The Interface

Initially, masks were custom-made from silastic compounds. In the mid-1980s new forms of plastic self-sealing masks that were more convenient to use were commercially available. Mask technology has improved greatly, and this is important as mask comfort remains a pivotal influence on CPAP acceptance and adherence. Poorly-fitting masks permit air leakage and a drop in pressure leading to persistent "breakthrough" OSA and sleep fragmentation. The leak is usually the source of considerable discomfort; for example, if it is directed toward the eye, it may cause conjunctivitis (63). A potential problem with a poorly fitting mask is the development of bruising or even ulceration of the bridge of the nose.

There are few studies comparing different mask types despite the constant availability of new designs. Anecdotally, the newer generation of mask types is associated with fewer mask-fit problems. Nevertheless, certain patients become claustrophobic when using nasal CPAP with any mask. Changing the interface prescription from a nasal mask to less confining nasal prongs or "pillows" may correct that problem. However, nasal prongs may cause irritation in the nares and long-term use data is needed. Newer interfaces are constantly being developed to address mask problems but for some patients, particularly younger patients with mild disease, perceived aesthetic problems with CPAP, regardless of interface, preclude this treatment modality.

An infrequent but difficult problem is the patient who has no upper front teeth. The upper teeth provide the rigid structure against which the lower part of the mask can be pulled. If there is no dentition, the mask simply rolls around the top gums into the mouth, with loss of an adequate seal. The problem may be rectified by providing a denture (64) or possibly an oronasal (i.e., "full face") mask.

Sleep Apnea

Sleep Apnea

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