77: 3 reasons why the smallest CPAP mask may not work

"If I have to wear something on my face every night, then give me the smallest mask you've got!"

I've heard this so many times from my patients, and I completely understand where it's coming from. Back in 2009, when I began testing CPAP masks, the full face masks seemed so daunting with their bulky appearance. Naturally, I assumed that the smaller nasal pillow masks would be a better fit for me.

However, as it turned out, my assumptions weren't entirely accurate.

At that time, nasal pillow masks were the only option available, and I decided to try one out. But as soon as I put it on, I found myself tossing and turning, fussing and fidgeting to get the right fit. Throughout the night, I even woke up due to air leaks, which was frustrating.

Reason #1 the smallest masks are not necessarily the best:  air leak.  The seal of these smaller masks is less stable, especially for those who, like me, may move around a bit during sleep. Trying to get the seal just right becomes a Goldilocks-like quest, leaving me feeling tense and insecure about potential leaks during the night, which inevitably affects the quality of my sleep.

While I can manage using nasal cradle and nasal pillow masks through the night, they aren't my favorites. After a few days of use, I often experience some soreness in my nostrils caused by the mask pillows. If you encounter a similar issue, adjusting the pillow size or using some aqueous lube may help improve the fit and reduce irritation.

Reason #2 the smallest masks are not necessarily the best:  nostril/nose irritation.    Personally, having the mask fitted right up to my nostrils or the base of my nose doesn't sit well with me. My skin is sensitive, and the constant contact with the silicone can lead to irritation, adding to the discomfort during sleep. Furthermore, the silicone's slippery feel from the humidification and my facial moisturizer can be bothersome when I wake up in the middle of the night.

Reason #3 the smallest masks are not necessarily the best:  cloth mask liners.  I was happy to discover cloth mask liners, which work great with nasal and full face masks. However, they don't fit as well with nasal pillow or nasal cradle masks. When sandwiched between the silicone cushion and the skin, cloth liners help my mask feel much better, especially with moisturizer on. This also ensures a stable seal and may even extend the lifespan of the mask since the silicone doesn't come into direct contact with my skin.

For me, the real breakthrough came when I switched to a nasal mask with a cloth liner. Suddenly, I could sleep longer throughout the night with the treatment in place. The seal felt more secure, and I could finally relax, knowing that any movements during sleep wouldn't cause leaks.

While the idea of a small CPAP mask might seem appealing, it's essential to consider the potential drawbacks, such as air leaks, nostril irritation, and limitations with cloth mask liners. Finding the right mask that offers both comfort and a secure fit is crucial for a successful and restful CPAP therapy experience.  If you’re not there yet, keep your mind open.  You won’t know what works for you until you try it.