CPAP machines and masks: Which ones are right for you?

Your doctor says you need continuous positive airway pressure (CPAP) to treat your sleep apnea, and you're eager to begin treatment. You're also a little worried, since you've heard that using a CPAP system can be uncomfortable and challenging. How do you choose a system that will give you the best odds of success? Here are some tips to help.

Understand the treatment

CPAP is the first-line treatment for people with obstructive sleep apnea, a sleep disorder marked by repeated pauses in breathing caused by a blocked airway.

The CPAP system's job is to keep your airway open. It does that by pushing a forceful stream of air through a tube and into a mask you wear while you sleep. The air comes from a small bedside pump (an air compressor).

Other forms of positive airway pressure (PAP) may be helpful for people with central sleep apnea, although pauses in breathing in this type of sleep apnea are related to garbled messages from the brain, not blockages (see "What is sleep apnea?").

Trust your doctor

Your physician will determine what kind of CPAP device you need. "The device and its settings are by prescription, just like a medication," says Dr. Noah Siegel, director of Sleep Medicine and Sleep Surgery at Harvard-affiliated Massachusetts Eye and Ear.

With CPAP, a single fixed air pressure is used throughout the night. Other types of PAP therapies include

• auto-adjusting positive airway pressure (APAP), which provides a range of preset pressures throughout the night
• bilevel positive airway pressure (BiPAP), which provides two different preset pressures — a more powerful one when you inhale and a less powerful one when you exhale
• adaptive servo ventilation (ASV), an advanced device that provides pressure based on breathing patterns throughout the night.

"Generally speaking, people with obstructive sleep apnea respond better to CPAP or APAP. People with central sleep apnea may respond better to BiPAP or ASV," Dr. Siegel says.

Investigate face mask options

You get to choose the face mask for your PAP system, and it's an important decision.

Face masks often feel bulky, making people reluctant to wear them. Dr. Siegel recommends looking at mask options online and trying on a few before making a selection. That might happen at a medical supply store or during a home visit from your medical equipment supplier.

The masks fall into two categories.

Full-face masks. These cover the nose and mouth and deliver air to them both. They are ideal for someone who breathes through the mouth or has nasal or sinus problems.

Nasal masks. These masks deliver air through the nose only. They are less bulky than full-face masks and come in styles that fit over, under, or in the nose.

An important consideration for both mask types, Dr. Siegel says, is the site where the tube from the pump enters the mask. "Traditional-style masks connect the tubing in the front of the mask, near the nose. That's not great for people who roll over a lot in bed or people who are claustrophobic," he says. "Newer styles attach at the top of the mask. It's much less intrusive."

Give it time

Adjusting to any PAP system takes time. You may need to try a few masks to find the right fit and comfort. "And if allergies or frequent sinus congestion keep you from using a nasal mask, we have interventions — such as nasal sprays or surgery — that might make a nasal mask more tolerable," Dr. Siegel says. Also, your doctor may need to make adjustments to your machine, such as changes to settings for pressure and humidification.

Just stick with it, and remember that using a PAP system, like taking a medication, is an ongoing therapy that needs regular evaluation.

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