I am a guy with LOTS of facial hair, beard, sideburns, mustache, etc... (I figure not shaving has saved me thousands of dollars over the years )
I also found when I was getting my titration study for my CPAP is that I am both a nose and mouth breather.... Actually I'd thought so for a long time, but this confirmed it... If I try doing just a nasal mask, I have issues w/ my nose plugging up, so I start mouth breathing... W/ a full face mask, I seem to switch back and forth.
When I was having the titration study, and then when they were doing the early setup I was given trials on several different 'silicone balloon' style masks such as the Resmed Air FIT F20, and Philips models... They would give me reasonable seal if they were cranked down tight enough to be seriously uncomfortable.
If I started loosening them to fit as suggested in the Wiki articles on mask fitting, I got a good seal if the mask was positioned "just right" and didn't move my mouth at all, but any movement of the mask from sleep movement, face wiggling, etc. I'd start getting leaks... I was frequently waking up and needing to futz with the mask position. Oscar said I was AVERAGING 25% of the time in Large Leak.
I had a followup virtual visit w/ my sleep doc, after sending him the summary report from OSCAR, (He didn't want the daily data) and said this was the only real issue I was having. He said the therapy results were very good, as I was running well under 1 AHI most nights, but agreed that the LL time was a concern. He said that he had seen some reports that the 'foam' mask cushions seemed to work better for hairy faces...
I was past the 90 day 'trial' window, which meant our options were limited, but he said that the Resmed Air Fit and Air Touch cushions both used the "F20" headgear and frame... I'd had moderately decent results with the Air Fit, so he suggested that I try the AirTouch as he could do a prescription for that and get me a cushion and have insurance cover it...
IT WAS WONDERFUL... I dropped to averaging less than 5% in Large Leak, often having ZERO LL nights, and found that I usually still had a good seal when I'd wake up to turn over or for other reasons... I'd sometimes need to mess with the mask to get a seal after yanking on the hose while turning over, and sometimes otherwise, but FAR less often.
The mask shape is apparently the same as the Air Fit, and has a similar silicone skirt, but instead of the silicone 'balloon' it has a strip of some sort of foam. It may be a 'memory' foam, but I'm not sure.
Downsides -
1. The instructions say not to get the foam wet, or expose it to alcohol, etc. The suggestion cleaning method is to use 'CPAP wipes' I haven't priced those, but I suspect they aren't cheap... However I have not felt a great need to clean it beyond wiping with a reasonably clean rag.
2. It seems to want to keep leaking once it starts. Just wiggling the mask around often fails to get a good seal, especially on the bridge of my nose. What I find more effective is to pull the mask away from my face and hold it for a few seconds before letting it settle back down in the right place. I suspect this has to do with the foam getting a chance to 'decompress' while repositioning.
While I am using the Resmed mask, my understanding is that Phillips has similar foam cushions that fit their headgear / frames.
Bottom line - if you have a hairy face, and are having problems getting a good seal with the balloon type cushions, I'd HIGHLY recommend trying the foam version that seems like a good fit otherwise.
ex-Gooserider