Which Full Face Mask with out the forehead piece is the best?

         A rather late but needed innovation in the treatment of sleep apnea was the development of the full face mask that does not include the traditional forehead stabilizing piece. Full face masks (or FFM's) are for those who are unable (or unwilling) to breathe through their mouth at night while on CPAP. Until very recently they all have had a stabilizing piece that extended from the top of the mask and rests on the forehead. Although the newer FFM's that do not include the forehead piece can only treat patients who are prescribed a pressure of no higher than 12cm of pressure (upwards of 12cm cause the masks to leak around the eyes in some cases), they are very popular for their lack of a forehead piece. This is because the mask can barley be seen when the patient is wearing it. As opposed to mask that use the traditional fore head piece, these masks allow the patient to watch TV or read at night before going to bed without obstruction. This is very helpful since one of the main problems in sleep medicine is adapting the patient to CPAP usage. But these patients can now relax and get used to breathing on CPAP without a constant visual reminder in their eyes. These type of masks are very popular amongst women and also with those who suffer from claustrophobia. In short, they have their place in sleep medicine.

          But which one is the best? I'm not sure which came out first between the EVO comfort fit (featured in the upper left) or the Respironics Full Life (featured on bottom). But the Evo was the first which actually gained attention in the sleep community. The Full Life originally had headgear which did not really work that well. The Evo has enjoyed a significant presence in the pacific north west. It is very popular with providers of sleep medical equipment due to its low cost ($45 compared to the average FFM cost of $85). Although it does not last as long as other masks, most patients insurance's pay for two replacement cushions (the piece which touches your face) per month for masks, so this is not necessarily a problem. Although other masks can last longer they still will develop holes in their mask cushions, especially when not cleaned extensively. But many patients do not want to take the time to clean their masks all the time when they could rather pay a small co-pay (around $10 -$20) and cut down on the cleaning. The one true problem with the Evo is its headgear. It honestly does not strap on conveniently and also does not fit on the patients head. It slides around and does not fit well which leads to leaks and patient annoyance in some cases.
          Although they claim they were developing it before the emergence of the Evo's popularity I believe that the ResMed Quattro FX (featured in the upper the left) was likely made in response to the Evo. The mask is likely superior in patient care. Although the Evo has its place and fit some patients very well the Quattro FX has very good headgear and also appears to be of a higher quality. The only problem is that like all ResMed masks it costs more than double what the Evo does for providers. ResMed refuses to give providers good pricing on these mask until providers buy their machines which due to multiple factors are not as high quality as other manufacturers. But their machines are still widely used. Due to a new marketing strategy by ResMed, providers who now purchase their machines receive their masks for free. This has resulted in ResMed regaining some of their territory they lost to the Evo.

          Then there is the Respironics Full Life (featured on bottom) which has been around a while but has not been very popular. Like the Quattro FX the Respironics mask does look a little classier. The problem with it was that the mask's headgear has historically not functioned very well. But the mask has recently started coming with a new headgear which has made it much more functional. My clinical experience with this mask is limited and I will update you more once I hear about it/use it more.

          If I were a patient I would either use the ResMed FX or the Evo. The Evo is quieter most of the time. But the ResMed FX is durable, is not flimsy, and it is classy looking. If I were a provider though I would carry the ResMed Quattro FX but only use it when ever the Evo did not work. The Evo fits well, patients get new cushions twice a month for a pretty small expense, its quieter and the mask is simple to use and clean. While the headgear is somewhat difficult to use a simple adjustment during the night is all that is needed to slide the headgear into place. Patients can and will adapt. Plus a little troubleshooting hear and there for patients can help build their knowledge about using CPAP. It also make is easier for providers to make a profit while still providing quality care to patients. Many many patients get uninhibited care without complaint using the Evo. The mask provides a good balance between patient care and profitability.

(But in the interest of full disclosure I must admit I need to try using the Respironics Full Life more as I have only used it on a few patients. I'll let you know how it goes. )

-Sleep guy