CPAP masks: types and how to choose the right one

Choosing a mask is not a minor detail: it is one of the decisions that most affects whether CPAP gets used every night. In clinic it is common to see patients who give up treatment because they are wearing a mask that, quite simply, is not right for them.

There are dozens of models, and it is normal to feel overwhelmed. This guide sets out the types, their advantages and drawbacks, and the criteria for choosing. It is general information: it does not replace a medical assessment or a mask fitting with a professional.

Why the mask decides whether CPAP succeeds

CPAP works by delivering pressurised air that keeps the throat open all night. But that air reaches you through the mask: if it leaks, presses too hard, makes noise or dries out your nose, you will end up taking it off.

Scientific reviews reflect this: the type of interface probably influences whether you accept CPAP and whether you keep using it in the long term [2]. The right mask is not the most expensive or the best known, but the one that suits you. That is why it is worth trying and adjusting, rather than settling for the first one you are given.

The types of mask at a glance

The choice is not a ranking from ‘best’ to ‘worst’. Each type solves a different problem, and what helps one person may get in the way for another.

What the evidence says

A 2022 meta-analysis brought together 29 studies with 6,378 participants. Compared with oronasal masks, nasal masks and nasal pillows were associated with fewer residual apnoeas, lower pressure required and better CPAP use [1].

In that same analysis, the nasal mask had the best result for residual apnoeas and for use, and nasal pillows required the lowest pressure. The benefit was clearer in patients with less severe apnoea before treatment [1].

A 2006 Cochrane review, with only four studies, had already pointed out that nasal pillows gave fewer adverse effects and more satisfaction than the nasal mask in one study. That review did not recommend the full face mask as a first option, but did as a possibility if nasal obstruction or dryness limits use of the nasal mask [2]. Its authors admitted that the evidence was scarce. In short: nasal or nasal pillows first, and oronasal when the nose does not let air through.

And the best brands?

There is no single brand that is best for everyone, and the scientific evidence I use compares types of mask, not manufacturers. For that reason I do not rank brands in this guide.

Manufacturers' technical data sheets are useful for comparing models of the same type, although they are informational material from the manufacturer itself and not an independent comparison. Look at:

• The sizes available and how the headgear is adjusted.
• The cushion material and how easy it is to clean.
• The position of the tube (on top or at the front) and the weight of the whole mask.
• The noise from the air outlet and the quick-release system.

A model with good features that does not seal on your face is still a bad mask for you.

How to choose: what it depends on

The decision rests on a few factors, which are worth reviewing with a professional:

• How you breathe: if you breathe through your nose, a nasal mask will do; if you breathe through your mouth or through both, you will need an oronasal mask.
• Your nose: if there is congestion or obstruction, or if it dries out, you need a nasal mask with a humidifier and nasal moisturisers.
• Your face: bridge of the nose, beard, size and sensitive skin. You need low-contact masks such as nasal pillows or nasal olives, which do not press against your nasal bones, or you will end up with an erosion/ulcer on the skin of your nose or cheeks. A beard prevents oronasal masks from sealing and not leaking.
• How you sleep: on your back, on your side, with a lot of movement.
• Your tolerance: if you feel claustrophobic, you will prefer little contact. In these cases you must get used to it very gradually.

If the cause of the problem is the nose, it makes sense to investigate it. Rhinitis, a deviated septum or other causes of obstruction can be treated temporarily with nasal corticosteroids combined with an antihistamine, prescribed by your doctor, or permanently with surgery by means of turbinoplasty, septoplasty or functional rhinoplasty, which can help you adapt to the mask, even reducing the pressure required and improving tolerance. Likewise, CPAP machines with a humidifier also help reduce nasal dryness. Moisturising nasal sprays, as directed by your doctor, can help improve the congestion and dryness caused by CPAP.

Common problems and what can be checked

Adapting to CPAP is a process. With the right mask, properly adjusted and with your nose looked after, many patients manage to use it regularly. If that is not your case, there are other options that are worth exploring.

There are companies in Madrid that I trust, such as Neumotec or MyRespira, experts in masks and CPAP, who can help you find the best solution. These are informational links, with no commercial relationship with the author.