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Adventures in Polysomnography

How many masks?

Published January 24, 2008 11:11 AM by Pam Ryan

How many masks do you have available at your sleep laboratory? Do you try to always get the "latest greatest" masks, or do you stick to mostly "tried and true"? How often do you use a full-face mask instead of a nasal mask?

I got to talking about these issues with a couple of people at the last APSS/AAST meeting, and the exchange got a little heated! People have passionate opinions about this - similar to the divergent passionate opinions I've heard expressed about home sleep testing (HST).

I'll try my best to explain the rationale on both sides of the mask-choices debate. Please feel free to share your opinion.

On the one hand, too many choices may be confusing and overwhelming to the new CPAP user. So perhaps it's a good idea to start with a standard, inexpensive mask (trying to minimize out-of-pocket expenses for the patient.) Then, only if the patient has specific complaints, try an alternate. It can also be cost-prohibitive for the sleep lab to try to stock too wide a variety of masks. Or there may be space limitations that make it impossible. Some DMEs do not carry all masks; patients could be frustrated if they are unable to obtain the same type of mask for home use, as they used at the sleep lab.

On the other hand, the sleep study night is the golden opportunity to impact the patient's long-term compliance with PAP therapy. So maybe it makes sense to experiment to see which mask optimizes things like patient comfort and leak control. Perhaps we do a disservice to our patients, if we use a "one-mask-suits-all" approach. We tweak the CPAP pressure, seeking that one perfect setting that will address our patient's individual need. So why would we treat mask choices any differently? The mask is a critical component of acceptance of CPAP therapy.

So, there are the two sides of the story. Which approach do you use at your lab?

posted by Pam Ryan
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3 comments
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We have several types and brands of masks to choose from at our lab. I admit that I have become a fan of one particular brand and 2 of its types, a nasal and a pillow. I show my patient 3 masks a nasal, a pillow, and a full face. I let all of my patients know the pluses and minuses for the different choice of mask, but always make sure to inform them that they are all clinically proven to take care of the apnea, and that mask choice is a comfort issue. I allow them to pick a mask to use and let them know that they are not stuck with this mask and that we can try another if need be. I find that patients are 100%+ more likely to comply with CPAP therapy if we have covered all the bases for comfort the night of the study. I have had several patients that come in and have had a sleep study at a hospital where some non-caring technician just threw a full face mask on them and went on about their way without a second thought. These patients were not informed that they had options and their CPAP machine ended up in the closet a month later. These patients have been off the machine for 5 years and come to see me and have no problems. I think that patients should be educated and informed of choices and further options so that they know that there is somewhere to turn when they find a problem.
Krystal Scott, RPSGT March 7, 2008 4:19 AM

We practice very similarly to Mr. Mayer's Sleep Clinic.  We as well show a variety during the PSG portion of testing to desensitize the patient and provide education about CPAP therapy.  Our techs are required to show at least 3 different masks to the pt with the full face being the last resort due to excessive leaks and excessive returns.  A good mask fit and pt education is crutial for compliance.  It is important for the patient to understand that the mask they choose to start out with is not the one they are stuck with.  If it is not working for them during testing they are encouraged to alert the tech to provide assistance and change the mask if necessary.  In the event that once the patient gets home and is intolerant we require our DME companies that we refer to to offer a 30 day mask exchange program.  %0d%0aWe also have a CPAP Success Program for assessment for compliance in our clinic to assist pt with acclimation and any supply needs they might have.  it has been very rewarding to witness the benefit of CPAP compliance and be apart of bettering so many peoples lives.  Mental, Physical and Emotional well beings.
Tammie Roberson, , Lab Director Sleep Center of Tulsa March 7, 2008 12:09 AM
Tulsa OK

In our lab we aggressively try to find the right mask because it is such an important part of compliance. Yes, we try all the latest and greatest if we possibly can. Of course, being a physician practice, we also do all the follow up and sleep counseling, so our patients comply at a very high rate. (You should see what happens to hypertension, especially in our younger mild to moderately severe cases. They rebound to normal quite often.)
Tom Mayer January 31, 2008 1:34 PM

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