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Tracy R. Nasca
In a perfect world, sleep apnea patients would be sized for their mask during the titration period of their sleep study and be able to count on knowing exactly what mask size they wear for the duration of their CPAP therapy life.
The adjustment period for CPAP is challenging. Getting used to the continuous flow of air from the CPAP machine is but one challenge. The other, and I believe the most difficult, is finding the right mask for our individual faces. Dismiss theory and logic; they just don't apply.
Later this year, I will be inducted in to the “Jackson Club”. In December 2009, I celebrate the 20 th anniversary of my sleep apnea diagnosis and positive airway pressure therapy. I am older and wiser by the sheer experience of trial and error in having used nearly every single mask available to patients since 1989. What I have learned about mask fit and choice, I am sharing today.
How fortunate we are today to have so many mask choices. I applaud the manufacturers for the phenomenal masks they bring to us. The research and development process for masks is serious business and yes, they seek out and listen to patient feedback. They strive to deliver product that will assist our needs in successful therapy.
In a perfect world, there would be one standardized sizing system. There is not. I used to wonder why the industry never set a standardized sizing system. Wouldn't it be a simple, logical solution? The truth is that patents play a roll, not to mention human beings are unique; our faces are different sizes and shapes. We all know there is no such thing as “one size fits all”, especially if you are one of those people who falls outside of that range. Even “one size fits most” should send the red flag of “buyer beware”.
Think of clothing and shoes. Is there a standard sizing system? I don't think so. Most of us would not consider buying clothing off the rack without first trying them on. Shoes for example, not only would we try them on, we would then walk in them before we buy. A salesman might measure your feet and bring you a size 8, but you may put them on and know immediately they don't fit YOUR foot. Your foot is unique and may have a narrow heal or high instep. You might have size 8 shoes in your closet, but this size 8 does not fit you. The point is, you have to take personal responsibility in mask choice Don't let a healthcare provider measure your face and choose for you without trying it on and making your own decision.
When choosing a mask, patients need to know all options. There are 3 categories of masks:
It is important to understand the 3 basic mask components which consist of:
As a general rule, headgear is usually “one size fits most” and comprised of a soft fabric which offers Velcro fasteners. Actually, “one size fits most” does fit most. You know who you are if you have a smaller or larger than average size head; smaller and larger headgear is available by special order. These are rarely offered, so you must ask for them.
You can take the guess work out of choice by taking personal responsibility in your mask purchase.
Start by looking in the mirror and note:
Overall head size
Length of your entire face and noting specific length of
Some nasal pillow systems offer separate nasal pillow inserts allowing you to wear a size small in the left nostril and a medium in the right. Some nasal pillows openings are rounded, some are elongated. Find the one best suited to your nostrils! Some nasal pillow inserts can be turned or manipulated to accommodate the shape of your nostrils whether they be rounded or elongated. If nasal pillows leak, choose the next size larger.
Many mask styles are offered in small, medium, large and extra large. What you don't know is that often the mask frame is one size and it's the softer inner seal that comes in small, medium, large and extra large. The mask frame is meant to lay near the top of your nose bridge and seat on what I call the upper lip – the area of skin between your top lip and nose. What does this mean to the patient? This means that the first consideration for the traditional nasal mask choice should be noting how LONG your face is from nose bridge to upper lip. One should also consider the width of the nose bridge as this is a most common trouble area for mask fit. If you have a narrow nose bridge, you'll probably experience mask leak up in to the eye area. This occurs when mask frame is too long for ones face. If you have a really narrow nose bridge, you will want to be sure to choose a shorter style mask frame that is meant to sit further down from the nose bridge or even over the end of the nose only. Your best bet, however, if you have a short nose or narrow nose bridge, might be a nasal pillow system mask.
Another common mask frame issue is one that I have problems with as do many other patients I have had contact with. It is uncomfortable to have the mask frame lay on the sensitive sinus area or the soft tissue under the eyes. This happens to patients who have a short or narrow face, short nose, narrow nose bridge and also an issue when our eyes are set close together. When I put on a traditional nasal mask, the first thing I pay attention to is how the frame sits on my face. How high does it ride on my nose? How close is it to my eyes? Will it put pressure on my sinus area? If these are concerns for you, again, you might do better with a nasal pillow mask system.
I cannot stress enough, the importance of noting the mask frame size when choosing a mask for your face. Once you know to consider the overall length of your face, length and width of your nose, the width of your upper lip, mask choice becomes much easier.
My favorite winter coat is a size 10. I love it not only because it is beautiful and slimming, but the label says SIZE 10. It is the only size 10 anything I own. Most of my clothes are size 12 or 14. I have some favorite clothing brands but even within that line, I cannot trust that I can pull off the rack. My point is, you try things on and buy what fits your body. Never assume you know your size.
Just as the machines have evolved over time in size or shape, the masks have changed shape, and often in sizing because manufactures are trying to get a better seal and make them easier to use. So you can't assume that sizes are the same from mask to mask or from manufacturer to manufacturer . Avoid further frustration by knowing that mask sizing varies not only between manufacturers, but within manufacturers. What do I mean by that? Here are some examples from my own observation:
If you wear the FlexiFit 431 full face mask in size medium, you will probably wear a large in their FlexiFit 432 or their new Forma Full face mask. F&P does not currently provide sizing guides online, however, they will send you an electronic copy by request email info@fphcare.com
Most ResMed mask sizing is consistent. They have made visible enhancements as a direct result of customer feedback. For instance, the new Swift LT incorporated the feedback that customers want more comfort at the entrance of the nares and added dual-wall nasal pillows to the Swift mask.
ResMed has also redesigned frames and cushions and increase fit range by reducing the number of sizes. This makes mask choice more intuitive for patients. For instance, Ultra Mirage Full Face is offered in 6 sizes vs the newer Mirage Quattro which is offered in 4 sizes. The new XS size increased the fit range but the redesign of the other sizes made it possible to have more intuitive sizes. Cushion names have also been re-named to make it easier to remember.
The Mirage Activa mask is sized the same as their newly launched Activa LT mask but the Activa LT cushion names have changed . Keep in mind that the reduced size of the expandable cushion will feel lighter but different on your nose simply because they removed the short tube and added the dial. So while the sizes may be the same dimensions...how it performs makes all the difference on your fit.
The Mirage Liberty full face mask has a choice of small or large which then comes with small, medium and large nasal pillow cushions. All of my OSA life, I have worn a size small mask, but I wear the large Mirage Liberty. I would not have known this, had I not tried both sizes and judged for myself that the larger size just sealed better for me. This is another example of taking personal responsibility, you see, its not just about sizing, its about mask performance – the comfort and seal ability factors!
Click here for a printable sizing guide for most ResMed masks
Most of the Respironics mask sizing is consistent. One exception is the new ComfortGel Full face mask which runs a bit smaller than their ComfortFull 2 full face mask.
You can access the full line of Respironics mask sizing information at http://masks.respironics.com/
This intuitive manufacturer makes two great full face masks, but their sizing system is radically different than the others. They offer the largest size range which includes choice of petite, extra small, small, medium and large. Hans Rudolph company states; “Our V2 Oro-Nasal Interface (or Mask) runs larger than others on the market. In some cases patients have gone a size and even two sizes smaller than what they have worn in another brand.” Patients are encouraged and welcome to receive mask information and sizing guides by calling: 800-456-6695 or visit hri@rudolphkc.com
Sizing guides are a great tool.. Most companies offer online sizing guides that you can print and cut out to use at home. It is a good place to start and they can be helpful, but know they are not always completely accurate. Again, I cannot stress enough, the importance of trying masks on in person.
After everything you have learned in the article so far, you would think that trying a mask on in your local home healthcare dealer is the bottom line and the smart thing to do. It is, but know a mask fits and feels totally different when you are sitting or standing in a showroom. “Huh”, you say? “There is more?” You bettcha!
The best mask for YOUR face is the one that is so comfortable you can sleep well with it throughout the night. If you have the right mask for your face, it should never cause pain or discomfort. It should seal well. It should never need to be tightened so much that it leaves imbedded mask strap marks on your face; it should not cause skin irritation. There is no such thing as a “perfect mask”. All masks will probably leak a bit when we change sleeping positions. Think “gravity”. Adjusting a mask to fit well for side sleeping will need to be fitted differently if you sleep on your back. Always consider YOUR preferred sleeping position when doing your final mask fit adjustment. If you change sleeping positions during the night, consider that factor as well.
When you retire for sleep, put on your mask, turn on your machine and lay in bed, on your pillow, in your sleeping position. Then and only then, slowly pull mask straps JUST UNTIL you get a good seal. It's quite amazing how loose and comfortable a mask can be worn while still achieving a good seal.
The message I want to leave you with is that YOU must take responsibility in your mask choice. Take the time to sum up your individual facial features. This will allow you to make informed decisions. Be proactive, know you have choices and take the time to learn your mask options. Equipped with the right tools, you can reap the rewards of CPAP therapy. It's your sleep, health and life at stake, not to mention your pocket book. Masks are expensive so it's important to get it right the first time. CPAP, live long and prosper!
To contact Tracy with comments or questions, email tnasca@talkaboutsleep.com
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