CPAP Mask Marks, Skin Irritation and Pressure Sores

Common causes

• Straps that are too tight, often to stop a leak.
• A mask or cushion that is the wrong size.
• Constant pressure on one spot, especially the bridge of the nose.
• Oils, soap residue or sweat under the cushion.
• Sensitivity to silicone (uncommon).

Fixes to try

• Loosen the headgear. A common rule of thumb is that you should be able to slip a finger or two under the straps. Reseat the mask rather than tightening.
• Get refitted. A different cushion size may spread pressure better.
• Use mask liners or gel pads made for CPAP to reduce friction and pressure.
• Switch styles. Under-the-nose nasal or full face masks and nasal pillows avoid the nasal bridge.
• Rotate between two different mask styles if your provider agrees, so pressure does not sit on the same spot every night.
• Wash your face before bed and keep cushions clean and well rinsed.
• Replace worn cushions and headgear, since they push you to overtighten.

Skin care around the mask

Wash your face with a gentle cleanser before bed and let your skin dry before putting the mask on. If you use a moisturiser, apply it well before bedtime or choose a light, water-based product, since heavy creams and oils make cushions slip and break down silicone. In the morning, rinse your face and give your skin a break from pressure during the day. Some people find that a barrier cream recommended by their doctor helps on spots that rub.

Nostril soreness from nasal pillows

If pillows are too large or angled wrongly they can rub. Try a smaller size, adjust the angle, or use a water-based nasal gel recommended for CPAP. Avoid petroleum-based products near the mask.

When to see a doctor

Seek medical advice if you have open sores, blisters, signs of infection (warmth, swelling, discharge), a spreading rash, or marks that last for hours. Pressure injuries need time to heal and a change of mask. Do not keep pressing on a sore spot.