Rochelle Collins, DO, is board-certified in family medicine. She is an assistant clinical professor of family medicine at Quinnipiac University and works in private practice in Hartford, Connecticut.

If you use a continuous positive airway pressure (CPAP) machine to treat your sleep apnea, you are undoubtedly familiar with the pros and cons of your CPAP mask. Depending on your mask style, you may notice that it leaves ugly red marks and lines or creases on your face in the morning.

Luckily, there are things you can do to avoid these problems by selecting the right mask style, optimizing the fit, and exploring simple fixes to pad the mask edges.

The most important initial choice in starting CPAP therapy is the selection of your CPAP mask. In general, it will be one of four styles:

The amount of contact between your face and the mask will determine how likely it is to leave marks. The simple rule is that the smaller the surface area pressing onto your skin, the less likely you will be to have morning creases.

If you are prone to skin creases (particularly if you are older and have less collagen in your skin), opt for a smaller mask. If you simply want to reduce creases on the center of your face, choose a total-face mask if your healthcare provider says it's PK.

Once you have selected the best size, you will want to ensure that it is sized properly. Remember that the tighter the mask, the more impressions it will leave on your face. Not that this is always possible. Higher pressures often require a tighter mask, which usually means more lines, creases, and marks.

While bilevel therapy may help (by regulating inhalations and exhalations reducing the overall air pressure), the better solution is to find a mask that fits snugly without shifting or gaps.

The primary aim is to ensure the mask fits correctly so that there is no air leakage; this improves the overall quality of the CPAP therapy. Less leakage also means a better fit, so you won’t have to tighten the mask nearly as much.

Many masks have padding or covers for the straps. These should be used if you notice marks on your face in the morning. If you need a little extra padding between the mask and your face, you may have a few additional options.

REMZzz liners are a soft fabric lining that can reduce allergic reactions to the plastic and minimize marks. Silent Night liners are another popular option. PAD A CHEEK manufactures a wide array of liners, strap pads, and anti-leak mask stabilizers.

Some are disposable while others are durable and even washable. Some online options can even be tailored to fit the style and size of your mask.

If the problem occurs at the nasal bridge, consider products like Gecko nasal pads or LiquiCel nasal cushions. Each of these works best with masks rather than nasal pillows.

Barrier creams or lotions, such as RoEzIt, may also reduce marks caused by allergic reactions or rashes. If an allergy persists despite the use of a liner or barrier cream, it may be necessary to change to a different mask or mask type.

If lines persist, it may help to sleep on your back. To keep your position, you may need to bolster yourself with cushions to prevent rolling over. Sleeping on your back will reduce the pressure against the mask.

If you find it impossible to sleep on your back, ask your healthcare provider about a CPAP pillow which has a special cutout to reduce direct pressure on the mask. If all else fails, give yourself a little time in the morning to recover. Within the first hour or two, the marks should fade away.

If problems persist, speak with your sleep specialist about other CPAP mask options. This is especially true if you develop sores or ulcers, are prone to bruising or easy bleeding, or develop scarring, roughness, or discoloration at a contact point.

Finding a mask that fits is the most important initial step when using CPAP therapy. It can make the difference between adhering to treatment or quickly losing interest. Reach out to get the help that you need, either from your sleep healthcare provider or your medical equipment provider. Time spent on a mask fitting quickly pays dividends.

Once you find a mask that you like, keep using it. The improved comfort will translate into increased use and benefits from CPAP therapy.

Tossing and turning night over night can have a big impact on your quality of life. Our free guide can help you get the rest you need. Sign up for our newsletter and get it free.

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American Sleep Apnea Association. Mask types.

Alqahtani JS, AlAhmari MD. Evidence based synthesis for prevention of noninvasive ventilation related facial pressure ulcers. Saudi Med J. 2018;39(5):443–452. doi:10.15537/smj.2018.5.22058

Rowland S, Aiyappan V, Hennessy C, et al. Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med. 2018;14(1):101–108. doi:10.5664/jcsm.6892

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