There are three main types of CPAP mask: nasal pillows that seal at the nostrils, nasal masks that cover the nose, and full face masks that cover the nose and mouth. Hybrid and under-nose full face masks sit in between. The right one depends mostly on how you breathe at night, your pressure setting, your face and how you sleep, and many people try more than one before they settle.
Why the mask matters
CPAP works by sending a steady flow of air through a mask to keep your airway open while you sleep. If the mask leaks, rubs or feels closed-in, it is hard to wear all night, and therapy only helps on the nights you use it.
Most mask problems can be fixed with a different size, a different style or a few small changes. If you are new to treatment, our guide to CPAP and BiPAP therapy explains how the whole system works.
Nasal pillow masks
Nasal pillows are small soft cushions that sit at the opening of each nostril. They are held in place by light headgear.
- Less on your face — they leave the eyes and most of the face clear, which may help people who feel closed-in by bigger masks.
- Glasses and reading — you can wear glasses, read or watch TV with them on.
- Beards and mustaches — they touch only the nostrils, so facial hair is less likely to break the seal.
- Side sleepers — their small size often makes it easier to lie on your side.
- Limits — air goes straight into the nostrils, which some people find uncomfortable at higher pressures. They do not work well if you breathe through your mouth unless you also use a chin strap.
Nasal masks
A nasal mask is a cushion that covers the whole nose, from the bridge to just above the upper lip.
- Steady seal — the cushion spreads the airflow over a wider area, so many people find it comfortable at higher pressure settings.
- Active sleepers — it tends to stay in place if you move around a lot at night.
- Middle ground — it covers more of the face than nasal pillows but less than a full face mask.
- Limits — like nasal pillows, it relies on breathing through your nose. Pressure on the bridge of the nose can cause redness or sores if the fit is off.
Full face, hybrid and under-nose masks
A full face mask covers both the nose and the mouth. Hybrid and under-nose styles also cover the mouth, but they seal under the nose or at the nostrils instead of over the bridge of the nose.
- Mouth breathing — if your mouth falls open during sleep, air can still reach your airway through the mouth.
- Blocked nose — they may help if allergies, a cold or a nasal blockage make nose breathing hard.
- Hybrid and under-nose styles — nothing sits on the bridge of the nose, so they may suit people who wear glasses or get sores there.
- Limits — they are bigger, may leak more because there is more edge to seal, and can feel closed-in. Sleeping on your stomach is hard with them.
Matching a mask to your needs
There is no single right answer, but these patterns can guide your first try.
- You breathe through your nose — nasal pillows or a nasal mask are often tried first.
- You breathe through your mouth — a full face or hybrid mask, or a nasal style with a chin strap.
- Your pressure is high — a nasal mask or full face mask may feel better than nasal pillows.
- You have a beard or mustache — nasal pillows often seal more easily.
- You feel closed-in — nasal pillows or an under-nose style cover the least of your face.
- You sleep on your side or stomach — a smaller mask, such as nasal pillows, usually moves less against the pillow.
Chin straps and mouth breathing
A chin strap is a soft band that goes around the head and under the chin to help keep the mouth closed. It lets some mouth breathers keep using nasal pillows or a nasal mask.
Signs that air is escaping through your mouth include waking with a very dry mouth, a hissing sound from your lips or high leak numbers on your machine. A heated humidifier and treating a stuffy nose can also help. If a chin strap does not fix it, a full face or hybrid mask is the usual next step. More fixes are in our guide to common CPAP problems and solutions.
Tips for a good fit
- Fit it lying down — put the mask on, turn the machine on and lie in your usual sleep position before you adjust it. Your face shape changes when you lie down.
- Snug, not tight — tighten the straps evenly and only until the leak stops. Overtightening can cause sores and can make leaks worse.
- Check the size — many masks come in more than one cushion size. A cushion that is too big often leaks; one that is too small may pinch.
- Clean skin, clean cushion — face oils and lotion can weaken the seal. Wash your face before bed and keep the cushion clean (see how to clean your CPAP equipment).
- Give it time — wearing a new mask for short periods while awake can help you get used to it. Our tips for getting used to CPAP walk through the first weeks.
- Children — kids need masks sized for their faces, and they may need a new size as they grow.
When to call your sleep doctor or equipment supplier
Your mask and supplies come from a medical equipment supplier, who can help with sizing and swaps. Reach out if you notice:
- Leaks that will not stop — air blowing toward your eyes, or leak numbers that stay high after you adjust the fit.
- Skin problems — red marks that do not fade, sores or rashes where the mask sits.
- Pulling the mask off — waking up with the mask off most nights, or not wanting to put it on.
- A change in your face or body — weight gain or loss, new dentures or dental work, or a child growing out of a mask.
- Symptoms coming back — snoring, gasping or daytime sleepiness even though you use CPAP every night. This needs your sleep doctor, because the pressure or treatment may need to change.
- Worn parts — a cushion that has gone soft, stretched headgear or cracks. Worn parts leak.
If you switch to a different mask type, tell your sleep doctor so your therapy data can be checked.
Getting help in Cedar Park
Dr. Minal Patel is board-certified in pediatrics and sleep medicine. Our sleep medicine team offers in-lab and home sleep studies, CPAP and BiPAP therapy and titration, Inspire evaluation and CBT-I for insomnia, and we see both children and adults. Medicaid and CHIP are accepted for sleep medicine patients. We are accepting new patients Monday to Friday, 8:30 AM to 5:00 PM (no walk-ins).
