As a health care worker, not only have I experienced the effects of prolonged mask
wearing, I’ve heard the same echoed from family, friends and colleagues. I’m sure if you
haven’t directly experienced any of these symptoms, in all likelihood you may have
heard other people describe them as well. There is conflicting information on whether
or not prolonged wearing of face masks can cause physiological changes in a person’s
medical condition, but there is ample anecdotal reporting from people experiencing a
variety of symptoms after prolonged mask wearing. These include headaches, dizziness,
shortness of breath, blurred vision and fogged glasses.
A 2012 article by Brian V Shenal, et al.[1] in the Journal of Occupational Hygiene found
that with continual use of an N95 mask over an 8 hour period the magnitude of
discomfort did appear to increase significantly over time. It also went on to say that
discomfort may also interfere with a worker’s ability to complete their occupational duties.
According to the Food and Drug Administration, there are 2 major forms of masks, N 95
also known as respirators, and disposable surgical masks. Both were tested for fluid
resistance and their ability to efficiently filtrate the air.
They concluded that N95 masks, because they are more tightly fitted, may be more likely
to inhibit breathing if worn for extended periods of time. Conversely, they indicated that
because surgical and other types of cloth masks fit more loosely, the wearer would be
less likely to experience a significant depletion in oxygen intake. Additionally, they
determined that because these masks are porous, they allow more normal in and out air flow which is consistent with normal respiratory functioning. However, this is counter to my personal experience as well as the anecdotal reports I’ve heard from friends, families and colleagues after extended cloth or surgical mask wearing.
The U.S. National Library of Medicine listed a study which examined “The Physiological
Impact of N95 Masks on Medical Staff” and reported the results on their site, Clinical
Trials.gov. It was determined that wearers of N95 masks for extended periods of times
commonly experienced dizziness, headache, and shortness of breath. They concluded it may also reduce working efficiency and impacted a person’s ability to make correct decisions.
Let’s explore the range of difficulties many people may be experiencing after prolonged face mask wearing.
Breathing Difficulty
Wearing a mask has resulted in reports of difficulty breathing. We naturally emit carbon
dioxide when we exhale. Therefore, when wearing a mask, we are breathing in a small
portion of the exhaled carbon dioxide. This creates an environment in the lungs which
may mimic the symptoms experienced by people with COPD, Chronic Obstructive Pulmonary Disease. These persons experience shortness of breath because the disease process in their lungs prevents them from adequately expelling the carbon dioxide that is a natural bi-product of our breathing. Thus, the carbon dioxide builds up and is trapped in the lungs which results in a feeling of breathlessness. Persons with extended mask wearing have described a similar shortness of breath as well as lightheadedness, occasional dizziness and fatigue.
In trying to achieve a snug fit to avoid releasing droplets into the air, or exposing yourself to droplets, the mask may be too tight which gives the wearer less room to breathe. Therefore, It is recommended that persons with COPD and/or other respiratory conditions such as asthma, refrain from extended mask wearing.
Dangers for Persons Positive for the Virus
Droplets trapped inside the mask from a person infected with virus may be reintroduced into the lungs when they inhale. For those who may be positive but do not know it, this may place them at greater risk for increased severity of the virus.
Visual Difficulties
People have reported to me that they are experiencing blurry vision after extended mask wearing. It’s possible that, especially for more loosely exhaled air may be directed upward into your eyes. This may not only cause blurry vision but may also result in a person being more inclined to touch their eyes, thereby exposing them to infection. It may also be that the lightheadedness experienced after prolonged face mask wearing may affect one’s vision.
Glass Fog
Anyone who wears glasses has probably experienced their glasses becoming fogged when wearing a mask. When not wearing a mask, our warm exhaled air is released into the atmosphere. However, when you are exhaling warm air into a mask, no matter how tight the seal, small amounts
may be redirected upwards onto your glasses and they can become fogged.
AARP has suggested this possible solution: wash the glasses in warm soapy water and allow to air dry. The thin film residue may coat the glasses sufficiently to prevent fogging. You may also want to check the seal of the mask around your face. However, as mentioned previously, too tight and it restricts breathing. If you must tighten the top of the mask to prevent the warm air from directing upward onto your glasses, instead loosen the bottom of the mask instead.
Inadvertent Side effects
Because it is more difficult to hear people talking when they are wearing a mask, there may be a tendency for people to move closer to each other in order to hear what a person is saying. Clearly, that would be counterintuitive to the idea of social distancing.
Masks can also create a false sense of security and therefore; people may think that the practice of 6 feet as an appropriate social distance is not necessary.
Other Pitfalls
Re-wearing masks without proper cleaning, can spread germs. This would be counterintuitive to the reason we are wearing them in the first place. If wearing a cloth mask, wash daily and allow to dry before reusing. If absolutely necessary, medical masks may be sprayed with appropriate and recommended grade disinfectant.
Remember to remove face masks carefully. Avoid touching your eyes, nose and mouth when removing and wash hands immediately.
Dry Skin
One of the least problematic of extended mask wearing, and possibly the easiest to remedy is the issue of dry skin. If your skin is sensitive, try applying moisturizer before applying the mask to avoid chafing and dryness.
What steps can you take to mitigate the symptoms of shortness of breath, dizziness or fatigue when wearing a mask during extended period of time? Consider the self-care techniques associated with "IMpathy" (TM).
Here are some suggestions: Get to a place where you can remove the mask for brief periods whenever you feel the need. This may vary from person to person. Take 3 to 5 slow deep breaths to re-oxygenate your body. Using either of these techniques should should help you feel a renewed sense of energy as well as an increased feeling of calm.
1. One helpful technique is Andrew Weil's 4-7-8 breathing technique. Breathe in for a count of 4. Hold you breath for a count of 7 and exhale for a count of 8. Do this several times.
2. Another suggestion is alternate nostril breathing. Press your forefinger against the side of one nostril to close it off. Breathe in deeply. Then switch the forefinger to close off the opposite nostril and exhale. While keeping the finger against that same nostril, now inhale deeply. After that inhale, switch the forefinger back to the opposite nostril and exhale. Repeat 3-5 times.
3. Another idea would be to remove the mask for a period of time and try a 5 minute meditation. If you are unfamiliar with meditation, try downloading a free app called Insight Timer.
4. Try employing a mindfulness technique which can help you feel grounded. Again, get to a place where you can remove the mask for a short period of time. Get present with what you are feeling including your feet on the ground, hearing the sounds around you, feeling yourself inhaling and exhaling. Be present with those or other sensations you are feeling. Stay with that feeling for 3-5 minutes.
Another idea would be in that period of time, think about something you thoroughly enjoy. Continue thinking about it until you can feel yourself totally enjoying whatever that is, as if you were there. A walk on the beach, a vacation spot, your favorite ice cream flavor, favorite food, reading your favorite book, etc. You get the idea. Get so present in that feeling that a wave of happiness comes over you until it swells up inside of you to the point where you smile. Some people refer to this as savoring the experience. I call it "finding your inner smile". This should help you feel renewed.
The Insight Timer app also has techniques for achieving mindfulness.
Let’s all do our best so that we stay safe and stay well and wish the same for others.
[1] Brian V Shenal 1, Lewis J Radonovich Jr, Jing Cheng, Michael Hodgson,
Bradley S Bender Journal of Occupational and Environmental Hygiene.
2012;9(1):59-64. doi: 10.1080/15459624.2012.635133.PMID: 22168256
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