Deciding which mask to use can be very difficult. There is such a great number of tools and information available to you; you can also ask your health care professional for help. Before being influenced by a health care professional however, do some research! Look into reviews of different mask and the advice offered. It may mean the difference between an amazing night and your sleep forever improving your health compared to not tolerating and struggling mightily. You may sway from a tradition full face style of mask to a more specific style of full face hybrid. Also remember that nearly every manufacturer allows for a mask exchange policy that your DME provider can utilized; meaning that if you use a new mask, but do not tolerate well and need to switch it can be done at no charge to you through your DME provider. You have a safety! So review, research, question and decide! The full face mask is different than the nasal cushion and nasal pillow style and not only in it's shape. Most people feel that a full face mask is only for patients with severe mouth breathing habits or nasal congestion issues. Although the style of mask is an alternative for these patients (it is not the only alternative), this style also is a great option just for comfort in some patients as well!
So, you have done your research and you think that a full face mask looks like a more accommodating style for you! That is great. There are a great number of providers and DME companies that try to stray away from using the full face mask style. The theory is that nasal CPAP mask are more productive than a full face mask at controlling sleep apnea. That is another topic for another time. A good portion of the CPAP community along with providers will disagree and urge you to use the full face mask if you feel it to be more comfortable or that the therapy is more productive for you! The bitter truth - there is absolutely nothing wrong with using a full face mask in any way.
What most technicians, respiratory therapists or physicians will ask when helping you find a suitable mask is in regards to mouth breathing. Do you feel that you are a mouth breather? The reasoning is simple, you should not open your mouth when using a nasal style of mask and if you do open your mouth then try to minimize it as much as possible. If you are waking in the morning thirsty with a dry mouth and/or dry and itchy throat then it is a sign that you are likely mouth breathing while sleeping. The level of severity of your mouth leak will be a factor as well as sometimes despite a patient being a frequent mouth breather they are able to strengthen their jaw and keep their mouths closed on a night to night basis without mouth leaking becoming a factor. So the question can be more technical. You may be a mouth breather, but is it a severe enough issue that a full face mask is needed? Once again, evaluate yourself. Do you feel that you mouth breathe often while awake for comfort or to alleviate congestion? You could even have some symptoms of continuous mouth breathing such as bleeding gums or discomfort. The goal is to truly evaluate if mouth breathing is something natural you do throughout your day and night or if it is something you only do at night while sleeping. If you feel that mouth breathing is going to be a factor with your success on your CPAP therapy then a full face mask style may be the option for you!
SIDE NOTE: MOUTH LEAKING RESULTS WHEN YOU ARE WEARING THE CPAP THERAPY WITH A NASAL CPAP MASK. WITH THE PRESSURE TURNED ON AND YOU OPEN YOUR MOUTH THE AIR MAY ESCAPE CREATING A DISCOMFORTING FEELING.
With the first question of mouth breathing asked, your technician may likely to jump to the next area of concern, which is concerning nasal congestion. Now, to some degree everyone struggles with having a congested nose. However, the importance of the questions manifests itself differently when in relation to the full face style of CPAP mask. If you have frequent nasal congestion then breathing through your nose can become a factor which leads to a pretty large problem if you are using a nasal style of CPAP mask. There is a point to remember here that sometimes your nasal congestion can be alleviated by using the CPAP therapy with humidifier! There are also nasal sprays and rinses that can help or ease any anxiety when considering nasal congestion! So, as I questioned above the level of severity can become a large factor. If your congestion wakes you or causes mouth breathing for comfort then the full face mask may be a valid option. What information I will add is that some users will maneuver between using a nasal mask at some points and a full face mask some points. There is nothing wrong with this either! So what is your level of concern in relation to your nasal congestion? Is it or is it not a factor when choosing your CPAP mask? Remember that ultimately it is about your comfort and if you feel a full face mask suits you best then go for it!
Moving forward! You've decided that mouth breathing or congestion is a risk factor and you are willing to utilize a full face mask style. The next step is to look int the mirror! There are a great number of full face masks on the market including some "hybrid" styles. I want to stray away from the hybrid style and focus solely upon the traditional full face mask . And to assure a good fit in the traditional style of full face mask you have to first evaluate your face shape. It is important to know the width of your mouth to understand that width of the mask you are needing. You want the full face mask to fit closely to your lips, but not on them. The width of the full face is a simple fit, where it becomes complex is the height measurement.
When using the full face mask it is important to understand that the mask is going to cover more skin area which could possibly result in more leaks. Enhancing comfort on a night to night basis starts with an optimum fit being completed at the initiation of therapy or when you first try a new style of mask. Again, the full face mask is going to cover more skin, no doubt about that. It will reach to the top of your nose (the nasal root/nasion) and encompass the sides of your nose extending inferior (downwards) above your mouth on the nasolabial groove (above your mouth close to your cheek) then finishing underneath your bottom lip and above your chin (labiomental groove). You want to assure the right fit as the mask could be to small or to large when covering these areas. You will measure from the bridge of your nose to the portion underneath your mouth, but above your chin resulting in your height measurement. Remember that the full face mask will come with sizing templates and though they are a great place to start the size you may need could differ from what the template suggest. For example, the template may say you need a small when truly a medium or large would be best. So, do not be afraid to attempt different sizes! Remember that a measurement is a starting point when it comes to fitting you with the best full face mask.
After you have found a full face mask that you feel to be the best fit and according to sizing; it is time try the mask with pressure applied. When you connect the CPAP to the mask via your CPAP hose you will want to take careful consideration of where problem areas arise, if any do. As with the nasal cushion, nasal pillow and other hybrid styles the traditional full face mask has a few pressure points that can become a problem. However, if the problem is addressed quickly - then you can avoid discomfort or possible failure to acclimate to your CPAP therapy. Pay attention to what the mask and the skin of your face is telling you.
I find three main pressure points of concern when I fit a full face mask. The first is at the nasion/nasal root where the mask fits snugly to the bridge of your nose. Depending on your face shape the mask may cause leaking upward and discomfort in the eyes. This will lead to the mask possibly having to be over tightened to correct and possibly lead to irritation of the skin. The second region extends down the sides of your nose to the sides of your mouth which is termed the nasolabial groove. There are so many different factors that your technician/respiratory therapist should take into consideration in this region. However, if leak occurs then tightening typically ensues. Over tightening could once again lead to the irritation, tenderness and discomfort of your skin. The last pressure point is underneath the mouth, but above the chin called the labiomental groove. The mask typically will seal well here, but it could cause pain due to the amount of pressure that is placed at this point. Notice in these areas there is a correlation with tightness being applied to the mask cushion and discomfort possibly forming on the skin. To much pressure at one point can cause a pressure sore - in the worst case scenario. So when you are being fit with a traditional style of full face mask pay close attention to these pressure points. However, it can be hard to show the perfect fit in a fifteen to thirty minute fit session in comparison to how a mask could fit over the course of a night. So be patient with the mask and pay close attention to any irritation that could be forming.The last pressure point I want to separate, because on traditional full face masks sometimes it is present and sometimes it is not! That is the forehead support cushion. Some masks do not have this allowing you to have a more open field of vision when wearing the full face mask. If you decide on a mask that has the forehead support for any reason it would be considered the fourth pressure point. Typically if over tightening in this area occurs then the same skin break down follows with discomfort on the forehead.
Avoiding this problem can be simple. When you are tightening your full face mask do not take drastic measures! Start with slight adjustments to the straps on your CPAP mask headgear. Tighten slowly and slightly until the leak at the point of origin is controlled. If you over tighten the head gear the cushion could create a larger leak than before resulting in not only discomfort, but a lack of benefit from your CPAP therapy.
As offered with the tradition nasal cushion style of mask there are options for patients if your mask is causing these problems, but you truly do not want to switch to a different type of full face mask. Remember that is okay! Sometimes a mask that is found is so comfortable that you want to give it every option before opting to switch. That is okay! Try a "RemZZZ", "Nasal Gecko Pad" or "LiquiCell Adhesive" as these accessories can used with the traditional full face mask style. So you may not have to switch your mask, you may just need one of these accessories to alleviate the discomfort! One problem with these accessories is that they are not typically covered by your insurance and must be private payed out of your pocket.
So, you have come so far! You have done your research and now fitted with a traditional full face style of CPAP mask. I hope this information has given you insight into choosing a mask that would fit you best and when you are working with a provider. However, there are a vast number of scenarios you could experience outside of the suggestions I've given you. And I must give you this disclaimer even though it makes me angry to do so. In any scenario I should be able to refer you to your health care provider for your CPAP therapy whether that is your technician, respiratory therapist or physician. Even though this is the correct suggestion, it is not always the most reliable. Sometimes the fitting technician is inexperienced or the DME provider can not offer sufficient support. Sometimes the physicians office is not accustomed to positive pressure therapy so a lack of support is available. This leaves you with searching and hoping via the Internet or utilizing other resources. If you have used a DME (durable medical equipment) provider or physician's office in the past and found a lack in support, try another. You have the choice to use any DME provider or other provider (pending your insurance coverage). Do not ignore the problem and simply suffer. Do not endure through discomfort to eventually walk away from your CPAP machine. There are so many types of traditional full face mask styles that can offer a change to aid you. The problems your experiencing does not only encompass you and your health, but sometimes the anxiety/health of the person sleeping next to you! Remember that the Internet is a wonderful tool for suggestions and different mask types, but you'll eventually have to use some form of provider to get the supplies. However, there is wonderful information available at your finger tips.
Below is a list of some of the traditional full face masks I have tried and suggest for users to use! I categorized by the manufacturer to help you if you are researching. I also want you to know that there are so many different manufacturers than these three with lots of different masks to offer. These three manufacturers are the typical styles that your local DME company would likely keep in stock, but not the only ones that are available by any means. So do not, in any way, think that these suggestions below are the only traditional full face style of masks. There are hundreds more available.
Ultra Mirage: Available in sizes small standard, small shallow, medium standard, medium shallow, large standard and large shallow.
Mirage Quattro: Available in sizes extra small, small, medium and large.
Quattro FX: Available in sizes small, medium and large.
Quattro Air: Available in small, medium and large.
Airfit F10: Available in small, medium and large.
Amara: Available in sizes petite, small, medium and large.
Amara Gel: Available in sizes petite, small, medium and large.
ComfortGel Blue Full: Available in sizes small, medium, large and extra large.
Fisher and Paykel:
Simplus: Available in sizes small, medium and large.
Forma: Available in sizes small, medium, large and extra large.
***By the way, I'm sorry if I missed any references to calling anyone a "patient". I tried to change all of them "users".