CPAP Mask Guide: Balance Comfort With Effective Therapy

Medically Reviewed & Written By: Bobby Afshari (B.Pharm.MPS)
Last Updated: 18/10/2023

If you’re reading this, chances are you’re on a journey to find the perfect CPAP mask to accompany your therapy and improve your sleep quality. We understand that with a myriad of CPAP mask types and options available on the market, choosing the right one can be a daunting task.

The truth is, there is no such thing as a “perfect” or “best” CPAP mask that we can recommend to you, and it may be that it takes a few months or even years before you find the ideal mask for you. We certainly encourage you to try out new masks and experiment to find a mask that strikes a balance between your comfort and your therapy outcomes.

However, in this CPAP Mask Buyers’ Guide, we’ll walk you through the key considerations to help you make an informed decision so that, at the very least, you can narrow down which masks are suitable for you in the first place.

What masks are compatible with my CPAP Machine?

A great feature about CPAP masks is that they will almost all be compatible with almost any CPAP machine. While there are many CPAP masks and brands, there is almost an unspoken agreement that they all are compatible with standard size hose fittings on the end of your CPAP hose. In other words, any mask should theoretically be compatible with any CPAP machine except for the ResMed AirMini, which has a proprietary connector.

The reason for ResMed’s breaking of this unspoken mask rule with the AirMini has never been outright stated, but it is likely due to their inclusion of the HumidX HME Filters to allow waterless humidification as it is a travel CPAP machine.

What is most important is making sure that you understand the different types of masks available to you, what their differences are and, in the end, selecting and wearing a mask that ensures not only comfort but also the effectiveness of your therapy.

What masks are compatible with me?

With the way that mask technology has improved in recent years, with decades of design research, technological advancement and millions of patients’ feedback, the good news is long gone are the days when most CPAP masks looked like this:

CPAP masks in 2023, put simply, are all very good at delivering pressure while prioritising patient comfort. Therefore, among the few considerations you need to make to choose your perfect mask, there one question that must come first:

Do you want your therapy to be delivered through your nose only, or both your nose and your mouth?

In other words, do you need a mask that delivers air pressure only through your nose, like a nasal or nasal pillow mask, or do you need a full face mask that delivers pressure through both your nasal passages and your mouth?

If you have a history of nasal congestion or a nasal obstruction, a full-face mask is often the preferred choice. It covers both the nose and mouth, allowing you to breathe through your mouth if necessary, and ensuring effective therapy even when nasal passages are blocked. Similarly, if you’re a mouth breather, especially during sleep, a full-face mask is typically the most suitable option as these will ensure a consistent flow of pressurised air even when you breathe through your mouth, preventing airway obstruction.

Alternatively, whilst they are extremely rare and make up a very small percentage of masks that get manufactured, an oral mask like the Fisher & Paykel Oracle 2 Oral CPAP Mask is also suitable for people who fit into the above categories.

Aside from these cases where full-face or oral masks are necessary, most people tend to prefer a nasal-style mask.

Once you have your mask style figured out, your final consideration will be figuring out what size to get. For most masks, a printable mask guide or using measurements around your head will be the best guide to figure out which size mask to go with. Otherwise, masks like the Fisher & Paykel Evora Hybrid Full Face Mask and almost all nasal pillow masks, offer a fit-pack which comes with multiple (if not all of the available) sizes of the cushion included, so you can test out which size works best for you.

What masks fall into which categories?

There are traditionally three main types of masks. These are: Full Face Masks, Nasal Masks and Nasal Pillow Masks; As new technology is created and the designs of masks have evolved over the years, the lines have been blurred, catering to a plethora of different user preferences and facial structures.

Now we have options such as Under The Nose masks which are not quite the same as Nasal or Nasal Pillow Masks since, as the name implies, they sit under the nose. There are also now Hybrid Full Face Masks which are the same as Under The Nose masks, but with a mouthpiece.

ResMed makes figuring out which masks fall under which category easy with its simple naming scheme. The model name will start with a letter (“F”, “N”, “P”) and this letter refers to type of mask (i.e., F = Full Face Mask, N = Nasal Mask, P = Nasal Pillow). If the model name ends with the letter “i”, this means that the mask is arranged such that the tube attachment is at the top of the head, rather than the front of the face.

Listed below is an outline of the different categories of masks we have here at CPAP Online Australia:

Full Face Masks

Full face masks cover both the nose and mouth, ensuring that a continuous flow of pressurised air is delivered to maintain an open airway throughout the night. Full face masks are a valuable option in the world of CPAP therapy, catering to individuals who need comprehensive airway coverage or breathe primarily through their mouths during sleep.

Hybrid Full Face Masks

Hybrid Full Face Masks were designed for CPAP users who toss and turn at night, allowing them to move more comfortably in their sleep. Compared to a traditional full face mask, these masks are designed to be lighter and more compact, providing a “best of all worlds” option for those who require their mouths to be covered by their masks while avoiding bulk as much as possible. In addition to this, the tube-up design and 360° rotation included in masks like the AirFit F30i offer users a more natural sleep experience and a clear field of vision, allowing you to read or watch TV while wearing it.

Nasal Masks

Nasal masks are designed to cover the nose only. They provide a seal around the nose, delivering pressurised air directly into the nasal passages. These masks are well-suited for individuals who primarily breathe through their noses during sleep. They are often preferred by people who find breathing through their mouth uncomfortable or those who experience dry mouth with full face masks.

Nasal masks tend to be less bulky and more comfortable for many users compared to full face masks. They offer a wide field of vision, allowing users to read, watch TV, or wear glasses comfortably before bedtime.

Nasal Pillow Masks

Nasal pillow masks are the least invasive CPAP mask type. They consist of soft, cushioned inserts (pillows) that fit directly into the nostrils. These masks are highly favoured for their lightweight and minimal design, providing an open field of vision and allowing users to wear glasses or read comfortably before sleep.

Choosing a suitable mask is a personal decision and it is not always the case that the smallest, lightest or least obstructive mask is going to provide you optimal comfort or the best possible therapy outcomes. It’s essential to consider factors like your sleeping position and habits that could impact how your CPAP Mask fits as the right fit is crucial for effective therapy.

Choosing a mask based on scientific research

You may be wondering if there is any research that should be considered when selecting a CPAP mask. After all, considering that there are a few different kinds of masks, surely there must be some statistical difference in their overall efficacy.

Fortunately for you, the American Thoracic Society conducted a workshop¹in 2020 to answer this exact question. Their goal was simple: to examine the significance of mask choice in CPAP therapy for Obstructive Sleep Apnoea (OSA), and they were able to derive some extremely valuable insights and conclusions from this exercise.

In summary, scientific research supports the use of nasal CPAP over oronasal (full face) CPAP, with studies indicating better adherence, lower residual apnea-hypopnea index (AHI), and higher therapeutic levels with the former. However, oronasal masks can still be effective for some OSA patients. See the below table for a summary outline of the pros and cons of the two kinds of masks:

Mask	Advantages	Disadvantages
Nasal	More comfortable	Risk of mouth leak
	Lower overall leak
	Lower therapeutic pressure requirement
	Higher adherence
	Lower cost
	Less risk of aspiration
	Lower risk of CO₂ rebreathing
	Lower risk of aerophagia
Full Face / Oronasal (Mouth & Nose)	Better control of mouth leak	Less comfortable
	Better control of REM-associated leak	Higher overall leak
		Higher therapeutic pressure requirement
		Lower adherence
		Higher cost
		Higher risk of aspiration
		Higher risk of CO₂ rebreathing
		Higher risk of aerophagia

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640631/

First and foremost, it was established that nasal CPAP should be the initial preference for most OSA patients, as it offers effective therapy while maintaining airway patency. Mouth breathing, which is common among OSA patients, is usually best addressed with a nasal mask, as it prevents upper-airway narrowing and provides a consistent airway. In other words, having CPAP therapy delivered to your nose, in and of itself, may cause you to default to using your nose to breathe during the night, even if you are ordinarily a mouth breather.

The workshop also underscored the importance of managing nasal symptoms that can affect CPAP adherence. Nasal congestion, rhinorrhea, and other nasal issues are common reasons for non-adherence to CPAP therapy. Effective management strategies include humidification, nasal steroids, and nasal surgery, all of which can significantly improve nasal CPAP adherence.

The issue of oral leak during nasal CPAP therapy was addressed, with recommendations for intervention, including reviewing the mask seal, treating nasal obstruction, considering chinstraps, and using heated humidification. Patients who continue to experience oral leak may switch to oronasal CPAP with close monitoring due to potential upper-airway narrowing and increased CPAP pressure requirements.

Monitoring for adherence and adverse effects was highlighted as a crucial aspect of OSA treatment. Early usage, nasal passage size, and nasal resistance were found to be among the best predictors of CPAP adherence. The resolution of adverse effects should be addressed early in the therapy to enhance compliance.

In conclusion, scientific research emphasises the importance of mask selection in CPAP therapy for OSA. Nasal CPAP is generally the recommended initial option, but the management of nasal symptoms and the prompt resolution of adverse effects are also key factors in optimising treatment outcomes. Adherence to therapy, along with effective mask selection, can significantly improve the well-being of individuals with OSA.

Choosing a mask based on your sleep position

Are you wondering which CPAP mask is your perfect match based on how you sleep? We’ve got you covered! Your sleep position plays a crucial role in choosing the right mask to maximise comfort and effectiveness. Let’s break it down so that you can make the right choice for you, regardless of whether you’re a back, side, or stomach sleeper.

CPAP Masks for Side Sleepers

Sleeping on your side is a great choice for managing sleep apnoea, as it can help prevent airway blockage caused by gravity when sleeping on your back. However, despite its benefits, we understand that finding the ideal CPAP mask for side sleeping can be a challenge.

It is hard to recommend full face masks for side sleepers as they tend to be the bulkiest mask type. Unless you find a significant difference in therapy quality between the different mask options, we would recommend that you use nasal pillow masks. These low-profile masks rest comfortably above your pillow, and they maintain their seal even if you shift your face against it.

Your next best options are nasal masks, which cover part or all of your nose and can also work well for side sleepers. With their effective seal and adjustable headgear, they minimise air leaks which you may experience when using a nasal pillow mask. When using a nasal mask as a side sleeper, you may wish to consider using a CPAP-friendly pillow like the Best In Rest Memory Foam CPAP Pillow, to make room for your shoulders, your mask and its tubing and prevent mask leaks as suggested by The American Thoracic Society.

CPAP Masks for Back Sleepers

Back sleepers have more options since this position naturally accommodates various mask styles. Full-face masks can be used without any trouble, making back sleeping a convenient choice for CPAP users. However, it’s essential to be aware that back sleeping can increase the risk of airway collapse due to gravity.

If you’re a back sleeper and your doctor hasn’t advised changing your sleep position, then this particular aspect of your sleep should not factor into your mask choice and you’re free to choose any mask that fits your needs.

CPAP Masks for Stomach Sleepers

Stomach sleeping is less common than the other two sleep styles, and it tends to create some unique challenges when selecting a CPAP mask. Having the weight of your head pushing down against the pillow while wearing a mask means that your mask may press into the face, leading to discomfort and air leaks. Additionally, the mask may force your head into positions that strain your neck, causing long-term discomfort.

For these reasons, nasal pillow masks are often the go-to choice for stomach sleepers. Their low-profile design minimises the risk of displacement and discomfort, no matter how you shift during the night. However, if you are a stomach sleeper, it’s crucial to ensure that your sleep position isn’t affecting your CPAP therapy or your sleep quality in general.

Choosing a mask based on your habits

CPAP users have unique preferences and habits. Some may need a mask that accommodates glasses or allows them to read before bedtime. Others might not want to have to choose between sacrificing their sleep or their facial hair. In this section, we’ll delve into how your habits can inform your CPAP mask selection.

Do You Have Facial Hair? – Nasal Pillow Mask:

If you have facial hair, particularly a beard or moustache, you may find it challenging to achieve a secure seal with a full face or nasal mask. A nasal pillow mask is an excellent choice in this case, as it provides a comfortable seal directly in the nostrils without interference from facial hair.

Do You Wear Glasses, Read Or Watch TV Before You Sleep? – Nasal Pillow Mask:

If you like to read or watch TV while in bed, a nasal pillow mask is the way to go. Its compact design keeps your field of vision clear, so you can enjoy your entertainment without any mask-related hindrance. If you prefer to wear glasses before sleep, a nasal pillow mask is an excellent option for this too. Its minimal design leaves ample space for your glasses without obstructing your field of vision, allowing you to enjoy your activities before bedtime.

Do You Get Claustrophobic? – Nasal Pillow Mask:

If you’re prone to claustrophobia or simply prefer a more open and minimalistic feel, a nasal pillow mask is an excellent choice. Its lightweight design and minimal facial coverage can help reduce feelings of confinement, providing a more comfortable experience.

Do You Move a Lot During Sleep? – Many Options:

If you’re an active sleeper who shifts positions frequently during the night, consider a nasal mask or hybrid mask. These masks offer a secure fit and are less prone to dislodging during movement, ensuring uninterrupted therapy.

Some masks are designed such that the tube attachment is at the top of the head, rather than in front of your face, which you will likely find makes it easier to move around with. Alternatively, if you want to try this but already have a mask, or find that the mask you like doesn’t come with its tube attachment at the top of the head, you can also consider purchasing a Best in Rest Premium CPAP Hose Lift to achieve a similar effect.

Are You A Woman? – Small / For Her Options:

Some manufacturers, like ResMed, offer alternative versions of their masks which are made especially for use by women. ResMed refers to these variations as the “For Her” versions of their masks. These masks come with smaller headgear and are coloured in traditionally “feminine” colours like pink and purple.

Do You Have Magnetic Implants? – Avoid Certain Masks

If you have certain magnetic, metallic medical devices or objects, including but not limited to pacemakers, metallic stents and neurostimulators, which are implanted in your body, you may be at risk when using certain CPAP masks which use magnets in their headgear clips to secure the masks. Some of these include the ResMed AirFit and AirTouch mask ranges like the F20, F30 and N20.

As per the FDA, a few of these masks, manufactured by Philips, were previously recalled due to not clarifying their potential danger in their safety information. The masks have since returned to markets now that their safety information has been updated to warn users of the potential dangers of magnetic interaction between implanted magnets and the magnets used in the headgear clips.

A list of these masks is below:

Amara View Full Face Mask
DreamWisp Nasal Mask
DreamWear Full Face Mask
Wisp and Wisp Youth Nasal Mask
Therapy Mask 3100 NC/SP

If this is a concern for you, we suggest that you take a look at the Fisher & Paykel range of masks since, according to their official statement following the Philips recall, their masks do not feature any magnets at all.

Do You Breathe From Your Mouth? – You Still Have Options

As noted previously, the main recommendation for mouth breathers is to use a full face mask, otherwise, there will be an issue of air escaping the mouth. For those who have nasal congestion or some other form or breathing issue arising from the nasal passages, this may remain the only solution.

However, for those who are habitual mouth breathers or who find that sleep apnoea therapy forces their mouth open (perhaps due to high pressure settings on their device), there may still be a way for you to overcome this.

If you are compelled by the research outlined earlier in this article and wish to use a nasal mask despite being a mouth breather, you could consider using a chin strap.

Using a Chin Strap to Close Mouth

A chin strap is a straightforward and non-invasive accessory that can significantly enhance the performance of a nasal mask. It is designed to keep the mouth closed during sleep, preventing air from escaping and encouraging the user to breathe through their nose and preventing symptoms such as air leaks and dry mouth.

At CPAP Online Australia, we offer two kinds of chin straps:

The Best in Rest Chin Strap is gentle, comfortable and uses one-size-fits-all, adjustable headgear. This chin strap uses two head straps around the crown to ensure there is no slipping off during the night.

Alternatively, you can consider the ResMed Chin Restraint Strap which uses only one strap, compared to the two on the Best in Rest Chin Strap but which is also an excellent, comfortable, adjustable solution to open-mouth sleeping.

In conclusion, a chin strap can be a game-changer for mouth breathers using a nasal mask. It promotes nasal breathing, improves therapy outcomes, and enhances overall comfort during sleep apnea treatment. With the right combination of equipment and adjustments, you can enjoy the full benefits of your CPAP therapy.

Using a CPAP Pillow to enhance comfort

If you’ve found a mask that works to provide a proper seal and effective therapy but just can’t seem to sleep comfortably, The American Thoracic Society recommends that you try pairing your mask with a CPAP-friendly pillow to complement your CPAP therapy and prevent mask leaks.

The primary benefit of CPAP Pillows like the Best In Rest Memory Foam CPAP Pillow are their unique cut-outs/indentations which can accommodate your CPAP mask and make space for your shoulder if you are a side-sleeper. The use of memory foam in this particular pillow means that it will conform to the unique shape of your head and neck, assisting your airways to be aligned properly. This aided alignment can assist you in reducing blockages and even snoring.

Conclusion: Final Thoughts on Choosing a Mask

Ultimately, the decision on which CPAP mask to choose is a personal one. It hinges on your individual needs, preferences, and comfort. By exploring the factors outlined in this guide, you’ll be better equipped to make an informed choice that enhances your sleep quality and, in turn, your overall well-being.

If you are absolutely desperate for a recommendation, we have found that the ResMed AirFit F20 full-face mask is the most popular mask option that we sell at CPAP Online Australia. The AirFit F20 is known for its universal fit, and tends to mesh well with most facial structures. However, just because it is likely to work well enough for most people doesn’t mean that it is the best possible option for you specifically. It is important to find a mask that is comfortable and that you are actually willing to commit to using long term because, at the end of the day, consistent, quality sleep therapy is going to make a world of a difference to your sleep quality and energy during the day.

If you still have questions, we encourage you to contact us, whether that be through the Live Chat on our page or by calling one of our friendly representatives on 1300 994 133 any time between 9-5pm (AEST/AEDT), Monday to Friday.

Frequently Asked Questions about CPAP Masks

What do I need to clean my mask effectively?

CPAP Mask Wipes:

We recommend that you use the Purdoux CPAP Mask wipes to clean the underside of your CPAP mask cushions (the part of the cushion which makes contact with your face/nose). These are especially useful for those who travel or who have limited access to water, as the wipes can be used without the need for water. The cushions should be cleaned daily.

CPAP Soap:

When cleaning your mask and tubing, most manufacturers will recommend that you use gentle/mild detergents, avoiding scented soaps, alcohol, bleach and antibacterial soaps. The easiest way to make sure you’re using the right product to clean your mask is to use one designed for CPAP gear like the Purdoux CPAP Mask and Hose Soap. This same soap can be used to clean both your mask cushions and hose. The tubing, like the cushions, should be cleaned daily.

CPAP Hose Brush:

Since CPAP hoses are long and narrow, you may have difficulty cleaning them thoroughly and properly reaching the inside. We suggest that you use the Purdoux CPAP Hose Brush in combination with warm water and your CPAP soap to resolve this issue.

Is there a guide I can follow to determine my mask size?

Yes there is! All of our mask pages on the CPAP Online Australia website feature their respective fitting guides. Simply print out the guide, make sure it is to scale (there is usually a ruler included on the guide to confirm this with) and follow its instructions to determine which size for that particular mask is for you.

Can I provide my weight and height to determine mask size?

Unfortunately not. Whilst it would be extremely convenient if those data points could be used to determine mask size, there are simply too many factors at play when it comes to mask size including face shape and structure, weight distribution and body fat percentage, to name a few.

Instead, we suggest that you either purchase a mask fitting kit with different sized cushions so that you can try them out yourself. Otherwise, if you are only looking to purchase one mask, using a mask guide before buying is a good option to determine mask size.

If I get a new mask, should I choose the same size as my old one?

Just like with clothing and shoes, whilst some people may notice that they are a consistent size across different mask brands and models, your mask size may vary and it is highly recommended that you check your mask’s sizing guide to confirm before committing to buying one.

Part of my mask is damaged and/or worn, do I need to buy a new mask?

No, not at all. In fact, we recommend that you replace parts of your mask regularly, when needed. Mask cushions and pillows should be replaced around every month, the mask frame (excluding headgear) and tubing should be replaced about once every three months and the headgear and chin strap should be replaced about once every six months.

You can find all the replacement parts we have available for purchase here, including Tubing & Hoses, Mask Cushions & Pillows, Mask Headgear, Mask Frames, Mask Clips, Mask Elbows & Diffusers.

When should I buy a new mask?

Your CPAP mask should be due for replacement once every 6-12 months. However, as noted above, if you find that part of your mask is worn but the rest of it is in good condition, you can simply replace different pieces of the mask without having to buy a whole new one

Of course, this is just a guideline and you should definitely replace your mask if you find that there is persistent leakage, that your mask no longer fits you or if you are having some sort of irritation or other reaction to your mask.

Bobby Afshari (B.Pharm.MPS)

Bobby Afshari studied a Bachelor of Pharmacy and is a member of the Pharmaceutical Society of Australia. Bobby is the sleep technician at CPAP Online Australia.

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