HME Business Handbook: Sleep Therapy

How to Fast Track Getting the Right Mask and Fit For Patients

How can sleep therapy providers implement the sorts of procedures that will foster the right mask selection and fit?

Sleep therapy is a double-edged sword. Obstructive sleep apnea is a serious health condition for which patients must receive therapy, but it is exceedingly difficult to keep patients engaged and compliant with their therapy.

A study published by the NIH in 2016 found that, despite increased awareness of OSA and positive airway pressure therapy over the previous 20 years, “No clinically significant improvement in CPAP adherence was seen even in recent years despite efforts toward behavioral intervention and patient coaching.” In terms of compliance rates, the study reported that “adherence to CPAP continues to be a problem frequently encountered in clinician’s offices, with adherence rates generally ranging from 30 to 60 percent.” It added that between 2000 and 2015, ongoing adherence rates ranged from just 30 to 40 percent.

Ask any sleep therapy provider why those rates are so low, and they will tell you that much of it stems from mask fit. Having the right mask and ensuring it is properly fitted remains a crucial determinant in ongoing therapy compliance. That makes sense given that we’re talking about strapping a mask to a patients face, blowing pressure into their airway, and telling them it will aid their sleep. The scenario doesn’t exactly scream “sweet dreams.”

So knowing all that, how can a provider implement the sorts of procedures that will foster the right mask selection and fit?


No two sleep patients are the same. Providers need to spend some solid face time meeting with patients and talking to them about their sleep. Each patient has his or her unique sleep habits, so it’s important for our clinicians to query patients to better those habits. Their answers will start to paint a picture of their sleep patterns and how they breathe while asleep. This will help staff understand your patients’ sleep and their body and that will start to shed light on the types of masks they need and how to fit them most appropriately.

Not only will this ensure the right mask selection and fit, but it creates a better sense of engagement between the provider and the patient. Also it will help foster better therapy compliance, and hopefully cement a much longer-lasting patient relationship.


As mentioned, creating a sense of engagement is critical. The best way to start creating that sense of engagement is at the referral. Sleep providers want patients to be well educated about their condition, their therapy, and the equipment that will provide that therapy before patients meet with them.

So, providers should strive to help their physician, healthcare system and sleep lab partners by giving them as much education as possible on sleep therapy devices, masks, resupply and related products as possible. If the patient walks in not knowing much about obstructive sleep apnea, what their test results are, or how it hurts them, or what PAP therapy is, or how a CPAP works, or the different types of masks available, then the provider has a long way to go in determining the right equipment for a patient.

Bearing that in mind, it is essential that providers do whatever they can to facilitate their referral partners in educating their patients. And sometimes that starts with explaining to referral partners why this education needs to start with them. There is a tendency among some referrals to simply refer the patient to the provider and be done with it, so the provider must explain to referrals how they can help reinforce compliance with those up-front discussions.

Once those referrals are on board with that, providers must give those partners tools that can help them educate the patients. Brochures, PDFs and other electronic and print assets can go a long way toward keeping patients informed and engaged. This way, when those patients arrive at the provider’s office, they are ready to have a discussion about their sleep therapy objectives and sleep habits and condition, and start working toward a mask and fit that fits their objectives and habits.


Assuming that the patient has been properly on-boarded by both the referral partner and the sleep equipment provider, and they are fully engaged and ready to start taking ownership over their therapy, the provider can now start to zero in on the right mask format and fit.

This is where the conversation between the provider’s clinician and the patient really comes to fruition. In learning about how patients sleep and how they breathe during their sleep the clinical staff can start to arrive at the right mask. Someone who likes to read before going to bed is probably not going to succeed with a full-face mask, but a patient that needs higher pressure therapy probably won’t succeed with just nasal pillows. This is where the value of the up-front conversation becomes clear.

In addition to sleep condition and habits, clinical staff must also understand patients’ facial characteristics and lifestyle to start to zero in on the right mask format. Once they have the right format, they need to start looking at how to adjust and position the mask so that they optimize comfort. Again, open discussion and feedback are central to the process.


Once the patient has been outfitted with a mask that both the clinician and the patient feel is going to make for good compliance, the job is far from done. As any good sleep therapy provider knows, this is an ongoing process. With all the remote patient monitoring and data being collected on the patient, the provider and the referral have a wealth of information to see how the patient is progressing with his or her therapy.

Not every patient will be a success story right from the start. Yes, there are some patients that will go home with their mask and device, self-manage their condition, and do fantastically. But others will need help. When clinical staff see that a new patient is struggling with therapy, they need to re-engage them and see what is happening.

Once again, they need to start asking open-ended questions about how they are sleeping as well as how the equipment and the mask are performing. For instance, a seemingly innocuous question about how a patient’s therapy is impacting his or her partner’s sleep could yield some solid insight into poor mask fit, if the patient replies that his or her partner can’t sleep in the same room because the mask is making noise.

Here staff can work to fine-tune the mask fit to ensure and offer coaching that will help keep that patient engaged and seeing positive results from his or her therapy.


  • While awareness and diagnosis of obstructive sleep apnea, as well as knowledge of how PAP therapy can help continues to increase in the consumer mindset, therapy compliance remains low.
  • Mask fit plays a central role in ensuring that patients continue to adhere to therapy.
  • Providers need to put into place policies and practices that can help ensure the patient gets the right mask and fit from the outset.
  • That starts by having a conversation with sleep patients and learning about their habits and condition.
  • It also involves educating referrals so that they help get patients on-boarded with their therapy.
  • Follow-up is crucial. Providers need to identify patients that are having problems and help them immediately.


Sleep is a hot topic regularly covered in the Sleep Therapy Solutions Center.

HME Business Podcast