Continuous positive airway pressure, or CPAP, is usually the first treatment for sleep apnea. CPAP therapy helps to keep a person’s airway open by delivering pressurized air through the mouth, nose, or both. In order for CPAP therapy to be successful, a person must wear a mask that both fits properly and is comfortable enough for regular use.
Your doctor can help you select a CPAP machine and mask that is suitable for your diagnosis and needs. However, there are over 9,000 possible combinations of masks with different customizable options. Although having so many options increases your chances of finding the right fit, it can be overwhelming and difficult to sort through.
Learning about the different features of each type of CPAP mask and how to anticipate potential side effects can help you find the mask that’s right for you.
CPAP Mask Types
Several mask options are available for CPAP, including:
- Nasal masks
- Nasal pillow masks
- Oronasal masks
Nasal and oronasal masks are the most widely used masks for CPAP therapy. In particular, some experts may recommend a person try out a nasal mask first and then try other mask options if they are having problems with the fit or results. Finding the best mask can be a significant factor for determining how successful CPAP therapy will be.
Nasal masks are designed to deliver pressurized air through the nose. There are two main types of nasal masks. One covers the entire nose with a frame that sits on the bridge of the nose and the upper lip. The other sits only on the upper lip with prongs that go directly into the nostrils. Both types are anchored to the face with a strap that attaches behind the head.
Compared to other types of CPAP masks, nasal masks offer several advantages, including:
- Generally more comfortable
- Fewer air leak issues
- Lower pressure required from CPAP machine
- Longer periods of use
- Less costly
Nasal masks aren’t the best option for some people. In particular, those who breathe mainly through their mouth are also less likely to benefit from a nasal mask. Additionally, having a mustache can interfere with the fit of the mask, causing air leakage. Nasal masks may also be especially uncomfortable for people who experience claustrophobia.
Nasal pillows may be a more comfortable alternative to nasal masks. Some people find nasal masks uncomfortable if the prongs go deep into the nose or if the mask puts too much pressure on the bridge of the nose. In contrast, nasal pillows use soft rubber cones that seal at the entrance to the nostril and reduce the pressure on the nose.
Nasal pillows may be a better option for some people, including:
- People who have facial hair
- People who enjoy doing leisure activities in bed such as reading or watching TV
- People who experience claustrophobia
- People who want something easy to take on and off
- People who sleep on their side
Nasal pillows have shown to be equally as effective as other nasal masks in delivering CPAP therapy.
Oronasal masks deliver air through the nose and the mouth. They may be a helpful option for people who experience “mouth leaks” while using nasal or nasal pillow CPAP masks. Mouth leaks occur when the pressurized air from the CPAP machines escapes through the mouth.
Compared to nasal masks, oronasal masks have been shown to reduce mouth leaks. However, they can cause higher rates of other types of air leaks. Additionally, oronasal masks are generally considered less comfortable, which may lead some people to take the mask off during the night or avoid using it altogether on some nights.
Despite several disadvantages, the overall effectiveness and benefits of CPAP therapy for those who use oronasal masks appear to be similar to those who use nasal masks.
Though not commonly prescribed, other mask designs may be an option for people who have not been able to tolerate treatment with nasal, nasal pillow, or oronasal masks.
- Full-face masks: These masks offer full face coverage, sitting on a frame that extends from the forehead to the space between the chin and lower lip.
- Oral interfaces: This type of mask covers only the mouth and may be an appropriate option for people with nasal airway problems or who find headgear uncomfortable.
Common CPAP Mask Problems
The ideal CPAP mask should be one that is both comfortable and effective. You should be prepared to try more than one type of mask as you are adjusting to routine use of your CPAP machine. Let your health care provider know if you are having any problems with the fit or comfort of your mask.
People who wear CPAP masks may report certain side effects.
- Dry nose: For those who use nasal masks, the positive airway pressure can dry up the nose and cause irritation. Using a humidifier to reduce the amount of air resistance through the nose can make CPAP treatment easier to tolerate.
- Congestion: Similar to dry nose, starting CPAP therapy may cause congestion in the nose, which can make it difficult for air to pass through. Certain medications or switching to an oronasal mask may be helpful to address this problem.
- Pressure ulcers: Pressure ulcers or injuries are wounds that can develop where the CPAP masks come in contact with the bony areas of the nose, mouth, or face. They indicate that the mask isn’t fitting properly.
- Claustrophobia: Some people have a fear of tight spaces and may feel anxious when wearing a mask. A nasal-pillow mask could be a better alternative for those individuals. People with claustrophobia may also want to try the mask for a short period of time at first, then slowly increase the time spent using the device.
- Facial marks: Headgear that comes with most masks can leave undesirable imprints on the face and often interferes with hairstyles. Some mask manufacturers have addressed this when designing new products.
- Difficulty tolerating pressure: Some people experience discomfort when they breathe out against the pressure set on the CPAP machine. This problem can be solved by working with a doctor to adjust pressure settings and make other modifications to improve comfort.
Adjusting Your Mask
Commercial CPAP masks come in standard sizes such as small, medium, or large. Unfortunately, masks don’t always account for each person’s unique facial features. Additional accessories or customizable features are usually available to customize the mask.
In order for CPAP therapy to be most effective, it is important to find a mask that fits well and provides a good seal. Once you find a mask that seals correctly, you can work with your doctor to make additional adjustments to make it fit more comfortably.
Finding the Best Mask
Ongoing research is investigating whether certain individual characteristics like a person’s age, sex, body size and the shape of their face and nose can influence which type of mask a person should use.
As you work with your health care provider and review your options, there are some questions that may be helpful to consider in selecting your mask:
- Do you have facial hair?
- Do you mostly breathe through your mouth while sleeping?
- Do you sleep in different positions?
- Are you claustrophobic?
- What activities do you typically do before sleep?
- Is physical intimacy important to you and your partner before sleep?
How to Optimize CPAP Therapy
Starting CPAP therapy can be a confusing time and you will likely have several questions and concerns. The goals are to find a properly-fitting mask, follow the direction provided by your doctor, and communicate with your health care team frequently to make ongoing adjustments as needed. There are other steps you may consider as well to help optimize your treatment.
- Follow up with your health care team: Treatment for sleep apnea is long term. Routine visits or check-ins with your health care team are an important part of your care. They can help you troubleshoot any issues you may be having with your mask or CPAP machine and monitor how well your treatment is working.
- Actively participate in managing your treatment: Treating sleep apnea may require making lifestyle changes along with medical treatment. Taking an active role in learning about your diagnosis and treatment options may help you feel more empowered to make decisions like choosing a mask.
- Involve your bed partner: If you have a bed partner, they can help evaluate your CPAP success and identify problems you may be experiencing while asleep. Be sure to include your partner’s observations about how frequently you use your CPAP machine and whether its use is disrupting their sleep when you check in with your doctor.
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