In this article I talk about:
- Why the CPAP Mask is the most important part of your sleep apnea regime;
- Why it will help you get more comfortable use out of your machine;
- How to cure facial sores, dry mouth and acne caused by your mask;
- How to maintain your mask for optimum use.
CPAP Mask: The most important part of you CPAP system
Huh? Does that even make sense? Most people think it’s the most expensive part of the system: the CPAP machine.
Actually the machine is only the third most important thing.
The absolutely most important thing is your CPAP Mask.
A badly fitting mask is the number one reason why people stop using their machine. It can lead to:
- Air blowing into your eyes
- Dry mouth
- Facial sores
- Not enough air pressure to work
A bad mask will make CPAP a complete failure for your sleep apnea treatment.
Types of Masks Available
There are five types of masks available:
- Nasal Pillow
- Full Face
All masks can be used on all machines.
Nasal and Nasal Pillow Masks
The nasal mask covers the whole nose. Instead of wrapping around the nose, the nasal pillow mask rests up against the nostrils. Both types of mask come with a strap system that wraps around the head holding the mask tightly, but not too tightly, to your nose.
These masks are small and lightweight and doesn’t cover up your eyes so you are able to read in bed or watch tv. It’s very comfortable for those who are claustrophobic or with a lot of facial hair.
These types of masks can only be used by nose breathers. Nose breathers are people that breathe through their nose when they sleep; mouth breathers only through their mouth. Some people are both nose and mouth breathers. Mouth breathers have to use oral masks, hybrid masks or full face masks.
If you go to the bathroom frequently then this is also a good mask because it easy to take off and put back on.
Nasal pillow masks are only suitable for low pressures (less than 10 cm H20). Nasal masks are good to 20 cmH2O. Respironics Optilife Nasal Pillows are the exception: they’re good to 25 cmH2O.
The common problems with Nasal Masks are:
- Severe dryness of the nose,
- Nose bleeds,
- Pain in the nostrils.
- If you’re having these problems then you can:
use a humidifier to moisten the air in your nose;
use smaller nasal pillows;
make sure the nasal pillows don’t go too deep into your nose.
Oral CPAP Mask
The oral CPAP mask is like the nasal mask but instead of encompassing the whole nose, it goes all around the mouth. Because it covers your mouth it doesn’t dry out your nasal passages which reduces the side effects of dry nose, nose bleeds, congestion and sinus infections.
However this type of mask isn’t without it’s problems. If you’re a nose breather then this mask won’t work for you. Also if you have a thick beard/mustache then you will experience a lot of leaks.
The biggest complaint is the amount of drooling you do when wearing this mask. It’s like a mini-waterfall. Most people find this stops after 14 days but it’s unpleasant until then. It’s doubly-worse if you’re a side sleeper.
If you’re a back sleeper then this is a good choice for you.
Full Face CPAP Mask
When I heard that I had to wear a full face mask I was terrified it was going to be like a space helmet. But not to worry: a full face mask is a mask that covers both your mouth and nose in one piece. A bit like a Oral and Nasal mask in one.
Because it wraps both nose and mouth it’s claustrophobic and you can’t read or watch TV when wearing this mask.
This type of mask is suitable if you:
- are a mouth or mouth and nose breather;
- suffer from dry mouth when using a nasal mask;
- suffer from allergies;
- need a high pressure (> 20 cmH2O);
- have a deviated septum;
- have dentures that you take out at night.
This type of mask is NOT suitable for you if you:
- feel nauseous wearing it (you wanna puke);
- have a cardiac sphincter problem;
- excessive reflux;
- have a cough reflux that is impaired;
- have a hiatial hernia;
- have a sinus infection;
- have a middle ear infection;
- are claustrophobic.
Hybrid CPAP Mask
Hybrid sounds fancy but it’s actually describes a mask that has an oral mask with a nasal pillow mask. It’s ideal for mouth and mouth/nose breathers. It’s normally used by people who need a full face mask but can’t use it for medical reasons like claustrophobia or sinus infections.
Another consideration for this type of mask is that it’s the noisiest type of mask.
Choosing your CPAP Mask
It took me 10 minutes to decide on what CPAP machine to buy. It took me 6 months and 12 different masks to find the best mask for me.
It is extremely rare to get a mask that will work with you on the first time.
And there’s no point testing them in a store or doctor’s office: the real test comes when you’re actually sleeping with it on.
And you have to test them over many nights. It takes time to find out if it causes congestion, severe wind or how often it moves and you get air leaks.
All is not lost though: after you’re sleep test/study your doctor will be able to tell you if you’re a side or back sleeper, nose or mouth breather and what pressure you should use.
If you’re a side sleeper you should use a nasal or nasal pillow mask or oral mask.
If you’re pressure is high (> 20cmH20) then you need a full face or hybrid mask.
If you’re a mouth breather you need a full face, hybrid or oral mask.
If you’re a nose breather you should use a nasal, nasal pillow, full face or hybrid mask.
What are the Side Effects of the CPAP Masks?
Even if you get a perfect mask there are still some side effects you have to be aware of and consider.
Dry mouth is caused by leaks in your mask. Plain and simple. See the document Causes of Masks Leaks.
If you have dry mouth you have to be extra vigilant with your oral hygiene. A dry mouth creates an environment that’s ideal for bacteria to grow and cavities will form.
When I got dry mouth lasting for 6 months I ended up with 20 cavities. So be very aware.
The best cure is a) fix the leak and b) take Biotene at night. It will help keep the mouth moist.
Dry Nose, Nose Bleeds and Congestion
This is caused by the air being too dry as its forced into your nose.
Your nose is your body’s natural humidifier. It makes the air moist. Too much air and the nose will dry out. To fix this you need a humidifier. Refer to the Humidifier Buyer’s Guide.
Facial Sores and Pressure Ulcers
Normally this is caused by your straps being on too tight. Tightening the mask is probably because you’re getting leaks or the straps are losing their elasticity. Check out the maintaining your mask section below for fixes to the straps, or refer to Causes of Masks Leaks document.
If you’re using a nasal mask then switch to a nasal pillow to give the skin time to heal. If you’re using an oral, full face or hybrid mask then speak to your doctor. You don’t want to not use your CPAP machine if you’re recovering from the sores. Normally you will need to use a CPAP Mask Liner like REMzzzzs.
Acne will build up around the rim of the mask because the mask hasn’t been cleaned properly. The mask must be cleaned every morning to remove oils and sweat from the night before.
Clean the mask with a specially formulated CPAP Disinfectant cleaner. But you can also use hot water and soap and let it air dry.
DO NOT CLEAN YOUR MASK WITH ANTI-BACTERIAL SOAP. It will destroy your mask.
Red marks/sports are an early sign that the mask is on too tight. If this goes unaddressed you’ll end up with facial sores or ulcers. If you’re using a lot of pressure to keep the mask on tight then check for causes of leaks and/or if the straps are wearing out.
Sometimes it could simply be a sensitive skin. In this case I’d use RemZzzzs CPAP Mask Liner. They’re a mask ‘towel’ that rests between the mask and your skin. It helps create a better seal and keeps the mask cleaner.
Bloating, Gas, Wind and Farts
This is a common and very embarrassing problem. Your CPAP machine is forcing too much air into your airway and the excess air gets redirected to your stomach.
You can try changing your sleep position, use a CPAP pillow or cushion.
If you are thinking about reducing your pressure then speak to your doctor first.
Rainout is a fancy term for drowning in your own saliva or having too much condensation. Refer to the Humidifier Buyer’s guide for more details.
The Mask Doesn’t Stay On
I’d wake up and find that I’ve taken the mask off without realizing it. Actually it was spooky because not only did I take it off but I placed it neatly on top of the machine.
This is caused by the mask disturbing your sleep:
- it’s leaking and air is blowing into your eyes: read Mask Leak Resolutions
- the air isn’t getting through because the hose is kinked or filled up with condensation: read Humidifier Buyer’s guide for condensation and consider a Hose Holder (see Accessories)
- the pressure is too low that you’re suffocating yourself: in this case you need to speak to your doctor about changing your pressure.
Maintaining your CPAP Mask
The mask should be cleaned every morning. You need to remove any oils and sweat on the mask as well as any condensation in the mask.
Do not use anti-bacterial soap: it will damage your mask.
Ideally you should use a specialized disinfectant cleaner designed for CPAP but you can use mild soap and water and let it air dry.
Parts of your mask will wear out quickly: much quicker than you’d expect:
- the pillow (nasal pillow mask) and gel packs on the full face masks need to be replaced every 3-4 months;
- the headgear (straps) is normally replaced every 6 months or sooner if the straps are stretching;
- the mask itself should be replaced very 6 months too.