“First developed in the early 1980’s, continuous positive airway pressure (CPAP) has become established as the treatment of choice for OSA (Obstructive sleep apnea). CPAP consists of a mask through which airflow is delivered by a blower. This servo-controlled fixed pressure is designed to overcome the tissue forces tending to collapse the upper airway thereby stenting the airway open. Because of this concept, CPAP is commonly referred to as a ‘pneumatic splint’.” (1)
Getting the appropriate continuous positive airway pressure (CPAP) therapy, depends to a great extent, on acquiring the right CPAP mask. But selecting the best one may not be an easy task since there are so many models available in the market. Therefore, finding the mask that best suits your needs can be a bit overwhelming as each patient has different respiratory needs, sleep practices, routines and standards. In this article, we provide you with some of the advantages and disadvantages of the different CPAP masks currently available in the market.
“CPAP therapy success largely depends on selecting the right mask and training patients on proper use. The right size is very important to reduce leaks, red marks, and discomfort. At present, there is a large variety of masks, including oronasal masks, which cover patient’s nose and mouth, nasal masks, which cover the area from the bridge of the nose to the upper lip; and nasal pillow masks, which have two nostril inserts. Nasal pillows have emerged as an alternative to nasal masks because they are smaller and have less contact with the face.” (2)
Full Face Masks
This type of mask may go over the entire face or part of it. Full face masks are manufactured with special straps on the sides which allow them to stay in their position. Hybrid masks are designed with prongs and these can be placed inside the nasal cavities, similar to nasal pillows.
Some of the advantages that full face masks offer include the following:
- They are perfect for patients who breath through the nose or for those who do not feel comfortable wearing nasal masks with chin straps.
- These masks are also the best choice for those who constantly suffer from nasal congestion due to allergies or cold.
- They are the perfect selection for an elevated CPAP pressure configuration because they have a wide surface area which helps to make the pressure more bearable and less direct.
- They are highly recommended to patients who feel better when sleeping on their backs since this is considered the ideal position to get the best air seal. In addition, the straps incorporated in the full-face mask allows the item to remain in its place and provide extra comfort and support to uneasy sleepers.
- Strange as it may seem, patients who suffer from claustrophobia tend to opt for this type of mask as it makes contact only with the external part of the face, whereas other masks make contact with the upper part of the lip, philtrum and/or nasal bridge.
Some of the disadvantages of full face masks are the following:
- Many patients have stated that there is air loss in the upper part of the mask which can generate irritation and dryness in the eyes.
- Some patients suffering from claustrophobia, cannot stand the added weight and material of these masks. However, there are cases in which patients might feel comfortable using them despite experiencing this condition.
- Wearing a full-face mask might become a nuisance for some patients since it makes it difficult to read, wear glasses and watch television.
- Full face masks may not be the best option for those patients who tend to sleep on their stomachs, since its bulkiness may make it uneasy to sleep in that position.
“Given that as many as 50% of patients have at least one complaint regarding their mask interface, improving mask fit has been another target for increasing CPAP adherence. There are a wide range of mask types available today including nasal masks, oronasal masks, nasal pillow masks, hybrid oral masks with nasal pillows, and oral only masks. One small randomized trial found CPAP use was 1 hour per night greater with a nasal mask versus an oronasal mask. However, a subsequent meta-analysis found no consistent difference between mask types. Nevertheless, a large observational study found oronasal mask use was an independent predictor of non-adherence. Of note, the oronasal mask was typically prescribed as rescue therapy so these results may be confounded. Nevertheless, data demonstrating that pressure requirements may be higher with an oronasal mask suggest a nasal mask may be preferred as first choice. However, given the wide range of facial structures and nasal pathology, it is important to tailor mask choice to patient preferences.” (3)
Because of their minimalistic layout, these masks have become the preferred choice for a lot of patients who deal with CPAP therapy. Nasal pillows are smaller than the average mask as they stay put on the upper lip. These masks come with two tubes that are inserted in the nasal cavities through which pressurized air is blown out. They are fastened by straps which surround the head.
Nasal pillows have the following advantages:
- Their slim and minimalistic layout is suitable for those patients who suffer from claustrophobia or who do not feel at ease with excessive weight and materials on top of their faces.
- They are ideal for patients who enjoy reading or watching television prior to sleeping since it gives them a much better field of view.
- Patients wearing glasses also benefit from them since the nasal bridge is not covered.
- They are a great option for patients who are used to moving around in bed throughout the night.
- They are good for those who have a considerable amount of hair on the face, since this may cause air loss in other types of masks.
Some of the disadvantages of nasal pillows are as follows:
- They are not recommended for patients who require high pressure airway since they provide airflow more directly and may cause inconveniences to the user if utilized at higher pressures.
- Because they deliver a more direct pressurized air, some patients have stated that their use may generate dryness and irritation inside the nose, sometimes leading to nosebleeds.
- They are not the best option for those patients who are used to breathing through the mouth. However, if the person is willing to use a nasal pillow, then he or she can try wearing it along with a chin-strap. If breathing through the nose is not normal for the patient, wearing a nasal pillow may cause a feeling of uneasiness.
Nasal masks, just like nasal pillows, are not recommended for patients who are used to breathing through the mouth. Specialists advise wearing them along with a chin-strap to maintain the jaw closed.
- There are patients who have experienced irritation on the nasal bridge and forehead due to the mask pressure.
- It is not the perfect model for those patients who constantly suffer from allergies or cold since they can experience nasal congestion and the mask may cause uneasiness.
- Patients who have been diagnosed with the following conditions: Turbinate hypertrophy, nasal valve collapse or deviated septum, should not opt for this model, as it can lead to respiratory problems.
Before getting a CPAP mask, there are some important aspects that need to be taken into account:
- The mask must be the correct size and should satisfy the requirements of the patient. This will allow the user to adhere to the CPAP therapy.
- When getting a mask, there should be no hesitation in taking help from a durable medical equipment (DME) technician, if needed. This person can provide assistance when selecting the ideal mask. If the mask acquired is not the best choice, the user can look for a different one.
- If the user has facial hair, the mask obtained needs to be able to avoid air loss or leakage due to irregular surface areas.
- To avoid interruptions, users should inform the DME technician while selecting the right mask if wearing glasses, reading, and watching television before sleeping is part of their nighttime habits. This will allow the user to obtain a mask which provides a better field of view.
- It is important to let the DME technician know if the user moves a lot throughout the night so that the mask acquired is one that can be securely fastened.
- Patients must let the DME technician know if they suffer from claustrophobia or if there is an area on their face that is prone to irritation.
- Inspection of the mask is needed to know if cushions and/or other parts need to be replaced.
- There are various kinds of cushions made out of cloth, silicone, gel and foam, to enhance the mask comfort level. Patients must figure out which one best suits their needs, to have a better experience during their CPAP therapy.
“Significant knowledge gaps still exist pertaining to the role of the interface in PAP acceptance and adherence. Mask comfort is likely among the more important factors that can significantly influence the ability to use CPAP, particularly in the period immediately after initiating therapy, which may determine long-term adherence. Masks come in several sizes and styles, most of which fit into the categories of full-face/oronasal masks, nasal cushion masks, and nasal pillows. Choosing a comfortable and effective mask is critical in order to provide a new CPAP user with a good chance of long-term success, and yet despite this, there are no clear guidelines for selecting masks. Furthermore, robust prospective data that address this elementary issue are lacking. Few labs employ a systematic procedure for mask choice, and there are no readily available objective assessments that can be employed in a clinical setting. Thus, mask choice is a highly variable and subjective procedure.” (5)
Looking for the right mask can sometimes become a real hassle, but with the appropriate help and guidance, users can be sure to find the right mask to satisfy their needs and help them adjust to CPAP therapy.
“Identification of predictors of CPAP adherence is critically important given the many unwanted negative consequences of untreated OSAHS (Obstructive sleep apnea-hypopnea syndrome), such as deficits across multiple cognitive domains,hypertension, type II diabetes, stroke, reductions in quality-of-life for both the individual with sleep apnea and his or her partner, increased rates of psychological disturbances, and increased mortality risks and economic burden. These negative consequences are striking when viewed in context of the extremely high nonadherence rates associated with CPAP therapy. Approximately 50% of patients prescribed CPAP are completely noncompliant with therapy recommendation. In addition, 15% to 30% of patients with a new diagnosis of OSAHS (Obstructive sleep apnea-hypopnea syndrome) reject CPAP treatment prior to ever receiving a CPAP machine. In general, the pattern of CPAP adherence over time has been described such that the majority of CPAP dropouts occur early in treatment, with relatively fewer patients discontinuing use as time with CPAP increases.” (6)
(1, 3, 4) New developments in the use of positive airway pressure for obstructive sleep apnea. Donovan, L.M., Boeder, S., Malhotra, A. & Patel, S.R. Journal of Thoracic Disease. 2015. http://jtd.amegroups.com/article/view/4955/5208
(2) Patients’ preferences and the efficacy of a hybrid model of a minimal contact nasal mask in patients with sleep apnea treated with CPAP. Blanco, M., Jaritos, V., Ernst, G., Salvado, A., Nogueira, F. & Borsini, E. Sleep Science. 2018. http://sleepscience.org.br/details/523/en-US
(6) Adherence to Continuous Positive Airway Pressure in Existing Users: Self-Efficacy Enhances the Association between Continuous Positive Airway Pressure and Adherence. Dzierzewski, J.M., Wallace, D. N. & Wohlgemuth, W.K. Journal of Clinical Sleep Medicine. 2016. http://jcsm.aasm.org/ViewAbstract.aspx?pid=30454