Hi everyone! Looking around the community, I didn’t see any recent guides on PAP (CPAP, VPAP, VAuto, BiPAP, etc) and thought I could provide some insight on what masks are out there. I myself am not a user and have no formal training whatsoever. That said, I think I’ve fit ~100+ patients with masks in the last two years, and myself have slept with pretty much every mask I can get a hold of on variable pressures (on a borrowed machine of course). Below is what I hope will turn out to be a helpful summary of the more common masks I’ve fit with patients. Keep in mind that my bias may be pretty heavy, my opinion on a lot of these are based off of my experiences or what I’ve seen other’s experience as well.
1. FULL MACE MASKS (Covers both nose and mouth)
In general tend to have higher success rates with most beginner patients. Bonus points because you get to act out Bane/Darth Vader/Jet Fighter Pilot with your kids/spouse. In general tend to look more intimidating, and sometimes a pain to fit. Claustrophobia may be an issue as well.
Popular Over-the-Nose/Mouth Full Face Masks
– (Fischer and Paykel – Vitera/Simplus) My personal favorite within this category. I grouped these two masks together because they are practically the same, the Vitera being the Gen-2 of the Simplus. It’s pretty much a nicer version with a sick airy headgear for people who don’t like the feel of a strap behind their neck. The cushion of the mask is the only I’ve EVER FOUND to be flexible around the nose for a full face mask, removing the chance for people wearing it to get those pesky sores on the bridge of the nose from wearing a mask too tight. Keep in mind that the headgear is fastened by hooks instead of magnets like Resmed masks, making it a little harder to put on/pull off.
– (Resmed – Airfit F20) I like to call this mask “The Standard” because it’s basically your bread and butter mask. Seriously, you couldn’t get anymore stereotypical than this in my opinion. Maybe I’ve just given out so many of these. Also pretty cool because I feel like I’m a fighter pilot wearing this. They are a reliable fit in general, but people have a tendency to pull them real tight, leading to sores on the nose and cheeks. Really make sure you exchange the cushions regularly with this bad boy. I’m a fan of the magnets holding the headgear to the mask, they’re easy to click on/remove and keep on the mask pretty well.
– (Resmed – Airfit F10/Quattro Air) For some reason, it seems everyone and their mother had this mask. Like seriously, everyone who had a CPAP for around 10 years had this where I work. I grouped the F10 and Quattro Air together because their parts are interchangeable. The only difference is that the Quattro Air has a stabilizing bar in the middle, whereas the F10 does not. I personally do not think a stabilizing bar is that big a deal to really make a fuss over, but if you think so let me know and why! The mask is more rigid than the F20, but still reliable. I would say that it’s longevity is key here; if you want a mask that will last you a LONG WHILE get this one, I’ve seen people with year-old puppies.
Shoutout to the Mirage Quattro for being the ugliest mask out there. Seriously, every person I show that mask to makes a horrified face! Hahaha! Still, even though it’s an oldie, it’s a goodie and deserves some recognition.
Popular Under-the-Nose Full Face Masks
A quick note: While comfortable, these masks tend to be less reliable, especially regarding seal. The two I’ll discuss below have the same fundamental problem. They often leak around the edges of the nose and at the cheeks. Also tough to fit, especially for side sleepers
(Resmed – F30i/Respironics- Dreamwear Full Face) If your dream is to look like Bane from the Dark Knight Rises, this mask (the F30i) is your guy. Seriously, you’ll look great. Key feature for this guy is the hose attaches to the TOP OF THE HEAD, meaning it’s easier for you to roll around, much like the Respironics Dreamwear. THe main difference between the two masks is the different material, the F30i being a tad softer, and the hose being detachable on the top with the F30i. Being flat on you’re face, it’s not too hard to sleep on your side with this. Shows the very weaknesses explained above regarding under-the-nose masks in general, so watch out for that. Also completely gives out at higher pressures for me, for the life of me I could not get it to fit whenever the PAP went 20cmH2O or above. For those who find the nose-holes too small, the Dreamwear is a good, if not a little bit older, option to try out.
(Resmed- F30) Honestly not the biggest fan of this guy. Seriously, I’ve had so many of these returned over the past two years. They always seem like a good idea but they give out whenever the PAP kicks up to a clinical setting from the ramp. Think of it as an Airfit F20 that fits under the nose. The main problem is that with people who have looser skin, I’ve found that it leaks something awful around the bottom of the cheek and the edges of the nose. Easy to push to the side when you are side sleeping. Give it a whirl if you liked the F20 but hated the sore feeling on the bridge of the nose, but at your own risk.
Non-Silicone Full Face Masks
Are rare. The main one I am familiar with being the Airtouch F20, which isn’t the most ideal option in my book. If you think you have or have been diagnosed with a silicone allergy, I’ve found these mask liners a pretty good option for those who already like their mask selection. There are cloth mask options as well on the internet, but I have no idea how well these work.
(Resmed- Airtouch F20) Much like the Airfit F20, you could consider it the twin sister that got plastic surgery to make itself look (and feel) cooler. The memory foam really is cool, and makes for a great seal. Some things to keep in mind: the very bridge of the mask, the part that touches your forehead, is made of really weak material. The mask tends to press into the forehead over time as you pull the mask tighter. The memory foam is more delicate than the straight silicone, so you’ll need to take care washing and replacing the mask. While you could get away with using and Airfit F20 cushion for a long time, you really can’t with the Airtouch since they are so weak. Also super expensive randomly.
2. NASAL MASKS (Covers only the nose)
These masks take up a lot less space than full face masks, making them a really good option for people looking for a more minimalistic approach to their setup. In general are really easy to fit and usually really comfortable. Minimal leakage, but only assuming that you can KEEP YOUR MOUTH CLOSED at night. It feels super weird when you open your mouth and you wind up losing the needed air meant for therapy. Gentlemen, if you don’t know whether or not your mouth at night, ask the women in your life, because it is likely that they know. Ladies, in my experience the gentlemen don’t really watch you so you’re just gonna have to guess. Just kidding! But seriously, this one thing could really make or break your experience with nasal masks. On an important side note, BiPAP users on really high pressures may feel uncomfortable feeling the full gale of 20+cmH2o going up their nose. Just something to think about 😉
Familiar Over-the-Nose Nasal Masks
(Resmed- Airfit N20) Your classic over the nose nasal mask. Most often associated with elephants, since it has a really long trunk that attaches from your nose to the hose. It looks like there’s a lot going on, but the mask is actually supremely simple to wear and put on. The headgear attaches with two magnets like most of Resmed’s stuff, only it feels really secure with this nasal mask. People also find them really comfortable, so an optimal option if you want your nose to feel free.
(Respironics- Dreamwisp) The Rudolph mask, as in Rudolph the Red Nosed Reindeer! A good over the nose option that also has a hose attaching to the top of the head. This is one of Respironics newest additions to their selection. I’ve had mixed results with this for the majority of my patients, but some pretty key features are that it comes in and XL and a Pediatric size. So for those few blessed children (or Santa Clauses) that need masks, this might be a good option.
(Fischer and Paykel- Eson2) Eson basically took what they did with the Simplus/Vitera and incorporated that bazooka strategy with a nasal mask. It looks like a lot, but it’s pretty darn comfortable. Really, it’s only weakness is how bulky it feels; other than that, it’s a really good nasal mask and worth a shot. Like all F&P products, they put a lot of love into the material, so it tends to last users a good long while.
The Wisp and the Mirage FX are also good options to look into, they aren’t provided where I work however, so I rarely see them.. Take a look! They’re old, but they seem to be very reliable.
Under-the-Nose Nasal Masks
(Resmed- Airfit N30i/) This is hands down my personal favorite. The under the nose feature is supremely comfortable. The mask wears loose, but does not leak at all, and the headgear is nice and thick. Like other innovative masks, the tube attaches to the top of the head, and the mask brings the air through the sides of your head to the nose. If you were to sleep on your side, the other side would compensate with air, so you wouldn’t feel any difference in airflow. Some complaints my patients have brought to me are: the silicone headgear catches on their hair, or that they hear the air at night flowing by their ears. For me, not really an issue, but definitely keep it in mind. Exhaust comes out the front of the nose and on top the head.
(Respironics- Dreamwear Nasal) This mask is basically who Resmed stole their idea from, so if you will, this is the OG. Same features and weaknesses as the N30i, except for a few minor differences. Headgear is a little bit more flimsy in the back, top of the head doesn’t remove as easy, but the nose-hole is larger, making it easier to breathe for some people. Also important to note that for those with spouses, Exhaust is the same as the N30i, except shoots a little more forward than the N30i so it may blow on our spouse more than yourself.
(Resmed- Airfit N30) Is almost identical to the Resmed Airfit P10 (reviewed directly below under nasal pillows), with a few key differences. It features the same nasal cushion as the N30i, while coming with a much more minimalist design. Since it doesn’t fit in the nose like the P10 it tends to leak a little bit more than most nasal masks, but it comes with a secret weapon: THE ADJUSTABLE ELASTIC HEADBAND. Resmed needs to put this on their P10 as well. If the elastic headband gets too loose, guess the freaking what? You can TIGHTEN it. 5/5 execution.
Seems to be the most common category for nasal masks, namely because of how simple they are. Some things to keep in mind: If your mouth stays closed, with the right size there is virtually no leak with a pillow mask since it’s INSIDE your nose. That said, some people’s noses are sensitive to the constant pressure over a long period of time, and develop sores inside the nose. If you are one of these people, it might be time to consider switching out to one of the other options above.
(Resmed- Airfit P10) Is as small as they come in PAP masks. Seriously, there is nothing more simple than this guy. The headgear consists of a single elastic band that goes over your head and the back of your head. It’s also the most popular nasal mask I’ve given out by far, probably due to it’s size. Keeping in mind the things I wrote about nasal pillows in general above, it’s a really solid pick. Biggest and only weakness is: the elastic band is non-adjustable, and prone to stretching. Over time the headgear gets too weak, and the little headgear-holders provided in package don’t really do the trick. Either you need to replace the headgear periodically, or find a way to tighten it up.
(Resmed- Swift FX) Is the direct predecessor to the P10, with some strengths. The neoprene and headgear combination looks old, but it’s more durable than the P10. Mixed reviews as to which is better, but it’s worth mentioning that the people who are fans of this tell me they will probably use it until they die.
(Resmed- Airfit P30i) This right here is the cool-kid spaceman mask. Features all of the strengths and weaknesses of the N30i reviewed above, except now any chance of leak whatsoever is negated by the pillows. Biggest feature hear is Resmed’s QuietAir technology, making it so you cannot hear the exhaust out the front, nor feel it, which is absolutely wicked, If you are into pillows, this is absolutely worth a try. I personally found it really comfortable.
(Fischer and Paykel- Brevida)
I hate this mask. But I’ll try to set aside my differences to write afair review, because frankly, just because it didn’t work for me or some of my patients doesn’t mean it isn’t a bad mask. Headgear straps are thicker and therefore last longer, and are adjustable. It has a filter in the front to keep exhaust from blowing on people around the patient sleeping, and keep the mask quiet. Pillows fit around the nose, reducing any risk of leakage whatsoever. Sounds amazing right? It did win some design awards in 2017 apparently. But here’s my quick take. the pillows often pop inside-out, making it a glorified nasal mask. The mask pinches my nose so it’s hard to breathe. this is the only mask I actually found uncomfortable.
I think that’s it. Sorry it’s so long. A good way to navigate is ask yourself what type of mask you would prefer, and.go from there. Best of luck and sweet dreams!