Mask Primer

an informational post - a work in progress - suggestions are welcome

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 CPAP.COM.
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.
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
b. incorrect assembly
c. incorrect size
d. your mask is worn out and needs replacement


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.

great info. thanks.

i wish i would have found this forum a month or so ago.

really appreciate all the advice on here.

cheers

Interesting post, but, all this information is already spelled out by cpaptalk wiki at the top......

wiki/index.php/CPAP_Mask

LSAT wrote:Interesting post, but, all this information is already spelled out by cpaptalk wiki at the top......

wiki/index.php/CPAP_Mask

give the guy a break, he's only been a member for eight years, he probably didn't have time to read it

LSAT wrote:all this information is already spelled out by cpaptalk wiki at the top......

Oh...you mean that area where if people would take the time to read stuff they might find the answers to questions and not have to repeatedly post the same questions here on the forum? Novel idea.

People don't take the time to read anymore. They want to be spoon fed all the answers and not do any work like reading much less searching for what to read.

Now we do sometimes get a question that hasn't been covered before but it's rare.
Most of the time it's been covered a gazillion times already. Hell...sometimes even in the very same thread they post in...that just irritates the crap out of me when the answer is right above their post.

palerider wrote:

LSAT wrote:Interesting post, but, all this information is already spelled out by cpaptalk wiki at the top......

wiki/index.php/CPAP_Mask

give the guy a break, he's only been a member for eight years, he probably didn't have time to read it

I love you too.

Pugsy wrote:They want to be spoon fed

that just irritates the crap out of me when the answer is right above their post.

Shocked to hear you say that, because I have always admired you as the All-Time Patient Spoon-Feeder Queen.

The Choker wrote:

Pugsy wrote:They want to be spoon fed

that just irritates the crap out of me when the answer is right above their post.

Shocked to hear you say that, because I have always admired you as the All-Time Patient Spoon-Feeder Queen.

+1

bonjour wrote:

palerider wrote:

LSAT wrote:Interesting post, but, all this information is already spelled out by cpaptalk wiki at the top......

.

give the guy a break, he's only been a member for eight years, he probably didn't have time to read it

I love you too.

xCareful he has a cult following

bonjour wrote:

palerider wrote:

LSAT wrote:Interesting post, but, all this information is already spelled out by cpaptalk wiki at the top......

wiki/index.php/CPAP_Mask

give the guy a break, he's only been a member for eight years, he probably didn't have time to read it

I love you too.

doesn't really have anything to do with love, just that it's a little silly, or maybe self important? to spend a lot of time duplicating something that's already part of the board reference materials, in a post that'll just get buried with the other 1,091,002 posts in 108,590 topics, (as of this moment).

We would all have a crappy life if we didn't have some feeling of importance.

Even if it is redundant information it all seemed concise and good to me. No harm in having another source of information from a different perspective. Every forum I've been on provides links to multiple sources for the same information.

I'm new to the forum and was trying to find the mask information you all were referring to. I finally gave up and used the link posted earlier. There's no way I would have found it without someone pointing it out.

I've been surfing around the site for the last few weeks, reading various things. There's so much information about apnea that it makes your head swim. Way more than my sleep deprived brain can absorb in the near future. I suspect that's why many people take the short route. Also I suspect most people that come here are pretty desperate to get some relief. They pretty much have lost all the patience that they once had.

Luckily we have some good folks here that are willing to help out by taking on the monumental task of answering the same questions over and over and over.....and point people in the right direction. Sometimes it makes you a little callous, sometimes it costs you your sanity, but you persevere and help those in need. Your efforts don't go unnoticed. Thank you so very much.

I have been perusing this forum and reading as much as I can about sleep apnea and cpap since last summer. I didn't know about that info at cpap.com until that link was mentioned in this thread. I found the information posted by Bonjour helpful and I am happy it was posted here. I'm sure it does get old for members who have been involved in this forum for a very long time to hear the same information again and again. But for some of us who are newer, it is appreciated. Thank you to all of you more experienced Cpap'ers for sharing what you have learned and what has helped you along the way. It really is a huge help to us who are newer on this path.

the point, which you two seem to be missing, is that this thread, given a couple of days, will fade into obscurity, unless someone keeps pointing it out, whereas the wiki, should anybody ever bother to look in there.... is always right up there at the top of the page.

This is good work, but as mentioned it's just the wrong mechanism (unless the thread were made a sticky, and that would be redundant with the wiki). If I were you, I'd go take a look at the wiki and see where your guide might be an improvement, then make those changes in the wiki. Anyone can do so (at least in theory... I am having some trouble logging into the wiki this morning). See the help pages off the wiki home page for guidance on editing and style.

Is anyone else having a problem editing the wiki right now? When I went to try to edit a page this morning I didn't have the edit tab at the top. I tried logging in to the wiki explicitly (with cpaptalk.com credentials), and no-go. It''s not recognizing my password. I double checked to make sure my password manager was filling in the password properly (and tried manually as well).

One thing I haven't said is I'm targeting this as a wiki article, but I'm not ready to submit it as such yet. Apparently individuals like it but this is not wanted here. No problem. Personally I don't like tone of the wiki article here. Just not my way to present.