CPAP mask

A CPAP mask is worn on your face and attached with headgear. CPAP masks receive air through a tube which is attached to a CPAP machine. Properly fitted masks should be comfortable, leave no red marks and seal completely. CPAP masks come in a variety of types, of which the most popular are the traditional nasal and the new nasal pillow style.

Mask Types

Images of masks worn by real users, can be found here: Mask types

For help in obtaining the proper mask size & type, go here: Mask Primer

Mask Leaks

Air leaks are caused by masks that are too big, too old, or just the wrong style. Air leaking into the eyes is usually an indication that the mask is too big (long) as are leaks at the base of the nose. Leaks may also occur under the nose due to facial hair. As the silicone in the mask cushion ages, it deteriorates and becomes too soft to hold a seal. For many masks, you can get a replacement cushion. You may be able to tighten it enough to stop the leaking when you go to sleep, but during the night it will loosen and leak. Mask Leaks may also be caused by the pillow pushing against the mask and changing the position of the mask. There are special CPAP pillows which are are designed to minimize the contact of the CPAP mask with the pillow, even when you are sleeping on your side. Go to Mask leak solutions for additional help.

Mask Care and Cleaning

Masks should be washed daily in warm water with baby shampoo and left to air dry. Never use antibacterial soap as it will break down the silicone of the mask. Avoid soaps with lotion or lanolin which can coat the mask and cause it to lose its seal. Remember to go to bed with a clean face, this will improve your seal and protect the lifespan of your mask. The best time to clean your mask is in the morning so that the oils from your skin are removed.

Mouth Breathing Issues

If you are a mouth breather, you can wear most masks with a few adaptations. The nasal pillow, nasal prong or nasal mask can be worn with a chinstrap. A full face mask or hybrid mask can be used without a chinstrap because the seal covers your nose and mouth. A full face mask will allow you to breathe through your mouth or through your nose. If you have or develop chronic sinus problems, a full face mask or an oral face mask are the ones to try. Oral masks work best for mouth breathers with blocked nasal passages. You must use a heated humidifier with the oral mask.

Side or Stomach Sleepers

Sleeping on your side or stomach is preferable to sleeping on your back because sleeping on your back worsens all forms of sleep-disordered breathing. However, sleeping on your side or stomach can present problems to CPAP therapy. Both positions can put pressure on one side of your mask increasing your leak rate. Your options are to (1) try a mask that other side sleepers like (2) try bed pillows made for CPAP users.

Mask Replacement Schedule

Medicare allows for Pillow and Nasal mask cushion replacement twice (2) a month, Full-Face Mask cushion once a month, the mask frame every three (3) months, and the headgear every six (6) months. CPAP manufacturers and vendors suggest these replacement schedules as well. Most mask cushions begin to deteriorate after about a month of use. The silicone eventually becomes too soft to hold a seal and headgear straps must be tightened more and more to get the same quality seal. Replace cushions and pillows as soon as they start to soften. Air leaks may reduce the effectiveness of CPAP therapy and headgear that is too tight may cause facial sores at pressure points. You can also replace the headgear of your mask if it is stretched out or the Velcro worn out.

Air Leaks from Mouth

Air leaks happen from the mouth whenever the mouth is opened during CPAP therapy. This occurs for many reasons, but a very common one is due to nasal irritation from the CPAP airflow. The correlation between a lack of humidification and mouth leaks is a topic being heavily researched. Studies are now being conducted on the hypothesis that a large amount of mouth leakage is caused by the following cycle:

   * CPAP therapy is used with ineffective or no humidification.
   * The nasal membranes are unable to adequately condition the increased airflow and after a few minutes the airway and nasal passages become dry.
   * To remedy the dryness and obtain moisture, the body uses the mouth to breathe.
   * CPAP air follows the path of least resistance and leaks out of the open mouth.
   * The air leaking through the mouth causes more dryness.
   * Patient wakes up feeling tired with significant dryness in mouth and dry, swollen nasal passages. 

The answer to this cycle is humidification. If the mouth continues to open during sleep, a chinstrap may be needed to hold the jaw up so that the mouth can close. If mouth breathing continues, a full face mask, hybrid mask, or oral mask is suggested.

CPAP Masks and Beards

Full Face Masks work well for CPAP users with full beards. One tip is to smooth the beard with lanolin where the seal makes contact. Nasal Pillow Masks are also liked by full bearded CPAP users. If you are a mouth breather remember to use a chinstrap. Total face masks encompass the entire face and can be an option for people with facial hair. Masks with a gel or foam cushion can also be better with facial hair to be able to mold better to the face to create a seal.

Nose Irritation

Sores at the bridge of the nose or below the nose are usually due to tightening the headgear straps too much. The pressure will create soreness, then a bruise, and may eventually create an open sore if left untreated. Headgear is usually tightened too much to reduce or eliminate air leaks. A small degree of this may be necessary, but too much is an indication that the mask is too large, too old or just the wrong style. If your mask is six to nine months old and the silicone is becoming too soft to hold a seal, try replacing it.

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