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Adventures in Sleep

The Challenge of Mask Fit

Published May 17, 2012 9:50 AM by Amy Reavis

Amy Korn Reavis, RPSGTI have talked about mask fit before (here and a little bit here) but I believe that we can never talk about it enough. Mask fitting is one of the most important parts of a titration study. It will be what determines success. It is one of the biggest challenges you face since many patients will make decisions that may not be right for him or her.

Everyone has a favorite mask but I find that it is essential to give the patient at least two choices. Sometimes it can take five or six masks before the patient finds one that he likes. The one thing that will help for the DME company and billing is if you document all the trial masks. This is especially true if you are going to switch to Bilevel therapy.

Last week, we had several different patients who had mask challenges. We had a man with a full beard who would not wear a nasal mask or pillows. We finally got him on a FFM but the leak was ridiculous.  He was placed on Bilevel because that seemed to work better. Ultimately, he was not completely titrated but he was significantly better and he said he felt better. I am hoping that he will trim his beard.

Another patient had failed CPAP previously. The patient was originally placed on pillows because she was claustrophobic. The truth is that most patients who have this problem do not do well on pillows because they cannot breathe through their mouth. It actually makes them more claustrophobic. She was placed on a FFM which she did very well on and thanked us the next morning for helping her. I have also had success with the Fitlife mask for the claustrophobic patients.

My final patient will never use a CPAP or Bilevel. He refused to even try on a mask. In the end he walked out AMA. Unfortunately he had severe CSA and he has very little options for treatment. 

What ultimately is the cause of success for therapy? When I talk to other techs I have heard that it has to do with how open minded and determined the patient is. Those who come in with a closed mind will never accept therapy and even if they feel better will not use it and find multiple excuses why they cannot use it. However, anyone coming in with at least a little bit of an open mind will usually be successful. 

What tips do you have for techs to help them make the CPAP experience more successful?

posted by Amy Reavis


Mask comfort is a relative thing when the patient is just getting started. It is key for the patient to at least get started on CPAP and feel some improvement. (that can take a while) As you stated, nothing is going to feel 100% comfortable. Even though you have seen hundreds if not thousands of patients, to this patient, only their set up matters. It is personal for them. There is a psychological acceptance that often needs time to happen. This is totally foreign to their life before diagnosis. Accepting that forever you will sleep with a mask and machine is pretty daunting. The fact that their brain is oxygen deprived and comprehension may not be easy, they have to wrap their brain around this. Careful education about the serious nature of sleep apnea and their attitude toward treatment may have as much effect on successful mask fit.

Karen Moore May 24, 2012 8:20 AM
Stanardsville VA

As a user and provider for acute care and nonacute BIPAP/CPAP I can whole heartedly agree on fiting of the mask leads to compliance. I went through so many ffm, nasal and pillows before I found the one that fit. As we know, one size does not fit all. Addressing their concerns is formost, using of the ramp mode and giving good instructions on how to adjust the mask. It would be nice if when you fitted them with their machine, have them lay down with the mask to see how it feels when they turn their heads on a pillow with it turned on. Its a different feeling than sitting upright adjusted. I admire the company that gives the 30 day exchange.

Lorenza, RespiratoryTherapy - CRT Baltimore-Washington Medical Center May 23, 2012 8:58 PM
Glen Burnie MD

I'm speaking from the medical equipment side.  If a patient has compliance issues it's usually because of the mask.  Our company participates in a 30 Day Mask Exchange Program.  Resmed, Respironics and Fisher/Paykel have this program.  While doing a setup I always tell patients in the beginning that nothing is going to feel 100% comfortable, but you need it to feel "reasonable."


Talk to the patient as your best friend. As much as possible support the patient's concerns about using their Bipap/Cpap machine use and their likes/dislikes. You have to explain to the patient the rational behind the machines purpose and how it can help the patient. If they comply make sure to place the mask securely and check for leaks and adjust accordingly.

Johnleo Devenecia, Allied Health - RCP, WSMC May 18, 2012 4:17 PM
Chicago IL

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    Adventures in Sleep
    Occupation: Sleep technicians
    Setting: Various sleep facilities
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