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Nasal versus Full Face Mask: Which Mask Style is Better for CPAP Treatment of Sleep Apnea in 2024?
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- Опубликовано: 14 апр 2023
- The choice of mask by far is the key to success in using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). @andyberkowskimd of ReLACS Health compares the two major mask styles: nasal versus full face.
To understand why mask fit is the most important factor in successful treatment of sleep apnea, watch this video:
• In 2024, Mask Fit is S...
There is a lot of misunderstanding about CPAP and which mask style to choose, even from durable medical equipment company (DME) staff who do mask supplies and fittings. Normal breathing at night involves breathing almost exclusively through the nose, full stop. The purpose of the full face mask is NOT to breathe through the mouth, but rather, to keep the mouth closed to prevent air leakage/mouth venting. An individual with untreated sleep apnea may breathe through their mouth, but this is abnormal. On a CPAP, which treats the obstruction in the throat by holding air pressure in the throat to prevent collapse, the person will breathe normally through the nose. However, occasionally, the mouth can open and the air from the nose can come through the mouth and escape from the open mouth. This can cause discomfort, dry mouth, disruption to sleep, and decreased effectiveness of treatment.
A person new to CPAP should always start out with any model of nasal mask first. Most will do just fine with a nasal mask and the mouth will remain closed. If there is mouth venting to a bothersome extent, then a chin strap can be added to keep the mouth closed. If a trial of chin strap models are unsuccessful, only then should an individual try a full face mask to keep the mouth closed.
Nasal mask are preferred because they tend to fit better as they are smaller and cover less of the face, leading to better comfort and reduced leakage. Full face masks can sometimes be less effective. If the mouth opens while using a full face mask, air can flow in the wrong direction into the mouth and counteract the air pressure from the nose going behind the mouth. Full face masks can also exert force on the lower jaw (mandible) in the wrong direction, narrowing the throat further, leading to higher pressure requirements from the CPAP. Nevertheless, many individuals will require a full face mask to prevent mouth venting, and these can be very effective as well, but perhaps with more trial-and-error when it comes to mask fitting. However, perhaps a major of CPAP users have full face masks who do not need them. A large subset struggle with tolerance and mask fit on a full face mask and should consider trying a nasal model.
With increasing numbers of adults developing sleep apnea due to the obesity epidemic in the United States, continuous positive airway pressure (CPAP) is by far the safest and most effective treatment in 2023. Depending on the nature of the sleep apnea and the settings of the device, CPAP can be virtually 100% effective and restore normal breathing to those with sleep apnea in the majority of cases. However, CPAP is not as simple as a pill you swallow. It is a machine that has to deliver airflow to create pressure through the nose into the back of the mouth and throat to hold it open. Sleep apnea occurs when a person falls asleep and the throat muscles relax and disrupt breathing. The pressure from CPAP acts like a splint inside the muscles to keep the throat open and the air flowing normally. The treatment is only effective if the mask is worn continuously while sleeping, ideally 100% of the time. With a mechanical treatment, the mechanical solution must be in place for the mechanics to be corrected.
For most, this treatment is very important so it is necessary to spend the time and resources on mask trials so that the best fit can be found. Nasal masks should be tried first without a chin strap. A chin strap can be added for significant mouth venting. If a chin strap fails, then an individual should consider a full face mask.
For those who have trouble using CPAP consistently, it may be time to discuss the issue with a licensed sleep provider or doctor who is prescribing the CPAP device. The treatment options outside of CPAP are often less effective and/or pose more serious risks of side effects or complications, so again, working on mask fit and getting used to the CPAP should be the focus for most people with sleep apnea.
To read in more depth about sleep and sleep disorders, follow A ReLACSing Blog:
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I am about to get my equipment - I am a retired physician… thanks so much for this information- very helpful
Thank you. I just placed an order for my first CPAP. This was very useful in choosing the mask
Thank you so much for this video. I have looked and search for a video that explains the breathing in the different masks and why you use the mask for the different types of breathing and air leakage great great informative video. Thanks again.
very informative, thanks
Thank you for your wisdom. You answered all my questions in about 5 minutes.
Glad it was helpful!
Great info
Glad it was helpful
I do best with an N30i nasal mask and mouth tape.
I have been suffering from relentless sinus headaches during the day after using nasal masks. I have reduced pressure, raised pressure, same with humidity, basically every setting (epr) and after a year roughly of sporadic headaches I feel like giving up.
I got a full face mask hoping there was some truth that breathing through mouth might alleviate pressure on sinuses, but today after third night I also have a headache.
Are some people just not made out for Cpap? Any ideas?
As a side note, re the most obvious, lowering pressure unfortunately makes it feel like I’m breathing through a straw, and my flow limitations reflect this.
CPAP pressurizes the nasal passages and can move fluid into the sinus cavities located behind the nose, cheeks, and eyebrows, which may create irritation. Sometimes addressing fluid and inflammation in the sinuses with help of a primary care doctor, allergy specialist, or even an ear nose and throat doctor can help with eliminating this effect from the CPAP. Likely the type of mask will not make a difference in this situation because there will be pressure through the passages regardless.
I have very mild sleep apnea about 5 episodes. I can’t keep my mouth closed when sleeping so nasal masks won’t work for me. I have tried a chin strap and I tried a full face mask but with allergies and nasal congestion I can’t inhale or exhale. Plus I can’t sleep on my back. I have tried Flonase, was addicted to Affrin nasal spray, have had allergy shots and with high blood pressure I shouldn’t take a decongestant. I’m going to try a dental device. The last mask I had gave me headaches because I had the straps so tight because of leakage trying to sleep on my side.
Thanks for sharing. Your story is common to many people struggling to use CPAP with nasal congestion and mouth venting.
Hi mate , any idea why, I have the heated tube for airsense 11 , and I usually use 11 pressure with the P30i mask and is fine. But I needed a full face mask. So I bought the airfit F20 full face AIR FIT mask by resmed. And I can't breath right. I have go over 19 pressure and still feel like I need more air and wake up in the middle of the night with not enough air and need to change mask. Thank you for anwser anyone! Any good full face idea for more air , I guess?
Sometimes full face masks can exert force on the lower jaw (mandible) that push the jaw toward the back of the throat and make the collapse of the throat worse. In other ways, in can direct air into the mouth and it counteracts the air coming through the nose down the back of the throat. The result of these is a higher pressure or poor control of sleep apnea when different masks are used. However, air escaping through the mouth with nasal masks can be difficult to fix without a full face mask so this can be a challenge.
What do you recommend for someone who occasionally has a plugged nose? I am new to using CPAP and have had success using nasal pillows, however I have mild seasonal allergies which sometimes block my nose. I am now trying a full face mask for those times when my nose is blocked -but it sounds like breathing through my mouth releases the CPAP pressure which defeats the whole purpose! is there a solution?
Most patients with difficulty getting air through a CPAP mask from nasal congestion go through a progression of approaches including nightly nasal rinses, anti-inflammatory medications like Flonase®, Nasacort®, etc., anti-histamine nasal sprays (Rx only), and even antihistamine pills for prevention. Sometimes a sleep physician can help a patient figure out things to keep the nasal passages open. When more conservative measures fail, an allergy specialist can help identify causes for prevention as well as treatment. Even occasionally an Ear-Nose-Throat doctor can do small procedures if there is a mechanical or structural cause of blockage if the above strategies do not help.
A full face mask is not really a solution to those who cannot breathe through their nose at all. This type of mask is intended to keep the mouth clamped shut in those whose jaws open with a nasal mask, leading to air venting out of the mouth that is going into the nose and down the throat. The full mask is not like for Darth Vader or a scuba diver to breathe through the mouth. Most would gag if they tried to breathe through the mouth with the pressurized airflow blowing in.