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By: Rita Brooks on December 20th, 2017

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Which CPAP Mask is Best for Your Patient? Pros & Cons of Various Mask Types

Sleep Technologist Advice

Sleep disorders have been a huge health problem in the U.S., including sleep apnea. In fact, around 22 million Americans are currently suffering from sleep apnea and 80 percent of these sleep apnea cases are moderate to severe undiagnosed obstructive sleep apnea (OSA).

Society is finally recognizing sleep apnea as the dangerous and life-threatening disease it is. There's still a great deal more that needs to be done, however, in recognizing its dangers and treating it. One particular common and standard treatment for sleep apnea is continuous positive airway pressure via a CPAP mask.

Patients wear a CPAP mask during the night over their nose or nose and mouth. The masks connect to a small machine with a hose. The machine pumps pressured air into the patient’s airway to keep it open while they're sleeping.

Continuous positive airway pressure is a type of treatment proven effective for sleep apnea. Even though it is effective, compliance with this therapy continues to be problematic. In fact, up to 83 percent of patients don't comply with CPAP therapy. While the average CPAP use is around five to six hours a night, many patients use it fewer than four hours a night.

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Studies show that more than six hours a night of therapy leads to normal levels of self-reported and objectively measured daytime sleepiness, along with substantially improved daily functioning and memory. Yet, so many people don't use their masks for multiple reasons. In many cases, it's because it's not comfortable to wear. Therefore, it's important that your patient is comfortable with their mask.

Below are three types of CPAP masks you may want to recommend to your patients.

1. Nasal CPAP Mask

The nasal CPAP mask covers your patient's nose from the bridge to their upper lip area. This delivers an indirect airflow to the airway via the nasal mask and works well for patients who need higher pressure settings.

The nasal CPAP mask offers your patients many versatile options and is a popular compromise between the bulky full face CPAP mask and the lightweight nasal pillow.

A physician may recommend nasal CPAP masks to patients who:

  • Move around in their sleep a lot.
  • Need a higher pressure setting on their CPAP machine.
  • Want a good selection of mask options they can pick from.
  • Prefer a more natural airflow.

How Are Nasal CPAP Masks Used?

Nasal masks are popular among patients who wear CPAP masks since there are many fits and sizes available.

Pros of a Nasal CPAP Mask

Some pros of nasal CPAP masks include:

  • Indirect and natural airflow.
  • Work better than nasal pillows for higher pressure settings.
  • Various styles to cater to almost any type of facial feature and structure.
  • Good if your patient moves around in their sleep or sleeps on their side.

Cons of a Nasal CPAP Mask

Nasal CPAP masks do come with some downsides. They're not a great choice for patients who are mouth breathers, unless they are used with a chin-strap that keeps their jaw and mouth closed. In some cases, users may experience some irritation from mask pressure on their forehead or the bridge of their nose.

If your patient has a cold or a history of allergies, blockage of their sinuses can be a problem in the delivery of the pressure. 

A nasal mask may not be the best choice for your patients who find it hard to breathe through their nose due to certain medical conditions, like a deviated septum, narrowed or collapsed nasal valve, or enlarged turbinates.

2. Nasal Pillows

Nasal pillows are a compact and lightweight option for your patient with designs that allow minimal contact with their face. They work best with prescriptions of low-to moderate pressure settings, since airflow that is direct to the nostrils may be uncomfortable at high settings.

A physician may recommend nasal pillows to patients who:

  • Toss and turn in their sleep.
  • Experience claustrophobia when wearing larger masks.
  • Breathe through their nose.
  • Have a lot of facial hair.

How Are Nasal Pillows Used?

Nasal pillows rest at your patient's nostril entrance and create a seal that directs the pressurized air directly into their nose.

Pros of Nasal Pillows

Some pros to nasal pillows include:

  • Some patients like to watch television or read before they go to sleep, and regular CPAP masks could make it harder to do this. Nasal pillows provide more open vision than full face masks or traditional nasal masks.
  • Patients may wear their glasses when wearing nasal pillow masks since there's no coverage over the bridge of their nose.
  • Nasal pillows provide minimal facial coverage and are lightweight which is why many patients with claustrophobia prefer them. Patients also like the fact these masks don't have a lot of material touching their faces.
  • Nasal pillows reduce air leakage since they direct air into the patient's nasal passages.
  • These work well for patients with a beard or mustache.

Cons of Nasal Pillows

Nasal pillows are not ideal if your patients require higher pressure since they direct airflow into their nasal passages and this could be uncomfortable. Some patients may experience higher incidences of nosebleeds or nasal dryness due to the direct air pressure. If your patient isn’t used to breathing out of their nose, nasal pillows not be ideal for them. However, if they are mouth-breathers and they prefer the nasal pillows, they can be used with a chin-strap.

3. Full Face CPAP Mask

Unlike nasal masks and nasal pillows that seal on the nose exclusively, the full face mask covers your patient’s mouth and nose. They cover a larger area of your patient's face to create a CPAP seal over both airways. Although some patients may find the bulky size of these masks a bit uncomfortable, they're the perfect solution for those patients that require higher pressures or if they breathe through their mouth.

A physician may recommend full face CPAP masks to patients who:

  • Breathe through their mouth primarily.
  • Need a high-pressure CPAP setting.
  • Have allergies or other medical issues that make it difficult for them to breathe through their nose.
  • Sleep on their back.

How Are Full Face Masks Used?

These full face masks cover your patient’s mouth and nose and much of their face using side straps to keep their mask in place. 

Pros of a Full Face CPAP Mask

Full face CPAP masks are good for patients who breathe through the mouth. Patients with frequent congestions due to cold symptoms or allergies or nasal obstructions will benefit from these masks. Claustrophobic patients often prefer full face masks that cover their entire face, oddly enough, since they only touch the outside of their face. This is opposed to nasal CPAP masks and nasal pillows that touch the patient’s bridge of the nose and upper lip of fit directly into the nostrils.

Full face masks work well for higher CPAP pressure settings since the wider mask surface area makes the pressure seem less direct and more tolerable to the patient. These masks are ideal for patients who sleep on their back since this position is best for an optimal air seal with a full face mask.  But, the extra support and straps help even restless sleepers keep their mask in place.

Cons of a Full Face CPAP Mask

Some full face mask cons include:

  • Higher chance of air leaking due to larger surface area.
  • Some patients complain about irritated, dry eyes due to air leaking from the top of their mask.
  • The mask bulk makes it hard for patients who like to sleep on their side or stomach due to the bulk of the mask and likelihood of it being dispaced in these positions.
  • The mask makes it hard for patients to wear glasses to watch TV or read.

What Advice Should you Give to your Patient When Assisting Them to Make a CPAP Mask Choice?

Some advice you may want to give your patients includes:

  • Keep their focus on the health benefits of the therapy.
  • Talk with their sleep partner about any concerns they may have.
  • Get educated on sleep apnea and the benefits of CPAP therapy.
  • Tell their sleep physician if they're having trouble with their mask or equipment.

Fit, size, and comfort are essential considerations when your patients are selecting a CPAP mask. If their mask isn't comfortable, doesn't fit, or doesn't meet their breathing requirements, it's likely they won't stay compliant with their CPAP therapy. Be sure to go over the most suitable masks or alternative interfaces for your patients and let them know that there's nothing wrong with changing to a different mask later on, if needed.

Let them know that the wrong interface may lead to non-compliance to their CPAP therapy and they should work with their sleep technologist to assure the best mask for their needs. Let your patients know they have a lot of cushion options available to them such as foam, gel, cloth, or silicone, so they can find a mask that's most comfortable for them. 

As with any medical disorder, when your patients are educated on CPAP therapy and are proactive in their CPAP treatment regimen, they're more likely to find success. Encourage your patients to stay positive about their treatment. Once they get their sleep apnea diagnosis and start their treatment, they're on their way to being more alert, having better overall health, and living a better life.

Key Takeaways:

  • More than 22 million Americans suffer from sleep apnea.
  • Finding the best CPAP mask or alternative interface is important for your patients' treatment success.
  • Patients are more likely to stay compliant with their CPAP therapy if their mask suits them well.
  • Patients can always change their mask at a later date if needed.
  • Providing your patients with CPAP education and encouraging them to be proactive in their therapy will increase their chance of success.

PAP adherence is important. It increases the likelihood of successful treatment. That’s why it’s essential that you educate yourself on how to increase and better monitor PAP compliance in your patients.