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[How to] How to achieve the perfect mask fit - GUARANTEED!
[the original post in this thread was copied from our old forum]

jeffy1958 Wrote:I am not a doctor or a member of any medical profession. I am not an engineer or a designer of any CPAP equipment. I am not affiliated with any company associated with any type of CPAP Equipment. I receive no compensation for any information I may provide that may be helpful. What you are about to read worked for me and should not be used as a substitute for the manufacturer’s written instructions. This is written to offer guidelines to those who may have a need.

I have been on CPAP, actually APAP, since October of 2010. I came into this kicking and screaming. No way was I going to sleep with a big hunk of plastic on my face every night. Then the first week in December I had a drastic realignment of my thinking thanks to a brilliant cardiologist named Peter. I have heart disease and I may not have had to endure what I did the summer of 2010 had I gone to him in the first place. I won’t bore you with the details, there is post titled OSA and your Heart, you can read about it if you want.


As a result of my thinking realignment, I went all out and started to research as much as possible. I had nine days off over the Christmas Holidays and a computer. I researched until my eyeballs would bleed. Am I an expert? Far from it. There are still things I’m learning. During the course of my research I found there were many who complained about the way their mask would fit. This is when I decided to focus my attention on getting the perfect mask fit and helping as many people (hose heads) as possible.

I have been a mechanic just about all my life. Learned how to trouble shoot and fix things growing up on a farm in the late 60’s and early 70’s. Continued on in the military, U.S.A.F., as an aircraft mechanic the late 70’s, 80’s and early 90’s. Discharged in the early 90’s and have been an Industrial Mechanic ever since. My training and experiences have taught me to never accept the obvious, but to look at all angles and possibilities to find the best solution. I am not an engineer; I use the common sense approach. Please do not take this as disrespecting engineers. {Why is the part that’s broke and held on with only two bolts, behind something that’s held on with 20? So I must thank them for my job security.} Most of what I have learned about fitting my mask, I found on my own using trial and error. But the most important thing to remember is PATIENCE. You need to have patience to obtain the most comfortable (perfect) mask fit. If you can’t be patient and get frustrated, you have no chance. Therefore; don’t waste your time reading any further. It will have no use to you.

CPAP can only help you sleep better if you have a good-fitting, non-leaking mask.

Why does one of the most important parts of our therapy/treatment; have to be the most difficult and/or painful to get right? All CPAP masks work with all machines. Is it an engineering issue? One would hardly think so because of the many different types and styles of mask available to Sleep Apnea patients. There can’t be that many incompetent engineers. So why can’t most patients get a good fit? It has to be the way our minds were/are trained to think. If it leaks - tighten it. When it comes to properly fitting your mask, keep this, the most important thing in mind:


Go and get your mask. Look at it, touch it, fondle it, caress it, feel it, stroke it, or do whatever it is necessary to become intimate with your mask. It’s going to be intimate with you every night. It’s going to be a part of you. It has to be if you want to enjoy life to the fullest. If your mask has to become part of you, then it should be just as comfortable on your body as the rest of your body parts. If not then what is the point? You will not get the full benefit of your CPAP therapy if you sleep uncomfortable every night.

Fact 1: You need to exercise extreme patience when trying to fit your mask. Yes, this is worth repeating. You need to have patience.

Fact 2: You need to have P. M. A. That is: Positive Mental Attitude regarding anything concerning your CPAP therapy/treatment. Positive attitude = positive results. Negative attitude = negative results.

Fact 3: If you remember nothing from this, remember Jeffy’s philosophy: What the mind can conceive and believe; the body will achieve!!

Fact 4: Hose Heads are normal people; it’s the rest of the world that is abnormal. It takes a very special individual to sleep with a hunk of plastic and a 6 foot hose attached to their head every night!!! And look sexy as hell to our life partners.

Fact 5: Tighter is not always the answer. Just because it leaks do not assume it needs to be tightened.

Fact 6: The air supplied from the machine creates the seal around your face.

Fact 7: The head gear holds your mask in place and has very little to do with the seal.

Fact 8: Your head gear straps need to be even. Uneven straps will cause your mask to shift or twist on your face.

Fact 9: Just because it leaks around the top, don’t assume you need to adjust the top straps. Just as if it leaks around the bottom, don’t assume you need to adjust the bottom straps. Sometimes you need to think in reverse.

Fact 10: Your clinician knows less about you than you do, and they deal with many different types of machines. Therefore; they are experts of none.

Fact 11: You need to know all there is to know about your machine and all its accessories. Especially the mask. How well do you know all your other body parts? You need to know your mask like you do a foot or hand or…

Fact 12: Any strap adjustments should be small, minuscule, minute, little, slight, etc; etc; adjusting the same amount on both sides.

Now that you know the facts, let’s try to get the correct (perfect) fit. You should not feel the pressure of the mask pushing on your forehead. Remove the head gear and hose from your mask, lay flat on your back and place it on your face. This is about how it should feel if it is on correctly, no air flow. Just the weight of the mask. You should not have to “rig” or “modify” your head gear with rubber bands, string, tape, etc; etc; if you do, throw it away and get a different mask. If the engineers and designers of the mask thought it would be necessary, they would have included it with the mask. You should not have any marks on your face when you wake up. Your skin is far more resilient than the rubber or silicone used to seal the mask. Connect the hose to your mask and to your machine leaving the head gear off then turn on your machine. Let it ramp up or do whatever it needs to do to get to full operation mode. Hold the mask in place using your fingertip and slight pressure. Did you notice how the seal fills with air? This is what makes the seal, not the head gear. While holding the mask in place with your fingertip, slight pressure and ensuring there is no leaks, turn on your sides. How much pressure do you need to apply with your finger to keep the mask from leaking? This is about how tight you need to adjust your head gear.

Your mask should be filled with air when fitting.

Now we can attach and adjust the head gear. The head gear needs to be EVEN. If the head gear is uneven your mask will have a tendency to shift or twist on your face which will break the seal and cause leaks. Most head gear, the ones I’ve looked at, are one piece construction. The easiest way to find center is to completely undo the straps from the Velcro and fold it in half. The fold is the center which you can mark with chalk or tape or some other kind of non-destructive marker. You should now have two marks; one for the center of the top straps and one for the center of the bottom straps. The distance from the top mark to the top anchor points on your mask should be equal. The distance from the bottom mark to the bottom anchor points on your mask should be equal. ALL FOUR DO NOT NECESSARILY HAVE TO BE THE SAME – DON”T EVEN TRY!!! The tops have to be equal to each other and the bottoms have to be equal to each other. Yes; exactly would be best!!! You will need to figure out your own “starting” point. Remember how much pressure you needed to hold the mask on your face with your fingertip? That should be your guide to a starting point. When you put the mask on, with head gear, while in the sitting position, it will feel like it’s going to fall off. This is normal because we don’t sleep in this position. Lie down and check for leaks. Keep in mind that the air pressure from your machine will try to blow (push) the mask off your face. The head gear is there to keep that from happening. Think about what is happening for a moment. The silicone seal inflates with air creating the seal, the air also causes your mask to “float” on your face, and the head gear is the “anchor” so to speak. The mask doesn’t weigh that much, air is trying to push it off your face, so why would you need a lot of strap pressure to hold it down?

Now comes the adjusting part. This is critical in obtaining the “perfect” fit. The one that lets you sleep without realizing you are wearing a mask. Well almost. Adjust it until it stops leaking. Make sure you adjust both sides equal. Try it in every sleeping position; on your back (not recommended) left and right side. If it leaks; make the necessary adjustment. Keeping in mind that if it leaks on the top… Fact 9. Once you have achieved “no leaks” try backing the adjustment off about half of what you did. As ridiculous as this sounds, that 16th or 32nd of an inch can and will make the difference. This is where the “patience” part comes in. You need to leave frustration in the hallway and out of your bedroom. Once you have it exactly as you want it, mark the head gear. (A small stitch, permanent marker, etc, etc.) Washing it will change how it fits and you will need a starting point. Your head gear will stretch over time and you will need to make very minor corrections. If you take the time, you can get this perfect for you. I worked at it for a week before I finally got it. When that night comes, you will be doing cartwheels down the hall. Your family members will think you went off the deep end because they won’t understand. Your Apnea family will understand and chances are we will be doing the cartwheels with you!!! I know I will if I hear of any successes based on what was applied using information from this paper.

Remember: Positive attitude = positive results and small, I mean SMALL adjustments. You can and will achieve the ultimate fit. I know it in my heart. I’m pulling for you. GOOD LUCK!!!
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Excellent post, jeffy1958. We expect our masks to fit miraculously but they don't. Patience is definitely needed as we tweak the headgear to get the right fit.

I would also recommend if you've had your mask for a while and it is leaking, replace the silicone and cushion. It is recommended that they are replaced every 6 months because the silicone does wear done making it tougher to get a good seal.
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It is a very good article... I sure hope the author makes it over here to the new forum okay. (jeffy1958).

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The author made it so you better watch, out you better not cry, you better not pout... Oh sorry got carried away.

This article is being printed and handed out by the VA Clinic in Appleton, WI. Never thought I could be so famous!!!
How To Get The Perfect Mask Fit

How important is Quality Sleep to your heart

What The Mind Can Conceive and Believe - The Body Will Achieve

Positive Attitude = Positive Results / Negative Attitude = Negative Results
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(02-25-2012, 11:15 AM)jeffy1958 Wrote: The author made it so you better watch, out you better not cry, you better not pout... Oh sorry got carried away.

This article is being printed and handed out by the VA Clinic in Appleton, WI. Never thought I could be so famous!!!

Hey, when you've got it... you've got it.... Tongue

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(02-25-2012, 11:15 AM)jeffy1958 Wrote: This article is being printed and handed out by the VA Clinic in Appleton, WI. Never thought I could be so famous!!!

It is a great article. I'm glad a professional organization recognized that also. CongratsThumbs-up-2
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Thank you for the information, by trial and error I was about halfway there but this should help greatly.
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This is very sage advice. I hadn't seen this article on the old forum but everything contained in it is spot on. Two of the contained points and two of the most misunderstood things in fitting a mask that I've learned through my personal experiences thus far are 1) the belief by many that tighter is better, and 2) the fact that sometimes you need to think in reverse (adjust the bottom straps to eliminate a leak at the top). THANKS!! Thanks
We're all family here...you can call me B36 if you'd like!Cool
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What a great post! I've printed out the pertinent parts and will go try it in a few minutes. My first night was virtually leak free but then, I didn't move. Second night, moved around quite a bit and the leak rate went up. Last night was just horrible and annoying enough to awaken me at which point I inserted a liner which helped a lot, for a while, until I turned onto my side. Was seriously considering plugging my nose and tape the tube directly into my mouth. I could pretend I was scuba diving! ;-)
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Thank you, I really appreciate the information! I believe I have the tenacity and perseverance to succeed! As a retired engineer I'm used to solving challenging problems, and I sure have a huge personal vested interest in this problem. It amazing in just 10 nights how much better I feel. I know the positive attitude is there, you reap the rewards every morning!

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