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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.
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.
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.
|Mask Type||Full Face||Nasal||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 pressure setting||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|
|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.
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:
Some CPAP mask considerations for side sleepers include:
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.
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:
Some CPAP mask considerations for back sleepers include:
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.
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.
Some CPAP mask considerations for stomach sleepers include:
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.
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:
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.