Choosing a CPAP Mask: Nasal, Nasal Pillows or Full Face

Why the mask matters so much

Your machine can only deliver its pressure if the air reaches your airway without escaping. A mask that leaks, presses too hard or feels confining can wreck an otherwise good treatment plan. Clinical sources including the Mayo Clinic and AASM's patient site list an ill-fitting or uncomfortable mask among the most common CPAP problems.

There is no single best mask. The right one depends on whether you breathe through your mouth, how you sleep, the shape of your face, facial hair, your prescribed pressure and simple personal preference.

Nasal pillow masks

Nasal pillows are small soft cushions that sit at the entrance of the nostrils, held by minimal headgear.

• Good for: people who feel claustrophobic, people with beards or moustaches, those who like to read or wear glasses in bed, and many side and stomach sleepers.
• Watch out for: nostril soreness or dryness, and some people find them uncomfortable at higher pressures because the air is directed straight into the nose.
• Need: reliable nose breathing, or a plan for mouth leaks.

Nasal masks

A nasal mask covers the nose, usually sealing over the bridge or just under it, with cushions in a triangle or cradle shape.

• Good for: people who breathe through the nose and want a natural feeling airflow; often comfortable at a wider range of pressures than pillows.
• Watch out for: pressure on the bridge of the nose, and mouth leaks if your mouth falls open during sleep.
• Variations: under-the-nose cradle styles avoid the nasal bridge entirely, which helps people with marks or sores there.

Full face masks

Full face masks cover the nose and mouth. Traditional designs seal over the nasal bridge, while newer minimal or hybrid designs seal under the nose and around the mouth.

• Good for: mouth breathers, people with frequent nasal congestion, and some people on higher pressures.
• Watch out for: more surface area, which means more places to leak, and more bulk, which some people find confining. A larger mask can be harder to keep sealed if you sleep on your side.
• Tip: if your mouth leaks with a nasal mask, a full face mask is the standard fix, though a chin strap is another option to discuss.

Other things to consider

• Sleep position: back sleepers can use almost any style. Side sleepers often do best with smaller masks that stay sealed against a pillow. Stomach sleepers usually prefer nasal pillows.
• Tubing connection: masks with a tube that attaches at the top of the head give more freedom to turn over.
• Glasses and reading: minimal masks leave your field of view clear.
• Magnets: some masks use magnetic headgear clips. In 2024 the FDA issued a safety communication about masks with magnets because the magnets can interfere with certain implanted devices, such as pacemakers, some neurostimulators and metal implants. If you or your bed partner has an implanted medical device or metal in the body, ask your provider for a non-magnetic option or check the current labeling.
• Allergies: if you react to silicone, ask about fabric or memory-foam cushions.

How to get the right fit

Most masks come in several cushion sizes, and many include a sizing guide. Ask your DME to fit you while you are lying down in your usual sleep position with the machine running, because a mask that seals while you sit up can leak when you lie down.

Give a new mask a fair trial of several nights, but do not suffer for weeks. Many suppliers allow you to exchange a mask within a set window after setup. Ask about the policy up front, and ask your insurer how often they cover a new mask so you know your options.