Monday, December 14, 2015

Top 10 CPAP Masks - Part 2 - Nasal Masks


Edit: We had a late addition to this series, the DreamWear by Philips Respironics. Rather than bumping one of the masks which had already made the cut, we opted instead to revise the article to reflect the top 11 nasal masks. The addition of the DreamWear did not change the order of the 3 masks which had the overall highest score.

Here we are with the second part of our 3-part series on the best CPAP masks available. In part 1, we reviewed nasal pillow masks. This article covers nasal masks. In part 3 we'll take a look at full face masks.

As was noted in part 1, there is an overwhelming number of choices in CPAP masks. Which is a good thing for consumers, to a point. The problem comes in trying to decide which one is best for you. 

That's where we come in, with data compiled from over 2,000 actual users of CPAP masks. As in part 1, we'll review the features of each mask, give a brief overview of our staff experiences and thoughts, and finally assign an actual score to the ten most highly-regarded masks.

Remember, there is subjective opinion at play here, so please do not take the results as gospel. You may find that a mask which did not make the list is your personal favorite, and that's great. Once you find the "perfect" mask, it's usually best to stick with it.

We have remained objective in compiling this list. We purchase and use every mask represented here; although we may offer comments on a particular mask, the final score is not affected by any personal bias.

A brief note regarding the manufacturers:

ResMed does not allow discounting on most of their products. The prices listed for their masks are the Minimum Internet Retail Price, or "MIRP". All ResMed masks can be purchased as a parts kit, with no prescription required. We compiled a very simple how-to guide on buying the ResMed parts kits here, which walks you through the steps.

Philips Respironics masks carry a Minimum Advertised Price, or MAP. They do allow discounts via coupon codes, which are easy to locate. On our site, the coupon code is the product name (Pico, Wisp, DreamWear, etc.). However, Respironics does not offer assembly kits for people who can't find their original prescription. You can purchase replacement cushions and headgear for their masks without a prescription, but not the parts needed to assemble a complete mask. 

Now, let's jump in and see which are the top rated nasal CPAP masks.

The most unique nasal CPAP mask on our list is also the most controversial, as we would expect. For many users, the cloth material used in lieu of a silicone cushion is a blessing, while for some users it is more of a curse. 

The manufacturer, Circadiance, really tries to educate people about the proper fitting technique of their masks. They even include an instructional DVD with every Elan. While this is very helpful, we tend to think that the majority of people who buy the mask do make an effort to give it a chance; it just isn't for everyone.

The Elan is available as a Starter Kit (shown in the above photo), which contains small, medium, and large cushions; you can also choose between beige and blue colors in the Starter Kit. Circadiance includes a Feather Weight Tube with the kit, which attaches between the mask and CPAP tubing. This is to help reduce the tugging and drag from the heavier CPAP tubing which may result in leaks. The Feather Weight Tube (seen attached to the elbow in photo below) performs double duty as a quick disconnect point as well. Lastly, a Tether Strap is included to allow the user to secure the tube to the headgear.

  • Comfortable, less leaks, quiet, leaves less marks on face, requires less tension to seal, silicone-free, good for side sleepers
  • Leaks (most common complaint), poor seal at high pressure, tubing disconnects from mask easily, noisy

Score: 76.8%

Scoring a bit ahead of the Elan, the Pico nasal CPAP mask by Philips Respironics is one of the newest masks on the market. Introduced in March of 2015, it follows the design philosophy of "less is more".

It comes packaged with 3 cushion sizes: small/medium, large, and extra large. It is one of only four masks on our list that comes standard with multiple cushion sizes included, which is a great way to find the proper fit - but only if the mask is a keeper for you. This mask just seems to lack a killer feature, which doesn't mean it's a bad mask; it simply competes in a crowded field where there may be better choices.

Philips Respironics claims that the Pico is "the lightest and smallest traditional nasal mask on the market". We have no reason to doubt this claim, and have seen a moderate amount of success using this mask in our local office. It is not necessarily the top choice for the Respiratory Therapists in our office, but it definitely has a place for certain users. 

  • Comfortable, small size, lightweight, minimalist design, stays in place well, price is only $79 with coupon code
  • Leaks, skin irritation

Score: 79.0%

Introduced in the Spring of 2014, the AirFit N10 is the nasal mask entry in ResMed's "AirFit" trio (the others being the P10 nasal pillow mask and the F10 full face mask). 

This one surprised us a bit, as we have had good overall success using this mask in our local office. It has several unique features which are actually useful, and which help it stand out in the category. 

The most obvious of these features is the clear, unobstructed view the mask allows, due to no forehead riser to obscure the vision of the user. That feature may ironically be part of the explanation for the lower-than-expected score, as it appears to lead to less stability which subsequently causes this mask to leak more than some of the competition. 

The really awesome feature is the use of magnets (depicted in photo above) on the lower clasps of the headgear, which is a first in the industry and works extremely well. We did not log a single complaint related to the magnetic clips, and are hopeful that ResMed will implement this on other masks in the future. We would like to see other manufacturers do this as well, but ResMed has the patent and are unlikely to allow a competitor to copy this feature. The magnets facilitate easy removal and reattachment of the mask during the night.

The AirFit N10 is available in three sizes: Small, with pink and gray headgear (the "For Her" iteration), Standard, and Wide (Standard and Wide sizes are assigned the blue and gray color combination).

It also features the SoftEdge headgear, which is seen on the newer ResMed masks. More detail on this style of headgear is found later in this post, in the section about the Mirage FX mask.

A large number of reports of excessive leaks was the single most commonly cited problem, and is unforgivable when there is such a wide selection of other masks which do not suffer from this. It is a brilliant design overall, just not enough to overcome the flaws and lead to a better showing.

  • Fits well, no leaks, easy to adjust, quiet, good for side sleepers, great headgear design, magnetic clips
  • Noisy, leaks, not good for side sleepers, short tube is bothersome

Score: 80.1%

This is an update to the venerable ComfortGel CPAP mask, in which Respironics made tweaks and improvements to the legendary design which was the mask of choice for many users. Fans of the discontinued model may argue if these improvements actually improved anything, as bashing this newer version seems to be a very common trend among people who used the first generation mask. 

The tweaks which were made primarily related to reducing noise (via the micro exhalation ports), and improving comfort (by using a softer gel insert). See photo below of gel insert and silicone flap.
The cushion is a 2-part design, consisting of a blue gel insert and an outer silicone flap. This has been a successful design for Respironics over a period of many years. The mask is available in petite, small, medium, and large; it is also available as a DuoPack which contains 2 of the same size cushions for a premium of $15. There is another option as well, which is referred to as a FitPack. It contains one small cushion and one medium cushion, and also commands a $15 premium over the standard configuration. Confused yet?

The most commonly noted remarks in favor of this mask relate to its comfort (hence the name), good seal, and very simple attachment mechanism utilizing the ball and socket clips on the lower portion of the headgear straps. It is also relatively inexpensive, which may in part account for the massive sales volume we see with this mask. In our local office, the ComfortGel Blue outsells all other masks on this list combined.

Conversely, the most frequently cited complaints mention leaks, bulkiness, breakage of the frame where the ball clip connects to the frame, and general discomfort due to the need to overtighten it to avoid or eliminate leaks. The breakage issue has been successfully addressed with the newer versions, and we rarely encounter this problem.

Pretty much the same pros and cons we see with all CPAP masks. Some people have great success with the ComfortGel Blue, others loathe the redesign and long for the original iteration.

  • Inexpensive, seals well, easy to adjust, comfortable
  • Leaks, bulky, breaks easily, uncomfortable

Score: 86.2%

The Eson nasal CPAP mask by Fisher and Paykel Healthcare follows the "less is more" design philosophy of the Respironics Pico (although Fisher and Paykel brought this mask to market well before the Pico was introduced). 

It has a very small footprint on the face of the user, and uses the extremely effective "Q Cover" on the exhalation port to reduce or nearly eliminate noisy air emanating from the elbow exhaust. The Q Cover is essentially just a filter, made of the same material which F and P uses on their CPAP machines. The filter can be removed if the user wishes; it is not necessary to keep it in, and some complaints related to difficulty exhaling could possibly be related to the filter media causing a minor amount of back pressure.

There is also a unique ball and socket type joint at the point where the elbow meets the mask frame. This feature is more forgiving of the unavoidable movement we engage in while sleeping, while lessening the movement of the actual silicone seal on the user's nose. We have found this to be a fairly effective design, and it does seem to reduce the leaks associated with rolling over or moving during sleep.

The last unique feature to mention is also seen on the Pico: instead of a silicone "bumper" on the forehead, the riser uses the straps on the upper headgear to rest on the user's forehead. This is being seen more commonly on the latest masks, and is done for one of two reasons. Either to make it more comfortable for the user, or to save money in the manufacture of the product. Less parts equals less cost. Depending on how jaded you are, one of these is the answer. While less parts are generally a good thing, the inability to make minor forehead adjustments is not (in our opinion). These designs use a fixed forehead riser, so you lose the fine tuning possible with adjustable forehead assemblies.

  • Small footprint, quiet, lightweight, seals well, leaves no marks on face, comfortable
  • Difficulty exhaling (due to filter in Q Cover), leaks, noisy, clips disengage from lower headgear easily 

Score: 86.7%

The Zest Q by Fisher and Paykel (along with the Lady Zest Q) was a surprise to us. Even landing on the Top 10 List was a bit of a shock, much less grabbing the #5 position. 

However, this mask addresses one of the most common complaints: noise. Remember, the Q is for QUIET! It does succeed in this regard, as low noise level is the most commonly mentioned attribute of this mask. It is essentially a Zest mask, with a retrofit filter covering the exhalation ports on the elbow. Just as with the Eson, the elbow filter can be removed with no degradation in performance, aside from a noisier experience. The dimensions are also slightly smaller than its predecessor. Otherwise, it is a replica of the Zest.

When first shown this mask, we were amused by the fact that it was simply a Zest with a diffuser filter (depicted in photo above). Time has shown, however, that it is a quite popular and well received offering in its own right.

It has a dual cushion, like many of the legacy Fisher and Paykel masks: a soft foam inner cushion, covered with a silicone flap cushion.

  • Quiet, comfortable, seals well, minimal exhalation air flow  
  • A bit difficult to adjust, antiquated headgear, excessive condensation in cushion (likely due to the diffuser filter)

Score: 92.5%

One of the products which ushered in the new era in CPAP masks, we are pleased to see the Ultra Mirage II mask have such a strong showing. It serves as proof that just because a mask has a few years under its belt (OK, a lot of years), it can still be relevant.

The name itself can be confusing, as ResMed introduced such a plethora of masks with Mirage in the title. Ultra Mirage, Mirage Vista, Mirage Swift II, Mirage Activa, Mirage FX, Mirage SoftGel, Mirage Liberty, Mirage Micro; and who could forget the Mirage Tesla Z06 Shelby GT Ultra? (That last one is a joke, just making sure you're paying attention).

This mask was a pioneer in modern cushion design, utilizing a two-stage silicone seal: a very thin and soft outer layer covering a slightly more rigid inner layer for a stable fit. The quick-release clips are rarely seen on newer mask, but to many CPAP users the clips are the easiest approach to attaching and detaching the lower straps. 

Although it may appear bulky compared to newer offerings, much of that bulk is due to features that make it more comfortable. Take the rather wide forehead riser. It has multiple position adjustments (four to be precise) which is used to fine tune the fit of the mask. The forehead support arm can be tilted out to alleviate pressure on the bridge of the nose, or tilted in further to eliminate leaks around the top of the cushion. 

The biggest drawback to these older designs are the sheer number of parts involved. We count at least 12 separate parts just looking at the photo (swivel, elbow, elbow retaining clip, vent cover, headgear clips, frame, cushion, cushion clip, port caps, forehead support, forehead pad, headgear included but not shown in photo). Phew, that's a lot of parts! 

Compared to the new breed of mask which strive for only 3 individual parts (frame, cushion, and headgear), it can be a confusing mess to order replacement items if something breaks. On the other hand, it can also be nice to replace small, inexpensive parts as needed. See photo below for an exploded view of this mask.

There are four sizes available: Standard, Large, Shallow, and Shallow-Wide. Any size cushion will fit the frame, so if you order a size which is not a good fit, you can simply order a different size of cushion. 

  • Fits well, easy to adjust, solid history, comfortable, quiet, quick release clips, lightweight, headgear does not slip
  • Leaks, uncomfortable, noisy, headgear inelastic, pinches bridge of nose

Score: 93.2%

The newest mask in this review is the well-received DreamWear. A major departure from traditional design, Respironics has hit a home run with this offering. It melds the best features of a nasal pillow interface with a nasal mask. Some users simply cannot tolerate nasal pillows, but would enjoy the very minimalist style inherent in them. How about the best of both? 

In a rare instance of inserting our personal opinion, we feel that everyone who uses a nasal CPAP mask owes it to themselves to at least try this innovative product. It has very quickly become the top choice when making a recommendation to customers in our local office. Not to steal the thunder from the next three masks on the list, but we have found that a majority of people find this mask to be the most comfortable design currently available. 

So why then did it not have a stronger showing in this match-up? We have several theories, the most obvious of which relates to the short history it has compared to the higher rated masks. The scoring method we used was flawed, in that it favored masks which had already built up a loyal following. In defense of the scoring model, there is not a more realistic method to determine the "Best", unless we conducted a full scale randomized study using only CPAP virgins to provide feedback. Which is completely beyond the scope of anyone, aside from a university or a manufacturer (and does anyone actually trust a study which is funded by a manufacturer?).

Now that we have explained the (probable) reason behind the fourth place finish of the DreamWear, let's delve into the features and see why it is performing so well for us and many of our customers.

The DreamWear is available by default as a FitPack, which contains four sizes of cushion - small, medium, medium-wide, and large. The frame which ships with the FitPack is a size medium, but it is available in size small and large as well. Having the full range of cushion sizes included removes one of the main obstacles people face when choosing a new mask, namely which size is needed. Mask fitting templates are helpful, but are certainly less useful than being able try a variety of cushion sizes. Additional cushions may be purchased for $29.24 using the coupon code "cushion".

Another small, but very useful, feature is the small arrow on the left side of the cushion. This assures that the user does not try to place the cushion on the frame incorrectly. There is a corresponding arrow on the left side of the frame. We love easy! 

Below is a comparison photo of the various cushion sizes.

As noted, the standard FitPack configuration contains a size medium frame. This is not a traditional rigid polycarbonate frame; rather it is made of soft silicone, which is hollow. The design directs the airflow from the tubing inlet port (located at the top of frame) down each side of the frame. Although it is soft, and can be completely occluded if lying on one side, the flow of air will not be cut off due to the fact that both sides allow air to pass through. 

The size medium frame is not a perfect fit for all users, although it is the best option for about 75% of people. Respironics also offers the frame in a size small or large. We are seeing some users who need a small frame (primarily women), and a few folks need the size large. Frames can be purchased separately, priced at $22.50 using coupon code "cushion". 

See photo below for a comparison of the small, medium, and large frames.

Although the frame material is very soft, some users may experience the dreaded strap marks on their cheeks. To minimize this, fabric soft wraps are also included with the mask. These are not the thin fabric of some cheek pads; rather they are more heavily padded and actually offer some benefit. As with the other items, replacements may be purchased separately. Below is a photo of the soft wraps.

Another unique feature is the placement of the tubing attachment/swivel/exhalation port, as seen in the photo below. 

The elbow should sit at a position just forward of the crown of your head. It is a dual swivel design, much as you would find on traditional masks. The point at which the tubing attaches swivels, as does the juncture where the elbow fits into the silicone frame. We have not documented any complaints with this design, but some users do not care for over-the-head tubing. It generally does a good job of tubing management, helping to direct the tubing to a position where it interferes less with movement. There are exhalation ports built into the elbow, as well as a small exhalation port on the tip of the mask cushion.

All said, a very unique and welcome addition to our choices in a CPAP mask. Perhaps when we revisit the top masks in a few months it will have moved into a higher position. We feel it would be well-deserved, as this mask definitely checks all the right boxes in features we look for. The DreamWear should easily take a top three spot, if not outright contention for number one.


  • Seals well, comfortable, lightweight, no marks on face, good for side sleepers, manages tubing well, not confining
  • Noise from hollow frame, headgear may ride up, difficult to seal, position of elbow makes it top heavy

Score: 94.3%

Wisp with Silicone Frame
Wisp with Fabric Frame

By the narrowest of margins, the Wisp mask by Respironics edged out the DreamWear to take the Bronze in this shootout. 

This mask appears to be the best (and most popular) of the new generation of nasal CPAP masks which adhere to the less is more philosophy, at least as that designation applies to the cushion and line-of-sight. The headgear/frame is a different matter; it gives the appearance of being somewhat bulky, but in actual use it performs extremely well and is not cumbersome. The ability to adjust the upper straps at a more acute angle gives it a notable edge in performance over two other masks on this list which have no forehead riser - the ResMed AirFit N10 and the SleepWeaver Elan. 

The frame is available in either a silicone or a fabric material. Choosing between the two is a personal preference, as both versions receive virtually identical praise and derision. The fabric frame gets better marks for softness and comfort, yet may suffer from a higher rate of premature failure. The silicone frame gets higher marks for durability but may not be as comfortable for some users. So you get to choose either a more solidly constructed frame, or a more comfortable one. The frame is a bit steep at $30, but finding out which one is best for you certainly won't break the bank if you were to order both.

A feature that we love about this mask is one that is rarely mentioned by users, which is the fantastic implementation of the quick release. At the end of the short hose (where it connects to the elbow) are two tabs, which have several ridges for a tactile feel so you can easily find the correct spots to squeeze to release. This is a nice addition to several of the newer masks from Respironics. The ability to leave the mask on your face for a quick bathroom break in the middle of the night allows you to avoid fiddling with the straps to detach and reattach. It seems like a minor detail, but if you have ever engaged in a wrestling match with your mask when you're half asleep you can certainly appreciate a well-implemented quick release.

There are 3 cushion sizes (seen in photo above) included with the Wisp: Small/Medium, Large, and Extra Large. This packaging is referred to as a FitPack. A size petite is available separately. Upon initial release, Respironics included the Petite size, and did not include the XL size. Some websites still erroneously list it as including the petite cushion (but not the XL). This means that either these sites have not updated their product description, or are still sitting on old inventory. It's always nice to have multiple sizes when you first order a new mask, but it would be welcome if they also had the option of a DuoPack in which you get 2 of the same size cushion. Minor detail.

At the top of the headgear is a hose guide (a small elastic loop), which allows you to place the tubing over the crown of your head. Some side sleepers and/or restless sleepers prefer this, although most users don't seem to care either way. Regardless, it's one more feature that is nice to have if you like to run your tubing up and over.

The cushion receives generally high marks as well, with many users commenting on the leak-free fit. One note regarding the cushion fit: it is designed to sit lower on the nose than a typical nasal mask cushion. 

Most of the knocks relate to the durability, or lack thereof, of the frame. The fabric frame seems to suffer from reliability issues more than the silicone version. A number of users also reported ill-fit, discomfort, leaks, and the usual array of problems inherent in nearly all CPAP interfaces.

  • Comfortable, seals well, lightweight, quiet, good for side sleepers, good for restless sleepers, unobstructed view, multiple cushion sizes included, small footprint on nose, cost is only $84 if you know the coupon code
  • Frame not durable, leaks, difficult to fit, discomfort

Score: 94.7% (Bronze Medal Winner) 

Activa Mask depicted without Inlet Tube

Another surprise (to us at least) was the Activa mask even landing on the Top 10 list at all, much less taking the Silver Medal.

Originally introduced many years ago, the Activa was revolutionary due to the much-hyped ActiveCell Technology, as ResMed refers to the cushion feature. The rest of this mask is very standard fare; it is definitely the cushion which is the killer feature here. It's also the cushion which allows the mask to remain relevant after so many years. 

Not to be confused with the Activa LT, which was introduced several years later, the original Activa outscored masks which are newer, lighter, and smaller. Looking at the Activa in person is a revelation. The most often mentioned comment relates to the size of this beast. We can't argue with that. When you hold it side-by-side with a newer mask, the appearance of the Activa may make you think that it ate too much silicone. This cushion is huge, but that is where the magic comes into play. 

The best analogy is to that of an accordion, or a bellows. The business side of the seal stays put on your nose, while allowing the remainder of the mask to wiggle and twist freely. Before the advent of the new wave of masks, this was the gold standard for side sleepers and restless sleepers. It also requires very little tension to secure a solid, leak-free seal. 

Speaking of the secure seal, too often with this mask we see people applying far more headgear tension than necessary. With the design of the cushion, you are doing yourself a disservice if you torque it down to the point that you lose the "float". The cushion is engineered to be worn much looser than you might expect, so don't nullify the best feature by burying the accordion through over-tightening. One other point regarding the cushion: keep it clean. This is true of all masks, but daily washing is rewarded even more handsomely with the Activa.

Our only caveat with this mask, aside from the bulk factor, is its tendency to ride back and forth during inspiration and exhalation. This phenomenon is a bit difficult to convey with words. Picture the mask performing push-ups on your face; that is probably the best way to describe it. If you are on a BiLevel machine, this can be quite pronounced, especially if there is a significant difference in your inspiratory and expiratory pressure. It can also be experienced if you have C-Flex or EPR at a high setting on a CPAP machine. You may get the sensation of the mask dancing on your face as the ActiveCell expands and contracts with your breathing.

Looking at the frame, headgear, and elbow, we can refer back to the comments about the sheer number of parts on the Ultra Mirage II. The Activa also consists of at least 10 separate pieces, as depicted in the exploded view above, which virtually mirror those of its fourth-place brethren mask. In addition, it also has a 7" Inlet Tube which connects to the mask elbow at one end and your machine tubing on the other. That's a whole lotta mask.

Is it relatively large and bulky? Yes.
Is it prone to certain parts breaking? Yes.
Is it an aging design? Yes.
Is it still one of the best masks ever made? Absolutely YES!

The basic design of the mask is much the same as several other ResMed masks. It consists of the 4-point headgear which is standard among many of their offerings, the forehead riser and pad which is adjustable to four positions, and the extruded polycarb frame. Very functional, perhaps pedestrian.

Yet for a tremendous amount of CPAP users, this function over form is preferable to a smaller, lighter, prettier mask. We could not agree more. The Mirage Activa is probably the Ugly Duckling of this list, but when it performs so well who cares about looks?

  • Seals exceptionally well, comfortable, no marks, quiet, great for restless sleepers, can be worn much looser than other masks, good for side sleepers, works well for people with facial hair
  • Bulky, heavy, noisy, movement of mask bellow during inspiratory/expiratory cycle

Score: 96.3% (Silver Medal Winner)

ResMed should be very pleased with the strong showing of their products in this list. With a record 4 out of 10, including 2 in the top 3, the Australian manufacturer proves they are still the leader in the field of sleep medicine and especially interfaces. Most Respiratory Therapists we speak with acknowledge that ResMed masks are an excellent choice for many CPAP users.

So how close to perfection did they come with the Mirage FX? Well, if our grades in college were as good as the final score of this mask, we would all be doctors. It very nearly achieved a perfect score (which is actually not even possible when scoring products that inherently must include subjective factors). 

Regarding this marvelous little mask from Down Under, it falls into the subcategory we have already touched on previously in this list: less is more. 

Less weight.
Less parts.
Less bulk.

This mask hits the mark on so many points that we struggled to find nits to pick.

ResMed has made an effort to minimize the number of parts on their newest lines of masks, and the Mirage FX has only four: cushion, frame, elbow, and headgear. Oddly enough, you cannot purchase just the elbow itself (nor can we). 

Let's run through the high points of this mask, and help you decide if it's the one to rule them all.

Comfort, along with minimal leak, is far and away the most important asset of any CPAP mask. The Mirage FX is a knockout on both. The cushion is a sweet little sculpted design, contoured in just the right places to achieve a reliable seal without causing undue soreness or pressure points on the nose or surrounding tissue of the user. The soft outer portion (where silicone meets flesh) integrates into the slightly firmer body of the cushion, with a deeply contoured and softer section for the bridge of your nose.  It does not use any tricks such as a gel insert or a bellow, and it does not need to. Like most products that work well, it just simply works. The cushion is easily removable for cleaning, foregoing separate clips or clasps to secure it in the frame.

As for the frame, it appears at first glance to be a spindly little affair. Upon closer inspection, you realize that it too is a no-nonsense piece of hardware designed to do a job and do it well. Some users may lament the lack of headgear quick release clips on the frame, but once you get accustomed to the structure of the integrated headgear clasp it likely will not be a sticking point. While it appears to be weak and prone to breaking, we have not documented one single case of a broken frame or snapped forehead riser.

Take a close look at the frame in the photo below, which we enlarged to more easily visualize the simplicity and beauty of the design:

Note the difference in color of the upper portion of the bottom headgear clasp. It has a more rigid (seen as clear polycarb) lower section, which melds into a flexible (seen as more opaque) upper headgear clasp. The sharply angled upper portion is not only flexible, it does a great job of holding the headgear in place without being excessively complicated. Engineering simplicity is often overlooked, but when done correctly it should not draw attention to itself, it should just work.

Also note the gray colored button on the elbow with "FX" inscribed. There is an identical button on the opposite side, each of which have a bit of a grippy tactile feel to them to allow a quick release of the mask from the tubing. For a quick potty break in the middle of the night, simply squeeze these to disconnect (leaving the elbow in the end of your CPAP tubing) and click back into place after you've finished your business. We are big fans of a well-implemented quick release. Again, it's the small things that add up to greatness.

The exhalation ports are well-diffused. As you can see in the photo above, there is an array of small holes running around the entire circumference of the elbow. There are 11 sections, each containing 4 exhaust holes. This results in a very even dispersion of the air; instead of a tightly focused exhalation port design, you are pretty much guaranteed that no more than a few of the holes will be pointed directly at your pillow (or sleeping partner) at any given time. Quiet operation is one of the most mentioned features.

Last point regarding the frame: as with the Pico and the Eson, there are no separate forehead pads. The upper headgear straps become the contact point on your forehead. This is another area in which the Mirage FX outshines the competition. Go back and compare the forehead arm of the Eson and Pico to this mask. Notice that they are clear, solid polycarbonate. In contrast, the Mirage FX implements one last brilliant distinction. Note the opaque portion of this forehead assembly, which sits between the actual riser and the slots for the headgear. ResMed refers to this as a flex-wing (or butterfly wing) forehead support, meaning it lies flatter if you apply more tension to the upper straps or opens out wider with less tension. Sounds great on paper, works very well in actual use.

Let's briefly touch on the headgear (depicted above is the For Her version). Many manufacturers have moved away from the old design of a straight cut on the edges of their headgear. ResMed uses "SoftEdge" as the name for their design. The edges are contoured, purportedly for comfort. This is nice, but most users don't seem to notice enough of a difference to comment. These newer designs also have less elasticity than previous headgear, as the masks do not require as much tension to achieve a seal.

The Mirage FX is available in the following sizes: Standard or Wide for the regular (or men's) version with blue and gray headgear; Standard or Small for the Mirage FX For Her with pink and gray headgear. The pink and gray headgear which comes with the "For Her" version is a size small, the blue and gray version is a standard size.

Here is a side-by-side comparison of the standard Mirage FX and the Mirage FX Small:
 Standard on right, Small on left

To summarize, the Mirage FX is the current King (and Queen) of the mountain; it received positive feedback from such a majority of users that it nearly achieved a consensus. The Mirage FX is as close to perfection as any currently available CPAP mask.

We are pleased to bestow the title of "Best Nasal CPAP Mask of 2015" to the Mirage FX and the Mirage FX For Her.

  • Comfortable, seals well, quiet, lightweight, easy to adjust, does not leave marks, easy to clean, simple to assemble, diffuses exhalation evenly
  • Leaks, causes soreness on bridge of nose

Score: 98.7% (Gold Medal Winner)

Check back for the comparison of the best full face CPAP masks, coming soon!

Feel free to add your own comments and personal experiences in the comments.