Full face mask tightness pushing jaw back and leaks

[wickedsleepy]

Hi everyone 

Anyone find any creative solutions for the following?  

When I use my p10 with mouth tape, I pretty consistently get low AHI under 1.0.  No chin strap, no cervical collar or anything.  Just mouth tape to keep the air from blowing out my mouth when my tongue falls in my sleep.  Pressured range between 9 and 13 and max out around 14.

When I use pretty much ANY full face mask, I get leaks when I roll onto my back because my jaw relaxes.  So I tighten the mask so that it doesn’t leak.  However, my AHIs are consistently higher (not horrible, but like 2.5, 3 or 4), and I get leaks no matter what I do when the pressure spikes up to over 14, 15, 17, 18.  I feel like what is happening is that tightening the lower straps on my ffm is pushing my lower jaw back, resulting in narrower airways, more apneas, more hypopneas, and therefore higher pressures, which cause more leaks and higher pressures.

I can tolerate mouth taping on a short term basis, but I really need to be able to use some kind of full face mask.  However, the above keeps happening and it seems to occur with every single one of them: F30, dreamwear, Evora, Vitera.  No luck getting good seals over 14 with any of them when I lay on my back.

Anyone have any solutions that have worked for them?  I have tried using pillow to stay sleeping on my side but nothing works.  With the p10, I’m not using anything to keep my jaw forward when on my back, but there is no strap tension *pushing* it back, either.  Yet every FFM does.

[CPAPfriend]

It's a costly solution, but using an MAD in conjunction could be the answer. I understand exactly what you're describing, and it would happen to me too if I didn't use an MAD at the same time.

[SarcasticDave94]

The Vitera I had would handle up to IPAP 25 cmH2O with low leaks and wasn't uncomfortable. I didn't have to go tight on the straps either.

If your strap adjusting method is keep cranking it tighter, you need to stop doing that and possibly change size cushions or just move on to another mask. Since you can use a P10 maybe just stick with that. Pillows masks will naturally be easier to get leak free, they have less seal area to deal with.

[wickedsleepy]

I forgot to mention that about the MAD.  I did try that a month or so ago, with an over-the-counter device I got on Amazon a few years ago.  It totally did stabilize my lower jaw and my AHI's were down to like 0.4, and the pressure demand dropped, too. However, I felt AWFUL.  I don't know why.  It seems to defy explanation unless there's something else going on that the charts don't pick up.  I felt exhausted, dizzy, wiped out, just blah.

[wickedsleepy]

I had higher expectations for the Vitera.  They have me with a Medium size cushion, and I almost wonder if its too big even though I'm not a small guy/person.  So maybe that's an option to try, but yeah, mostly around the mouth area it leaks like crazy, especially when on my back and my jaw moves.  To stop the leak, I wind up having to crank those lower straps on my neck, and it still doesn't work when I got to those higher pressures (which I seem to only need when I have straps pulling my back all the way!)  It seems like these masks are creating their own problem for me.

The trouble with the P10 and mouth taping is that some nights I just can't do it.  I took it off last night after falling asleep and waking up multiple times within the span of an hour.  There were no apneas or other trackable events like that, but I kept waking up with my heart pounding.  I put an SP02 meter on my finger for the next time I fell asleep and woke up and noticed my blood oxygen saturation was down to like 93.  So, it seems that some nights the nasal-only route just isn't gonna work.  I had some vodka in the late afternoon/early evening, and that seems to swell sinuses which somehow causes the low SP02 even though I could breathe through my nose.  No idea.  Ugh.

[OpalRose]

IDK, I don't use a full face mask, so I can only advise on what I've head others say.

One thing I know is that over-tightening the lower mask strap can cause many issues.
The last thing you want to do is pull your jaw back. The jaw should be supported in a way that is it pushed "slightly" upward.  Also, over-tightening can actually cause more leaking, which is opposite of what you want.  

Try reading through the Mask Primer for tips on mask fit.  

https://www.apneaboard.com/wiki/index.ph..._Jeffy1958

Hope you find that perfect mask.  I wish it were easier!

[SarcasticDave94]

Vitera: I tried a medium cushion but it wasn't wide enough at the corners of my mouth. Large is wider there, and a bit taller top to bottom giving more space between nasal bridge and chin.

I had to adjust it properly to make it work. I always adjusted while machine was on and lying back reclined.

Loosen all straps. Top of head first. Adjust the landing spot for the mask, lower typically than other full face. Try to get the top nasal point down where the nose is a bit wider, prevents some small leakage. Next is lower set, moderate tension, not snug. Top set, similarly to bottom, edit a bit between both. If you tighten it too much, it will leak, no question. The Vitera needs looser adjustment to allow the cushion to act like a bellows.

Back to P10, if that's working fine, that would be what to stick with. Any full face masks are harder to prevent leaks because there's more area to deal with.

[cps22]

A couple of thoughts:

You said pillows didn't help prevent you from sleeping on your back. Maybe a different type of solution for that? If you search for "sleep positioner" at Amazon, there are a variety of different gizmos, such as sleep backpacks, mesh backpacks that hold something like a tennis ball, straps that go around your chest that have balls you can position to enforce side or back sleeping, etc. If you have any sort of waist pack or backpack at home, you might try stuffing those with something firm to see if that might help keep you from rolling on your back. Maybe something that is attached to you will work better than pillows.

If you feel you have to use a FFM, might also try using a cervical collar (or the KnightsBridge chin strap) with the FFM, even though you don't need it with the P10. I need to use a FFM and a cervical collar (I use the Caldera ReLeaf) no matter what kind of mask I use because that's the only way I can keep my jaw from sliding down or back as I start dropping off to sleep and having air pop out of my mouth. The collar isn't actually enough to keep my jaw from sliding backwards if I'm on my back (maybe because I don't wear it tightly enough?) but I don't sleep on my back anyway due to tailbone pain. With side sleeping, the FFM/collar combo works fine.

[TechieHippie]

I'm in a similar situation. I haven't been able to sleep on my back without horrible flow limitations. The pressure increases won't break through the obstruction of the jaw or even tongue and other soft tissues falling backwards so they just keep increasing and at the same time my oxygen monitor shows I have tons of deep drops. I may try a pillow from Amazon, but from my experiments I'm not sure that it matters when it's my tongue that's falling back which is my suspicion.

[wickedsleepy]

I am going to check those out. My attention has been on trying masks but maybe I just need to train myself to sleep on my side.

Last night I tried my Evora ffm with a chin strap over the mask. Aside from the swollen eyes and indentations from the chin strap squeezing the mask to my head, it did sorta keep my jaw more stable.. yet I got tons of leaks and had a higher AHI than any night this week. And I still woke up repeatedly all night, thinking about if it’s leaking or not, if I’m positioned right, if I’m waking up my wife, etc. I long to get to the point where this is just as routine as brushing my teeth before bed and I actually wake up refreshed. I’ve been using this thing for over 6 months and can probably count on one or two hands the number of mornings I woke up feeling rested. My doctor has been useless with this. He just points to the numbers, showing that my apneas are controlled, and suggests trying a different mask. Every single full face mask I have tried leaks in the same way and for the same reason. So yeah maybe I restrain myself so I must sleep on my side haha.