Sudden mouth leak with nasal pillows

[Possum]

Hi all,

I have been using pressure therapy for about 7 years now and have used nasal pillows almost the entire time without issue; however, within the last few months I developed a somewhat sudden problem with mouth leak after never having that issue in the past. I wake up with mouth so dry it takes a full glass of water to just to rehydrate my mouth and throat, and my leak scores are anywhere from 30-45 L/min in the MyAir app. I used to analyze my own data in Sleepyhead but stopped because there was never anything interesting to see - I had low leak and AHI's usually < 0.5. As I understand, the new software of choice is OSCAR, so perhaps I'll download that and have a look.

My question is why this could suddenly become a problem? I have actually lost about 60 lbs since beginning therapy, even though I still have about 50 more to lose, so I would think if anything my airway should be less constricted, not more, which would cause more soft palate collapse. Has anyone else experienced the onset of mouth leak, somewhat out of nowhere?

I have tried a couple of chin straps but find them to be incredibly uncomfortable and a pain to use - they tend to slip off and they have to be so tight to be effective. I am dreading the possibility that I might have to switch to a full-face mask, as I'm not sure I can tolerate that. My favorite sleep position is on my stomach, which the low-profile nasal pillows accommodate very well, not sure how that could work with a full-face.

Thanks for any feedback.

[Ockrocket]

I had to switch from a nose mask to a full face mask (covers nose and mouth) after about 12 months of CPAP.. there was no obvious reason as to why I started being unable to keep my mouth closed during sleep.
 

In the end I just assumed the cause was because I was finally going in to deeper more relaxed sleep, I just accepted the fact I had to change masks and stopped worrying about the reason.

[Sleepster]

My question is why this could suddenly become a problem?

Impossible to say, but weird stuff like this happens. You'll probably tolerate a ffm because you've been on CPAP therapy so long. An alternative to the chin strap is a soft cervical collar.

[enjoysleep59]

I have the best results with the p30i nasal pillow mask, and I had issues with mouth leaks too. This was the solution that works best for me.

https://www.amazon.com/dp/B01F9JFBBY?psc...ct_details

Each roll is good for about 90-days and it is a low cost fix to the problem.

[Apnea23]

Same happened to me - I lost weight and my therapy went haywire, leaks galore after being an expert nasal breather.

I tightened the mask, bought smaller headgear, reduced pressure, tried different pillows.. nothing worked.

Eventually succumbed and out ot desperation bought a soft cervical collar and *instantly* nomore leaking at all.

When losing weight, we have no idea what that is impacting - we assume lower pressures are needed and everything will improve, but perhaps not!

Less fat around the neck or anywhere on your body is a significant change in sleeping posture, altering alignment of many things.

Maybe your jaw can drop easier with less fat in the way, especially during certain sleep stages.

Maybe your airways are now less rigid as your neck has less cushioning/fat around it. Excess fat around the neck is essentially a soft cervical collar!

Either way, soft cervical collar or FFM may be the only answer to keep the airways straighter and give support to your chin/jaw. I opted for a collar because if my jaw is dropping now, it will happen with a FFM and could likely cause arousals.

I have also found I actually needed another few cm in pressure (go figure, floppier airways? Who knows).

I honestly wasn't expecting it to work, and I was so excited when I saw no leaks the next day.

[Possum]

Same happened to me - I lost weight and my therapy went haywire, leaks galore after being an expert nasal breather.

I tightened the mask, bought smaller headgear, reduced pressure, tried different pillows.. nothing worked.

Eventually succumbed and out ot desperation bought a soft cervical collar and *instantly* nomore leaking at all.

When losing weight, we have no idea what that is impacting - we assume lower pressures are needed and everything will improve, but perhaps not!

Less fat around the neck or anywhere on your body is a significant change in sleeping posture, altering alignment of many things.

Maybe your jaw can drop easier with less fat in the way, especially during certain sleep stages.

Maybe your airways are now less rigid as your neck has less cushioning/fat around it. Excess fat around the neck is essentially a soft cervical collar!

Either way, soft cervical collar or FFM may be the only answer to keep the airways straighter and give support to your chin/jaw. I opted for a collar because if my jaw is dropping now, it will happen with a FFM and could likely cause arousals.

I have also found I actually needed another few cm in pressure (go figure, floppier airways? Who knows).

I honestly wasn't expecting it to work, and I was so excited when I saw no leaks the next day.

Thank you for your insightful response. You make some interesting points, and you're right, losing weight is not always the panacea that it's made out to be, though I have to assume it is less stress on my heart and body overall to weigh a little less. I will look into this soft cervical collar. Are you able to provide a link to the one you use? I recall this site might have rules against posting links, but I would love to see some examples of products that have worked for other folks.

[Apnea23]

I agree, losing weight is definitely the way for health, it's just such a shame it can effect PAP therapy so dramatically if one isn't using Oscar and seeing what's really going on with leaks.

I suffered since November last year until last week with the mouth leaks until I bought this collar. I spent a lot of money on new gear and masks.. now I'm back to using the same old nasal mask I've had since 2021 with a cheap piece of foam with velcro attached.

If links aren't allowed, this is my first collar and it worked right off the bat. It's probably not the comfiest but I wanted to test it quickly to confirm/deny if it helped the mouth leaks so I bought the cheapest fastest one I could have delivered. 

[enjoysleep59]

I have also used the soft cervical collar but the one that I purchased was not tall enough to keep my jaw closed. It would make a great add on to airline travel and keep my head from falling into my lap but for everyday use it is a bit too small. The taping is working great for me, and by keeping the airway sealed, I don't need the humidity, so I picked up the side cover for the AirSense 10 AutoSet and gave myself a few extra inches on the night side table.

[bigla6940]

I am a newbie to CPAP and forum, being on CPAP therapy for 2 months. I have a Res Med Air Sense 11. Currently using a nasal pillow after discarding 3 different face and nose masks because of leaking. The nasal pillow was working just fine for 2+ weeks. All of a sudden, in the past few nights, I find my mouth full of pressurized air. This woke me up a few times during the night. If my mouth was open it wouldn't fill up and I use a chin strap. My events per hour have gone up from 2-3 to 4-5 since this started happening.  Here are my results from last night:

Events 5.9/hr, Pressure 11.8,  Leak 18L/min, AHI 5.9, Obstructive AI 0.0, Total AI 2.1

Has anyone else had this issue? Any suggestions? If this is the wrong thread for this, please advise.
Thanks

[enjoysleep59]

I have been using https://www.amazon.com/gp/aw/d/B01F9JFBB...asin_image