This has been the winner thus far out of about 8 or 9 masks that I've tried. I'm a 43 yo female. My face/nose is slender and the small cushion on this mask has been the best. This mask doesn't slide, nor make the loud velcro sound to adjust - it always stays snuggly in place. The front tube seems to help more than the top of my head situation, too. Less fidgeting at night. I do have one of those hose holders that stands up on the floor between my mattress and headboard and it holds the pipe upright and that keeps the airflow better than if it just laid flat on my stomach. I also have found that when I get up to go to the bathroom at night, I just leave it running (don't turn off my pap) and that way I don't have to deal with the re-ramp or lower settings to reinflate the cushion. I do wash the entire headpeice/nose cushion as a whole every morning though b/c I find the cushion is too cumbersome to remove on and off for my liking.