It can be hard to choose the right mask for a patient who is undergoing continuous positive airway pressure (CPAP) titration. There is no such thing as a one-size-fits-all mask, so important decisions must be made by the sleep technologist. Most manufacturers claim that their masks fit 80 percent of the adult population. For the other 20 percent, a category that includes many women like me, it can be a challenge to find a mask that fits. My experience allows me to speculate that about half of your female patients have small facial features that will make it difficult to fit them with a mask.
The following suggestions are based on both my personal challenges and comments from more than 300 women who responded to an online poll I was involved with several years ago and is certainly relevant today. I also include observations that I’ve made while interacting with hundreds of women who find CPAP compliance difficult due to poor mask fit. Remember that the goal is to provide a mask that will allow for a valid titration and that will increase the patient’s ability to achieve successful compliance at home.
There appear to be some common traits shared by women who have difficulty with mask fit. Some of the physiological anomalies include a short nose, a narrow nose bridge, a narrow face and a small head. You might be tempted to think that this list excludes obese patients, but you would be mistaken. At nearly 300 pounds, I wore a size-small mask. Even after massive weight loss to reach a normal weight, I still have the same short face, narrow nose bridge, and narrow upper lip; therefore I still have the same mask challenges.
In order to be productive and accurate in your mask choice when performing a CPAP titration for a female patient, I suggest that you visually examine the patient’s facial features and note the following:
Challenge: The headgear is too big. When the head is small but facial features are “normal,” a size-small headgear can make the difference in a successful fit. Since most masks come with a one-size-fits-all headgear, just ask your manufacturer’s representative about special ordering small headgear, which are readily available.
Short length of nose, from bridge to base
Challenge: The frame may sit on the sinus area or too close to the eyes, causing pressure-point soreness
and mask leak; the forehead pad also may be positioned too high. The patient probably needs a mask with a
shorter frame. This common facial feature reduces the traditional options for nasal masks; try extra-small or petite masks, or consider using nasal pillows.
Narrow nose bridge
Challenge: The mask is likely to leak around the eyes. This requires over-tightening of the straps, which can cause pressure-point soreness. This is a very common problem that is often overlooked; yet it is easy to solve. Try a mask with a shorter frame or nasal pillows.
Narrow width of upper lip
Challenge: When the surface of skin between the nose and top lip is too narrow, the mask frame may
not sit properly on the upper lip. This can position the lower mask cushion in a way that inhibits nasal breathing and produces mask leak. Try using nasal pillows.
It is noteworthy that the vast majority of women who responded to the poll indicated that they want less apparatus on the face. They want a mask that allows them to use night-time moisturizers, that eliminates pressure-point soreness caused by the mask straps, and that won’t interfere with their hair.
Using facial creams is not a wise choice for most CPAP users, since the moisturizers will interfere with mask-cushion seal. Mask liners are now available that can resolve this issue. But you can reduce female patients’ complaints about pressure-point soreness and hair problems by providing mask options with less headgear. This will make them happier and will give them the best chance to achieve long-term compliance.
Although vanity issues are much less significant than the medical importance of CPAP compliance, in
today’s world there are masks available that will satisfy both needs for women.
Who started the myth that patients on mid- to high-range pressures will not be able to tolerate nasal-pillow interfaces? It’s just not true. They have been my preference, with bilevel pressure of 20-11, since they were launched in the 90s. Hats off to the manufacturers who recognize the importance of nasal pillows and keep engineering intuitive new designs.
Since they feature minimal headgear, nasal pillows also solve most of the vanity concerns women have regarding hair, moisturizers and mask strap impressions that are left on the skin. Please make sure that all patients are shown and offered nasal pillows as an option. Let your patients make the final decision for themselves.
CALLING ALL SLEEP TECHS, would love to hear your feedback on challenges you face with titration and how you resolved them.
Thanks in advance for sharing your comments!