CPAP therapy: How to deal with common problems

Photo of a man holding his head with his eyes closed (PantherMedia / Wavebreakmedia ltd)

CPAP therapy can improve breathing at night and significantly relieve the symptoms of obstructive sleep apnea. But wearing a sleeping mask at night takes some getting used to and may require support.

CPAP stands for “continuous positive airway pressure.” In this treatment, people with obstructive sleep apnea wear a mask while they sleep. The mask either covers only their nose or both their mouth and nose. It is connected by a tube to a CPAP machine. This machine blows compressed air into the airways. The incoming air keeps the airways open, preventing breathing pauses.

CPAP therapy takes some getting used to, but most people can already handle their CPAP machine quite well after one or two nights. Others have problems and stop using it. This information offers some practical tips for dealing with common problems.

Tips for dealing with typical problems

  • The mask doesn't fit quite right: The breathing masks are available in different sizes. If you have the feeling that your mask doesn't fit well, you can try out a different mask size. There are also different types of masks: While some cover both the mouth and nose, others only cover the nose. There are also nasal pillows, where two soft plastic inserts are put directly into your nostrils. All of these masks have their pros and cons. Masks that cover the mouth and nose might make people feel trapped or anxious, especially when they first start using them. But they are better at preventing breathing pauses, and are also more stable. Nasal pillows are less confining, but they are more likely to fall out if people move around in their sleep. It is also worth checking the mask strap and possibly replacing it with a different one if it doesn't fit properly.
  • Trouble getting used to the sleeping mask: Even after finding the right size and type of mask, it might be difficult to keep using the mask regularly. Wearing it for 10 to 30 minutes during the day, for example when watching television or reading, might help then. Getting used to it during the day might make it easier to wear it at night too. Gradually increasing the time you wear it at night may also help. It is important to seek professional advice early on if you have trouble. You might consider talking to doctors, caretakers or other people who have sleep apnea.
  • Leaking mask: If the mask leaks, that changes the air pressure and reduces the effectiveness of the CPAP therapy. Leaking air can also dry out your eyes. Masks often leak because they don't fit properly or because the mask straps haven't been adjusted correctly. You can check this by changing the position and pressure of the mask. If that doesn't help or you're not sure whether the mask is working properly, it's a good idea to talk to the people who supplied you with the machine so they can explain how best to use it. Maybe a different size or a different type of mask is the solution. Another reason might be that the mask is too old and the soft silicone or gel insert has hardened. Masks have an average lifespan of one to two years.
  • Accidentally removing the mask in your sleep: It is normal to unconsciously take off the mask every now and then. But if this happens a lot and frequently interrupts the treatment, changing the type of mask might help.
  • Machine noise that disturbs sleep: Many of the newer CPAP machines are very quiet. Louder noise may be caused by a blocked air filter or because the machine isn't working properly. Then it's a good idea to have it checked by a professional. Bothersome noise is often caused by the mask valve. You can try out earplugs to muffle the noise or switch to a mask with a quieter valve.
  • Dry and stuffy nose: An air humidifier can be attached to modern CPAP machines. Moist air helps prevent the mucous membranes of the nose and throat from drying out. The level of air humidity can be adjusted by changing the temperature of the water. If the air isn't humid enough, the tube that feeds the air to the mask can also be insulated using a special tube cover. Some machines even come with a heated tube. Pharmacies or drug stores also offer moisturizing ointments and sprays for the mucous membranes lining your nose.
  • Dry mouth: Your doctor should make sure that the pressure isn't too high or too low. Adjusting the pressure might make it easier to breathe through your nose, preventing you from only breathing through your mouth at night. If you use a mask that only covers your nose, you can try switching to a mask that fits over both your mouth and nose. Using an air humidifier can help too. There are also special chin straps that can be used to keep your mouth closed while you sleep and might prevent it from getting dry.
  • Difficulty falling asleep: If you find it hard to fall asleep, you might benefit from general good sleep habits. This includes things like not drinking alcohol or coffee and avoiding heavy meals before going to bed, and making sure that your bed is in a quiet and dark place. Avoiding daytime naps so you feel more tired in the evening might also help. Getting used to the mask during the day may make it easier to fall asleep with it on at night.

Switch the machine

It's not only possible to change your mask, but also to try out a different machine. Studies have shown the various types to be similarly effective. Some people switch to a machine that works in a different way, for example auto-CPAP instead of CPAP: An auto-CPAP machine adjusts the air pressure level to the breathing, while a conventional CPAP machine delivers constant air pressure. Some people prefer varying air pressure to constant air pressure. It's also possible to switch to BiPAP (biphasic positive airway pressure) therapy: BiPAP machines produce less pressure when you breathe out than when you breathe in.

Research summaries