Tuesday, April 7, 2015

Top 10 CPAP Masks - Part 1 - Nasal Pillow Masks

Comprehensive Review of CPAP Nasal Pillows, Nasal Masks, Full Face Masks

As manufacturers continue to churn out more and more CPAP mask offerings, attempting to find the Holy Grail of masks becomes both easier and more challenging for users.

Easier, because the greatest CPAP mask you have ever tried is out there, somewhere, waiting for you to discover it. More challenging because of the Paradox of Choice, AKA analysis paralysis. So many choices, and obviously you want to choose wisely.

To help you overcome analysis paralysis, we compiled data from over 1,000 actual CPAP users and assigned a score to each mask. The pros and cons listed are the most frequently mentioned features which users liked or disliked. Obviously, this creates a sometimes-contradictory list; but since CPAP mask comfort is subjective by nature, we decided this was the best way to provide the pros and cons.

We have remained objective while compiling this information, and no personal preferences are presented. We purchase (and use) all of the masks represented here. 

In part 1 of this 3-part series, we'll look at the very popular nasal pillows category. In the coming weeks, we will publish the findings from the nasal mask and full face mask categories.

So, let's dive in and see which are the top nasal pillow CPAP masks.

Respironics Nuance CPAP Mask

This one surprised me a bit, as I expected the Nuance to score significantly higher. Several people on our clinical staff like this mask very well, and we have not seen a high return rate for the Nuance. Sean mentions that the pillows are very comfortable, each side can be tightened independently, but the exhalation is (subjectively) noisier than other choices.

  • Lightweight, easy to put on, comfortable, headgear doesn't slip, less likely to leave marks on face
  • Does not maintain seal, pillows difficult to adjust, presses too hard between nostrils and upper lip, short tube has excessive movement

Score: 80.4%

9. GoLife by Philips Respironics - Price $59.95

Respironics GoLife CPAP Mask

Another (lesser) surprise, as we assumed that the Nuance would score well ahead of the aging GoLife and GoLife For Women platform. We do not use this mask locally very often as of late; but, as is often the case, it has a loyal group of people who like it and continue to use it.

  • Doesn't leak, lightweight, stays in place
  • Difficult to get a seal, leaks, does not stay in place, leaves marks on face, hurts nostrils

Score: 82.5%

Puritan Bennett Breeze CPAP Mask

Yet another small surprise. The venerable (read: ancient) Breeze SleepGear has been around for many years, and continues to have an almost cult-like following. This is the original nasal pillow CPAP mask (actually the ADAM Circuit preceded the Breeze, but it was the precursor to the Breeze), and has seen only a couple of design changes over it's lifetime. It is prone to breaking, is relatively heavy, and the replacement pillows are on the expensive side. The killer feature for many users is the fact that nothing is in contact with their face, save for the actual nasal pillows. 

  • No leaks, good for side sleepers, nothing touching the face
  • Very fragile hose guide, heavy, noisy

Score: 83.2%

7. Swift II by ResMed - MSRP $118.00

ResMed Swift II CPAP Mask

Here we have another older design, which has seen minor updates over the years. It was a dominant player when first introduced, as it was the first foray into nasal pillows by ResMed. 

As with other "legacy" type masks, many of us may think that there are better choices. Much like the Breeze, however, the Swift II has a large fan base and will likely continue to be relatively popular for many years to come.

  • Easy to put on, no leaks, unobtrusive
  • Side straps uncomfortable, headgear slips, not a good choice for side sleepers, exhalation ports are not well diffused

Score: 84.0%

Fisher & Paykel Pilairo Q CPAP Mask

Here is one that landed on the list at about the position I expected. The Pilairo Q is a solid entry for Fisher and Paykel; it has several features which set it apart from the competition. The Pilairo Q also possesses a few quirks which detract from what could be a very strong player in this crowded field.

  • Very quiet, stays sealed, lightweight, good for users with facial hair
  • Headgear not adjustable enough, leaks excessively, "One Size Fits All" does not fit all

Score: 85.9%

5. TAP PAP by Airway Management - Price $97.99

Airway Management TAP PAP CPAP Mask

This mask scored very well overall, and also generates the strongest reactions from people who have used the TAP PAP. The adherents love it, and the users who disliked it really disliked it. 

The most frequently mentioned feature by both the lovers and the haters is the mouthpiece. Which makes sense, as that is the feature which sets the TAP PAP mask apart from the rest of the pack. 

This is truly a love-it-or-hate-it mask, and it is absolutely unique in this (or any) segment of CPAP masks.

  • No lines on face, no headgear to adjust (headgear is optional), very quiet, good for side sleepers, good for users with facial hair
  • Mouthpiece uncomfortable, makes teeth sore, pressure on teeth

Score: 88.9%

ResMed Swift LT CPAP Mask

The Swift LT was the second nasal pillow CPAP mask to be released by ResMed, and represented a marked improvement over the Swift/Swift II. With the LT, ResMed addressed many of the criticisms of the original Swift (aside from their insistence on bestowing confusing names upon every product). 

The LT, which stands for Light Touch, was another monster upon it's release, and continues to sell relatively well. Especially when you consider that the ResMed family of masks is a monster unto itself, with consistently better products being offered every year. 

The Swift LT is still preferred by some ResMed fans, many of whom have tried the newer (better?) versions and found them lacking in important areas.

  • Comfortable and quiet, great seal, good for users with facial hair
  • Leaves marks on face, leaks, noisy

Score: 89.1%

ResMed Swift FX CPAP Mask

What??? Third place? The Swift FX can't possibly be rated in third place!

Yes, I too was stunned when the numbers were crunched (and re-crunched) and the long-time favorite of millions of CPAP users was relegated to position 3.

OK, how did this happen? A closer look at the numbers reveal that the Swift FX is loved for it's minimalistic design, light weight, great seal, and a multitude of other great features. It also drew some sharp criticism over the inability to actually adjust the position of the nasal pillows. There are enough people who purchased this mask and were not happy with it to drag down it's overall rating. This also means it was somewhat a victim of it's own success, with buyer expectations set so high that perhaps it was inevitable for it to get taken down a notch or 3.

When all is said and done though, the Swift FX (and it's sister, the Swift FX For Her) is still our best-selling nasal pillow CPAP mask. It outsells the previous seven masks in this article combined. It is a force to be reckoned with, and many a user will continue to use this mask for the next 10 or 20 years. I fully expect it to have a lifespan akin to the Breeze, with legions of users choosing this mask over newer, flashier rivals.

The Swift FX is in a class of it's own, even if it did only win Bronze in this particular comparison.

  • Very comfortable, quiet, lightweight, no leaks, very soft pillows, high quality, good for back and/or side sleepers
  • Strap at base of skull rides up, side straps are hard, air leaks on face

Score: 89.7%

2. AirFit P10 by ResMed - MSRP $99.00

ResMed AirFit P10 CPAP Mask

The latest, greatest nasal pillow CPAP mask from the company generally regarded as the manufacturer to beat, the AirFit P10 and AirFit P10 For Her. 

This was possibly the most anticipated CPAP mask in recent memory. When ResMed releases a new mask it is an event, and it is usually a home run. No question the P10 is a knockout mask. It has all of the requisite features (lightweight, simple to adjust, seals great). That being said, why is it in position number 2? 

Well, ResMed has to fight really hard to maintain its dominance. Many users, as well as many suppliers, feel that ResMed abuses its position by charging more than their competitors. The market is very efficient though, and users are typically going to purchase the best mask, even if it costs more.

ResMed wisely lowered the price of the P10, allowing it to better compete with lower priced alternatives.

That really does not explain the P10 taking Silver in this comparison. We'll go into more detail when we arrive at position 1. For now, lets just agree that the P10 is a fantastic mask, and will serve many users very well for many years to come.

  • Lightweight, easy to adjust, simple to clean, minimal headgear, very small, stays in place, exceptionally quiet 

  • Headgear stretches with use, difficult to exhale (ResMed's response is that the perceived difficulty exhaling is simply user perception and is not supported by the test data)

Score: 91.3%

1. Aloha by RespCare - MSRP $79.50

RespCare Aloha CPAP Mask

What kind of sham is this? Does someone on the staff have an interest in RespCare? How does an upstart manufacturer dethrone the great and powerful ResMed?

All valid questions. First, let's start off by noting that the Aloha took Gold in this comparison by a very small margin, which is exactly what should occur in any comparison of the best. Second, let's also note that far, far fewer people actually purchase this mask than many of the masks on the list. This is not to diminish the fantastic showing of the Aloha, but simply to determine the reason for what may be construed as an anomaly. 

There was absolutely enough data (nearly one hundred users) to bestow the crown on the Aloha. Oftentimes a small player can gain some very loyal followers, which appears to be the case with the Aloha. It is like comparing Windows Phone to the Apple iPhone. The 1980 U.S. hockey team vs. the heavily favored USSR team. Underdogs are often propped up by rabid fans, allowing them to perform better than most would predict.

The Aloha has thousands of happy users, and after shaking our heads in disbelief we are pleased to crown it as "The Best Nasal Pillow CPAP Mask of 2015".

For now.

  • Does not leak when moving, small and light, comfortable and simple headgear, doesn't leave marks, self-adjusting, short tube does not drag, good for users with facial hair, virtually noiseless, low price, straps do not sit on cheekbones
  • Intermittent leaks, tight headgear, nasal pillows detach too easily, feels "cheaper" than some

Score: 93.1%

Check back for the comparison of the best nasal CPAP masks and best full face CPAP masks. Perhaps we'll see another astonishing upset!