How to Choose a CPAP Mask

There are hundreds of CPAP masks available in all shapes and sizes. Patients with sleep apnea frequently ask me which is the best one. If you ask 100 different patients, you will probably get dozens of different answers, so don’t make a decision based on what other people wear. All CPAP masks are FDA-approved and should therefore work. I believe the most important consideration in picking a mask should be patient comfort. Unless a patient has an idea of which mask they want to use, I write “fit mask to comfort” on the prescription. In this Advanced Respiratory and Sleep Medicine blog article, I explain how to choose a CPAP mask.

Breathing through the mouth and nose.

One piece of false information that I hear frequently is that is if you open your mouth while you sleep, you must wear a full face mask. This is not true for several reasons. First of all, when humans are born, we are default nasal breathers because it aids in breastfeeding. Mouth breathing is an adaptive behavior that occurs with chronic nasal obstruction. Second, anyone who has sleep apnea is going to open their mouth at night. When humans are struggling to breathe, we open our mouths. Therefore anyone with sleep apnea should open their mouth at night. However, once the obstruction is relieved by a CPAP machine, most people return to breathing through the nose.

“Full” face masks.

Finally, when CPAP was first described as a treatment for sleep apnea, the setup resembled nasal pillows. Masks that cover the nose and mouth (called oronasal or “full” face masks) were discouraged because they pushed the mandible posteriorly, which worsens airway obstruction and increased the pressure required for CPAP therapy. Since then, “full” face masks have been shown to work and are necessary in some cases, even with higher pressure requirements.

The other reason full face masks are promoted is because reimbursement (payment from an insurance company) is higher for full face masks than nasal masks. Unfortunately, most medical decisions in our current system are based on money rather than research or patient preference.

Trial and error.

Even with a good mask fitting, you may not end up with the optimal mask for you. Getting the right mask is often a process of trial and error. Be sure to take advantage of the 30-day mask replacement guarantee that is offered by the big mask manufacturers. Finding the right mask for you is an important part of the learning curve that comes with getting used to CPAP.