Getting so frustrated with leaks and not sure what to do......

Hi - I wrote a few weeks ago about how high my leaks were getting, and no matter what I do, they seem to be getting worse. What makes it frustrating is that at my sleep titration (with pressure of only 9, however), they said I didn't leak at all - even with the exact same style mask I've been using.

First year, leaks were always under 24. Then this year came along, and they started getting higher - never below 24. My doctor increased my pressure from 6-10 to 9-15, since I was still tired and having a lot of RERAs, and now my leaks are at a low, 32, and all the way up to 42. I even tried a different mask - the P10 nasal pillow mask, instead of the dreamwear nasal I've been using, and it was up to 37. And, I totally tape my mouth at night, so I don't think it's that.

I know the higher pressure now (usually around 12, vs the 10 I started with) could make it worse, but how do you balance what your body needs to not wake and have respiratory events all night with leaking? I can't do a full face (tried the other night) because it pushes on my jaw, and I have TMJ/displaced discs.

Help - just at a loss, extremely tired ever day to where I have to go out to my car and take naps during work, and I'm not sure where these leaks are coming from. As I said, the first year with the same style mask, I had no issues at all (though was tired because of the RERAs)

Thanks! Theresa

When I look at your SleepyHead leak rate charts you previously posted, I think it either has to be mouth leaks or the mask simply being displaced off your nose. When you get up in the morning have you tried blowing air out of your mouth to see how secure the mouth tape is? You should not be able to force the tape open. On the mask displacing, the first approach is to slightly tighten the mask straps and try to find a happy spot where they are not too tight but not so loose that the mask displaces. I also find it helpful to sleep with the mask hanging over the edge of the pillow. I use a fairly soft down alternative pillow that deflects fairly easy and does not push back. I also use a satin pillow protector so my head slips around easily on the pillow without deflecting the mask off my nose. I know there was some previous discussion about EPR. My experience is that the maximum pressure is not as high with the EPR turned off. That is about all I can think of for now...

I would agree that, logically, it would be either mouth leakage, mask displacement, or both. A possible fix is as follows. Ditch the mask with straps and use a more secure, stable system that attaches to your upper teeth. See: www.tapintosleep.com.. View the TapPap nasal pillow mask. You can order this yourself at CPAP.com and it is easy to install. For the mouth leakage, I have a modified version of the TapPap nasal pillow mask that comes with an intraoral mouth shield that seals the mouth from the inside. It is very soft and gentle and would not harm your tmjs. This is not yet in volume production, but you can get one from me at www.naplescenterdentalsleepmedicine.com. Arthur B. Luisi, Jr., D.M.D.