Sleep apnea is one of the most common sleep disorders affecting people around the globe. Millions of Americans are forced to deal with it, as it is a condition without a real cure. This illness is characterized by a temporary loss of breath while the patient is sleeping. Obstructive sleep apnea, for example, happens as a result of a physical blockage in the patient’s airways during sleep as the muscles in those airways relax (often letting the tongue cause a further blockage), which can cause choking or snoring or wake the person up. Sleep apnea can have a whole host of negative consequences, making it a priority to treat.
Despite the absence of a proper cure, treatment options exist. There are a few different types of sleep apnea you may encounter, and these come with specialized treatment methods. The primary way to deal with this condition is PAP treatment. PAP stands for positive air pressure, and the treatment method is very straightforward. An airflow generator uses its built-in fan to draw in the outside air, which is then humidified and pressurized, before being sent towards the patient through a hose that is connected to a mask on their face. How much pressure and humidity is applied (along with other factors) depends on the specific recommendation from your doctor, and is largely connected to what kind of sleep apnea you’re experiencing.
The main problem with PAP therapy is that the mask can often cause discomfort. Depending on your preferred sleeping position, you may experience situations where the mask presses very uncomfortably against your face, and the hose itself can pose problems. In this article, we will go over various masks and the sleeping positions they’re made for. If you find that your mask isn’t ideal for your sleeping position, you may want to consider a change or some adjustments to how you sleep so you can comfortably deal with the symptoms of sleep apnea. Let’s get into it.
Overview of PAP Treatment
Depending on which type of sleep apnea you’re dealing with, different airflow generators will suit your therapy requirements and needs. Continuous positive air pressure therapy (or CPAP for short) is the go-to option for dealing with OSA or obstructive sleep apnea, and these generators maintain a fixed and steady airflow intensity throughout the night. Exactly how much pressure and humidification you need depends on your medical exams and prescription.
On the other hand, Bi-level positive air pressure (or BiPAP for short) offers two main airflow options – higher and lower pressure. These options correspond to inhalation (higher intensity) and exhalation (lower intensity), helping regulate breathing in patients with central sleep apnea (CSA), where their brain cannot send the signals for breathing regulation properly.
Another popular treatment option is APAP therapy. APAP stands for automatic positive air pressure, and these generators stand out thanks to their ability to automatically adjust to the patient’s breathing patterns. For mixed sleep apnea (MSA – which is just a combination of obstructive and central sleep apnea), this treatment produces the best results. However, because it offers different airflow options, it’s flexible enough to cover both ends of the spectrum as well.
PAP therapy masks are what all your comfort worries will likely revolve around. Much like with generators, you require a prescription to purchase a PAP therapy mask. Luckily, almost every mask is compatible with all types of airflow generators. Keep in mind that these masks are often all labeled as “CPAP therapy masks,” even though they’re versatile enough for other kinds of therapy. Make sure to get additional information from your doctor or the salesperson. Here are the main kinds of masks you will encounter in pharmacies near you:
- Full face masks cover your mouth and nose region and supply air to both your nasal and oral passage. Because they tend to be larger than other mask types, full face masks often come with extra cushioning, to provide some semblance of comfort to the user – and maintain the seal. The head straps are almost always located near the jaw, with some masks offering additional support in the form of extra straps that wrap around your head. The most luxurious masks give you a dial that lets you control how tightly the straps are attached in small increments, helping you find a sweet spot for comfort.
- Nasal cradles were originally known simply as “nasal CPAP masks,” as they’re the oldest available nasal model. They’re also the most popular type of nasal mask even today. Unlike full face masks, nasal cradles feature a smaller triangular seal around the nose. This seal touches the mouth without covering it, so you get to avoid some discomfort. Most models feature a chin strap that helps keep your jaw closed, which can be of interest to people who often sleep with their mouths open. This strap also helps secure the mask in place, preventing it from accidentally getting separated from your nose.
- Nasal pillows are the compact alternative to nasal cradles. Instead of sealing off your entire nose, these masks connect only to your nares (nostril edges), using a special cushion (the “pillow” that these masks get their name from) to stay attached. Nasal pillow masks are unquestionably the lightest and smallest of the bunch, and their very specific sealing method makes them perfect for people who have irritable skin and would like to avoid a bigger mask.
- Nasal prong masks are the least common type of PAP therapy mask on the market. They offer much of the same functionality and comfort as nasal pillows, but they don’t use special cushions to stay attached. Instead, they’re secured via a special set of headgear that wraps around your head entirely.
There’s more to a PAP therapy mask than just its categorization, however. Each mask consists of a few separate parts that are worth examining individually, so you know what you’re purchasing. When you compare specs, these are the things you will want to be aware of:
- The frame: This is the “mask part” of the mask. It’s the breathing apparatus, the part that is attached to your face (or nostrils specifically) via cushioning or straps. Make sure the frame is of adequate size for you – most full face masks, for example, come in multiple size options.
- The elbow port: The elbow port is the part of the mask that connects the frame to the hose, and subsequently the airflow generator. It’s called an elbow port because it’s usually jutting out at roughly a 90-degree angle. Some elbow ports have buttons and other options for better attachability, and they can often move around during the night for optimal comfort.
- The headgear: This term is used to refer to the straps that secure the entire PAP therapy mask to your head. Depending on which mask type you chose to purchase, these straps will connect at different angles and come into contact with different parts of your head. Make sure you’re comfortable with how they fit, as otherwise, they may negatively impact your sleep onset latency.
- The cushioning: The cushioning has two essential functions to perform. The first is simply to help secure the mask to the front of your face, or your nostrils. The second (and often more noticeable) function is to provide comfort for the user. Having a mask on your head is already a drop in overall comfort, so the softer the cushioning can be, the better it will feel. Most cushions are fashioned out of silicone, although gel, foam, and cloth models are growing in popularity.
Sleeping Positions and Recommended Masks
Depending on your preferred sleeping position, not every PAP therapy mask is ideal. Choosing an unsuitable option can lead to discomfort, increased sleep onset latency. It can also render the entire PAP treatment setup pointless, as the mask can detach or have an opening for the air to escape. Let us look into what kind of features you want to consider based on your potential sleeping positions:
How to Choose a Mask for Side Sleepers?
Side sleeping is without a doubt the most popular sleeping position – and the healthiest one, according to sleep experts. However, side sleepers face certain unique issues when it comes to wearing CPAP masks. If you’re a side sleeper, you want to think about these factors:
- Pillow thickness (or loft) is a vital concern for side sleepers dealing with sleep apnea. Because one side of your face is constantly touching the pillow, you can’t afford to use bulky or inflexible masks or very thick pillows. The seal can get loose, causing the mask to simply detach from its intended position and stop providing pressurized air. You may be able to find specialized CPAP pillows with cut-out slots for the mask to fit in, which provides a subtle benefit – resting your head on its side with a mask can put a strain on your neck due to the odd angle the mask imposes if you use a normal pillow. Specialized pillows solve this.
- Sometimes, PAP mask headgear has side buckles and similar bits. A problem can occur when you rest your head on that side since it can result in those normally useful components pressing into your head and causing discomfort.
- Your face may get irritated when the mask “sinks in,” as you rest your head. Look for softer and better-cushioned edges to keep your face comfortable while sleeping on your side.
Overall, these factors don’t limit the type of mask you can use. Just make sure that the cushioning and flexibility are good enough to maintain an airtight seal, and that the headgear fastening components are at the back of the head, not on the sides.
How to Choose a Mask for Back Sleepers?
While not as common as side sleeping, back sleeping is still quite popular. Problems arise when the back sleeper suffers from sleep apnea, as it can increase the potency and frequency of sleep apnea symptoms by causing the breathing muscles to relax and the tongue to fall into the throat. This sleeping position makes the following factors important:
- Arm movements are common among back sleepers. While normally not an issue, the arms have a chance to dislodge the mask during the night. Focus on finding a mask that’s not too big (as bigger ones tend to be easier to reach and subsequently accidentally move), and an elbow port that can swivel around a bit.
- Headgear can pose a similar obstacle to what happens with side sleepers. The most popular approach is to have fasteners and buckles at the back of the head. However, unless you can slide these along the strap, you put yourself in a position where these fasteners press into your head when you rest it on the pillow. Try to find a mask with buckles on the side, or ones you can adjust and move around.
- Back sleeping is the optimal position for high-pressure treatment. As a result, full face masks and nasal cradles that support that pressure are highly recommended. Try to sleep on your back if your doctor prescribes high-pressure treatment.
The combination of these factors makes full face masks and nasal cradles the optimal choice if you want high-pressure treatment, whereas the increased maneuverability of nasal pillows and prongs helps deal with unhelpful arm movement if you don’t need high air pressure.
How to Choose a Mask for Stomach Sleepers?
Stomach sleeping is the most uncommon preferred position, and it is one that sleep experts recommend against at all costs. Even without a CPAP mask to cause further discomfort, the act of sleeping on your stomach pulls down your center of mass, which can put considerable strain on your neck and even cause lower back pain. Luckily, it’s easy to narrow down the critical factors for CPAP mask selection for this position:
- Facial discomfort is inevitable to some extent. One way or another, the mask will press into your face and cause irritation. For this reason, super-soft cushioning is very important, and bulkier masks like full face masks or nasal cradles aren’t recommended.
- A swiveling elbow port is practically mandatory for stomach sleepers. Unfortunately, even that feature won’t prevent the majority of discomfort that you will experience as the hose presses into your torso or arms. It makes an additional reason to avoid stomach sleeping if you’re dealing with sleep apnea.
Stomach sleeping puts you in a bad spot when it comes to mask options. Stick to nasal prongs and pillows, since those apply less pressure on your face, and make sure the elbow port is mobile enough to avoid a portion of the discomfort. If at all possible, avoid sleeping in this position (even if you don’t need PAP treatment).
Michael is a professional writer based in Boston and someone who has always been fascinated with the mysteries of sleep. When he’s not reading about new sleep studies and working on our news section, you can find him playing video games or visiting local comic book stores.