Seeking advice on a suitable Full Face Mask

[elliotg]

For many years I have been successfully been treating my sleep apnea with a nasal mask - the Resmed Mirage Activa. In recent times however I have encountered a problem with leakage.  A very good person at the place I get my equipment from, looking at my results, suggested that I was getting mouth leaks.  This fitted with what I had noticed - sometimes I was awoken and noticed that although I was breathing in through my nose, air was spurting out through my not quite closed lips.  I tried a chin strap but this did not help.

So the next step was to try a full face mask.  And this has been a rough ride. I started with a Resmed AirFit F20.  But this resulted in frequent drastic and irreversible (until I woke) leaks.  When I opened my mouth while sleeping the bottom of the cushion would slip up my jaw to above my lower lip leaving my mouth open below the mask. I tried the F30 but got a similar issue.

I then tried the AirTouch F20  cushions. These were actually better They seemed to stick better on my chin, but with 1 proviso - I had to have the mask very tightly fitted. Tight enough to result in waking up with a sore neck each morning!

I would put up with this but it also lead to another issue.  The cushions are only lasting between 2 to 3 weeks. Unfortunately I have to sleep on my right side due to an injury in my left shoulder.  And with my mouth opening I am afraid that the foam surface of the cushion gets quite wet in the bottom corner.  That plus the pressure leads to a quick deterioration in the foam in that area. And thus breaks the seal.

So while this is better than the my previous situation, I don't think that this is sustainable as a permanent solution.  So I was hoping to get some suggestions about other masks which I could try!

[Billygoat]

I also use an Airfit F20, and maybe have an out of the box suggestion. From what I'm understanding is the mask is okay until you open your mouth, then it leaks. Since you are used to wearing a chin strap, try wearing the chin strap with the F20 to keep your jaw closed. . Or maybe go back to your old mask, and use mouth tape to keep your lips sealed.

[Big Guy]

I swap back & forth between an AirFit F30 and AirFit F20. 

I'm a side sleeper as well as a mouth-breather. Both serve me well. My F30 is going on 7 months old and is still doing fine.

[sheepless]

idk about mask options but I wear a soft cervical collar to reduce my lip leaks. not perfect, but for me it's the difference between terrible leaks & manageable leaks (mostly below 24L/m). it also helps reduce clusters of obstructives.

[Gideon]

From the Mask Primer (see my signature)
Mouth Breathing
Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
With OSCAR look at your Leak Rate graph where it is shaded (large leak/ LL), flat tops on this graph suggest mouth breathing. In OSCAR right click on the left header of the Leak Rate graph and click on Dotted Lines then select "Leak Rate Upper Threshold" to get a line across the graph for ResMed. Manually set the value for Philips Respironics. Severity depends on how much over this threshold and for how long it is in the Large Leak territory.
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, does not happen overnight, but it works for some. The tongue trick is where you want to be but it takes a lot of time and some people just cannot get it. Place the tongue on the roof of your mouth and breathe with your mouth shut. Breathing thru your nose, right? Now leaving the tongue where it is open your mouth, you should still be breathing thru your nose. Now that you have that down move your tongue, breathing thru your mouth right? OK, put your mask on, under pressure, and repeat the above. Expect to need to turn your machine off when you start to repeat. Add talking while under pressure, It takes a while to get any of this down. It took me months. The exercises above are to help you understand the positions that cause the issue and how to correct it. For all this to become automatic will take a while.
Cervical Collar. A "soft" Cervical Collar (Releaf is popular). This helps support and align the neck and keeps the jaw/mouth from dropping. This is becoming a very popular option. Rarely used prior to mid 2016. Users are posting a high success rate with this device. When OA tends to occur in clusters at different times of night. It's an indication that an obstruction may have occurred when the chin tucks towards the chest. It's common, and the solution is either an ergonomic pillow or soft cervical collar that prevents the neck and head from being out of alignment and cutting off the airway, but they can be comfortable, prevent leaks and prevent an airway from closing up due to tucking your chin to chest and other issues. An Anti-Snoring collar or Sleep Collar, which has a small strap in back also works. (Dr. Dakota is popular)
It's a very small investment that has worked very well for some people. More pressure may solve the obstruction, or it might go away with positional therapy.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw-dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to. There is one chinstrap that is notably different than others, Knightsbridge Dual Chin Strap which pulls up instead of back. Search for it if you desire.
Ergonomic Pillow or CPAP Pillow, The purpose is to maintain a proper head and neck alignment while allowing for the mask maintaining the seal in multiple positions.
Mouth Guard The concept here is a closed mouth guard to keep the air from leaking out.
Taping. Definitely the most controversial. The purpose of taping is to seal the lips and prevent mouth leaks/mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth when taped, if I need to.
FFM – Full Face Mask or Hybrid Mask. This is a very traditional solution and it is generally effective.
Dry mouth is a symptom mouth breathing that is uncomfortable. It can and does occur with some users of a Full Face Mask.

• Many users use a product called Biotene to get relief from this symptom.
  

[elliotg]

idk about mask options but I wear a soft cervical collar to reduce my lip leaks. not perfect, but for me it's the difference between terrible leaks & manageable leaks (mostly below 24L/m). it also helps reduce clusters of obstructives.

Thanks for your suggestion. I intend on giving this a try!

[becker44a]

Hi Elliot,
A few years ago, I switched to a Fischer & Paykel Simplus mask after reading a number of posts here about good experiences.  F&P also has a newer mask called the Vitera, that is very similar, but a few mods, especially around the bridge of the nose area.  I have tried a Vitera, but it doesn't work for me.  However, I'm doing well with the Simplus, as I have for more than 5 years now.  Either or both may be worth a look for you.

[elliotg]

idk about mask options but I wear a soft cervical collar to reduce my lip leaks. not perfect, but for me it's the difference between terrible leaks & manageable leaks (mostly below 24L/m). it also helps reduce clusters of obstructives.

Yes.  I dug out my old cervical collar and tried it yesterday with my nasal mask.  It certainly improved the lip leaks to a manageable level.  Will continue with it for a few days to see if it continues to help! Thanks!

[elliotg]

Hi Elliot,
A few years ago, I switched to a Fischer & Paykel Simplus mask after reading a number of posts here about good experiences.  F&P also has a newer mask called the Vitera, that is very similar, but a few mods, especially around the bridge of the nose area.  I have tried a Vitera, but it doesn't work for me.  However, I'm doing well with the Simplus, as I have for more than 5 years now.  Either or both may be worth a look for you.

Thanks.  I may give this a go if my cervical collar doesn't give me a lasting solution.

[sheepless]

glad to hear the collar is helping. I wish I didn't have to wear one but I haven't come across another solution to mouth/lip leaks that works better for me.