The Anatomy of a CPAP Mask
By Andrew Senske, President CPAP-Supply.com
Last Updated 12/9/2006 4:39:00 PM



New CPAP users generally need help finding the right CPAP mask to go along with their new CPAP machine. It's all too easy for CPAP suppliers to recommend the most popular CPAP mask, which for us is the Respironics ComfortGel. It's also pretty easy to ask the new user what they wore during their sleep study and which mask their physician may have recommended. Those are good starting points in the CPAP mask discussion, but I believe it's better to dig a little deeper and to help educate CPAP users before they make a purchase. I know I wouldn't want to buy a CPAP mask - an item that can't be returned for a refund if opened - only to learn very quickly that it's not the right mask for me. In this article I'll outline the different types of masks, identifying their strengths and weaknesses. I'll also let you know if it's even possible to find the right mask without trying any of them on.

As most of you know the CPAP mask is by far the most significant and troublesome variable in the CPAP circuit (the circuit being comprised of the CPAP machine the CPAP tubing and the CPAP mask). As long as the CPAP machine is relatively quiet and blows air at the prescribed pressure setting, it isn't likely that the CPAP machine will cause problems vis-a-vis patient comfort and compliance. If your CPAP tubing is long enough and free of leaks then you've got nothing to worry about there. If you're humidifier is filled with water and working properly, it generally won't present too many problems. Those elements of CPAP therapy are the basic ones, which pretty much work the way you want them to work. They're also the elements that aren't affected by the shape of your head, the size of your nose, or the fact that you sleep on your side. The CPAP mask, however, is a completely different story.

"Which CPAP mask should I buy?", is a question we hear from customers every day. And it's not always easy to answer definitively. Often this simple question leads into a 10 minute discussion of not only the various CPAP masks we sell, but also of the physical characteristics and sleeping habits of the CPAP user. More than once after ending a phone call I've realized I had forgotten to tell a customer about a particular mask feature, or a cushion style that might suit their particular needs even better than the masks or cushion styles we were discussing. I do my best to point CPAP users in the right direction over the phone, but inevitably the customer wonders whether the mask she just bought is actually going to work when it's strapped to her face. There's really nothing like trying before you buy, and not being able to do this is the single weakness of online CPAP suppliers. Letting customers see, feel and try masks is the only advantage of the local CPAP supplier (but considering what most local suppliers charge for CPAP equipment, you could buy several masks online and try them to your heart's content). I recognize this as a deficiency but I also recognize the fact that it's possible to communicate a tremendous amount of product knowledge via the telephone and internet. And the nice thing about communicating it via the internet - in an article like this - is that it's always here, ready and waiting for you.

So let's now take a look at the different types of CPAP masks. I've created several categories of CPAP masks below and in each category I'll highlight at least one example of a CPAP mask that fits within the category, outlining the general design of the mask as well as advantages and disadvantagess of the specific masks and of the category of masks.

Gel Cushion (Profile Lite, Goldseal)
The gel cushion has been around for quite some time and continues to be popular today. Gel cushions like the Respironics Profile Lite and the Respironics Goldseal nasal CPAP masks feature a malleable, firm gel within a silicone membrane. The design intent is for the gel to easily form to any facial feature. A good seal with a gel cushion is generally attained by tightening the headgear on the CPAP mask. The Profile Lite is designed to be customizeable, much like a mouthpiece that a football player or boxer wears. The gel is warmed up, placed on the face, and then allowed to cool thus forming a mold of the patient's face. The customizable nature of the Profile Lite is attractive to many CPAP users. Tight headgear, on the other hand, is not such an attractive thought. Older style gel CPAP masks like the Profile Lite and the Goldseal are generally very basic in all respects. For example, these masks don't have adjustable forehead supports. Also, these CPAP masks simply have slots through which velcro headgear straps are inserted and attached to the mask frame, meaning that the headgear must be readjusted each time the mask is removed. However, you can add a cool little thing called a quick clip to a basic CPAP mask with standard headgear slots which eliminates the need to "un-velcro" the headgear when removing the CPAP mask from your head.

Inflatable Cushion or Bubble Cushion (Ultra Mirage)
For the last several years inflatable (or bubble) cushions have been extremely popular, with the ResMed Ultra Mirage series of nasal CPAP masks leading the way. The primary advantage of an inflatable cushion is that you can get a great seal without tightening your headgear. This means that you likely won't experience irritation or pain on the bridge of your nose or your forehead, which are two common pressure points when wearing a nasal mask. The way an inflatable CPAP cushion works is simple. A secondary flap surronds the perimeter of the main cushion. When air is blown into the mask cushion the flap fills with air (forming something like a bubble). When the flap fills with air it creates a seal against your face, and since the "bubble" of air is creating the seal it accomodates different shapes and contours of your face - that is, it fills in where there's a gap, and it doesn't fill where there's not. It's somewhat counterintuitive for new CPAP users, but with this type of CPAP mask cushion loosening the headgear generally has a positive effect on the quality of the seal.

Impact Absorbing Cushion (Mirage Activa)
Designed specifically for the active sleeper, a CPAP mask with an impact absorbing cushion allows for quite a bit of force to be exerted on the mask cushion before the part of the mask contacting your face is affected. The Mirage Activa is the only mask we currently sell that falls in this category, and it happens to be the mask that my dad wears most frequently. If the Mirage Activa has a drawback it may be that it's slightly more bulky than other masks because of the extra silicone that acts as the "absorption buffer". For an active sleeper or side sleeper the Mirage Activa is a great choice.

Gel and Inflatable Cushion Combined (ComfortGel)
Respironics figured out that the gel cushion has the advantage of being customizeable, but that the gel cushion by itself may not always prevent air leaks. The ComfortGel nasal CPAP mask features a customizeable blue gel cushion along with a silicone membrane around the perimeter of the cushion which inflates when air is blown through the mask. The gel cushion can be used to enable the mask to conform to the major contours of your face, while the inflatable membrane will fill in any gaps. This design allows CPAP users to loosen their headgear and alleviate common pressure points on the nose bridge and forehead. The ComfortGel nasal CPAP mask also features a ball-and-socket headgear release design so that the headgear doesn't have to be adjusted each time the mask is removed. A four position forehead support enables the CPAP user to relieve pressur from the nose bridge while maintaining an effective seal. There really aren't any disadvantages of this type of CPAP mask cushion.

"Simple" Cushion (Respironics Simple Cushion)
I define a simple nasal cushion as one that is neither a gel cushion or an inflatable cushion. This type of nasal CPAP cushion is a low profile, non-bulky cushion that feels less invasive than bigger nasal CPAP masks. The Respironics Simple Cushion is a good example of this type of cushion. The Respironics Simple Cushion is found on both the Respironics Simplicity nasal CPAP mask and the Respironics ComfortLite 2 nasal CPAP mask. The cushion itself is about half the size of typical gel or inflatable cushions.

Nasal Pillows (Breeze SleepGear, Mirage Swift, ComfortLite 2, NasalAire II, AEIOmed Headrest)
Nasal pillows cushions are extremely popular due to the fact that they are the least invasive type of CPAP mask cushions. With most nasal pillows CPAP masks the CPAP user can wear glasses while wearing the CPAP mask allowing for bedtime reading or tv watching. Nasal pillows cushions fit directly into the nostrils, and come in a variety of sizes to accomodate most patients. Humidification can help prevent irritation of the nostrils. The Puritan Bennett Breeze SleepGear with Nasal Pillows Assembly is different from the newer nasal pillows CPAP masks, in that the nasal pillows are two individual cushions which are placed into a plenum. The ResMed Mirage Swift, Respironics ComfortLite 2, NasalAire II all feature single cushions or sleeves which contain two contoured parts which fit into your nostrils.

The ResMed Mirage Swift isn't ideal for side sleepers because the Swift's short tube fits onto either side of the CPAP mask frame. That means you can sleep on one side, but if you roll over to the other side, you'd have to wake up and switch the short tube to the other side of the mask frame.

The ComfortLite 2 is a great mask because it is designed to accomodate three different types of cushions - simple cushion, nasal pillows cushion, and direct seal cushion (which is very similar to the nasal pillows cushion). The ComfortLite 2 is available in combo packs so that you can try different types of cushions and different sizes of cushions, all for the price of a single mask.

Oral Masks (Fisher & Paykel Oracle)
Oral masks aren't very popular, but if you're a mouth breather while sleeping this is a good alternative to a full face mask. When wearing an oral CPAP mask the nostrils must be plugged (otherwise they create a very large air leak), just as when wearing a nasal mask the mouth must be closed (either naturally or by way of a chin strap).

Hybrid (Oral and Nasal Pillows Combined)
The Hybrid CPAP mask is a relatively new mask designed to be a lower profile alternative to the full face mask. It delivers air through a cushion that covers your mouth and through nasal pillows that fit into your nostrils. A great alternative for mouth breathers, the Hybrid CPAP mask eliminates the need to use a chin strap and offers the benefits of a full face mask without the bulkiness and invasiveness. You can easily wear glasses to read or watch television while your CPAP machine is ramping up.

Most customers ask how to determine the proper CPAP mask size. If you don't know your mask size I'd recommend calling us toll free at 1-888-955-2727 so that we can help you take some measurements over the phone. Then we can recommend a size for you. In the near future I'll develop a CPAP mask sizing guide so that the correct CPAP mask size can be determined easily on our web site.

After Rosie O'Donnell appeared on TV in November 2006 showing off her new CPAP equipment I received a few phone calls asking what kind of CPAP mask she was using. While I didn't see Rosie's show (I do actually work during the day) from the descriptions I received from callers it sounded as if she was using a Respironics ComfortLite 2.

So forget everything I just wrote and be like Rosie!

Andrew Senske
President
www.cpap-supply.com

CPAP-Supply.com is a leading online retailer of CPAP equipment. Located in Spokane, WA CPAP-Supply.com has been serving thousands of customers around the world since 2001. Founded on a belief that patients are their own best primary care providers, CPAP-Supply.com understands the importance of educating patients and customers on both the effects of and treatment for obstructive sleep apnea. For more information visit CPAP-Supply.com or call toll free 1-888-955-2727.

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