CPAP masks for side sleepers: nasal pillows, nasal or full face?

Who this is for, and who it isn’t

This page is for adults already using CPAP Strong, or about to start, who sleep on their side. Side sleepers often have the same complaint: the pillow pushes the mask, the seal breaks, and air leaks.

It isn’t for you if:

• You haven’t been diagnosed. CPAP starts with a physician and a sleep test. See home sleep apnea test.
• Your mask hurts or leaves sores. That usually means the wrong size or type. Talk to your sleep center or equipment supplier first.
• It’s for a child. A child with breathing problems in sleep needs their pediatrician.

Masks need a prescription; pillows don’t

CPAP machines and masks are prescription medical equipment. Medicare, for example, covers CPAP devices and accessories when your provider prescribes them for home use.

Pillows, strap covers, filters, tubing and cleaners don’t need a prescription. That’s why the pick on this page is a pillow, not a mask.

How we’re testing

CPAP pillow testing is planned. We haven’t tested any pillow yet, so there are no results. For each pillow, we plan to record:

• Height: measured at each setting, not taken from the box.
• Fit with each mask type: how nasal pillows, a nasal mask and a full face mask sit in the cutouts.
• Hose control: whether the tube tugs the mask when the sleeper rolls over.
• Leaks over 7 nights: the leak data the CPAP machine reports, compared with the sleeper’s usual pillow.
• Comfort: neck and shoulder notes each morning.

We won’t test masks, because they need a prescription and a fitting. The notes below come from the AASM, published research and what makers state. See how we test.

The options

The AASM describes three common mask types. Whatever you use, it says the mask must fit well and seal, or air leaks and the pressure drops.

Nasal pillows

Soft silicone tips sit just inside your nostrils, held by light headgear. There’s very little on your cheeks, so a pillow has less to push against.

The AASM says nasal pillows may help if you have leaks or dislike a mask over your face. A 2022 network meta-analysis of 29 studies found nasal pillows needed the lowest pressure of the three types.

Suits: side sleepers who breathe through the nose and want the smallest mask. Skip if: your nostrils get sore, or you breathe through your mouth.

Nasal masks

A nasal mask covers your nose only. The AASM calls it the most common type. Some sit under the nose rather than over the bridge, which leaves even less to catch on a pillow.

In the same meta-analysis, nasal masks had the lowest leftover AHI and the best nightly use.

Suits: most side sleepers who breathe through the nose. Skip if: your mouth falls open and air escapes, or your nose is often blocked.

Full face masks

A full face (oronasal) mask covers your nose and mouth, or sits under the nose and covers the mouth. The AASM says it may help if you have air leaks with a nasal mask.

It’s larger, so a side pillow is more likely to press on it. Two meta-analyses found full face masks needed higher pressure and were used less each night than nasal masks. The 2018 analysis put the gap at about 1.5 cm H2O and 48 minutes a night.

Suits: mouth breathers, people with frequent nasal congestion. Skip if: a nasal mask or nasal pillows already work for you. Don’t switch without your care team.

CPAP pillows

A CPAP pillow has cutouts at the sides where the mask rests, so your face can turn without pushing the seal. Some also have a clip or tether for the hose.

The AASM suggests trying a pillow shaped for a mask and tubing. The evidence is thin. One small study of 22 people found no change in leaks, pressure or nightly use with a cutout pillow. People did prefer a gel cutout pillow over their own pillow.

That makes a CPAP pillow a comfort item, not a fix for a poorly fitted mask. See the pick box on this page.

Side effects and fit

Most CPAP problems come from the mask. The AASM lists what goes wrong:

• Too big: you have to tighten the straps, which can rub and cause sores. Soft strap covers can help.
• Too small: it won’t seal, and air leaks out the edges, sometimes into your eyes.
• Dry nose, mouth or throat: a heated humidifier on the machine can help. A saline spray can ease mild congestion.

For side sleepers:

1. Check the fit lying on your side, the way you actually sleep, not only sitting up.
2. Tighten only enough to seal. The AASM notes that straps pulled tight can rub and cause sores.
3. Route the hose so it has slack when you turn. The AASM notes the tubing is long enough to let you move and roll over.
4. Check your machine’s leak data in its app or on its screen, and share it with your care team.

If you’ve tried these and still leak, ask about a different size or type. You may need a new prescription or fitting.

How to choose

Start with how you breathe at night, then how you sleep.

1. You breathe through your nose and sleep on your side: ask about nasal pillows or a small nasal mask.
2. Your mouth falls open, or your nose is often blocked: a full face mask may be needed. A CPAP pillow can give it room.
3. Your mask works but shifts when you turn: try a CPAP pillow and better hose routing before changing masks.
4. You’re choosing a new mask: your supplier fills the prescription. Online sellers such as CPAP.com also sell masks. You’ll need your prescription either way.

Whatever you choose, give it time. The AASM suggests wearing the mask while awake, reading or watching TV, so it feels normal by bedtime. If CPAP still isn’t working, see CPAP alternatives.