This is a work in progress, but this seems like a good place.
Mask Primer
Getting the right mask is one of the hardest parts of PAP therapy. This article is intended to help guide you through your choice of a mask.
First, all masks can and do handle all pressures associated with PAP therapy machines, this is from 3 to 20 (CPAP) or 25 (BiLevel/BiPAP) cmH2O.
Second, each of us has a different facial structure. This means that what works for me may or may not work for you, and what works for you may or may not work for me. You have to TRY the masks to see what works for you.
Third, You will have to try masks to see what works for you.
I’m going to call out 1 particular online vendor for 2 reasons. First they list masks by popularity within the mask type. This means that you can assume that the more popular masks work for more people. The second is that they offer “return insurance”, some free, some low cost, so that you can return a mask that does not work for you. That Vendor is
Supplier #1.
Your DME is an excellent resource to try different masks. Use them for this purpose. Make an appointment for a mask fitting. If you are using a DME it is their job to help you use your PAP system for effective therapy. If the mask doesn’t fit or is extremely uncomfortable they are not doing their job.
A Mask Trial Strategy
First, even a mouth breather can use ANY style of mask, even the simplest, most unobtrusive, Nasal Pillow. See the
Mouth Breathing section to see what to do.
Try masks from the most unobtrusive to the biggest bulkiest of masks. This would typically be starting with Nasal Pillows, Nasal Mask, Hybrid Masks, then finally the Full Face Mask. The smaller masks that you start with leave you with less mask on your face and more visibility.
Finally, as I have said before, you have to try masks on, under pressure, and preferably lying down in sleeping position.
Mask Types
Nasal Pillows
Nasal pillows rest under the nose covering the nasal openings and sealing against them. This mask style is among the least intrusive of all masks. Typically they easily seal and have very low mask leak rates. The main disadvantage of this style is with the light touch if you are a very active sleeper the headgear can shift and cause a mask leak. Generally these masks are for non-mouth breathers. There are ways (chin strap, cervical collar, tape) to eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from bulky to minimal, and they will fit differently. The only way to tell what works for you is to try them.
Size matters. Try the different sizes, I have trouble with the small and the medium here, the large works for me. This may differ depending on brands
Some users do not like anything touching their nose. I’d try a pillow to see if this is an issue for you. Don’t assume.
Nasal Prongs
Nasal Prongs are similar to Nasal Pillows except for the fact that they actually sit inside your nose and expand slightly to seal. Nasal Pillows have mostly replaced Nasal Prongs in the marketplace. This mask style is among the least intrusive of all masks. Typically they easily seal and have very low mask leak rates. The main disadvantage of this style is with the light touch if you are a very active sleeper the headgear can shift and cause a mask leak. Generally these masks are for non-mouth breathers. There are ways (chin strap, cervical collar, tape) to eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try them.
Size matters. Try the different sizes, I have trouble with the small and the medium here, the large works for me. This may differ depending on brands
Some users do not like anything in their nose. I’d try a prong to see if this is an issue for you. Don’t assume.
Nasal Mask
These masks cover the nose from the upper lip to the bridge of the nose. The volume of these goes from minimum, just barely covering the nose with minimal volume otherwise to considerably bigger. Most have a hard mask mount up to the forehead, but a few do not. These tend to have mask leaks a bit larger than the Nasal Pillows or Nasal Prongs. This is because they have more area to seal. With this type of mask it is important to try them because of the difference facial structures. You have to find what works for you. Again these are mostly for non-mouth breathers. There are ways (chin strap, cervical collar, tape) to eliminate mouth breathing and allow you to use this type of mask.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands
Hybrid Masks
Hybrid masks are mix between a Full Face Mask, for the mouth, and Nasal Pillows for the nose, all incorporated into one mask. These masks are growing in popularity because there is NOTHING on the bridge of the nose and nothing blocking vision. The mask does not extend above the bottom of the nose. Like the FFM below this style mask is primarily for mouth breathers.
Like all masks, Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands
Full Face Mask (FFM)
The primary purpose of the Full Face Mask is to eliminate the need to correct for mouth breathing. The FFM covers the nose in a manner similar to a Nasal Mask but the lower seal is below the lips so it surrounds the entire mouth and nose. This is the traditional method of solving mouth breathing. These masks are bigger than most other masks and because of their size have more area to seal. Generally the bigger the mask the higher the mask leak will be.
Brands are different. The headgear can be anywhere from minimal to bulky and they will fit differently. The only way to tell what works for you is to try.
Size matters. Try the different sizes. This may differ depending on brands
One specific FFM I will call out is the Amara View. I’m not saying that this mask is better than any other mask. This mask seals differently than other full face masks so it is one to try if you are having trouble finding one that fits and works for you.
OK, one more. The “Total” Face Mask. This mask covers the entire face including the eyes and is occasionally used when other choices are not working.
Mouth Breathing
Mouth Breathing is when you open your mouth and the air pressure from your PAP is venting out your mouth typically showing on your charts as a large leak which can substantially negate the effectiveness of your therapy. It is generally not good. The solution varies depending on the person
How to manage Mouth Breathing, not in any particular order.
Tongue Trick. Place the tongue on the roof of the mouth, Practice during the daytime. The idea is to train the tongue that this is a good place to be, not overnight, but it works for some.
Chin Strap. A chin strap is to manage mouth leaks from a variety of causes. Most result from the jaw dropping or opening either partially or wider. The chin strap is to gently keep the jaw closed. If you have to crank it shut to make it work this is not the correct solution. Note that your jaw is strong enough to open if it wants to.
Cervical collar. A Cervical Collar may also be used to keep the jaw from dropping.
Mouth Guard. The concept here is a closed mouth guard to keep the air from leaking out.
Taping. The purpose of taping is to seal the lips and prevent mouth leaks / mouth breathing. It is not to stop the mouth from opening. I make sure that I can easily open my mouth, when taped, if I need to.
FFM – Full Face Mask or
Hybrid Mask. This is a very traditional solution and it is generally effective.
Mask Leak Prevention
There are, somewhat arbitrarily defined, three kinds of leaks.
1.
Mouth Leaks. These are addressed in
Mouth Breathing, not here.
2.
Vent Leaks. This is a designed leak with the purpose of eliminating CO2 from the mask, it MUST be there.
3.
Mask Seal Leaks. This is the purpose of this section
a.
incorrect adjustment --- see Fitting a Mask
b.
incorrect assembly --- Owners manual
c.
incorrect size
d.
your mask is worn out and needs replacement
e.
your hose pulled it to a side
f.
facial features
Mask Seal Leaks.
Bridge of Nose – A common issue is air blowing into the eyes. Pick up the nask and lower it on the nose than gently move it up allowing the seal .
First and foremost it is important that a mask fits.
All PAP masks leak, it’s just a question of how much.
Fitting a Mask
Let’s get started
1.
While sitting place the mask on your face with all straps loose and the forehead piece is extended
2.
Turn on your PAP, your mask should be leaking like the proverbial sieve.
3.
Lay down on your back and listen, get a feel for the leaks,
4.
I place my hand on a mask and place it on my face, shift its position slightly as needed. If I can’t establish what feels like a comfortable seal at this stage I may reject the mask and try another
5.
Adjust the bottom straps, make sure they are even, tighten until either under the mouth just seals (Full Face) or under the nose just seals (Nasal)
6.
Evaluate, is the mask leaking? Are you comfortable? The mask should be easily and comfortably resting on your face. If it hurts, loosen it.
7.
You will likely have minor leaks, try these easy fixes
a.
run your finger around the mask to ensure the seal is folded under to allow it to form a seal.
b.
For leaks near the eyes, lift the mask from your face a bit, and lay it back down on your face a little low on the bridge of your nose, then slide the mask up a bit to the bridge of the nose to where you want it. That should turn the edges of the mask under and seal any minor leaks while making the mask more comfortable to the nose.
c.
For leaks under the lower part of the nose you can try twitching your mouth and nose every which way you can.
8.
Now test for leaks while on your side, both sides.
9.
Remember it only has to be as tight as you can handle comfortably. If you can't form a comfortable seal then you need a different mask.
10.
Adjust the forehead piece until it is comfortably resting on the forehead
11.
Tighten the top straps, you do NOT want the forehead piece to be digging in
12. The mask should fit comfortably,
not tight.
Fitting points
Modern masks are designed to fit “loose”, NOT tight. Too many users over tighten their masks thinking if I tighten it just a little bit more I’ll stop that leak. Generally this means one of 2 things, either you have over-tightened the mask or it is the wrong size. It’s a fine line.
PAP Mask Fitting Guides coming soon
