Selecting the appropriate continuous positive airway pressure (CPAP) therapy consists in acquiring the right CPAP mask. But finding a fitting one can be complicated since numerous models are available in the market. CPAP Masks have constantly evolved from the first models.
“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
Therefore, finding a suitable mask could be challenging, as each patient has different respiratory needs, sleep practices, routines, and standards.
“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 the 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
The following are some of the advantages and disadvantages of the CPAP masks currently available in the market.
Full Face Mask may go over the entire face or part of it. These are manufactured with straps on the sides to maintain in place. Hybrid masks have prongs that enter the nasal cavities, similar to nasal pillows.
Advantages of Full-Face Masks
Some advantages that full-face masks offer include:
- Patients who breathe through the nose prefer full face masks and those who feel uncomfortable wearing nasal masks with chin straps.
- These masks suit people who constantly suffer from nasal congestion due to allergies or cold.
- Patients with elevated CPAP pressure configuration find them suitable because of their wider surface area which makes the pressure more bearable and less direct.
- Specialists recommend it to patients who sleep on their backs since this position allows getting optimal air seal. Additionally, the straps in the full-face mask maintain the device in place, providing extra comfort and support to uneasy sleepers.
- 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 touch the upper part of the lip, philtrum and/or nasal bridge.
Disadvantages of Full-Face Masks
Some disadvantages of full-face masks are:
- Several patients say that air escapes from the upper part of the mask, which can generate irritation and dryness in the eyes.
- Some patients with claustrophobia cannot stand the weight and material, while others with the same condition wear them normally. ➧ Wearing a full-face mask might bother some patients since it disturbs their reading, wearing glasses and watching television.
- Full face masks may be unsuitable for patients who sleep on their stomachs since its bulkiness causes uneasiness while sleeping.
“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 is 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 the first choice. However, given the wide range of facial structures and nasal pathology, it is important to tailor mask choice to patient preferences.”3
Their minimalistic layout makes them the preferred choice for several patients who deal with CPAP therapy. Nasal pillows are smaller than the average mask as they rest on the upper lip. These masks come with two tubes that blow pressurized air into the nasal cavities. Straps around the head hold them in place.
Advantages of Nasal Pillows
Nasal pillows have the following advantages:
- Slim and minimalistic layout, suitable for those with claustrophobia or unease with excessive weight and materials on their faces.
- They give a better field of view in comparison to other masks. Nasal Pillows are suitable for patients who enjoy reading or watching television before sleeping.
- Patients wearing glasses also benefit from them since these do not cover the nasal bridge.
- Patients who move around in bed throughout the night find them comfortable.
- Patients with facial hair state that nasal pillows prevent air loss, unlike other CPAP masks.
Disadvantages of Nasal Pillows
Some disadvantages of nasal pillows are:
- Specialists do not recommend them to patients who require high-pressure airway since they provide direct airflow and may cause inconveniences if patients use it at higher pressures.
- Nasal pillows deliver a more direct pressurized air, which may cause dryness and irritation inside the nose in certain patients, leading to nosebleeds.
- They are uncomfortable for patients who regularly breathe through the mouth. However, if the person is willing to use a nasal pillow, he or she can try wearing it along with a chin-strap. If nose breathing is unusual for the patient, wearing a nasal pillow may cause uneasiness.
Nasal masks, just like nasal pillows, are discouraged for patients who are used to breathing through the mouth. Specialists advise wearing them along with a chin-strap to maintain the jaw closed. The following are some considerations for nasal masks.
- A number of patients have experienced irritation on the nasal bridge and forehead due to the mask pressure.
- Patients who constantly suffer from allergies or cold can experience nasal congestion and the mask may cause uneasiness.
- Patients with the following conditions: Turbinate hypertrophy, nasal valve collapse or a deviated septum, should not opt for this model, as it can lead to respiratory problems.
Considerations before acquiring a CPAP Mask
Before getting a CPAP mask, consider the following aspects:
- The mask must be the correct size and should satisfy the requirements of the patient. This promotes adherence to CPAP therapy.
- Seek or accept help from a durable medical equipment (DME) technician, if needed. This person can provide assistance when selecting the mask or recommend a different one if the one acquired is not the most suitable choice.
- If the user has facial hair, the mask should prevent air loss or leakage due to irregular surface areas.
- Users should inform the DME technician if wearing glasses, reading, and watching television before sleeping is part of their nighttime habits. This will allow the user to obtain a mask that provides a better field of view.
- Inform the DME technician if the user moves constantly throughout the night so that they select one with fasteners.
- If the patient suffers from claustrophobia or if an area on their face is prone to irritation.
- Inspect the mask to know if cushions and/or other parts need replacement.
- Patients can choose between various kinds of cushions (cloth, silicone, gel, and foam) to enhance the mask comfort level and improve their experience with 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
Predicting CPAP Adherence
“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 the context of the extremely high nonadherence rates associated with CPAP therapy. Approximately 50% of patients prescribed CPAP are completely noncompliant with therapy recommendations. 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
Finding a suitable mask can be difficult, but with the appropriate help and guidance, users can select the right mask to satisfy their needs and help them adjust to CPAP therapy.
(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
(5) CPAP Use: Unmasking the Truth about Interface. Budhiraja, R. & Bakker, J.P. Journal of Clinical Sleep Medicine. 2016. http://jcsm.aasm.org/ViewAbstract.aspx?pid=30774
(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