The Shell Game
Every time I get a new patient I think "What mask I am going to use?" I think about what we have available now, what we used to have available, and who is going to perform the study.
Everyone has a favorite mask. Everyone who has been in the field for a long period of time has seen their favorite mask change over time.
When I was first doing home care for Bane Respiratory many years ago, I had specific masks for specific types of patients. I always started with the nasal mask except if the patient was claustrophobic or had fragile skin.
Then we would get into some of the stranger masks out there. I had a mask I used specifically for my little old ladies who went to the hair dresser once a week. (These little ladies were always my favorites)
Back then, I would use mostly the new gel masks that you had to boil to make fit. It served two purposes. One, to get the mask fit properly and two, I would see what medications they were taking and make sure they did not have three bottles of the same med by different names that they were taking. If I was calling a doctor's office in the middle of the day, they know I was calling because I had just found someone who was overmedicating themselves. It was always about patient care.
If I had one of my little old ladies who did not want to muss their hair, I would break out a mask that was a cross between a wrestler's headgear and Princess Leah's hairdo. But oh, the things you could do with it to get a patient to wear their CPAP or BiPAP. I almost never put the straps where they were supposed to go. This way I had one strap across the forehead and one at the back of the neck and the nasal cushion secured using Velcro around the hose. The great part was that this mask was one of the first where a patient could wear glasses so they could read in bed before lights out.
Full face masks to this day I use whenever someone is claustrophobic and the wires do not bother them. This means it is not having something touching their face that keeps them from wearing the mask but it is a control issue. When you tell someone to breathe through their nose only you take away some of their control. With a full face mask and having the patient hold it to their face they are in control and they learn to adjust to using CPAP. I have many successes that way.
In the end, choosing masks is all about how much communication I have with the patient. I will always give them at least two choices, I will always listen to their fears and any health issues and I will always look at my biocals for upper airway resistance. Then I give choices. This is how I find the pea under the shell almost every time.