Common Problems

CPAP Mask Leaks: Causes and Solutions

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.

8 Comments

  1. The article states, “Remember, the guidelines are to change your mask cushions every 1-3 months and your mask every 6-12 months.” Keep in mind that these “guidelines” are from the manufacturers and from the sellers, who have a vested financial interest in our purchasing new product frequently. There is little objective science behind these “guidelines.” The user should inspect equipment carefully as part of the daily cleaning process, to determine the need for replacement.

  2. May L. Scocco Reply

    I have had this problem for some time and my doctor is not addressing it properly.
    He wants to put me on a narcotic drug to keep me alert during the day. I have to sign a form
    and return every three months (and labs) to monitor me. I said No thankyou. This is my “Standard”
    answer. Any suggestions would be appreciated.

    • Hey May, I am sorry that you are having problem with mask leaks. For starters, you must make sure that you are using the correct size cushion, secondly, you want to make sure you are keeping your cushions changed out every 3 months and change your entire mask ever 6 months to help reduce your leak rate. If you continue to have leaks, maybe the mask that you are currently using is not a good fit for you.

      Mask leaks are very common with CPAP users, and a lot of times those leaks are only conquered by trial and error. This means you have to just continue trying different masks, or making adjustments to your current mask until you get a good fit. If you have a local CPAP Supply Provider in your area, you may be able to get assistance there for sizing suggestions and by trying on different masks.

      I hope this information helps some. We wish you the best!

  3. Can you or someone please please help me I ordered my third one now the pillows in a small instead of a extra small and tried nasal one in medium which was worse but I feel like it’s collapsing in my nose. It’s quiet and idk if that means it’s collapsing or it’s suppose to be like that. Or if I should pull it out and have it lay on top of mouth so I can at least feel and know I’m getting the oxygen. I’m in my twenties and this is very frustrating especially knowing I’ll have it forever and had it for years! Thank you

    • Hi Nicole, I would be frustrated too if, my pillows were collapsing. Have you changed your nasal pillows recently? Most nasal pillows should be changed every 30 days. Also, if you are using the wrong size, the pillows this may cause the pillows to collaspe.

      Please see the link below to read what other CPAP users are saying about their pillows collasping.

      http://www.cpaptalk.com/viewtopic/t98617/Collapsing-nasal-pillows.html

      If switching to a different size does not keep the pillows from collapsing, you may want to try a different mask altogether. CPAP.com offers free 30 day returns on all complete masks purchased from us. This way you can try the mask and if you don’t like it for any reason, you may return the mask for your money back, or a different mask.

      For further questions, or concerns, please feel free to reach us at: 1-800-356-5221, or you may e-mail us at: cpap@cpap.com.

      Have a great day!

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