Some DMEs and manufacturers will accept returns or exchanges of gently used interfaces.

Like most products, CPAP masks can be returned if they are defective in some way. But many durable medical equipment providers (DMEs) and manufacturers will also accept returned masks that simply didn’t work for a patient.

These policies vary. Some DMEs will take all masks back for a refund or exchange; some will only accept returns of specific masks; others require that patients purchase “mask assurance” or “return insurance” if they want the option to be refunded for a used mask. Fisher & Paykel offers the SureFit 30 Day Mask Guarantee Program and ResMed offers a similar guarantee program to DMEs that complete a mask fitting training program.

Sleep technicians should know what the DMEs they work with offer, says Tracy Kopp, RPSGT, CCSH, a sleep educator at United Hospital System in Wisconsin. “Work together with them to get the best mask for that patient. Ask them what masks they initially use on their patients. Become educated not just on the diagnostic end, but also the treatment and ongoing follow up with that patient,” she told Sleep Review in an email.

Kopp notes that negotiating masks might be especially tricky for patients who have less contact with a sleep lab, like those who are diagnosed by home sleep tests and use auto-titrating machines.

“I have all our DMEs link our lab with our patients upon set up. I check their download within the first week of therapy. If I observe a leak or adherence issue, I make contact with that patient. If it’s anything to do with the mask type, that is when I inform them about the return policy.”

Returned masks are not resold, so companies—whether the manufacturer or the DME—have to absorb that cost. Perhaps that’s why so many offer free tutorials, guides, and other services that walk patients through the process of choosing a mask. It’s also why many are now selling “fit packs” along with masks, says Kevin Fisher, manager of North Coast Home Care in Oregon.

“Most of the new advents in mask design have centered around that flexibility,” he told Sleep Review in a phone interview. Providing different size cushions for the same mask frame makes it less likely that a patient will want to return the mask for poor fit, he says.

North Coast Home Care also operates a website called CPAP Guaranteed, which boasts an unusually flexible return policy. But Fisher says few customers take advantage of that policy, in part because of the fit packs, but also because the company has learned which masks to stock and which to avoid.

“If we don’t have good results we don’t carry them for that long,” he says. Fisher notes that the company is considering taking the website down since demand for out-of-pocket equipment—the site is geared towards the uninsured— has dropped following the passage of the Affordable Care Act.

Both clinicians and patients know that finding the right mask can be one of the biggest hurdles for new CPAP users. The option to try out a few different types can play an important role in a patient’s success, Kopp says.

“Put yourself in the patients’ shoes for a moment,” she says. “They may have just come from their doctor’s office after being diagnosed with a chronic condition. Now they go to the DME and have to learn how to operate a new appliance they may have never seen before. Now that patient needs to decide what mask they will be wearing for the next 6 months. The atmosphere at the DME is nothing like their bedroom and sleeping conditions. That decision can be overwhelming for an otherwise healthy patient, even harder for someone who may have comorbidities or mental health issues. Once they start sleeping with their CPAP on at home, that’s when the pitfalls over mask choice becomes apparent. Being able to switch out masks in the first month can really help with adherence and troubleshooting.”

 Rose Rimler is associate editor of Sleep Review.