Choosing a Sleep Position Based on Your CPAP Mask

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Millions of Americans live with sleep apnea, a condition characterized by temporary loss of breath during sleep; sleep apnea often causes chronic snoring, as well. While there is no cure, many people with sleep apnea treat their symptoms with positive air pressure (PAP) therapy. PAP therapy involves an airflow generator that draws in outside air using a motorized fan, humidifies and pressurizes the air, and the delivers the air to the sleeper through a connective hose and face mask. Common types of PAP therapy include continuous positive air pressure (CPAP), bi-level positive air pressure (BiPAP), and automatic positive air pressure (APAP).

PAP therapy has proven beneficial for many with sleep apnea, but this treatment method has its downsides. One notable con is sleeper discomfort due to the position of the mask and connective hose. The sleeper’s chosen position may compound this problem, depending on the size and shape of their mask, as well as the way the connective hose is arranged.

This guide will look at different mask options for PAP therapy recipients, recommended mask choices for common sleep positions, and some additional strategies for staying comfortable and well-rested while wearing a PAP mask.

PAP Overview and Mask Options

The airflow generators used in PAP therapy deliver air at different pressurized rates, which are measured in centimeters of water (cmH20). Most generators can deliver air at pressure rates of anywhere from 4 to 20 cmH20, metered out in 1 or 0.5 cmH20 increments. How this air is pressurized and delivered depends on the type of PAP therapy being used.

  • Continuous positive air pressure (CPAP) therapy delivers airflow at a fixed (or continuous) rate throughout the night, which is determined by the user’s prescription. CPAP is most commonly used for obstructive sleep apnea (OSA), which is caused by a physical blockage in the breathing passages.
  • Bi-level positive air pressure (BiPAP) delivers airflow at two different rates, one for inhalation (typically higher) and one for exhalation (typically lower). In most cases BiPAP is used to treat central sleep apnea (CSA), which occurs when the brain is unable to send signals to the muscles that regulate breathing.
  • Automatic positive air pressure (APAP) delivers airflow at a variable rate, and will automatically adjust based on the user’s breathing patterns. APAP may be used to treat mixed sleep apnea (MSA), which is a combination of OSA and CSA; APAP is also suitable for individual cases of either sleep apnea.

It’s important to note that the airflow generators and humidifiers used in PAP therapy require a prescription from a licensed physician. A prescription is also needed for the face mask; with few exceptions, all PAP therapy masks can be used interchangeably with CPAP, BiPAP, and APAP generators. However, they are commonly sold simply as ‘CPAP masks.’

CPAP masks generally fall into one of the following four categories:

The table below illustrates the similarities and differences between these four CPAP mask types.

Full Face Nasal Cradle Nasal Pillow Nasal Prong
Coverage Area Mask forms a seal that extends from the bridge of the nose to the bottom of the mouth Mask covers entire nose from bridge to nares (nostril openings), but does not extend below the upper lip Mask forms a seal around both nares held in place by a cushion (or pillow) for added support Mask forms both seals around both nares
Headgear Jaw and forehead straps connect at the back of the head Jaw and head straps connect behind the ears Single strap runs beneath nostrils and wraps around the head Single strap wraps around the forehead and crown
Airflow Delivery Indirect; users inhale air that accumulates within the coverage area Indirect; users inhale air that accumulates within the coverage area Direct; airflow is channeled into both nostrils Direct; airflow is channeled into both nostrils
Optimal Air Pressure Suitable for all pressure rates, but particularly well-suited for high pressure Suitable for all pressure rates, but particularly well-suited for high pressure Low to moderate; high pressure can cause irritation Low to moderate; high pressure can cause irritation
Availability Widespread Widespread Widespread Rare
Ideal Sleep Position Back Back or side Back, side, or stomach Back, side, or stomach
Average Price Range $80 to $150 $60 to $130 $80 to $100 $80 to $90

When considering a mask based on sleep position, the connective hose is another important variable. Depending on the position, the hose may rest away from the body or be positioned on top of it. CPAP masks are linked to the connective hose with a component known as the elbow port; some mask models have swiveling elbow ports, which allow users to adjust the angle of the hose to accommodate their sleep position.

Next, we’ll look at the most suitable mask options for side, back, stomach, and combination (multiple position) sleepers.

Choosing a CPAP Mask for Side Sleepers

Side sleeping is the most popular sleep position. It is also the healthiest, according to many sleep experts, especially sleeping on the left side; sleeping on the right side can apply excessive strain on the stomach, liver, and kidneys.

Common side sleeping positions include:

side sleeper positions

Some CPAP mask considerations for side sleepers include:

  • Pillow position and loft: Because one side of a side sleeper’s face will come into contact with their pillow, bulkier masks may not be suitable — particularly models that are inflexible or have thin seals. These models may slip off the face in places, which can cause air leakage. Pillow loft (or thickness) is key because high-loft pillows are likelier to disrupt airflow than medium- or low-loft pillows.
  • Specialized pillows: Some sleeping pillows are specifically designed for CPAP mask wearers that utilize the side position. These pillows have cutouts at the sides where the mask and connective hose can fit; these cutouts ensure the sleeper’s head won’t rest on the pillow at an uneven angle. Some of these pillows also feature straps that help secure the connective hose and keep it in place.
  • Facial irritation: Resting with one’s face on a pillow can cause discomfort in areas where the mask presses into the skin. For this reason, masks with softer edges tend to cause less irritation.
  • Headgear: Most CPAP masks have headgear that connects at the back of the head, but some may feature side buckles or fasteners; discomfort may occur when the pillow presses these components into the side of the sleeper’s head or face.

Our CPAP mask recommendation: Any full face or nasal cradle mask with softer edges, or any nasal pillow or prong mask. Back-fastening headgear is important too.

Choosing a CPAP Mask for Back Sleepers

Back sleeping is the second most common position behind side sleeping. However, people with sleep apnea — whether they receive PAP therapy or not — are generally discouraged from sleeping on their backs. The breathing muscles relax more in this position, which can cause the tongue to fall into the back of the throat; as a result, snoring may be louder and apnea episodes may be more frequent.

Common back sleeping positions include:

Sleeping Positions - Back

Some CPAP mask considerations for back sleepers include:

  • Arm and hand interference: Back sleepers who tend to move their arms/hands during the night may find larger masks problematic, as well as those with fixed elbow ports that require the connective hose to rest in a certain position.
  • Headgear: As we mentioned above, most CPAP masks have headgear that connects at the back of the head. However, some models have buckles or fasteners that slide down the strap; these models will cause less discomfort than those with fixed back fasteners, since the latter will likely press into the sleeper’s head when the pillow presses against the fasteners.
  • High pressure airflow: The back sleeping position tends to be most suitable for full face and nasal cradle masks, the largest and bulkiest of all mask types. These mask types are also the best option for high pressure airflow, as nasal cradle and nasal prong masks often cause irritation at high-pressure settings. For this reason, back sleeping might be the most comfortable position for people who require higher pressure rates.

Our CPAP mask recommendation: Any full face or nasal cradle mask with movable headgear fasteners and a swiveling elbow port. Nasal pillow and nasal prong masks with similar headgear and ports may also work for those who only require moderate to low airflow pressure.

Choosing a CPAP Mask for Stomach Sleepers

Stomach sleeping is somewhat uncommon compared to side, back, and combination sleeping. This may be due to the high discomfort potential. Most adults carry a large concentration of weight in their torso and stomach. When we sleep in this position, the weight tends to pull the rest of our bodies down. This can strain the neck and cause lower back pain. For this reason, many sleep experts discourage stomach sleeping.

Most stomach sleepers utilize the ‘freefall’ position, pictured below to the right.

stomach sleep position

Some CPAP mask considerations for stomach sleepers include:

  • Pillow interference: Regardless of mask type and size, facial discomfort is likely in areas where the mask presses against the pillow. Pressure will be somewhat minimized with nasal pillow and nasal prong masks.
  • Connective hose: In addition to the mask, the connective hose may also press against the face, neck, or torso and create discomfort. Unlike side and back sleeping positions, this problem is not easily mitigated with a swiveling elbow port; regardless of how the port is turned, the hose will press against the sleeper’s body in some places.

Our CPAP mask recommendation: The nasal pillow seems to be the best mask choice for stomach sleepers. This is particularly true of models with softer cushions. Nasal prong masks are another potential option. However, we should reiterate that this position is not recommended due to non-apnea-related reasons.

Choosing a CPAP Mask for Combination Sleepers

The term ‘combination sleeper’ refers to anyone who utilizes one or more of the positions discussed above on a nightly basis. Some combination sleepers switch between side, back, and stomach sleeping, while others flip to different positions of the same type (such as the log and the yearner for side sleepers). Combination sleeping has one unique benefit: by switching positions, sleepers tend to have better circulation.

Some CPAP mask considerations for combination sleepers include:

  • Swiveling elbow ports: For most combination sleepers, a swiveling elbow port will be essential; their flexible design ensures sleepers can shift positions without compromising their airflow. Fixed elbow ports are likelier to become disconnected or cause discomfort during position changes.
  • Arm and hand interference: As is the case with back sleepers, combination sleepers are more susceptible to interfering with their mask and connective hose when they switch positions, particularly if they move their arms and hands in the process.

Our CPAP mask recommendation: Any mask could be suitable for a combination sleeper; it largely depends on which positions they switch between during the night. A good rule of thumb for many is to choose a CPAP mask based on the primary position they utilize. For example, someone who predominantly sleeps on their side may find that full face or nasal cradle masks with softer edges, or nasal pillow or nasal prong masks are the most comfortable.

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