Determining the most Comfortable CPAP Mask
Whether you’ve been newly diagnosed with sleep apnea, or you are in the market for a new CPAP mask, you need to find one that fits you correctly and feels good. This means you need one that prevents air from leaking and that you can put on night after night and feel comfortable wearing.
When looking at the options you have for buying a new CPAP mask, remember one key point:
The best CPAP mask for you is the one that you will wear.
These masks are used to deliver pressurized air as part of continuous positive airway pressure therapy (better known as CPAP).
Three different styles of masks can do the job of helping you keep your upper airway open at night while you sleep so that you can breathe easily and without interruption.
⦁ Nasal Pillows:
This is the smallest of your options. This kind of mask streams a
light puff of pressurized air through the nostrils. It uses much smaller headgear as well.
⦁ Nasal CPAP:
This the most popular and common option. It is a dome-shaped cup which you place over your nose, where it delivers pressurized air. It
requires more headgear than the nasal pillows, but nasal CPAP masks have been greatly improved over the years, which means they are smaller, lighter weight, and have minimal headgear.
⦁ Full Face:
Also known as the Oronasal mask, the full face mask is longer than the nasal CPAP mask so that it can be positioned over both the mouth and the nose. It typically uses the same headgear as the nasal CPAP.
Each mask type has its advantages and disadvantages.
Key factors in choosing a mask
⦁ Pressure settings:
In general, if you have higher pressures, you will do better with the oronasal or full face CPAP mask, as they have more headgear to firmly keep your mask in place as you sleep. Lighter pressures can be easily handled by nasal pillows or the nasal CPAP mask.
⦁ Facial shape:
The length of your face, the broadness of your cheekbones, and the shape of your nose can all be definitive factors when selecting a mask. You want to choose the one that best “seats” to the specific contour of your face so that it is both comfortable and effective in delivering therapy.
⦁ Facial hair:
It is difficult to seal a mask to the face if there’s facial hair in the areas where the mask makes contact with the skin. Try all three options to see which one has the best seal based on your prescribed pressure. You may have to forego that cool looking goatee as my father-in-law discovered.
⦁ Your preferred sleeping position:
Generally, side sleepers need to choose masks that have effective headgear to keep their masks comfortably in place. Stomach (prone) sleepers may have to opt for a smaller mask or think about avoiding that position in order to ensure they sleep comfortably. Meanwhile, back (supine) sleepers will do well with all mask options. Restless sleepers will also benefit from more supportive headgear, and may even opt for a chin support.
Generally speaking, those who fear enclosed spaces may struggle to wear a full mask . The nasal pillows are a good choice for people who simply want to feel less contact with their mask and headgear. However, full face masks are optimal for those who find comfort in the added space for breathing that the larger dome allows.
⦁ Breathing “style”:
Either you breathe through your nose, through your mouth, or through both your nose and mouth.
For people who breathe through their mouth, this might have developed as a habit over the years. Using CPAP may eventually reduce your need to do so after the brain and body relearn to breathe only through the nose.
Others may have issues with nasal breathing that are related to sinus or nasal problems (such as allergies or narrow physiology). In this case, mouth or “oral” breathing may still be your chief means of getting enough oxygen at night.
If you are certain that you are a mouth breather and you think you will struggle with using CPAP, consider assisting yourself by way of a chin support, which can gently hold your jaw in place so that you breathe only through your nose. Barring this, a carefully fitted full-face mask can compensate for oral breathing without any compromise to CPAP therapy.
Do you read or watch TV as part of your nighttime routine? Selecting a mask that has minimal headgear can be one of the factors to consider when choosing a mask.
If there’s one main takeaway from this discussion about finding the best CPAP mask for your needs, it’s this:
Find the mask that you like the best,
that you find the most comfortable,
that best fits your face and your lifestyle.
Also, don’t be discouraged if you try one mask and discover it’s not “the one.” You can always express your concerns to your durable medical equipment (DME) provider and find another style or type to swap with until you arrive at the one you can easily live with, night after night.
These sleep experts are terrific resources, by the way; they can also help you with fit concerns, comfort issues, and tricks for adjusting to therapy, and they can help you determine when it’s time to replace or replenish your supplies. Get to know your DME provider; they can really make a difference with your CPAP success!
So, Which mask is best for me?
It can take some time to work out which mask is best for you.
Making that decision can depend on how you breathe on treatment. For instance, do you breathe through your mouth rather than your nose, or do you tend to get a blocked nose?
If you know you have no problem breathing through your nose wearing a mask, you should be able to use a nasal mask or nasal pillows mask.
If you breathe through your mouth (sometimes referred to as ‘mouth breathing’), you can try a full face mask or a chin strap to stop your mouth from opening during sleep.
How to treat mouth leak?
Mouth leak happens if you sleep with your mouth open, and air “leaks” out of your mouth during therapy.
Opening your mouth during sleep can either be out of habit, or it could be because your nose is blocked. Mouth leak can be very uncomfortable and leave you with a dry mouth. (It’s also very noisy; if it doesn’t wake you, it can wake your bed partner.)
If it happens every now and then, you might be able to stop it by wearing a chin strap to keep your mouth closed, or by using a humidifier to stop your nose getting blocked.
If mouth leak happens a lot, you may need to use a full face mask, which covers both your nose and mouth, so even if you breathe through your mouth while you sleep, air will not leak out.
⦁ Fitting your mask
The aim of getting a good mask fit is to achieve a stable seal (so that air does not leak out), without compromising your comfort.
If air is leaking out of your mask (mask leak) or your mouth (mouth leak) you won’t get the full benefits of therapy.
The best way to get a good seal is to fit the mask before connecting the tubing or turning on your therapy device. Putting the mask on with the air pressure turned on might crease or twist the cushion/pillows, which could create “leaks.”Creases in the cushion/pillows can be very small and hard to feel, and most people tend to react by tightening the mask too much to get a good seal, which can be very uncomfortable. Over tightening the mask can also lead to leaks and therefore should be avoided.
Once your mask is correctly positioned on your face, turn the air flow on. You may need to make minor adjustments with the device turned on to ensure you still have a good seal.
It’s normal to have to spend some time at first learning to put your mask on properly. You can use a mirror or ask someone to check if the cushion/pillows are positioned properly.
Incorrect fitting causes many of the problems people have with masks. Each mask type has a specific fitting sequence, so it’s best to follow the steps outlined in your user guide or videos.
The more you can get used to your mask the better. Practice putting it on, taking it off and detaching it from the tubing during the day, so that you feel confident about doing it at night, in the dark or when you’re half asleep!
It’s important to realize that you’re not expected to know how to fit your mask perfectly the first time. It takes time to perfect, and as you get used to your mask, you will find a way of fitting that works best for you.
And remember: if you’re having difficulty fitting your mask, your care provider should be available to help you smooth out any issues.
Contact them if you’re finding it difficult to get a good seal; you might have the wrong mask or wrong size.
Getting the right mask size
Your aim is to achieve a neat and snug mask fit—not too loose and not too tight. It’s hard to get a good seal and comfortable fit if you have the wrong mask size. If you’re having issues with your mask, check your User Guide to make sure you’re fitting it correctly. Also, check for creases.
Many people fit more than one size. So if the mask is still leaking air (especially around the bridge of the nose for a nasal or full face mask) it might be worth trying a different mask size.
Don’t assume if you’re male you need a large mask size or if you’re female you need a small one. Your mask size depends on the key measurements of your face.
Here’s how to make sure you have the right mask size:
Is your mask making funny noises?
If your mask is making some burping or blurting sounds, it’s likely you have a leak. The best-fitting masks may still have some minor leaks, but there should generally be minimal leak from everywhere other than the vent. You can manage small leaks by working on your fitting technique. Is your mask leaving marks on your face?
If you often wake up with redness or marks on your skin from wearing the mask all night, try adjusting your mask so that you get a good seal but with less pressure on your face.
If that doesn’t work, here are some tips you can try:
Check you have the right mask size.
Some masks are available with soft wraps for the headgear straps and act as an extra defense against facial marks.
Add a layer of padding between the cushion and your skin, with the Gecko nasal pads.
If you use a nasal mask or nasal pillows mask, alternate between wearing the nasal mask (which covers your nose) and the nasal pillows mask (which sits at the entrance of your nostrils). This can ease the pressure off different parts of your face.
Refer to your user guide for troubleshooting tips that may help solve any issues around facial marks. If you have tried everything and you still have red marks on your face, contact your care provider or equipment supplier.
When your mask wears out
Some people also tend to stick with their old products rather than try newer ones. If that’s you, you could be missing out on significant improvements and solutions to your therapy challenges. CPAP manufacturers are continually improving their products, and packing them with features to keep you treated and comfortable.
It’s important to clean your mask according to the guidelines in your User Guide, so that you can get the most performance out of your equipment, and ultimately, your therapy.
Managing ‘tube drag’
‘Tube drag’ is when your tube pulls on your mask and affects the seal, causing leaks. If you don’t realize it’s happening, you can find yourself tightening the mask for the wrong reasons and causing more leaks.
Many masks are designed to manage a certain level of tube drag. With the device turned on, pull gently on the tube to find out what tube drag feels like. Roll around a bit in bed to see if your tube gives you enough room to move, and how much tubing you actually need. Most masks have longer tubing available if you need it.
Finding the right CPAP mask is crucial to continuous positive airway pressure (CPAP) therapy. With so many different mask styles, shapes, and sizes, choosing the mask that works best for you can be a little daunting at first as there’s no “miracle mask” that is best for all patients. What it all really boils down to is finding a mask that suits your own individual breathing needs, sleep habits, and comfort levels. Here are some initial key pointers and things to consider when you meet with your durable medical equipment (DME) technician as you find the perfect mask for every night use.
Here are some advantages and disadvantages of the most popular types of CPAP masks.
⦁ Nasal Pillow:
Nasal pillow masks are among the most popular mask choices for CPAP users because of their minimal design. Nasal pillows are the smallest of the CPAP masks and rest on the user’s upper lip as it blows pressurized air through two soft nasal tubes that insert into the nostrils, and is secured by straps that go around the head.
⦁ Benefits of Nasal Pillows:
The lightweight and minimal design is ideal for patients suffering from claustrophobia or those that simply feel uncomfortable with too much material touching their face. Optimal for wearers who like to read or watch TV before bedtime, as it offers a better field of vision than many of the other mask types. Allows user to wear their glasses as there’s no material covering the bridge of the nose. The direct airflow into the nasal passages reduce air leakage. Good for active sleepers who toss and turn a lot. Works best for users who have a lot of facial hair that may cause leakage in other mask types.
⦁ Drawbacks of Nasal Pillows:
Often not ideal for patients with higher-pressure needs, as the airflow is very direct and may cause discomfort at higher pressure settings.
Some users find the direct air pressure leads to higher incidences of nasal dryness, and in some cases, even nose bleeds. Not ideal for mouth-breathers. If you’re not accustomed to breathing through your nose, using a nasal pillow may feel unnatural or uncomfortable. Although, if you’re a mouth-breather and really want to wear a nasal pillow, try using it in conjunction with a chin-strap.
⦁ Nasal Mask
Nasal masks are triangular in shape and fit over the nose, covering the areas from the bridge of the nose down to the upper lip. They are popular among CPAP wearers because of the wide range of sizes and fits, making finding a perfect mask for any user very likely.
⦁ Benefits of Nasal Masks:
More natural airflow than nasal pillows as the delivered pressure isn’t as direct. Better for higher-pressure settings than nasal pillows.
Many different styles cater to a wide range of facial structures and features. If you move around a lot in your sleep or sleep on your side, the suction of the nasal mask helps keep it securely in place.
⦁ Drawbacks of Nasal Masks:
Much like nasal pillows, nasal masks are not ideal for mouth-breathers unless accompanied by a chin-strap to keep the jaw closed.
Some CPAP wearers complain about irritation caused by the pressure of the mask resting on the bridge of the nose or the forehead supports of some models. Not ideal for patients who frequently experience allergies or colds that cause blockage of the sinuses. Not recommended for patients who have difficulty breathing through the nose from medical conditions such a deviated septum, enlarged turbinates, or a collapsed or narrowed nasal valve.
⦁ Full Face Mask
CPAP full face masks cover the nose and mouth and all, or part, of the face with side straps that keep the mask in place. Some hybrid face masks cover the mouth but also have nasal prongs that fit into the nostrils like a nasal pillow.
⦁ Benefits of CPAP Face Masks:
Face masks are ideal for mouth-breathers and those that haven’t worked well with the nasal mask/chinstrap combination. Ideal for patients who that have nasal obstructions or frequent congestion due to allergies or cold symptoms. Oddly enough, some claustrophobic patients have preferred the full face mask that covers the entire facial area, as the mask only touches the outsides of the face. Whereas the nasal pillows and nasal masks touch the upper lip and/or the bridge of the nose. Works well for very high CPAP pressure settings because the wide surface area of the mask makes it feel as if the pressure is more tolerable and less direct than with other masks. Works well for those that sleep on their back as the supine position is best for an optimal air seal. However, the added straps and support help keep the mask in place for restless sleepers.
⦁ Drawbacks of CPAP Face Masks:
Because of the larger surface area, there is a higher chance of air leakage.
Some users complain of air leakage near the top of the mask, causing dry, irritated eyes. Most claustrophobic patients can’t tolerate the extra material and weight of the full face mask, although there are some exceptions. Full face masks make it difficult to read or watch TV in bed or wear glasses. If you’re a stomach sleeper, the bulk of the mask will make it difficult to sleep comfortably on your abdomen.
Things to Consider When Choosing a CPAP Mask:
Size, fit, and comfort are the most import considerations when choosing a CPAP mask. If the mask doesn’t fit, isn’t comfortable, or doesn’t meet your breathing needs, it’s not likely that you will be compliant with CPAP therapy. Take the time to go over the best mask for you with your DME tech, and don’t be afraid if you change your mind later and want to try a different mask.
Make sure to tell your DME tech if you are an active sleeper so that you get the most secure mask possible.
Tell your DME tech if you are claustrophobic or if there are areas of your face that are easily irritated.
If you have facial hair, it’s important to find a mask type that won’t leak due to the uneven surface area.
If you read, watch TV, or wear glasses in bed, find a mask that allows you the best field of vision so as not to disrupt your nightly routine.
If you breathe through your mouth, you may need a full face mask or a nasal pillow/mask in conjunction with chinstraps.
As there are many different cushion types (gel, silicone, foam, cloth etc.), find which is most comfortable for you.
Check to see if the mask you choose has replaceable cushion parts.
It’s important to remember that opinions vary from one patient to the next and the best way to find the ideal mask is through trial and error. At some clinics and CPAP suppliers,they allow patients to return their masks within 30 days (more or less) of purchase for an exchange. This allows patients a chance to acclimate to their masks at home, as it is not often likely that one will know whether the mask they tried for a few minutes at the clinic will work for them every night once they take it home.
As daunting or frustrating as finding the perfect mask for your individual needs may be, take time to remind yourself of the benefits and life-changing results that you will experience through the use of CPAP therapy.
Most masks fall into one of these categories:
⦁ Nasal mask (covers your nose)
⦁ Nasal pillows mask (sits at your nostrils)
⦁ Full face mask (covers your mouth and nose)