Things to think about when looking for your first CPAP mask

This post is aimed at all of you newbies. If you are in the midst of the struggle to find a mask, I hope some of this helps you. At the very least, maybe it will let you know you aren't the only one trying to figure all of this out.

Welcome to the search for your perfect (or good enough) mask. It's your specific mask, because it has to fit your face and not drive you to distraction all night long.

I haven't found the perfect mask for myself yet, but since I'm still in the search the memories of what has worked and not worked are fresh in my mind.

As you'll read on the other cpaptalk.com posts, people vary greatly on what is "comfortable" for them. It is more complicated then it sounds. It is also more important than it may sound at first. It seems like most people try a few masks before they get what they like or at least verify that what they started with is the best fit for them. Having read lots of posts and tried lots of things in the past 6 weeks, it appears most people agree you need to lock down a good or at least acceptable mask first and then all of the other tweaks and adjustments will be around your specific mask. The mask doesn't have to be perfect, but it needs to at least fit and function pretty well for you. The fact that you aren't used to sleeping with a hose off the front of your head tends to exaggerate anything you don't like about the mask (at least it did for me).

If you are new to CPAP, maybe you've had the sleep study, but haven't seen your Durable Medical Equipment provider (DME) to purchase your equipment yet...

Try if at all possible to ask if you can borrow a mask, or better yet, two favorites to try for a week. I'd go as far as calling DMEs in your area before you get your equipment and tell them you are looking for a CPAP equipment supplier that can let you take a mask home for a few days to try. Their willingness to work with you may indicate a healthy partnership for your future equipment purchases. If you can't do loaners, I believe exchange or return insurance (if available) is well worth it until you have some idea what mask you want.

You can also look into the trial options on this website, but I don't see how that would work for a first mask since you have to have something to get started.

My DME did offer me two loaners along with my shiny new CPAP machine; I foolishly said no.

If you already bought your first mask and it is terrible for you, you may have one more option. If you truly cannot sleep with your mask, call your insurance and tell them. My insurance did let me get a 2nd mask within a week of starting CPAP because I told them I felt like "I could not breathe". My insurance said they allowed a 2nd mask in this situation as the CPAP machine was "medically necessary" and I couldn't use the machine without a mask.

-Be aware that the DME tech you are talking to may not use a CPAP machine. There is nothing wrong with a tech or salesperson who is not on CPAP, but keep in mind they may not have personal experience when you are asking your questions. If they don't use a CPAP machine, they still may have lots of great ideas, just not personally know how something feels.

Since I haven't found the perfect mask yet, a lot of the things below are what hasn't worked for me. I don't mean to sound negative, even with an imperfect mask fit, I am sleeping WAY better than before CPAP.

On to the specifics.

Obvious things to think about:
-Face shape - the mask has to contour to your face or nose enough to minimize leaks
-External nose size - you don't want excess pressure on your nose. My tech seemed to try find a size that was as small as possible without putting too much pressure on my nose.
-Internal nasal passage shape for pillows - not all tips fit the same in all shapes of nasal passages
-Head rest needs to hit the correct spot on your forehead
-Some masks work better for side sleeping than others (sometimes you can work around this with the right kind of pillow under your head)
All of the things above are fairly obvious, but you are putting a mask on your face and it feels weird. It is hard to be objective about what feels right at the DME, when the whole concept feels wrong (at first).

Less obvious:
-Just because it is comfortable at the DME for 5 minutes, doesn't necessarily mean you will like it after a few hours.
-The opposite is also true. A mask that feels claustrophobic at first, may be fine once you get used to it and have the air pressure blowing for a few minutes (or maybe a few hours if you are totally new).
-Some masks exhaust the exhaled air in a direction, volume or dispersal pattern that may bother you. You can sometimes work around this with blankets, pillows or hose hangers, but sometimes you can't.
-A few of us have found the nasal pillows don't feel like there is enough air flow at low minimum pressures (huge variation in what people find comfortable, I was probably on the high end needing about 9.5+ pressure for the pillows to feel like the air flow was high enough for me.)
-If you move around a lot, it gets complicated. I loved the nasal pillows, but so far haven't figured out how to keep the pillows I have on my face in a way that doesn't wake me up when I'm moving around. I go to sleep without a problem. After a couple hours when I'm partially rested, I wake up from the weird things the mask or hose are doing. Actually, that seems to be my problem with all the mask configurations I've tried so far.
-Hose management - a floppy hose bugs me, so does waking up with the hose wrapped around my head. I've bought the "HoseBuddy", but still haven't fully contained the hose issue for myself.
-My tech recommended a mask that flexed so I wouldn't knock it off when I sleep on my side and move against the pillow, but that also meant the mask flexed when I would inhale and exhale - which woke me up.
-Some masks have pliable gel that contours to your face throughout the night, some masks can be heated in hot water then pressed against your face for a less pliable "custom" fit.

Last and probably least relevant, my personal experience has been:
-Nasal pillows - I found this the most comfortable since it was the least stuff on my face, but I also got the least amount of sleep per night as various things would wake me up and I'd just end up waking up after a few hours. After awhile, sleep deprivation would drive me to another style. The nasal pillows came with several sizes, so trying various sizes was free. I'm still trying to figure out how to make pillows work.
-Nasal mask with flexible cushion against the face for "side sleepers"- this was okay and I used this for about a month, but the mask movement distracted me so I ended up tightening the mask down pretty hard to my face; thus defeating most of the intended flexibility.
-Just ordered a Gel "cushion" for my current nasal mask. Since it fits my existing nasal mask/frame, it only cost me $30 to try something different. (Since this one was with out of pocket $$$, I ordered it from CPAP.com, which is way cheaper than my local DME).
-I will probably purchase at least one more style, just to try it, when I hit 6 months and my insurance will pay for a new mask setup. Because I like the nasal pillows, but the floppy hose bugs me, if I need to try another mask I intend to try one of the pillow masks that attaches the hose to the headgear to keep the hose in place when I roll around (look at masks like the Swift LT on CPAP.com and you'll see what I mean). Some people have said this works really well in combination with a hosebuddy or your own homemade hose hook.
(Other people don't want the hose attached to their mask, so they choose the personal lesser of two evils and figure out how to contain the hose in a way that works for them.)

Good luck, fellow CPAPers!

Thanks for the post Java. Lots of great info there.

One thing I'd like to add is that getting from an okay mask fit to a great mask fit often takes a number of little custom personalizations.

For instance, when I first tried pillows they were okay. They delivered air, let me sleep alright on my side as long as I didn't dislodge them, and were not anywhere near as claustrophobic as I found the nasal mask I had been using for many years. They also had issues, mostly involving sliding off when I rolled over. Based on what I read here, I gradually tweaked them to overcome the various issues and make them more stable. I found using Astroglide or Lasinoh eliminated the tiny bit of irritation I had. I found they were much more stable using them in conjunction with a chinstrap. I found that using a pair of women's tights made them even more stable (search is your friend). I discovered that if they became impossible to seal in the early morning hours, it was because the back strap had slid up my head and I had to pull it back down to get the pillows to seal properly again. (I don't even know if that happens any more. If it does, I fix them without remembering it the next day.) I found that when using a buckwheat pillow, I wasn't continuously trying to readjust my head position to get comfortable and pulling the nasal pillows out. I found that running the hose down my body and tucking a short loop of tubing under the elastic of my shorts would keep the hose from pulling on the mask in a way that worked for me.

Now I find them really comfortable and stable and I hardly notice them. In fact, sometimes I don't. I'll start getting out of bed only to find that I'm dragging this hose with me, and it's only then I notice I still have the mask on. Getting this comfortable with them didn't happen overnight, and it did involve a bit of experimentation to find what worked for me.

There are lots of people on the board who have tried a wide variety of masks and can offer lots of little tips and tricks to try to turn an okay mask fit into a great mask fit.

Great information. Thank you. I should have read this 5 years ago.

With nasal pillows ( I wanted the least gear on my head) I found that my nostrils are shaped funny and although the largest size was the best (tighter fit less rubbing to make sores) it still didn't work because my nostrils are more oval shaped or slanted.

I have used the nasal mask since then with the forehead piece resting at my hairline. It was way too long but the medium cushion was great. I got a smaller mask but then the cushion smothered me (guess I have a short face with a big nose). I decided to tolerate the forehead piece going up to high rather than having my nose squished against my face. I can see why they wouldn't be able to make a mask to fit every possible face shape so it seems that you have to go with "best" fit rather than "perfect fit". I do sleep great with my medium mask but sometimes notice the forehead thing.

Although I agree that a tech who is a cpap user is great for not having to explain everything you are experiencing I had one who was a long time cpap user who was not fussy about equipment and I felt that I was being picky when I made a request. She was very kind but I still felt like "well if she can put up with a crappy old mask I guess I should too".

JointPain,

I've been slowly learning the tweaks from other people's posts as well. I was in my first pillow mask for only a couple of days at two of the different sizes before moving on to a nasal mask.

I was in the nasal mask for a full month, before going back to the nasal pillows to try a few more things to make that work.

Still not getting the nasal pillows to work and I'm back to the nasal mask again.

I'm not as advanced with the modifications you have mentioned, but by trial and error and building on other people's ideas I keep getting closer to a good night's sleep. Last night I slept all the way through the night for the first time in a few weeks, so that was a good night!

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Elle,

I hadn't thought about the fact that a DME person using a CPAP might work against you. I'm sure it was frustrating, but now that you mention it I can see how there is a danger of finding a person who says "well if I can put up with a crappy old mask, you should too".

I guess it makes sense that what is just "being picky" for one person, may for another person mean they truly can't sleep. It is all so subjective and we are all different.

It has been nice to hear so many people's ideas on this website. For every ten ideas I try, maybe only one works for me, but that still gets me closer to a good night's sleep!

JointPain wrote:I found that using a pair of women's tights made them even more stable (search is your friend).

Right, JP. I wouldn't be able to use my favorite nasal pillows mask at all "as is"..... but with the addition of a homemade stretchy strap to keep the nasal pillows stablilized better for my toss'n'turn sleeping, the pillows stay put wonderfully well.

To make the "search" a little easier...
"I have joined the pantyhose brigade"
topic started by dusty0318 - April 23, 2011
viewtopic.php?p=591171#p591171

rested gal wrote:but with the addition of a homemade stretchy strap to keep the nasal pillows stablilized

I do have to say that looking at what I have tried and reading some of the things people do to make their equipment work can be pretty funny. People are amazingly creative.

If you were shipwrecked on an island somewhere, you'd want to have a CPAP person with you to figure out how to save the day for everyone. It would probably involve some contraption from the TV show "Gilligan's island" - made with a pair of pantyhose, a clothes hangar, a scrunchy, a clothes pin, a pulley, blue painter's tape and some Lasinoh cream.

Java Time wrote:If you were shipwrecked on an island somewhere, you'd want to have a CPAP person with you to figure out how to save the day for everyone. It would probably involve some contraption from the TV show "Gilligan's island" - made with a pair of pantyhose, a clothes hangar, a scrunchy, a clothes pin, a pulley, tape and some Lasinoh cream.

Update - I've been using a "gel" nasal mask for the last couple of days and this is my new favorite. I also dropped to 2 AHI last night, for the first night since I've been on the hose (yay!), which may or may not be related to the new mask.

One thing that may interest new folks:
The mask I'm calling my new favorite, is one that I did not like initially at the DME when trying masks. It felt too claustrophobic during my initial mask fitting. However, now that I am 2 months into CPAP and not so freaked out by it all, this mask seems to work really well.

So my point is, after you have been "on the hose" for awhile, you may want to go back in and try on all the mask types again. My perspective at the 2 month mark is MUCH different than the first time I tried on a mask.

I still want to try one other nasal "pillow" style mask before I give up on the "minimal stuff on your face" concept, but this gel mask does seem to be the best for me so far.

Good luck on your search for a mask that works for you!

Since April, 2010, I have tried at least a dozen masks.
The new mask is the best-fitting one yet.
I am being realistic--one way or another, this will not be the last.
My favorite is more than likely the first discontinued.
It always happens.

Here's one example of why everyone says to try really hard to find a good mask for you.

My first 6 weeks on CPAP I averaged just under 6 AHI (better than my initial sleep study 70AHI, but not great).

In the past week or so, I finally seem to have come up with a mask fit that works for me!

Five days ago I switched to my new mask. Four days ago I crossed the 2 AHI threshhold for the first time!
I feel quite a bit more rested and I have stayed at or below 2AHI for four days in a row!

There are multiple things I have fine-tuned in the past 2 weeks, including sleep position and the use of the hosebuddy, but things really seem to have come together over the past few days thanks to my new mask!

Here's the visuals of the past 2 1/2 weeks progress, primarily messing with masks:



Good luck on YOUR CPAP mask journey!