will try to keep the details as brief as possible but still explain the scenario:

My mother was involved in a serious car accident approx. 6 months ago, following which during her hospital stay she went into respiratory failure 3 times due to hypercapnia/hypoxemia with blood Co2 readings well over 100.

Each time they were able to successfully treat her with non-invasive ventilation using a BiPAP machine.

Their theoretical diagnosis was that she likely had severe sleep apnoea and some degree of COPD, as well as obesity hypoventilation syndrome which were previously undiagnosed and unknown to her, but they were reluctant to prescribe her CPAP or BIPAP therapy in the hospital setting and were adamant she would need to have the issue followed up as an out-patient.

However, after the third visit to ICU and realising that due to her significant lower body injuries from the car accident it would be too long of a wait for her to follow this up as an outpatient and they started her on COPD medication, puffers & BiPAP therapy with a loaned Philips Dreamstation machine from the hospital.

Fast forward approx. 5 weeks and she has now just been released from hospital to return home and will undergo physio for her lower body injuries from home, still with the loan BiPAP machine from the hospital.

She is currently using a Fisher & Paykel Evora full face mask (the one that rests under your nose and goes down over your mouth) as she is a chronic mouth breather, however since she returned home we have noticed that she is suffering from severe mask leakage due to her jaw dropping while she is asleep.

She has to sleep on her back with an elevated head position due to injuries to her diaphragm sustained in the car accident so unfortunately side sleeping is not an option for her.

Her mask leakage due to her jaw drop is very severe and making the BiPAP therapy basically completely ineffective, resulting in her oxygen saturations dropping down into the low 80's when i tested her the past couple of mornings, it does quickly rise back to around 90 after waking and sitting up with a few deep breaths).

In summary, I am looking for urgent quick solutions before she ends up back in hospital, I understand there are chin straps, cervical collars & taping options available in order to keep her jaw closed, however I am not sure how she will fare breathing through her nose as she has never normally breathed through her nose while sleeping.

I spoke to one of her respiratory team members from when she was in ICU (the one who organised the machine for me) and he was kind of suspect of using straps/collars also saying we would need to be careful we don't cause a blockage using those, his advice was to try and find a full face mask that goes over the bridge of the nose as they may be more effective at preventing the jaw drop.

If anyone has any advice on a good mask to use to combat jaw drop that is compatible with the Philips Dreamstation BiPAP machine I would greatly appreciate it!

Thank you and apologies for such a long post.

I am thinking someone will show up in this thread and suggest a soft cervical collar? Not speaking from experience as i do not use one but it seems like a quick easy workaround you could try to help the situation. As a mouth breather myself with sinus challenges I have settled on the Oracle oral only mask but it's not for everyone. It's probably not for 99.9% of everyone, but it works for me in conjunction with some tape on the nares.

amenite wrote: ↑

Thu Dec 14, 2023 5:44 pm

I am thinking someone will show up in this thread and suggest a soft cervical collar? Not speaking from experience as i do not use one but it seems like a quick easy workaround you could try to help the situation. As a mouth breather myself with sinus challenges I have settled on the Oracle oral only mask but it's not for everyone. It's probably not for 99.9% of everyone, but it works for me in conjunction with some tape on the nares.

Thank you for the reply, I appreciate it a lot.

I spoke to the ICU team member this morning about it briefly, he seemed to think a full face mask that goes over the bridge of the nose may help although the problem could still be there.

I did mention the cervical collar as well as chin straps and he was a little hesitant on that idea based on it possibly causing a blockage? I'm kind of worried about that now, I don't really have any experience with this, it's all new to us, but there doesn't seem to be a mask specifically designed to address this problem.

Zaiforce wrote: ↑

Thu Dec 14, 2023 4:35 pm

cervical collar

Foam cervical collars help prevent jaw drop. They do NOT prevent mouth-breathing. You have to tape to stop mouth-breathing.

Another benefit of the collars is they hold the head/neck in the best position for airway patency. They don't allow the neck to bend down and crimp the airway.

Collars are not a foolproof solution to prevent jaw drop. They just have to be tried out. They do have a good success rate.

Good luck to y'all.

Zaiforce wrote: ↑

Thu Dec 14, 2023 6:08 pm

he was a little hesitant on that idea based on it possibly causing a blockage?

He doesn't have the experience or knowledge. I would expect him to be hesitant.

BTW, Gramps and I both have used foam cervical collars for years.

ChicagoGranny wrote: ↑

Thu Dec 14, 2023 6:14 pm

BTW, Gramps and I both have used foam cervical collars for years.

Thank you very much, I appreciate the advice! I will see if I can find one of these at the pharmacies in my area.

Zaiforce wrote: ↑

Thu Dec 14, 2023 6:08 pm

he seemed to think a full face mask that goes over the bridge of the nose may help although the problem could still be there.

It probably wouldn't help support the jaw unless it encompassed the chin itself to hold up the chin to prevent the jaw drop and it would have to be large, as in footprint, on the face...and I am unsure if any mask can do that.
Masks were never designed to support the jaw/chin.
Just because a mask is anchored on the bridge of the nose area doesn't mean the jaw won't/can't drop.
We have lots of forum members using such a mask and they still have to use something else to support the chin/jaw area.

I am voting for the soft cervical collar. It stands a better chance of holding that chin up.

Pugsy wrote: ↑

Thu Dec 14, 2023 6:20 pm

I am unsure if any mask can do that

Yes, we would already know that, and it would be a big seller. We can continue to hope.

ChicagoGranny wrote: ↑

Thu Dec 14, 2023 6:53 pm

Pugsy wrote: ↑

Thu Dec 14, 2023 6:20 pm

I am unsure if any mask can do that

Yes, we would already know that, and it would be a big seller. We can continue to hope.

It would for sure be a hot item. I wonder why no one has come up with one????
There's money there and we all know that the mask makers follow the money.
It's not like this is a brand new problem either.

The Innomed Hybrid and the Liberty have that little "shelf" that fits under the chin to prevent the jaw from dropping. I used the Hybrid for a while. My jaw would still drop and pull the mask out of fit so that it leaked. Standard knowledge was to cut the shelf off. I did, but the mask was too big and clumsy for me and the pillows pulled away from the nose easily. I don't think either mask ever caught on.

Pugsy wrote: ↑

Thu Dec 14, 2023 6:20 pm

Zaiforce wrote: ↑

Thu Dec 14, 2023 6:08 pm

he seemed to think a full face mask that goes over the bridge of the nose may help although the problem could still be there.

It probably wouldn't help support the jaw unless it encompassed the chin itself to hold up the chin to prevent the jaw drop and it would have to be large, as in footprint, on the face...and I am unsure if any mask can do that.
Masks were never designed to support the jaw/chin.
Just because a mask is anchored on the bridge of the nose area doesn't mean the jaw won't/can't drop.
We have lots of forum members using such a mask and they still have to use something else to support the chin/jaw area.

I am voting for the soft cervical collar. It stands a better chance of holding that chin up.

Thanks again so much to everyone for the replies, very helpful indeed!

I have been buzzing around my local pharmacies, unfortunately due to living in a rural area my options are limited, so I will need to do some ordering online for the cervical collar.

I did manage to pick up a ResMed chin strap for the time being, so will give that a try in the mean time, hopefully it can do the job for now, have many people found much success using chin straps?

Thank you everyone.

Zaiforce wrote: ↑

Thu Dec 14, 2023 8:39 pm

have many people found much success using chin straps?

Not a lot unfortunately.
But worth giving it a try since that is all you have right now.
Might get lucky.

Chin straps aren't supposed to be vise grip tight....too uncomfortable...so they are mainly supposed to be a gentle reminder to keep the mouth shut.

Did you try fitting the mask when you Mom's jaw drops (and she's awake)? Maybe you can find a angle where the straps' elasticity keeps the mask fitting
reasonably even when her jaw has dropped. I try to do that with the fitting of my ResMed F30. Granted, I'm not a bad jaw dropper - so I don't know if it would work for your Mom. But it's certainly worth a try. I would try the initial fitting of the mask when her jaw is relaxed, mouth slightly open. I think - and of course you may not be doing that - that focusing on "close your mouth" or "keep your jaw closed" might make her tense up in a way that makes the initial fitting worse.
Simply put: Focus on fitting the mask to how she sleeps. Not on changing how she sleeps in order to make the mask fit.

Can she use her hands to move the mask back into place if leaks wake her? Do they wake her? If so, try to get her to put the mask back in place keeping her jaw as relaxed as possible.
Part of it is training to use the mask -- and do the training when she's awake and feeling OK, not when she's tired and all she wants it to fall asleep.
Don't ask her to keep her jaw closed - she can't, and has far too many other stressful things to deal with now to try to focus on that.

Thank you ozij for the suggestion, we haven't tried fitting the mask with her jaw down, I guess that's something we can try, thank you

I did manage to get a hold of a cervical collar, could the people that use them to hold the chin up can you please let me know whether it's best to put the bipap mask on first followed by the collar, or the other way around?

Also, I have read that wearing a cervical collar for too long can lead to muscle atrophy in the neck and other complications such as dysphagia and an increase in intracranial pressure values (ICPs), does anybody know about these risks?

Thank you

Zaiforce wrote: ↑

Sat Dec 16, 2023 7:31 pm

Thank you ozij for the suggestion, we haven't tried fitting the mask with her jaw down, I guess that's something we can try, thank you

I did manage to get a hold of a cervical collar, could the people that use them to hold the chin up can you please let me know whether it's best to put the bipap mask on first followed by the collar, or the other way around?

Also, I have read that wearing a cervical collar for too long can lead to muscle atrophy in the neck and other complications such as dysphagia and an increase in intracranial pressure values (ICPs), does anybody know about these risks?

Thank you

which mask, please. i use a foam cervical collar and use a p10 nasal mask. i put the collar on first, then mask.

and i hope you are talking about a foam collar and not one of those stiff inflexible ones. i think the latter is where you get into the troubles you've read about.

i've used a firm foam cervical collar about seven years with no ill effects.