CPAP and Facial Hair: Finding a Fit
The COVID-19 pandemic has turned PPE and N-95 into everyday acronyms. Many people are unaware that N-95 masks are not one brand and one size fits all. Like CPAP mask users, health care workers must be fit tested to an N-95 mask. To stay safe, they must then remember what brand and size to wear. Staff with facial hair are told that they will not pass a fit test and will need to wear a PAPR hood instead of an N-95 mask. PAPR hoods combine with a mechanical blower worn on the waist to filter and flush the air. PAPR equipment makes a health care worker look a bit like an astronaut. It is also cumbersome and costly.
25% of people without facial hair fail N-95 fit testing, and they too need to wear PAPR hoods. PAPR equipment is in even shorter supply than N-95 masks. Consequently, health care workers with facial hair are encouraged to shave to preserve PAPR equipment for others who cannot pass.
For some, shaving is an emotionally charged decision. Many healthcare workers have found compromise solutions thanks to a poster put out by the CDC, showing where N-95 masks make contact and how facial hair can potentially be trimmed to allow the masks to fit safely.
People newly diagnosed with sleep disorders are often told that they must shave to fit a CPAP mask. Although that may be the case for some individuals, it is not a universal truth. Just as healthcare workers with facial hair can fit test to an N-95 mask with some tricks and compromises, CPAP users should explore some creative options before going clean-shaven. Human faces have a lot of variabilities, after all, and the current generation of home CPAP machines have algorithms to compensate for a degree of leakage.
Four Paths to Pursue
1. Easy Street: Nasal Pillows
Nasal pillows offer an effortless solution for many. Nasal pillows have tips that rest inside the nostrils, and the frame runs above the beard for many people. Since nasal pillows do not circle the entire nose, they cover less surface area on the face; that results in less space to worry about facial hair hindering the seal. The frame and headgear straps also tend to be thinner and smaller on nasal pillows than on other types of masks, adding up to less surface area where the mask contacts facial hair that could prevent a proper seal.
For the optimal results with nasal pillows, look for products with headgear that lies at the periphery of your facial hair.
People who are claustrophobic or who want a less bulky mask appreciate nasal pillows. Nasal pillows do not obstruct your field of vision, so it is no problem to watch TV or read. Nasal pillows work best for people who breathe mostly through their nose, who do not have chronic issues with nasal congestion, and who do not require exceptionally high CPAP settings.
2. The Scenic Route: Nasal Masks
Nasal pillows are the most friction-free route to success with CPAP and facial hair, and for many, they are a great choice. Some people, though, do not like the feel of the tips in their nares or the immediacy of the flow. After evaluating nasal pillows, nasal masks should be your next stop. Fortuitously for those with facial hair, nasal masks come in a variety of shapes these days. The traditional nasal mask uses an “over the nose” cushion that surrounds the nose. Some nasal masks use an “under the nose” cushion that covers the nostrils only.
Traditional triangular nasal masks that cover the nose and sit above the upper lip may work well if the mustache is trimmed shorter. Nasal cushions and nasal cradles are also well worth trying. Look for designs where the headgear and frame have reduced contact with the outline of your facial hair.
New mask designs are coming out all the time with new variations. If you looked for a nasal mask in the past to use with facial hair and came up empty, now is an excellent time to look again.
3. Going Off-Road: Full Face Masks
A person who breathes mostly through their mouth or who has chronic nasal congestion benefits greatly from full face masks. A clinician may also recommend a full face mask for someone who needs higher levels of support on their CPAP machine. Some people simply prefer the solid feel of a full face mask over a nasal mask or pillow mask.
Conventional wisdom says that full face masks cannot work with facial hair. Full face masks do take more finesse to fit than nasal masks and nasal pillows. Facial hair does complicate full face mask fitting further, so it may take a few tries with different brands and styles of full face masks to find one that works for you. Just be prepared for a few bumps in the road on the journey through the options on your way to a solution.
Like nasal masks, full face mask designs are plentiful. Full face masks may use a cushion that surrounds the mouth and the nose completely, an “over the mouth” cushion that covers the mouth and seals the nostrils, or some other variation altogether.
When evaluating full face masks, consider the shape of the cushion and visualize where your facial hair will contact it. If you can trim the hair flat or shorter in those regions, that may help.
Full face masks with face cushions that are triangular and fit near the bridge of the nose and below the bottom lip are the most common type of full face mask. This design is very stable and leak-resistant. Some full face masks of this type rest lower on the chin; that design tends to work very well with beards.
Some full face masks have a more compact design and use a cushion that sits over the mouth and under the nostrils. The cushion occludes the nostrils completely and seals around the mouth. This ultra-minimalist style may not be ideal for a person with CPAP settings in the higher range. It may also take a bit longer to fit precisely, but it does allow maximum freedom of movement with the least amount of contact on the face. The reduced contact on the face lessens the impact that facial hair has on the seal. Trimming facial hair or choosing a cushion whose edges stick to the periphery of facial hair growth can help.
4. Exploring Short Cuts: Liners and Lanolin
Adjunct tools may help the mask you prefer the most fit well. Mask Liners placed along the rim of the mask flatten facial hair and seal small gaps. Liners benefit people with and without facial hair when the mask has nagging areas of leaks.
Creams with lanolin or mustache wax can be applied to soften the hairs and press them flat, allowing the CPAP mask to seal. If you use creams or wax, be sure to wipe the mask clean after each use. Build up over time and cause the mask to get slippery.
Tips and Tricks
Not too tight
Over-tightening causes skin irritation and breakdown. It can also result in thinning and patchiness in your facial hair. Over-tightening often makes leaks worse as well by moving the mask away from other critical points of contact. If a mask requires excessive tightening, it is either the wrong shape or the wrong size for you.
Bigger is not better
Do not fall into the trap of thinking that an oversized mask is a solution. It is your facial size that matters the most. Over-sizing a mask results in more leakage. Start smaller and step up if needed.
Trim a bit
Give thought to trimming your facial hair in the regions your preferred mask touches. Keeping the hairs shorter can help.
Find and maintain your happy place
If you change the pattern of your facial hair grow it longer, or remove it on areas of your face, you will need to evaluate the fit of your CPAP mask again.