So you have been advised CPAP therapy. And understandably, you are not as much concerned about the therapy and its outcome as much as you are about CPAP masks, one of the most important components of the equipment. This is natural for any first time user. After all, the side-effects of this therapy, which is considered to be one of the most effective (claims 70% success rate), has reduced to actual usage to about 50%.
Before we make a deeper analysis about the various doubts and apprehensions about this therapy, let us turn positive for a while and look at the various benefits this therapy can offer you:
- It consistently keeps the air passage open during sleep.
- Its mode of action results in substantial reduction in snoring.
- Improves quality of sleep; you go to sleep early and wake up less frequently.
- Keeps you more alert during the day. This can have an impact on your regular activities including driving.
- Impacts blood pressure positively
- Refreshing and rejuvenating sleep means improvement of memory, time to reaction and improvement of focusing abilities.
What is the role of CPAP masks?
CPAP stands for Continuous Positive Air Pressure and the name somewhat explains its mode of action. It essentially involves infusing a constant flow of pressurized air to the lungs for keeping the airways open during sleep. This eliminates the frequent pauses in breathing (called apnea episodes), which is one of the most distressful signs of this disorder.
The equipment is made up of three components: the device that generates the pressurized air; the mask that conveys the air; tube that connects the mask to the device. The air generating device is small, lightweight and mostly quiet. What is the amount of pressure needed by patients to keep the airways open? It largely depends on how serious the condition is.
Efficacy of the therapy depends on whether the right amount of pressurized air is entering the lungs or not. In case there is any leakage of air, the therapy becomes ineffective. Additionally, compliance with the mask is an important deciding factor for continuing with the therapy. Thus, it could be summarized as:
- To avoid discontinuation, the user must be completely comfortable with the mask.
- People sleep and breathe differently. They may sleep on their backs or sides and breathe through the nose, mouth or both. Thus, when buying a mask, one needs to carefully consider one’s personal habits in these two areas.
Types of CPAP masks
Considering that people have varied sleeping and breathing habits, sleep apnea masks have also been designed to suit such personalized needs. The various types of masks are:
- Full face CPAP mask that covers the full face. This is good for mouth breathers.
- Nasal CPAP mask that covers only the nose
- CPAP oral mask that covers the mouth
- Nasal pillows which involves inserting silicone tubes into the nostrils.
- CPAP gel mask is for people who are allergic to silicone. It is made from a combination of gelatin and soft plastic. The big benefit is that such masks can be custom –made to fit individual facial contours. However, they are heavier than traditional masks and not as long-lasting.
To get the most out of this type of therapy it is imperative that the mask offers a snug and comfortable fit and does not allow any leakage. It is impossible to assess the quantum of pressure needed to keep the airways open unless the mask is fitted absolutely correctly. Additionally, a snug-fitting mask can make the use of the CPAP device easier.
- It should neither be too loose nor too tight. Choose the right size. Larger-than-necessary masks tend to promote air leakage than ones which fit snugly. Thus, to be safe, it makes sense to choose a size that is one size smaller.
- The best CPAP mask should offer a proper seal over the nose and/or mouth
- The straps which hold the mask in place should be comfortable.
- Keep in mind the way you sleep and breathe.
- Best purchase is when you try it before actually buying.
- Despite numerous online stores selling this product, offline outlets tend to be safer.
- The way to prevent air leaks is to ensure that the mask covers every little dent on your face.
- Remember that the right length of hose should be within 12 feet, as lengthier tubing may affect pressure settings.
Masks are generally designed triangular. They have straps which are adjustable and linked to a headgear designed to keep the mask from getting displaced during sleep. Straps are important – if they are loose-fitting they would permit air seepage; too tight will make the user uncomfortable. There are several types of headgears available in terms of color, size and materials. Those who breathe through their mouths need a chin strap to help in keeping their mouths closed during sleep.
What causes air leakage from a mask? This is an important issue with mask usage, since it can make or break the whole purpose of using this therapy. Air seepage reduces the air pressure which mars the efficacy of the treatment. Air leakage is a possibility when it is too big or does not fit properly.
Here are some design features of CPAP masks aimed to increase user compliance:
- A mask can have a plastic body but the seal is made of softer silicone. This silicone could expand when the machine is switched on; thus one need not tighten the straps.
- Some masks are designed in such a way that one can even wear eyeglasses while wearing a mask.
- Some masks work with specific headgears. The silicone seals carry a soft material to conform to the contours of the face. With the help of a thin plastic attachment, which moves from one side of the mask to the other, the user can turn freely during sleep. This facility also reduces air leaks.
- If you are allergic to silicone, you can easily opt for a mask made from rubber or vinyl.
- Some masks are also made from gel-like substance, but these weigh more than conventional silicone masks.
Pros and Cons of CPAP masks
It is time to know more about the different types of masks. But before you get all the details, you need to remember that majority of problems faced by users of CPAP therapy, relate to the mask. Thus, while they do deliver results, there are also various side-effects associated with the usage of each of these types:
- Full face CPAP mask: The name explains the design of this type of mask. it covers the whole face starting from the top of the nose till the lower lip and covering the chin. You could have extra straps at the mouth or forehead, if you want extra stability. Claustrophobia is a common problem with this mask, faced mostly by first-time users. Recommended primarily for mouth breathers, this mask does not allow the user to turn on the sides, as this can cause seal breakage. This kind of restriction in terms of sleeping position limits usage of this variety.
- Nasal CPAP mask: This is perhaps the running favorite of most CPAP users. Perhaps the reason for this popularity is that it allows the user to sleep any which way he or she prefers. Additionally, it offers the most comfortable fit. As the name suggests, it covers the nose extending up to the bridge on top. One has to use straps that go over the nose and circles the head to keep it in place during sleep. The functional benefits of this mask are: in-built ability for suction which prevents air seepage; chances are few of watery eyes, dry mouth, nasal blockage, skin irritations, etc, which are a few of the most common side-effects of other types of masks. Users prefer it because this mask does not require too many straps for keeping it in place.
- CPAP oral mask: This mask is designed for users who breathe through their mouths. This has a heated humidifier that prevents dry mouth and throat. One of the noteworthy features of this mask is that you do not have to depend on any headgear for keeping it in place (although people who keep their mouth open while asleep might need a chin strap. The best CPAP chin straps keep your mouth closed and allow the oral mask to sit comfortably in your mouth). Also, the bad news is that using this mask could result in blocked nasal passage. Even people who grind their teeth at night would not be able to use this mask.
What about side sleepers? What kind of masks do they wear?
Doctors treating sleep apnea would invariably advise you to sleep on the sides, more than on your back. But if you are on CPAP, you might find it extremely difficult to find specially-made CPAP masks for side sleepers since not many masks are made keeping this target user in mind. The typical problems faced by mask users like skin irritation, claustrophobia, restrictions on sleeping posture, seem to get magnified when the sleeper wants to sleep on the sides.
But not all is lost. There are still a few options left for side sleepers and if you know about these options, you can find the CPAP masks for side sleepers that you are looking for. Here are a few pointers to keep in mind when looking for these special masks:
- Ensure that the tubing (hose) is attached in the front and not in the side, as the latter would only allow you to sleep on one side. It does not permit the user to roll over to the other side. If you do, you simultaneously have to switch the tubing attachment from one side to the other. Some brands of such masks loom over the head and the outline of the head.
- Side sleepers sleep better when they rest their heads of sleep apnea pillows. These pillows help keep the head, shoulders and spine in perfect alignment. They also provide extra support while wearing a mask. These special pillows reduce the air and mask pressure significantly and also chances of air leaks.
- Nasal masks, or nasal pillows are also good alternatives for side sleepers.
One can also gather a lot of information about mask usage from other side-sleepers who are on CPAP therapy. For example, check the kind of firmness of your sleeping pillow – some users report that reducing the firmness often allow them to sleep on the sides, while wearing the mask. Similarly, sleeping on the edge, wearing the mask off-center initially, allowing the hose to run over your head, etc are important tips that can be helpful.
Then there are nasal masks made from soft cloth. You can sleep on your sides, back or on your abdomen, when you wear these masks. The texture of the cloth is smooth and permits free breathing, thus eliminating skin irritation to a large extent. They also offer strong seal as they press against the face, which also reduces chances of air leakage.
What are the main reasons for people to discard the therapy?
CPAP is a completely new and often perceived as bulky and cumbersome mode of treatment, according to many new users. But if you have time and patience, this therapy option can be one of the most rewarding treatment options. You might need several months before you actually feel comfortable with the idea of being ‘tied’ to the device, so to speak. Be that as it may, it is usually the mask which is the prime factor for discontinuation of the therapy.
Here are some major complaints related to the mask as well as using the device, as reported by patients alongside the solutions which can make clear to you that if there is a will there will also be a way to overcome the problem.
|Mask not fitting well||Find the right design of mask which ensures a snug fit. Learn more about the adjustment mechanisms before buying a product and try it before actually buying. A size smaller offers the best fit.|
|Difficulty in getting used to the therapy||This feeling is perfectly natural. Try using the device (including wearing the mask) during daytime. Check whether the pressure settings and the overall fit is making you comfortable. Be patient.|
|The artificially-induced air pressure is unnerving||Use a special feature called the ‘ramp’ which enables you to run the machine at low pressure initially. The increase of pressure can be adjusted gradually over time. If you want automatic pressure adjusting machines, ask your doctor for a bi-level positive airway pressure (BiPAP) machine, which is a variant of CPAP.|
|Dry and blocked nose||Attach a heated humidifier to the mask. you could also use a saline nose spray before going to bed which keeps the nostrils moist. Check for air leaks as this too can dry up the nasal cavity.|
|Feeling of claustrophobia||There is no scientific reason for such feelings and is considered to be purely psychological. To overcome this problem, try using the mask during daytime, use low pressure simply to get used to the device and its attachments.|
|Air seepage||Check and adjust the following: size and style of mask; pads and straps to make it fit more snugly; placement of mask on the nose. If problem persists talk to doctor regarding change of mask design.|
|Inability to get good sleep||Get used to wearing the mask by practicing it during daytime while you are awake. To supplement your efforts try other sleeping techniques like physical exercises during the day, avoiding stimulants at night, maintaining sleep schedules, etc.|
|Dry mouth in the morning||This happens when mouth is open during sleep. Try chin straps to keep mouth closed. The full face mask covering the nose and mouth can also be considered. Use a heated humidifier attached to the mask.|
|Mask displacement during sleep||The cause is usually clogged nose. Full face mask with a heated humidifier can be helpful.|
|Noisy device||Check filter which could be blocked or faulty. Ask representative of supplier to repair the problem if necessary|
Despite the many problems associated with mask usage, there is no denying that CPAP is one of the most effective ways to treat this distressful sleep disorder. It is difficult to get used to the device but if you give yourself some time, it could be the most appropriate therapy choice for you.
References & Resources:
- A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis
- Non-invasive ventilation in acute respiratory failure: a randomised comparison of continuous positive airway pressure and bi-level positive airway pressure
- Review of oral appliances for treatment of sleep-disordered breathing
- A Multicenter, Prospective Study of a Novel Nasal EPAP Device in the Treatment of Obstructive Sleep Apnea: Efficacy and 30-Day Adherence
- A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea