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CPAP mask problems: Is it just a bad fit or time for a replacement?

Critical to using continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA) is the way your mask fits.

A leaking CPAP mask compromises the quality of your treatment; optimal therapy depends on a secure seal between the mask and the face.

Leaks out of the tops, the sides, or the bottoms of masks can make the pressurized air treatment provided by CPAP machines(commonly called sleep apnea machines) less effective or even ineffective.

(Remember, a leak around the vent where the hose attaches to the mask is actually supposed to occur; this is where your exhaled carbon dioxide is released from the mask).

If your CPAP mask leaks, it could be for a number of reasons. In some cases, adjustments can improve fit. In other cases, you may need to replace your current mask with a new one.

Check out the following CPAP tips to uncover causes and solutions for poor-fitting CPAP masks.

When a CPAP mask leak can be fixed

Usually a mask leak signals poor fit.

The best way to achieve a good fit is to try it on before you connect the hose or turn on the machine. It’s far more comfortable to fit it by this approach, as the incoming pressure may “tweak” the way your mask fits in a way that encourages leaking.

Even better, try the mask on by fitting it comfortably using the adjustable headgear, then recline as if you are going to bed. Only then should you add the hose and turn on the air flow. This most closely mirrors the posture and architecture of the face during sleep and will help you achieve the most accurate fit.

Don’t worry if you don’t get it right at first. Everyone experiences “mask burps,” funny sounds that tell you your mask is not fitting well. Take your time and be patient. Use a mirror if you have to. Getting your mask to fit correctly is worth the extra effort.

Sometimes it’s just a matter of making adjustments to your mask fit in order to solve CPAP problems related to leaks.

  • The mask is too tight
    • If you over tighten a mask, thinking it will stay on better at night and prevent leaks, think again.

      An overtightened mask could potentially torque the dome over the face or the pillows in the nostrils in such a way as to allow air to leak.

      This can also lead to pressure sores or red facial marks.

  • The mask is not tight enough
    • If you notice the mask is constantly shifting or falling off, it’s too loose.

      A CPAP mask should rest neatly against the skin; the pressurized air “fills out”the seal when the mask is put in place and the machine is turned on.

  • You have new facial hair
    • If you’ve grown facial hair since you started using CPAP, you can expect that any new growth that comes in where the mask has contact with the face will result in mask leakage.
  • The mask is not properly positioned
    • You might simply have placed the mask against the face in such a way as to allow for air leaks.
  • Your skin is oily or you use lotions or creams at night before putting on your mask
    • Many topical skin applications can make it difficult to seal a mask to the face; in addition, these products may actually break down the materials of the CPAP cushion.
  • You might be an oral breathe
    • If you breathe through your mouth, you “break the seal” of your mask through a mouth leak; this creates problematic high leak values with your therapy. If this is the case, you need to contact your durable medical equipment (DME) provider right away.

When a CPAP mask leak can’t be fixed

Sometimes your CPAP problems are a matter of using the wrong mask for your needs or because it has become damaged in some way, or even because of normal wear and tear.

  • The mask itself has a crack or cracks in it

    • The rigid, durable part of the mask (in the case of nasal or full-face masks) will leak air if it has sustained a crack or cracks. This can happen as part of normal wear and tear or could be the result of your mask falling into the hands of a child or a pet.
  • The mask cushion has a hole or holes in it

    • Masks can be made up of multiple pieces, with some including a removable cushion. This is the soft, flexible part that has direct contact with your skin. If it rips or tears, it will result in air leaks.
  • The mask does not (and never has) properly fit your face

    • This is not the same thing as sizing. The actual shapes of some masks simply aren’t conducive for certain facial landscapes, and this can lead to leaks.
  • The mask is not the right size

    • Too small a mask (such as a nasal pillow) may not be able to adequately contain pressurized air without it blowing out the sides.

      Similarly, too large a mask may not rest against the landscape of your face without creating gaps where air can escape.

How to improve leak issues

Consider the following suggestions if you are attempting to troubleshoot your CPAP leak problem.

  1. If you can’t resolve your problems with positioning of the mask, you may wish to try lying down in sleeping position when you put the mask on; your facial muscles move and relax in this position, and your mask may better seal while reclined. If this doesn’t help, contact your DME for further support.

  2. If you can’t resolve your problems with headgear adjustments for best mask fit, contact your DME for advice about fixing leak issues. If the mask simply does not fit your facial landscape appropriately, this might mean you need to get a different style, shape, or size.

  3. If you do not want to shave the facial hair that may be causing a break in the mask seal, you may wish to contact your DME about finding a different mask that will work even with facial hair.

  4. If you cannot help your oily or sweaty complexion , contact your DME. They might be able to help you with some solutions that can help improve mask seal for those with skin concerns that result in more than usual sweatiness or oiliness.

  5. Those who wear nasal pillows or a nasal mask who are “oral breathers” should consider either adding a chin support to gently coax the mouth closed so that your breathing takes place only in and out through the nose, or consider swapping your mask out for a full-face mask, which allows for mouth breathing.

  6. If you wear a nasal or full-face mask and it leaks out the bridge of the nose (at the top), this might signal a poor fit. You will need to contact your DME to discuss whether you need to move to a smaller size or to a different style of mask altogether to eliminate this leaking problem.

  7. If you can see obvious damage to the mask components leading to air leaks, contact your DME so they can either find replacement parts or issue you a brand-new mask.

  8. If you’ve had your current mask with cushion for at least 3 months and are only now having troubles with leak, this may just be simply a normal wear-and-tear concern. Contact your DME to see what they recommend for CPAP mask replacement and what your insurance carrier will reimburse for.

If you really can’t identify why you have a problem, that’s okay. Simply call your DME provider (the specialist who provided you with your mask and machine kit) to get some advice and support.

We are prepared to help all of our patients with anyCPAP problems they have. Call our direct line at Sound Sleep Health (425.279.7151) to talk to a DME provider about any challenges you’re encountering.

You can also sign up for our free patient portal at to make interaction with Sound Sleep Health even more convenient.

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