Nasal versus Full Face Mask: Which Mask Style is Better for CPAP Treatment of Sleep Apnea in 2024?

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 Still the Key to...  

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.

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