Tightening harder fixes nothing
It is everyone's first reflex, and it is the one that makes things worse. A mask cushion works with the air: it inflates and seals itself against the skin. Over-tightened, it collapses, deforms, and lets air out through the very creases you just created. On top of that, the straps mark your face and the night becomes uncomfortable.
The right method: loosen until it leaks, then take it up very slightly, lying down, machine running, in the position you actually sleep in. A mask is adjusted in bed, never standing in front of a mirror.
Air in the eyes almost always comes from the top of the cushion
If air escapes towards your eyes, the cushion is not following the bridge of your nose. Three causes come up again and again: a cushion size that is too big, headgear sitting too low on the head, or a cushion at the end of its life that has lost its softness.
The size test is counter-intuitive: many patients are more comfortable one size down. A size too big leaks more than a size too small. If the problem persists, masks that sit under the nose, with nothing on the bridge, remove the question entirely.
Leaks that only happen at night
A mask that seals at bedtime and whistles at three in the morning is a position leak. Turning onto your side, the pillow pushes the mask or kinks the tube; with your mouth falling open in deep sleep, air from a nasal mask escapes through the mouth.
Two leads, in this order: a mask whose tube runs over the top of the head, which clears the space in front of your face and follows your movements, and, for the mouth that opens, a conversation with your provider about a chin strap or moving to a full face mask.
Cushions wear out, and you cannot see it
A silicone cushion loses its softness long before it cracks. Not every manual gives a frequency, but the ResMed patient guide suggests three to six months depending on use and care. For foam cushions, like those on the AirTouch range, the ResMed manual is stricter: replace monthly, with no washing and no soaking.
Skin oils and evening face creams speed up wear. A rinse in warm water with a mild soap every morning, and drying away from direct sunlight, noticeably extends a cushion's life.
When it is the mask, not you
Once you have gone through size, tightness, cleaning and position, what remains are the cases where the shape of the mask simply does not suit your face: a pronounced nose bridge, a narrow face, a beard, a very restless sleep.
That is exactly why this site exists. The six-question finder suggests the mask types that fit your profile, and reviews can be filtered down to patients who look like you.
This guide does not replace your provider
A leak that persists through all of this, a pressure that feels insufficient, symptoms coming back: those are questions for your provider or your sleep doctor, who can read your machine data. Never change your pressure settings yourself.
