Are you struggling with your CPAP mask?

Do you want to know more about the different types of masks and which ones might be better for you?

We understand how difficult it can be to find information. 

We put this CPAP mask guide together to help you. 

In this guide you will find illustrations that show the different types of masks.

Additionally, we provide and overview of 15 Topics which over 30  frequently asked questions that were asked on the internet. 

Our goal is to provide a comprehensive resource that you can use to help educate yourself and hopefully this information can help you decide what mask may be better for you.

Chinstrap on with a nasal triangle mask, the patient has a closed mouth. This allows the air to go down into the airway. CamachoMD.com
Chinstrap on with a nasal triangle mask, the patient has a closed mouth. This allows the air from the CPAP to go down into the airway.

Disclaimer: This is a blog site that is meant for educational purposes only.  There is no affiliation with any organization. Although we do our best to provide accurate and true information, it is possible that there may be mistakes or errors. The information is not meant to provide specific medical advice and if you rely on any information on this website, it is at your own risk. Even though the writer(s) on this blog site is/are healthcare provider(s), the information is for educational purposes only. If you are a patient, then you need to consult your own healthcare provider for information that is specific to you. You may need to seek urgent or emergent care depending on your situation. You should not perform any of the procedures unless you are trained and are licensed to do them. We reserve the right to update, change, delete and manage the content at any point. Our cookie policy can be found in our privacy policy.

Background information about CPAP and CPAP masks:

Dr. Sullivan and colleagues were the first to describe continuous positive airway pressure (CPAP) as a treatment for obstructive sleep apnea (OSA) in 1981.[1]

The initial masks were described as “two soft plastic tubes that were shaped to fit snugly into each naris.” [1]

This is a huge improvement over using a tracheostomy (hole in the neck) to treat OSA.

The initial machines were very large and were very loud. Today, the CPAP machines are much quieter and are much better tolerated.

These machines are still generally referred to as CPAP, but the new machines are most often automatically adjust the pressures based on how much your airway needs to keep it open (referred to as automatic positive airway pressure (APAP ) devices).

Frequently Asked Questions about CPAP masks:

Which CPAP mask is best?

The mask that is best for you depends on many different things.

First off, if you have blockage or congestion in your nose and are a mouth breather, then a nasal mask may be difficult for you to use

For mouth breathers, a full facemask may be a good choice as it might be difficult to tolerate a nasal mask.

It is recommended to treat your nasal congestion. After treatment of nasal congestion, it may be possible to use a nasal mask. 

In order to determine what the possible cause(s) of your nasal congestion is, you should see a healthcare provider

Some causes of nasal congestion include a crooked nasal septum (deviated septum), large inferior turbinates, allergic rhinitis due to environmental allergies, nasal polyps and large adenoids.

First line treatment for nasal blockage includes nasal steroids such as fluticasone and mometasone. 

If the problem is due to environmental allergies, then adding an allergy medication such as cetirizine could help.

If you don’t like medications, then a nasal sinus rinse could be an alternative (if you go this route than follow manufacturer recommendations for use and cleaning and also use distilled water only).

If your nose is crooked (deviated septum) on the inside or you have large inferior turbinates, then surgery could be considered if the medications did not provide enough improvement.

A study found that nasal surgery reduced the CPAP device pressures to a more tolerable level and therefore also increased CPAP use.[2]

CPAP full facemask in man with a beard. There is no leaking of air and it is going into his mouth to keep his airway open. CamachoMD.com
CPAP full facemask in man with a beard. There is no leaking of air and it is going into his mouth to keep his airway open.

What are the CPAP mask types?

Three commonly used CPAP masks are:

  • Inside the nose (nasal pillows),
  • Over the nose (nasal triangle masks), and
  • Over the nose and mouth (full face masks)

Four less frequently used CPAP masks are:

  • Inside the nose (nasal prongs),
  • Over the mouth (oral mask),
  • Over the entire face (face mask), and
  • Combined nose and mouth (hybrid mask).
Nasal pillow CPAP masks with the prongs inside the nostrils of the patient. This is generally considered to be a comfortable mask. CamachoMD.com
Nasal pillow CPAP masks with the prongs inside the nostrils of the patient. This is generally considered to be a comfortable mask.

Are there CPAP masks without headgear?

There are masks with headgear that go over the forehead and those that do not. 

Older masks used to have a plastic piece that goes over the forehead and some patients found the extra attachment to be uncomfortable.

Many of the newer masks have straps that go over the head, but do not have the forehead attachment.

Ultimately, the decision for having the headgear or not depends on your preference.

How should CPAP mask fit? How tight should it be?

A mask should fit comfortably. Most of the mask headgear can be adjusted to be looser or tighter. 

If the mask is too loose, then the air will leak out of the mask and onto your face.

If the mask is too tight, then there will be pressure put on your face and this can be uncomfortable.

So, the adjustment of the straps is definitely a balancing act.

If the power goes out, can I still breathe with a CPAP mask on?
Standard CPAP masks are designed to allow you to breathe in and out even if the power goes out.

Clearly, if the power goes out, then your obstructive sleep apnea will return. But, you should still be able to breathe through your mask as it has holes that let you breathe.

If you are worried about having your power go out, then you could purchase a backup power supply for CPAP machines through your durable medical equipment provider.

What CPAP mask is best for side sleepers?

If you prefer to sleep on your side, then a mask that is less likely to shift when your face sinks into the pillow is ideal.

So, masks with a forehead attachment could be harder to use if you prefer to sleep on your side.

What CPAP mask is best for stomach sleepers?

Similar to the masks for side sleepers, if you can avoid having a forehead attachment that can help reduce the chance that the CPAP mask will shift off of your face.

Are there special pillows that can be used with CPAP masks?

Yes, there are special pillows that have parts of it cut out so that the mask can fit better.

The cutouts make it easier for side sleepers and stomach sleepers as they allow for resting your head on the pillow comfortably (and without shifting) since cutouts have space for headgear forehead attachments.

How often do you get new supplies for your CPAP?

You will need to get supplies for your CPAP on a regular basis.

Each of the durable medical equipment companies have timelines for renewing supplies.

Generally, the Medicare guidelines are followed by many insurance companies, but it does vary.

What is the replacement schedule for CPAP supplies under Medicare guidelines?

         

  • New CPAP machine every five years
  • Chinstraps, headgear, humidifier water chamber and filters (gross       particle foam filter) once every six months
  • Nasal interface, face mask and hose (Tubing) once every three    months
  • Cushion for full face once every month
  • Cushions (nasal and pillows) two every month
  • Disposable filter (fine particles) two every month

What is the best CPAP mask for people who sleep with their mouth open?

If you sleep with your mouth open, then there are generally two options.

The first option is to use a full facemask since it covers the nose and the mouth.

The full facemask will allow the air to go into your mouth when you open it, which is especially helpful if your nose is congested.

The second option for mouth breathers is to use a nasal CPAP mask and add a chinstrap.

Chinstraps were designed to close your mouth during sleep, therefore, they will allow the air to flow from the CPAP machine, to your nose and then into to your airway.

If you have a congested nose and you are using a chinstrap, then it will take a higher pressure to get past your blocked nose. 

Unfortunately, the higher the pressure, the more likely that you will have leaking from the mask.

CPAP mask over the nose, showing air leaking from the mouth (blue arrows). A chinstrap is often a good choice for these patients. CamachoMD.com
CPAP mask over the nose, showing air leaking from the mouth (blue arrows). A chinstrap is often a good choice for these patients.
Chinstrap on with a nasal triangle mask, the patient has a closed mouth. This allows the air to go down into the airway. CamachoMD.com
Chinstrap on with a nasal triangle mask, the patient has a closed mouth. This allows the air from the CPAP to go down into the airway.

What CPAP mask is better for patients with beards?

The problem with beards is that they make it harder for a mask to fit snugly.

But wait, you don’t necessarily need to cut or trim your beard though.

Beards can be a big part of your identity and you generally should be able to wear the CPAP mask with one.

Consider starting with a nasal mask first (nasal triangle mask, nasal pillows or nasal prongs).

If you have nasal congestion and aren’t able to treat it well enough to use nasal CPAP masks, then you could try a full facemask.

It might require tightening it down more than if you didn’t have a beard.

Ultimately, you may need to try multiple CPAP mask types in order to find one that you can wear with your beard.

Are there bacteria on the CPAP masks?

Yes. Bacteria and other organisms live on the surface of human skin and they live on surfaces of equipment. Whether the bacteria are causing sickness is a different question.

How should you clean CPAP masks?

CPAP masks and equipment should be cleaned based on the manufacturer recommendations. So, by default, you need to read the packaging and follow that.

In general, you want to make sure to clean your mask, hose and humidifier water chamber on a regular basis.

Recommendations vary depending on the equipment, but manufacturers may recommend that you clean CPAP equipment daily or at minimum weekly.

Before you clean your equipment, you need to unplug the device from the electrical outlet to avoid shocking yourself.

It is important that you either use a clean sink or a clean container.

Sinks are often dirty and can have a significant amount of harmful organisms, so you may want to buy a bucket or container that you clean with cold water and a small capful of bleach and then let air dry. You can then use the bucket or container for the CPAP equipment only.

You need to wash, rinse and then air dry your equipment as per manufacturer recommendations.

Warm-hot soapy water can be used to wash, warm-hot water to rinse and then you air dry the equipment.

You shouldn’t get the electrical components of your machine wet. Follow the recommendations of your equipment manufacturer.

Masks and humidifier water chambers can air dry on a clean towel.

The hose can air dry by hanging it over a shower curtain rod.

Should you use CPAP mask cleaners, wipes or sanitizers?

You need to balance the effectiveness of cleaning your equipment and using chemicals that are so strong that they not only kill the organisms on the mask, but also degrade the material.

Washing, rinsing and sanitizing on a regular basis should help keep your CPAP mask and other equipment clean.

Should you use a CPAP mask cleaning machine?

CPAP machines have been around since the early 1980s. If infections were occurring because of CPAP machine use, then there would have been a big push by now to use CPAP cleaning machines in all cases.

It is definitely a personal preference as to whether or not to buy a CPAP mask cleaning machine.

In general, the chance of getting sick from CPAP use is very low if you follow the manufacturer guidelines for cleaning your equipment and you also replace your equipment on the proper replacement schedule.

For most people, cost is most likely the biggest deterrent against buying a CPAP mask cleaning machine.

If you are worried about infection and it is preventing you from using your CPAP machine, and you have the funds to buy a CPAP mask cleaning machine, then why not?

What are common CPAP mask problems?

Some of the more common problems with CPAP masks can include skin reactions or skin irritation, shifting of the mask off of the airway, leaking of the masks onto the face that can wake you up and claustrophobia.

Can CPAP masks cause irritation under the nose?

Yes, CPAP masks can cause irritation because the mask sits on the surface of the nose and skin is not accustomed to having anything on it for prolonged periods of time.

Your healthcare provider may need to prescribe an ointment if you have cracking or bothersome irritation.

Can CPAP mask cause skin problems such as a rash or itchiness?

Yes, you can have contact dermatitis (a reaction of the skin), acne that occurs at the site of the mask and rashes if you have a reaction to the material of the mask (rare). 

You could also have marks on your skin when you wake up in the morning if you keep tightening down the mask to the point where it puts pressure on the skin.

Can CPAP mask cause pimples (acne)?

Yes, some patients are predisposed to acne at the site of the mask. You should clean your mask regularly and also clean your face before you put the mask on to help reduce acne.

Benzoyl peroxide can help reduce acne and is over the counter.

If the acne is concerning to you at all, then see your healthcare provider as they can provide additional recommendations or medications.

Can CPAP mask make my face red?

A CPAP mask should not make your face red, but if there is a skin sensitivity to the mask then it could.

What is a CPAP mask liner?

If you have irritation on your skin, then a CPAP mask liner can be used. The liner will provide a barrier between your skin and the CPAP mask.

There are different kinds of liners, but in general cloth is used.

How can CPAP masks cause a dry mouth?

If your mouth is open while you have a nasal CPAP mask on, then the air can escape from your mouth, which can cause your mouth to feel dry.

If you have a dry mouth, then consider turning up the humidifier and/or obtaining a chinstrap to use with nasal CPAP masks.

If you have a full face mask, then make sure the humidifier is on and is set to an appropriate level.

CPAP mask over the mouth. This is a rarely used option, but can help patients who keep their mouths open and cannot tolerate a chinstrap. CamachoMD.com
CPAP mask over the mouth. This is a rarely used option, but can help patients who keep their mouths open and cannot tolerate a chinstrap.

Can CPAP mask have an air leak?

Yes, a CPAP mask can have an air leak. Generally, air leaks occur for one of two main reasons:

The pressure on the machine is too high (which causes the mask to lift off the face and causes a leak, or if the mask is too loose (tightening it down a little more should help).

Why does my CPAP mask vibrate?

If a CPAP mask is vibrating, then it is likely too loose or the pressure is too high.

You can tighten the mask more.

If it still vibrates, then you should contact your healthcare provider and they may consider adjusting your CPAP settings if appropriate.

Is it normal to have air escape from the front of the CPAP mask?

Yes, the CPAP masks have holes for air to escape when you breathe out. These holes are referred to as vent holes, air ports or exhalation ports.

Why does a CPAP mask fill with water (have condensation)?

The air you breathe is humidified and the CPAP machine, hose and mask have additional humidification.

What is CPAP mask rainout?

By design, the CPAP hose hangs down from the dresser or stand and then loops back up to you while you are in bed.

Water can build up in the loop and at some point it could build up to the point where air can’t go by the water; at that point the water can come rushing out of the hose and into the mask and this is known as rain out.

Is there a way to prevent CPAP mask rainout?

The way to help reduce CPAP mask rainout is to use tubing that has a heated coil in it that keeps the hose warm and therefore reduces the amount of condensation in the hose.

Is it normal for a CPAP mask to make noise?

CPAP masks don’t make noise, but they can move and vibrate.

Why do some people have claustrophobia while wearing CPAP masks?

Because masks cover the face, you may feel like you are being smothered.

The CPAP masks that are less bulky can help reduce this sensation, this would include nasal triangle masks and nasal pillow masks.

Why do some people have insomnia while wearing CPAP masks?

It is common to have insomnia after starting CPAP.

The human body was not designed to wear CPAP masks and to have positive pressure blowing into the airway all night.

In the initial phases of using CPAP masks, your body and brain have to adjust to having a CPAP mask on and also need to adjust to having pressure blowing into your airway.

Can cognitive behavioral therapy help me adjust to CPAP?

Yes, there are cognitive behavioral therapy providers (usually psychologists) who can help you adjust to using CPAP.

Some patients will wear their CPAP masks for a time period before they fall asleep so that their brain can adjust to it.

Is there a medication that can help adjust to wearing CPAP?

It is common for patients to start medications temporarily in the early weeks of using CPAP to help with the adjustment.

You can see your healthcare provider for a prescription medication if needed.

However, if you can avoid medications, then that is better so you don’t end up relying on them to help you sleep.

Can you use CPAP masks with dentures?

Dentures should be taken out per the recommendations of your dentist. Keeping your dentures in your mouth could irritate your gums.

If you need to keep your dentures in your mouth at night for some reason, then yes, you can use CPAP with dentures.  But, you should avoid keeping them at night to allow your gums to rest.

Links to other relevant websites:

For pictures of masks and to buy masks:

https://www.CPAP.com

For the Medicare replacement schedules for CPAP supplies:

https://oig.hhs.gov/oei/reports/oei-07-12-00250.pdf

Government Disclaimer: The views expressed in this website are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References:

1.            Sullivan, C.E., et al., Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet, 1981. 1(8225): p. 862-5.

2.            Camacho, M., et al., The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep, 2015. 38(2): p. 279-86.