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CPAP masks October 16, 2021

Posted by Clint Foster in Health.
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For those who aren’t familiar with CPAP, it’s a treatment for sleep apnea that pressurizes your airway to avoid regular awakenings and oxygen starvation due to repeated breathing lapses during sleep. Sleep apnea is on the rise in the US due to obesity. But anyone can suffer from it, especially as we age and things start to sag in our airway. Probably more people have it than we realize since many are undiagnosed. Sleep apnea may be yet another “problem” associated with humans living longer. If losing weight doesn’t help, there is generally no treatment that is more effective than CPAP, although people who are first diagnosed often hope a dental appliance or embedded device will cure them. Usually that is not the case, per this video, with the exception of highly invasive procedures such as tracheotomy or MMA.

Many people are in denial about having sleep apnea even after diagnosis. Some of this has to do with the difficulty of adapting to CPAP therapy due to problems such as mask leakage. This includes me.

I’m trying to get going on CPAP again after giving up several times over the years. My worst problem is the ever-escalating need to tighten the straps on my mask to the point where my face is smashed, yet I’m still getting leaks when I roll over on my side.

I’ll be referring to YouTube reviews by TheLankyLefty27 (Jason) in this post. I won’t be discussing the merits of specific machines like Philips Respironics, ResMed or Fisher & Paykel. They’re all just a box with a blower and a hose. For most people the type & fit of mask is more important. For nerds and those with special requirements like BiLevel see this video for a machine comparo.

You can use a ResMed mask with a Philips Respironics machine, and vice versa (with the exception of the AirMini). For example, even though I have a Respironics machine I’m thinking about trying the ResMed F30i. It’s similar to my current Respironics hybrid face mask, except it has more curvature for narrow faces. However, I’d prefer to abandon the hybrid face mask entirely and switch to a nasal cushion (more on that below).

For starters, check out Jason’s full face mask comparo. He also includes partial masks that don’t cover the nose like the DreamWare hybrid I currently use (shown center here). The video does not include nasal masks, which are arguably better for many people. We’ll get into nasal masks below.

Jason’s ResMed F30 fitting video is informative even if you aren’t interested in the mask. He shows how to measure your nostril width. Mine is right on the 3.5 cm line, so it’s unclear whether I would get a small or medium. Fit aside, an unnecessarily large mask is bulkier and can cause leakage for side sleepers due to the pillow pushing on it (one of the problems I hope to solve).

Tip: I was reminded of something from the above video that also applies to DreamWear masks: The whole point of the magnetic clips is to facilitate removing your mask in the morning without changing the strap adjustment. This also reduces wear on the velcro.

Mask types

This is roughly in order of most to least obtrusive.

Note: The ResMed naming convention is “F” for face and “N” for nasal. The first two types below are face masks. The last three are nasal masks.

  • Full face – Covers entire nose & mouth. I’m not sure why anyone would use this (except out of habit). Cannot be worn with glasses.
  • Hybrid face mask (nose/mouth) – Covers mouth & nose without going over the bridge. Seems best for people who mouth breath and don’t want to try curbing it with tape or other methods so they can use one of the 3 nasal mask types (more on this later).
    • Examples: DreamWare hybrid (my current mask) & ResMed F30/F30i. The “i” version is better for people who alternate between left & right side sleeping, thanks to the swivel positioned at the top of the head.
  • Nasal full nose – Goes over the nose. Best for nose-breathers who don’t like either of the nasal options below. Probably rare since it has the disadvantages of a full mask (goes over the bridge) yet doesn’t cover the mouth.
    • Examples: ResMed N20 & N20i. Note: The AirTouch version (memory foam) seals better than the AirFit (silicone) but requires monthly replacement of disposable cushion.
  • Nasal pillow – Fits under nose, with “pillows” poking into each nostril. Can wear with glasses.
    • Examples: DreamWear nasal cushion (not recommended for side sleepers, per video below). Also see the novel Bleep.
  • Nasal cushion – Fits under nose. I think this design should be the goal for most people if they can tame mouth breathing.
    • Examples: DreamWear nasal cushion and ResMed N30. Jason says avoid N30i (even though the “i” version of the F20/30 is best for side sleepers).

Jason’s DreamWear nasal pillow review shows how these can be problematic for side sleepers. Be sure to watch the “fake sleep” demo at the end. He recommends going with nasal cushions instead.

Lastly (and probably most usefully) watch Jason’s nasal mask comparo, which also has an overview of the other mask types up front. He gives his all-time favorites at the end.

Conclusion

Unlike Jason, I’m not a Registered Polysomnographic Technologist. Nor am I an MD. I may not even be human. Do not listen to me for medical advice.

That said, I suspect most people would be happiest with a nasal pillow unless they have a deviated septum or chronic nasal congestion not relieved by PAP, in which case they may need some flavor of face mask that covers the mouth. I found a chin strap to be useless in addressing my mouth breathing. Thus, even though it sounds potentially dangerous, I’m going to try tape. There are also these other methods. Below are Jason’s Amazon links for tape & strips. Note: Either tape or strips could be dangerous if misused. Consult your doctor.

  • Tape – Requires cutting vent.
  • Strips – Built-in safety vent. More expensive.

I’ll report my results with a nasal cushion in combination with mouth strips in a subsequent post…