CPAP therapy can have immediate positive effects on your sleep. Though there’s a period of adjustment while you get used to the feel of the pressurized air and mask, many people notice right away that there’s a difference in their energy level after a night or two of CPAP therapy.
They may wake up without the sore throats and headaches associated with apnea, and their daytime sleepiness improves a little more each day they continue therapy. In fact, one study suggests that the longer you use your CPAP, the more you’ll see your apnea symptoms improve.
If, however, you notice a backslide into your old symptoms after a while — if you’re waking up tired, if your head hurts, if your throat is raw, if you feel exhausted, or if your partner reports that you’re snoring again—don’t give up on your treatment. You haven’t built up a resistance to CPAP therapy. Your apnea may not be getting worse. The issue could be far simpler: your apnea mask may have a leak.
Why Does a Mask Leak Matter?
The effectiveness of your CPAP therapy depends on your getting the right level of air pressure delivered to your airway via the CPAP machine, tubing, and mask. This air pressure has been determined during your titration study and prescribed by your sleep medicine physician. It’s precisely what you need to keep your airway from collapsing.
While all CPAP machines and masks are designed to have a certain acceptable level of intentional leak (so that you can exhale CO2), an unintentional leak from a hole or a weak seal around your nose or mouth can bring the air pressure too low, outside the acceptable range.
If this happens, you may not be getting sufficient pressure. This means you could wear your mask all night but still experience a partial or full airway collapse. Your therapy is compromised.
A mask leak can be bothersome in other ways, too. Leaking air can reach your eyes and dry them out, causing irritation. A mask leak may also make a whistling or hissing noise that wakes you or your bed partner, contributing to fragmented sleep or insomnia.
To make sure your therapy is effective, a CPAP mask leak needs to be found and addressed promptly.
What Causes Apnea Mask Leaks?
A number of different factors may cause your apnea mask to leak. These include:
Poor fit. If your mask is not fitting you properly—for example, if there’s gapping around your cheeks or mouth—the seal may not be tight enough, and air may escape through this broken seal. Adjusting your headgear poorly can have the same effect; if the elastic straps are too loose or too tight, your mask won’t function properly.
CPAP mask cushions normally contain two layers; if the fit to your face is too tight, the outer layer can’t inflate to create a firm seal. If you’re not sure how to fit your mask to your face, ask your sleep technicians or supplier for guidelines.
Also, look to get a new mask or a new fitting after gaining or losing a substantial amount of weight, like weight gain and loss can affect the shape of your face and how well your mask creates a seal.
An old mask. If you’ve been using the same CPAP mask for longer than is recommended, it may begin to show signs of wear and tear. The silicone may soften and become thin, which can lead to cracks, tears, or holes. Or the cushioning around the mask may degrade, affecting the quality of the seal.
The straps that hold the mask to your head may also stretch out and become too loose, causing the mask position to slip. Remember, the guidelines are to change your mask cushions every 1-3 months and your mask every 6-12 months.
Dirt and oils degrading the mask. It’s important to keep your apnea mask clean; if you fail to clean it weekly (and to clean your face nightly before going to sleep), the dirt and oils from your skin can stick to the cushioning and break the seal, particularly as air pressure from the CPAP machine increases during the night.
Sleep position. If you are a restless or very mobile sleeper who tosses and turns a lot during the night, these changes in sleep position may disrupt the placement of the mask on your face. Some people even tear their masks off in their sleep.
High air pressure. Research indicates that high CPAP pressure can increase the likelihood of experiencing unintentional leakage. If you require high pressure for your therapy, keep a close eye on your symptoms and your machine readings. If your leakage is going outside the acceptable range, talk to your sleep physician about ways to compensate for this possible pressure loss.
Mouth breathing. Studies show that mouth breathing when wearing a nasal mask can also contribute to leakage. An oronasal mask (one that covers the nose and mouth) can help to compensate.
Deviations from the expected routine. The American Thoracic Society website shared two interesting case studies about why patients who stick to their therapy experienced unintentional mask leaks. It turned one patient had leaks because she decided to wear her mask over hair curlers.
Another patient realized her cats had been chewing on her mask and tubing. When finding the cause of your apnea mask leaks, sometimes you may need to put on your detective cap and do some sleuthing to eliminate variables. The more information you can gather about your equipment, your habits, and your sleep hygiene, the more likely you are to solve the mystery of why your mask is leaking.
What to Do if Your Sleep Apnea Mask (CPAP Mask) Has a Leak
Check your fit and seal. Sometimes a poor seal occurs because people put their apnea masks on incorrectly. The proper way to put on a CPAP mask, according to the American Sleep Apnea Association, is to secure it loosely to your face while you’re sitting in bed. Next, turn your CPAP machine on.
After lying down in your typical sleep position (back, side, or stomach), tighten your straps until you get a good seal, but don’t overtighten. Lastly, seat your mask by pulling it an inch or two off your face until the outer layer inflates. Then lower it. The dual layers of cushioning ensure a more secure seal.(4)
Try a new style of mask (or a new CPAP machine). A full face mask that goes over the nose or mouth may be more effective if you breathe through your mouth. If you already use a full face mask and still have leaks, a nasal-only mask with a chin strap may be helpful. A different style of machine may also help—for example, a BiPAP or APAP.
Replace your worn mask. An old mask (older than six months to a year) will need to be replaced as the silicon and cushioning wear out. Call or visit your supplier to discuss options.
Ramp up your pressure. Using the ramp function on your CPAP will gradually raise your pressure, minimizing the likelihood of breaking your seal or causing discomfort that makes you remove your mask.
Get mask accessories to help. Talk to your CPAP supplier if you have problems with leaks. CPAP mask accessories like a mask sealer, full face liners, nasal mask or nasal pillow liners, nasal gel pads, CPAP cushions, and eye shields can help to stop or minimize leaks and the annoyances associated with them.
A leaking CPAP mask is not a disaster—it’s usually a sign of either an improper fit or a need for replacement parts or accessories. Keep trying until you find the problem, and stay in touch with your physician and your supplier. They want to help you get the best possible experience with your therapy.
David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.