New launches showcase trends such as minimal face contact, noise reducing technology, and a natural feel.

By Lisa Spear

Some sleep apnea patients will tell you that it’s not always easy to sleep with a CPAP mask. Escaping air can create a loud hissing noise that wakes them up during the night. The headgear can feel claustrophobic and restrictive. Tight straps that keep the mask securely in place can dig into the skin and leave marks the next morning. Some patients may find that nasal pillow masks are less bulky, make minimal contact with the face, and allow them to move more freely. These masks continue to evolve, offering lighter, more comfortable interfaces.

“I find that a lot of patients are pulling away from the full facemask. They want the very small, petite, noninvasive, nonintrusive nasal masks,” says Russell Rozensky, MS, RRT-SDS, CPFT, RPSGT, program director at The Stony Brook School of Health Technology and Management’s Polysomnographic Technology Program in New York.

“A lot of the full facemasks cause a certain level of anxiety for patients and with the new nasal pillows, and the smaller nasal interfaces, it makes it a lot more comfortable for patients to sleep with,” says Rozensky.

When working with a new patient, Rozensky will first have them try a nasal pillow mask. If there isn’t enough pressure or if the sleep apnea is severe, he might move them to a full face mask, but then there are new problems that emerge. Sometimes patients on full masks will swallow too much air, which leads to stomachaches, flatulence and even, in some cases, vomiting. This is more avoidable with nasal pillows since they are easier to remove quickly during the night, if needed.

The “pillows” are small ports that look like earplugs. They rest inside or near the nostrils and create a seal that directs pressurized air directly into the nose to keep the airways open. Recent innovations are making them easier to use.

One device that is launching in early March, Bleep Sleep’s Dreamport Sleep Solution updates what CPAP interfaces can look like, eliminating headgear by using an adhesive surgical tape that creates a flush seal on the nostrils to prevent air leaks.

Airway Management Inc also has a headgear-less nasal pillow mask. The TAP PAP uses a mouthpiece that looks like a retainer. The mouthpiece stabilizes the device.

Several manufacturers have taken steps to reduce the noise of CPAP, creating a quieter bedroom for the patients and their bed partners. Fisher & Paykel’s Brevida nasal pillow mask incorporates a diffuser to reduce noise and air draft. One of the newest ResMed nasal pillows, the AirFit P10, comes with a mesh vent that reduces sound.

Nasal redness and burning is another obstacle that nasal pillow users sometimes report. Philips Respironics DreamWear and Amara View have under-the-nose cushions to eliminate nasal bridge irritation, a common and frustrating complaint of many patients, says Kevin Coldren, a spokesperson for Philips Respironics.

“The latest trends in CPAP masks, including nasal pillow masks, are centered on the patient experience. There is a basic expectation that the mask will work—meaning they will be stable and stay in place, stay sealed, and deliver the therapy the patient needs. But wearing a CPAP mask, especially for new patients, can be intimidating so there is a drive to make the experience more natural and comfortable for them,” says Coldren.

Other popular nasal pillow masks include the ResMed Swift FX and AirFit P10. These devices have just two straps that go over the back half of the head with only one strap extending from above the ears, onto the face. “The pillows or the cushion that actually touch the patients’ skin are extremely pliable,” says Rozensky. “Patients like the simplicity of these two devices.”

For nasal pillow users who need help keeping their mouth closed at night, the Philips Respironics OptiLife interface comes with a chinstrap. Since many patients with obstructive sleep apnea have been breathing through their mouths during sleep for many years as a result of the obstruction, it can be challenging for them to use a nasal mask, so the OptiLife can help smooth the transition, says Rozensky.

Everyone’s nostrils are different. Some are wide. Others are narrow. Sizing nasal pillows can sometimes be difficult. One solution to this is one-size-fits all sizing. For example, Bleep’s one-size-fits-all DreamPort Sleep Solution connects directly to the nose with tubing that hangs off the face. There is no headgear. This allows users to sleep on their back, side, or stomach. It’s also a friendly option for people with facial hair who might have trouble getting an airtight seal with more traditional full masks, explains Stuart Heatherington, RPSGT, the company’s founder and CEO.

A sleep technologist and sleep apnea patient, Heatherington says after suffering with uncomfortable CPAP devices for decades, he knew that he needed to create something that works exactly the same way as a traditional mask, but that fits comfortably and doesn’t restrict your movement.

A pulmonologist at the Mayo Clinic’s Sleep Disorders Center, Brendon Colaco, MD, says he has not yet used the DreamPort for his patients, but the concept is interesting. “If it is able to stabilize with that apparatus of the nose, it would be a very good solution because we have a lot of patients who don’t like anything around their head,” says Colaco, who treats sleep apnea patients in Jacksonville, Fla.

Since the plugs don’t go inside the nostrils, patients won’t experience the burning sensations that people who use standard nasal pillow devices sometimes report, says Heatherington.

Philips Respironics’ Coldren says, “Older CPAP masks were focused mainly on function—did the mask deliver the therapy the patient needed. Now we are taking radical leaps forward with mask designs to make CPAP therapy as natural and normal as possible.”