CPAP: A Guide to the Different Types of Mask

men using different CPAP masks

What is CPAP?

CPAP stands for “continuous positive airway pressure”. A CPAP device uses a mask to force air into your nose or mouth to keep your airway open. It is very effective in treating sleep apnea, a condition where the airway repeatedly closes during sleep.

Contrary to popular belief, CPAP does not give you more oxygen, it simply establishes a current of normal air that props open your upper airway to prevent it from collapsing.

Normal breathing works via negative pressure, where expansion of the chest creates low pressure that then acts like a vacuum to suck in air. Conversely, by using CPAP, the constant flow of air creates high, positive pressure that forces outwards and pushes the airways open.

What makes a CPAP device?

There are three main components to any CPAP machine:

  • Flow generator
  • Hose
  • Mask

The generator pushes air through the hose, to the mask and into your airways.

Whilst the generator and tube are much the same (with some subtle variations and features unique to each product such as humidifiers), the mask is the part that varies the most. When being fitted for a CPAP device, it is important to consider the type of mask that is best for you.

The importance of a correct fit

Compliance is a big problem when it comes to CPAP treatment, with many users giving up after only a few nights. So whilst CPAP can be very effective in treating snoring and sleep apnea, it is only useful when it is actually being worn.

There are many reasons that make people stop their CPAP treatment, but most complain of discomfort. One study found that over a period of three years, 91% of users had abandoned their CPAP treatment [1].

Therefore, getting the right mask for you is vital to ensure you get the most out of CPAP.

Nasal masks

This mask is dome shaped and forms a seal around the nose. Shapes vary so there are many options to suit different face shapes. Because air is not being introduced directly into the nose, the airflow feels a bit more natural. This also allows for higher pressures to be used, ideal for people with severe sleep apnea.

However, as the name suggests, nasal masks only work through the nose. Nasal masks are not effective if you breathe through your mouth whilst you sleep. Many devices address this by coming with a chin strap to prevent your mouth falling open. This option is therefore not suitable for people who suffer from allergies or have chronic sinusitis.

Air leakage is a potential problem with nasal masks; the seal formed by the padding can be compromised if you have facial hair. Some users also complain of discomfort from the straps on the head or pressure on the bridge of the nose. You can often mitigate this with proper fit and adjustment.

Nasal mask pros

  • Many different shapes for optimal fit
  • Higher pressures possible, therefore suitable for severe sleep apnea
  • Less claustrophobic than full face masks

Nasal mask cons

  • Potential air leakage with facial hair
  • Difficult to wear before bed or with glasses on
  • Not suitable for mouth breathers and people with nasal congestion

Nasal cushions

Also known as a nasal pillow, this type of mask rests on your top lip and uses two cushioned prongs that fit directly into your nostrils. This is the smallest and most simple of all CPAP masks so is popular with people who find other masks claustrophobic and uncomfortable.

Nasal cushions are less cumbersome than alternatives and cover less of your face. This is ideal if you want to wear the mask for some time before bed. With its slimmer design, you needn’t alter your nightly routine where other masks would be in your field of vision and prevent you from wearing glasses.

Nasal cushions are also beneficial for those who have more facial hair, as the seal is only formed on the nostrils.

Because the air is forced directly into your nose, high pressures can be uncomfortable. This means nasal cushion masks are less appropriate for people with severe sleep apnea. The direct airflow can cause nasal dryness and discomfort.

Again, the device only works for nasal breathers. If you have a tendency to breathe through your mouth when asleep but can still breathe properly through your nose, nasal pillows can still be effective when used with a device that holds your mouth closed.

Nasal cushion pros

  • Less claustrophobic
  • Can be worn comfortably whilst awake
  • Less prone to air leakage
  • Suitable for people with facial hair

Nasal cushion cons

  • High pressures can be uncomfortable, therefore is less suitable for severe sleep apnea
  • Can cause nasal dryness
  • Not suitable for mouth breathers

Full-face masks

These masks are larger, covering the nose and mouth, so are ideal for mouth breathers. If you have experienced discomfort with a chinstrap, or frequently have a blocked nose, full-face masks could be the answer.

Higher pressures are more tolerable with full-face masks as the air isn’t being sent directly into your airway. Being able to use high pressures makes this mask ideal for those with severe sleep apnea.

The added weight of a full-face mask means it has a tendency to loosen during the night, particularly if you are a restless sleeper. However, there are several straps that can be adjusted to get an optimum fit. This mask is ideal for people who sleep on their back.

Due to the increased area in contact with your face, there are more potential areas for air leakage, especially for those with facial hair. Leakage that occurs out of the top of the mask can sometimes dry out and irritate your eyes.

The bulk of a full-face mask makes it difficult to wear before you sleep as it interrupts your field of vision and makes it difficult to wear glasses.

Full-face mask pros

  • Ideal for mouth breathers
  • Suitable for people who sleep on their back
  • High pressures are tolerable, therefore is suitable for severe sleep apnea

Full-face mask cons

  • Potential air leakage
  • Bulky, so can move during the night
  • Difficult to wear whilst awake

How do I know which CPAP mask is right for me?

How a CPAP mask feels is different for every individual. General comfort and feelings of claustrophobia are subjective and dependent on the materials, design and fit of the mask.

When in consultation about using CPAP, it is important tell your doctor about all aspects of your sleep and nightly routine to decide on the best mask for you. Remember to try different types and make sure you get an optimum fit with the adjustments available.

Use this table to decide which CPAP mask is best for you:

 Nasal maskNasal cushionFull-face mask
Can be used at high pressuresYESSOMETIMESYES
Comfortable to wear before bedSOMETIMESYESNO
Doesn’t leakSOMETIMESYESNO
Can be worn with facial hairSOMETIMESYESSOMETIMES
Ideal for mouth breathersNONOYES
Ideal for nose breathersYESYESYES
Ideal for back sleepersSOMETIMESSOMETIMESYES

References

  1. Hussain SF, et al. Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients – a cross sectional study. BioMed Central Pulmonary Medicine 2014; 14:188. https://www.ncbi.nlm.nih.gov/pubmed/25433468 

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