All About CPAP Masks

This is an excerpt from my forthcoming book, The 7 Day Sleep Apnea Solution: Get the sleep you need and the life you want. Please feel free to make comments and suggestions. If I select and implement your suggestions, I’ll acknowledge you in my book.

The mask (or nasal interface) is probably the most important piece of CPAP equipment that can ultimately determine whether or not you can benefit from your machine. The mask forms an air-tight seal around your nose or nose and mouth, and is held in place by various types of headgear. The mask is also attached to a soft flexible hose that connects to your machine. 
Notice that I said air-tight, not tightly fitting. The seal has to be strong enough to prevent the set air pressure from leaking. It doesn’t have to to strapped tightly—some of the newer masks have a soft cushioning system that inflates using air that’s coming in from the machine, and forms a proper seal. Tightening the headgear straps can actually cause more leaks. 
There are three general styles of masks. The most commonly prescribed mask is your standard nasal mask, which goes over your nose only. The full face mask goes over your nose and mouth, and nasal pillows have two cushions or prongs that fit from under your nose into your nostrils. 
Most people would probably prefer the nasal pillows at first glance, but one of the disadvantages of nasal pillows is that it can’t accommodate for higher pressures. You’ll do fine at pressures lower than 10, but once you reach 14 or higher, you may find it more uncomfortable, due to the fact that total pressure is delivered within a much smaller surface area. The regular nasal mask has a much larger surface area, so average pressure that’s applied to the area of the nostrils alone is much lower. This doesn’t mean that you can’t try nasal pillows if your CPAP pressure is 14. Many people can use nasal pillows at higher pressure, but not as many as when people use a regular nasal mask. Some masks has holes that vent out a small amount of air. This is a normal function of the mask, as it allows carbon dioxide to escape while still maintaining optimal pressures. If you can’t tolerate the noise from this mask, try switching to a different mask.
The full have mask forms a seal over your nose and mouth. Because your mouth is also covered, this is the mask that is more likely to produce feelings of claustrophobia. It’s also much bigger, bulkier, and because of the extra surface area you have to cover, is much more difficult to form a good seal. This mask’s advantage is that if you tend to breathe through your mouth, using only a nasal mask or nasal pillows, it’s likely that air will leak air out of your mouth, lowering the optimal pressure that can reach your throat. People who mouth breathe due to having a stuffy nose sometimes complain of having a dry mouth at night. Even if you’re normally a nose breathing, leaking air out your mouth can create a dry mouth. Lastly, full face masks are best at tolerating very high pressures. However, with higher pressure, you also have a higher chance of leaks. 
There’s one unusually type of mask that’s worth mentioning. It’s called SleepWeaver, and it’s made entirely of soft fabric, similar to the outer shell of a ski jacket. It has no latex or silicone containing materials. It’s also machine washable. I have a number of patients that swear by it. Then there have been others that didn’t like it. Just like any variation of a CPAP mask, there will be some who like it and some who don’t.
There are also newer variations of masks or ways of securing the interface to your nose or mouth. On type of mask covers your entire face, including your eyes. These masks are designed for very high pressures. Another system uses a dental mold attached to a nasal pillow system, which eliminates head gear and straps entirely. One system called the Oracle goes through only the mouth. There are also hybrid models that include nasal pillows with a full face mask.
Most masks use three different types of materials to form a seal on your face. The first type is an air cushion type of seal, where the CPAP pressure itself is used to create a cushion of air on your face to create that suction feel. These are the masks that if you over tighten the straps, you’ll actually break the seal and create more leaks.
There are also gel materials or hybrid gel and air cushions. Lastly, some masks use foam to create a cushion. All three materials work well in general, but better in some people than in others. Everyone has different facial shapes and geometry, so not one mask will fit every face. 
One of the most common questions I get asked, is, “What’s the best mask?” My answer is usually, “The one that works best for you.” Since everyone has a different face, it’s hard to predict which mask ail work best without trying different masks. In general, most people do well with the first mask they’re given, but some people have to go through 3-5 masks before finding one that works well.
It’s also important to work with someone knowledgeable about CPAP masks to help you with the mask fitting and to troubleshoot any problems that may arise. This can happen during your follow-up visit with your sleep doctor, or with your DME provider during the initial set up phase.
Most CPAP mask companies have 30 day trial periods, so if you don’t like a make, you can try a different mask. You’ll need to work with your DME company to help you with mask selection, depending on what kinds of problems you’re experiencing. There are now literally hundreds of different models, sizes, and variations of masks. It’s impossible to try every mask, but with the right guidance from your sleep health care providers or even through online forums, there’s a very good possibility that you’ll eventually find a mask that you like. 
Remember that a mask that your friend likes may not fit your face very well, since everyone has a different face. There is no perfect mask. The only way to fit your face perfectly is to have a custom designed mask specifically made for your face. As you can imagine, this would be very expensive, and insurance will probably not pay for it. 
The mask you’re given in the sleep lab is usually the most basic mask. If it works, then keep using it. If not, move on to another mask. 
Next: CPAP Humidity issues

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3 thoughts on “All About CPAP Masks

  1. I’m just seeing some typos and missing words or incorrect words, probably caused in part by your spell check program. maybe you already got that fixed.

    I don’t know if you would want to add something about using tape over the mouth to prevent mouth leaks while using a nasal mask. I am a mouth breather but could not tolerate the full face mask. I could not use a chinstrap without having a serious bite block for my TMJ; like one that realigned my bite. but even with the chinstrap I had mouth leak. even with one piece of tape I had mouth leak. three pieces of tape, overlapping, did the trick.

    I used earplugs to tolerate the noise of the machine.
    (so yes, to sleep I had to put in earplugs, put in the bite block, then put on the tape, the chinstrap, and the mask.) I found that I could substitute a soft cervical collar for the chinstrap and it would do the same thing. I think it stabilized my airway so there would be less variation of pressure requirement due to neck position.

    I don’t know if you are going to talk about nasal vs. mouth breathing, how we are really intended to nasal breathe and even if not on CPAP there are groups that advocate taping the mouth in sleep to force nasal breathing. that still makes me nervous because I think if you are mouth breathing your body is trying to tell you that your nose is blocked. but I guess forcing nasal breathing can actually open the nasal airway. but using a full face mask concerns me because I worry that the pressure will push the tongue backwards into the airway and I’ve heard stories that sound like this is happening with the face mask. I think the full face mask is a compromise to accommodate people with significant craniofacial issues, because airflow is intended to go in through the nose and down the back of the throat.

    the human nose is a big problem, I’ve had a lot of nasal surgery to open my nose and still have issues. I use Afrin 3 nights on and one night off, to keep it open. on the off night I tend to wake with nasal congestion, and if I wake at 6 hrs my nose is open but after the REM cycle I’m congested. so I don’t know if it’s related to some OSA or to the crutch reflex. if you can address the crutch reflex effect on nasal congestion and how to deal with it, that would be fantastic. I’ve never seen anyone address this.

  2. hi Steve;
    I met with my allergist last week. he was the one who first pointed out the crutch reflex to me. he said that side sleeping is better because only one side will swell; if you sleep on your back both sides of the nose will swell. he said that the way to help prevent this was to use a nasal gel moisturizer at bedtime. this would somehow keep the nasal mucosa from swelling. I don’t really understand this, perhaps you do. unfortunately all of the nasal gel products out there that I can find have objectionable preservatives and I can’t use them. I’ve asked Xlear to make one.