by Carrissa Hankins, MSN, APRN, FNP-C, Hello Sleep Health & The Sleep NP LLC
When it comes to CPAP therapy, many people assume that bigger masks mean more difficulty breathing and greater levels of claustrophobia.
The opposite is actually true: the bigger the mask, the more air it can deliver.
But just like everything else in this world, increased mask size comes at a price - increased potential for leaking, dryness, discomfort, and noise.
So, what’s the best option? Let’s break down the choices:
Mask Size vs. Airflow: What You Need to Know
- Nasal pillows (tiny, lightweight, nose-only) – These seem like a great option because they’re small, but some people feel like they’re not getting enough air.
- Nasal masks (over or under the nose) – A great balance of comfort and coverage, providing solid airflow while minimizing leaks.
- Full-face masks (covering both nose and mouth) – Ideal for those who need to breathe through their mouth or can't keep their mouth closed with sleep - but more difficult to seal properly.
A full-face mask isn’t a universal win. If you can comfortably breathe through your nose while awake, a nose-only mask might be a realistic option.
Why Fit Matters More Than Overall Size
CPAP users often try after-market accessories to improve mask fit, but here’s the truth: a mask that never fit properly will never fit properly.
While accessories like Pad-a-Cheek and RemZzzz can cushion the mask for better comfort, they won’t fix a poor fit.
The only way to get a truly great CPAP fit is to try the mask on while lying down, at your prescribed air pressure.
HOT TIP: A mask that seems fine at a lower pressure might start leaking at higher settings, causing frustration, discomfort, and even dry eye irritation from air leaks into the eyes.
Your CPAP Mask Fit & Comfort Shouldn’t Be a Battle
If you’re tightening your mask so much that it hurts your face or you have to hold it in place to stop leaks, it’s time for a new (or different) mask.
A properly fitted mask should:
✅ Inflate slightly to create a seal—not press hard against your skin.
✅ Rest on your face comfortably—without being too tight or loose.
✅ Prevent air leaks into your eyes—which can cause irritation.
What If Your Mask Doesn’t Fit?
DME vendors often have exchange policies, but users are sometimes told to "keep trying" until their return window closes.
If your mask doesn’t fit, advocate for an exchange—you don’t have to settle for discomfort.
And remember: CPAP masks wear out! (Just like your toothbrush or your favorite pair of footwear.)
Even if yours looks fine, old headgear and cushions lose their integrity, leading to leaks.
🔹 Insurance typically covers a new mask every six months
🔹 Cash-pay users should aim to replace theirs yearly
The sweet spot for fit is letting the mask float lightly on your face—not cranking it down. If it’s too tight, it will still leak, but now it’ll also cause skin redness and pressure sores.
Finding the right mask fit isn’t just about comfort—it’s about effective therapy and better sleep. It's time to stop fighting your CPAP mask—get one that truly works for you!
Just like your toothbrush wears out and needs to be replaced, so does your CPAP mask.
Why this topic?
As a nurse practitioner working in the Sleep Medicine/Pulmonary space since 2011, it bothers me when I hear stories of CPAP users struggling.
🔹Maybe it's because a medical supplier's policy is to give everyone a full face mask even if they could get away with something smaller that would leak less.
🔹Maybe it's because of the mistaken assumption that overnight mouth breathing is a dealbreaker for a nose-only mask.
🔹Maybe it's because we didn't know what to watch for to tell us when to replace mask supplies.
I complied my Free CPAP Mask Tip Sheets so you don't have to figure this stuff out like everyone else -- the hard way. These sheets are full of common sense wisdom you can use right away.
If you're looking for something a little more interactive, check out Hello Sleep Health's coaching & consulting services.
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