CPAP Mask Selection Criteria

The interface—the mask—is the single biggest point of failure in CPAP therapy adherence. A poorly fitting mask causes unintentional leaks, which wakes the patient and causes the CPAP algorithm to incorrectly increase pressure to compensate.

The Three Mask Architectures

Selection should be driven by nasal patency and sleep position, not aesthetics.

1. Nasal Pillows

Silicone cones that seal directly against the nares. They offer the smallest footprint and lowest claustrophobia risk.

• Ideal for: Active sleepers, people with facial hair, claustrophobic patients.
• Contraindicated for: Patients with chronic nasal congestion, deviated septums, or those requiring pressures over 14 cmH2O (can cause mucosal irritation).

2. Nasal Cradle / Mask

Seals under the nose or over the bridge of the nose. Disperses pressure over a larger surface area than pillows.

• Ideal for: Strict nose-breathers who find pillows irritating.
• Contraindicated for: Mouth breathers. If the mouth opens, the pressurized air escapes, destroying therapy efficacy.

3. Full Face (Oronasal)

Covers both the nose and the mouth.

• Ideal for: Chronic mouth breathers, patients with frequent sinus issues, and those on high BiPAP pressures.
• Contraindicated for: Patients prone to claustrophobia, those with thick beards (hard to seal). It also has the highest risk of unintentional leak due to the massive surface area of the seal.

Managing Leaks

If your leak rate exceeds 24 L/min (ResMed) or your machine's defined threshold, the algorithm cannot accurately detect apneas. Use a mask liner (e.g., RemZzzs) to absorb facial oils and improve the silicone seal, or switch to a different architecture entirely.