Can a mask be TOO tight?

[Chalkie]

I am wondering if a mask can be too tight? Is a little leak desirable?

I am struggling to explain last night's charts. 

I have been really encouraged lately by better sleep and lower AHI after switching to a full face mask.    

The first chart shows my stats, under 5, albeit with a large leak:

   

The second is from last night and while leakage was way lower, AHI was up. In addition, the last part of the night saw the AHI steadily rocketed well into the 20s. I recall vivid dreams just before waking.   The mask was super tight by then as I had woken around 5.30 am and really pulled it tight. 

   

I am also puzzled as to how this surge in the AHI could have happened. It often occurs in the last hour of my sleep.

[SarcasticDave94]

Zero leaks isn't necessary, but low enough to be fairly consistent and with comfort.

There's much discussion on Apnea Board that a too tight mask is not normally correct or wanted. Too tight will likely create more leaks not less. It can distort the cushion, and it certainly will add pain and discomfort to the user. A too tight fit or adjustment state requires you to correct something on the mask. The cushion might be wore out, incorrect size, or mask isn't correct for your facial shape.

Your leak rate, the lower of the 2, signifies what the machine determines to be the excess. The total should be expected and excess. I'm pretty sure your leaks are far over allowed amounts. Why did your AHI increase with lower leaks? Your machine has more difficulty tracking the therapy and events with extreme leaking like your first chart. The second, leaks were somewhat less and the PAP can measure more accurate. So this means leaks go down and measurement accuracy goes up.

The bottom line is your mask leaks way more than is good or acceptable. You've tightened it too much and it isn't helping. It's actually made a bad situation worse.. You need to get a different mask model or size, because this one is literally blowing your therapy into not helping.

The last hour with increase of events may be sleep wake junk. You may be between sleep and waking, causing breath control changes and then high events they might actually be false. If in this sleep wake transition, you might be moving about, causing more disturbances.

[Sleeprider]

Your leak rate was so high, the machine was unable to maintain the set pressure or respond to events. Your leaks were high enough that the machine quit charting large-leaks. Look at all the places where the leaks are above the LL threshold and pressure drops. Masks are designed to seal best when work in good contact with the skin, but not pulled excessively tight. A very tight fit can cause distortion of the mask shape and underlying skin promoting leaks and discomfort. If a mask needs to be pulled tight to fit, it does not fit. Your history with mask leaks goes back a long way and this certainly doesn't look like you have found a good mask yet.

[Chalkie]

Interesting, thankyou.

This mask (ResMed F20) is not an ideal shape for my face but has at least stopped the leaking out of my mouth.

It is still a big improvement over the nasal mask I was using, which had both much higher AHIs and often higher leak rates. And apart f0rm last night I have felt better.

The clinic has given me a Respironics Amara full face mask to try. Sometime after Xmas, I will.

PS I also noticed my SCC came off my neck for the last part of the night so maybe that partly explains the slow of hypopneas. Maybe the pain of an overtight mask stressed me and caused more events also, I speculate.

I feel the only way to get leaks right down with this mask is to overtighten it but of now it still seems the best I have tried so far.

[Crimson Nape]

If you are experiencing sealing problems, you might look at the F&P line of masks. From strictly a personal standpoint, they seem to be more forgiving and have exceptional sealing capabilities.

[SarcasticDave94]

I'll ditto Fisher and Paykel masks as excellent choices. I have the full face Simplus and Vitera. They are similar, with the Vitera being a bit better as it's newer. Both have RollFit which makes them stay sealed with low strap tension.

I've started out in 2015 with that Amara View and it was not very good. It's a hybrid type with full face lower and nasal cradle upper.

[Chalkie]

Thankyou. I have printed Dave's recommendations off.

The NHS will probably not supply them (only Rresmed and Respeionics) but I will ask nevertheless, before any purchase.

[DaveL]

Chalkie I've had good luck buying masks from vendors on the list here.
It's saved me a lot of money.

I find that masks are the keystone to my treatment. Mine is giving me trouble. I hate that.

[clownbell]

May I chime with a recommendation for the Fisher & Paykel Brevida pillow mask? I find it has very low leaks, at least for me, probably because it has only a small area to seal. FFMs have to deal with a variety of face shapes and facial contours. As a nasal pillow mask, Brevida just needs to seal the nostrils. Its "air pollow" seal is very comfortable and effective, for me at least.

[StevesSp]

Masks are a very personal choice, and not just full face vs pillows etc. I was lucky to find one that worked straight off. That said, I didn't think it was right until I tried others, which were worse. I eventually determined that mask type/manufacturer was important, but so was 'mask eitquette' - learning how to use each mask. In my case, this involved finding the mask that suited me, but also learning how to precisely tension (and position) each strap to accommodate the shape of my face and, perhaps more importantly, learning how to adapt my sleeping position and pillow choice to minimise leaks (I am a side sleeper).

I don't think there is a simple solution to leaks in many cases, it being a combination of the above, but unless you get on top of this issue, your machine will be unable to deliver adequate support.

Experimentation and determination are the keys.

Good luck!