CPAP, at the present, is the most effective treatment for obstructive sleep apnea. It is, however, only a treatment and has no benefit if it is not used.  Current research estimates that the compliance rate for CPAP (how many people use CPAP more than a few months) is approximately 70%. One reason for this may be that CPAP users sometimes experience disagreeable side effects and simply stop using CPAP. Many of these side effects can easily be addressed if a health professional is made aware of the problem or if the CPAP user is educated about ways to manage these problems.

Wash your mask at least once a week in warm water and a mild dish washing detergent, rinse and dry thoroughly. Use only distilled water in your cpap humidifier.

CPAP Issues and Answers

Mask discomfort. This problem usually arises because either the patient adjusts the headgear too tight or because the mask does not fit properly.  A CPAP mask should fit the face snuggly to avoid air leak but not so tight that is feels uncomfortable or causes pain. If a mask has to be pulled tightly to prevent leaks the mask does not fit properly! There are a number of manufacturers of CPAP masks and not every nose or face is shaped the same. You probably have been given the type of mask suggested by the doctor or the respiratory therapist in the doctor’s office to be used during your sleep study. The technologist watched how you slept with this mask and determined that it was a pretty good fit for you so it is advisable to at least try that mask at the beginning of using CPAP. You may end up trying several masks before finding the one that works best for you, but be patient….  everyone is different, it may take several weeks before you get used to wearing a mask on your face. Also be aware that your insurance company may only pay for a new mask once every 3-6 months.

Nasal congestion, irritation, runny nose or dry mouth that seems to be caused by using CPAP.  Your nose is your airway’s humidifier. It warms and humidifies the air that you breathe.  If the CPAP begins to dry your nose, your body will increase the production of mucus in the nose to add more moisture to the inhaled air. Unfortunately, this may cause nasal congestion and a runny nose. In some cases the dryness will cause irritation, burning and sneezing.  These symptoms can be alleviated by the use of a humidifier with your CPAP.  Most CPAP units come with a heated humidifier.  This is a water pan that sits on a heating unit and is attached to CPAP.  Heating the air and the water will allow the  air to carry more moisture as it travels to your nose (just like the summer air is more humid than winter air). If you continue to experience these symptoms at the temperature setting suggested by the supplier of your CPAP machine, try turning your humidifier temperature up 1 notch at a time to see if this may help your symptoms. If you get too much “rainout” or condensation in your tubing you can try keeping the tubing under the covers with you to keep it warm or you can buy a “tube or hose cover” (you can purchase one of these on eBay, at or from our office). If you continue to awaken in the mornings with a dry mouth, it could be that your mouth drops open during the night. The problem with this is that your CPAP pressure then escapes from your mouth into the atmosphere and becomes ineffective. The solution for this problem is a “chin strap” which is a simple band that goes under your chin with a Velcro closure on top of your head. Like your mask, it does not have to be tight but will hold your mouth closed when you are asleep. If you continue to have problems seek further advice from your sleep professional or the supplier of your CPAP machine.

Difficulty breathing through your nose.  If you have allergies, chronic sinus problems or a deviated septum (your nose is crooked on the inside) you may have trouble using CPAP.  CPAP is usually applied through the nose. If during the day you often find yourself breathing through your mouth, CPAP may be difficult to use.  If the problem is allergies speak with your doctor about treatment. There are a number of good nasal steroid sprays and allergy medications that can treat your nasal congestion.  Individuals with a deviated septum or other structural/anatomical problems may benefit from seeing an Ear Nose and Throat specialist if CPAP cannot be tolerated.  Finally, there are CPAP masks that fit over both the mouth as well as the nose.  People have used these with varying success but it may be worthwhile to try a “full face mask” before looking into more invasive or expensive alternatives.

Headache or ear pressure. Although treating sleep apnea usually eliminates morning headache, some CPAP users develop headaches on CPAP.  Others find that their ears develop pressure or pain in them.  Most of this relates to underlying sinus congestion due to allergies or to CPAP itself. It is much like traveling in an airplane when you have a cold. The congestion can block the ear canals and changes in air pressure can cause pain when air is trapped. If you develop headache or ear pain on CPAP, speak with your sleep specialist.  In the interim, you may try decongestants or antihistamines. Check with your doctor before you take these medications.

I take off my mask at night and don’t realize it. This can happen for a number of reasons: difficulty breathing through the nose, mask discomfort or sleep disturbance. If your nose is congested when you awaken, read the two paragraphs addressing that in this paper. Speak with your home health provider if your mask hurts. If these two problems do not appear to explain why you are pulling off your mask, it may just be that you need some time to adjust to wearing a mask on your face at night. During an arousal, when you are not fully alert you may not remember that you now wear CPAP. It can be a scary thing to awaken with a strange thing on your face! This should improve over time. It may help to take either Benadryl or Tylenol PM an hour before bedtime so that you are drowsy going to bed and so that it is less likely that you will awaken at night. After a few weeks, you should adapt to wearing the mask. Be sure to talk to your doctor before taking these medications.

Air in the stomach.  Occasionally, a CPAP user will experience air trapping in the stomach and awaken with stomach pain or gas. Sometimes simply making sure that you sleep with your head aligned with your body can help with this. If you sleep with several pillows, it may cause your head to tilt forward and block your airway. If you need your head elevated, use a wedge pillow instead.  Lowering the CPAP pressure can help but your sleep specialist may not want to do this if it reduces the effectiveness of your treatment. Switching to a bi-level pressure machine or C-Flex may be helpful in these cases but may necessitate having another sleep study done to determine the bi-level pressure.

CPAP is too noisy. It is most likely a lot less noisy than your snoring, but if noise is a problem you have several options.  Most new machines are quiet so this is rarely a problem. Check with your insurance company if you have an old machine. You may qualify for a new CPAP if your machine is older than 5years old but your insurance may also require that you have new sleep studies done as well. A fan or other source of “white noise” can also help to disguise the noise. Adding additional lengths of tubing more than 8 feet will interfere with the level of pressure your machine delivers and is not recommended.

I take off my mask at night and can’t be bothered to put it back on. When you get up at night, to use the restroom for example, leave your mask on and just disconnect the tubing at the mask. This is easier than having to refit the mask during the night. Always remember how important it is to wear your CPAP. Lack of treatment for sleep apnea can result in hypertension, stroke, heart disease and daytime sleepiness can be the cause of automobile accidents and accidents on the job.

Get a new mask every 3-6 months or as your insurance allows. After about 3-6 months, the oils from your face begin to degrade the silicone in your mask. Once the mask begins to wear out, it no longer fits as well, makes a good seal or feels as good as when it was new. If you got your equipment from a home healthcare company, be sure to call them every 3-6 months to get new mask, tubing and filters.

CPAP devices, pressure settings, masks, tubing, and filters all require a prescription from your doctor just as a medication requires a prescription. Most insurance companies and Medicare/Medicaid will pay for a new mask, tubing and filters at least every 3-6 months. Some insurance companies require that information be downloaded from your CPAP machine at certain intervals. You must keep your follow-up appointments in order to get prescriptions for new equipment when needed, have downloads done from your CPAP machine if your insurance company requires that and to enable your doctor to make sure you are responding appropriately to your CPAP therapy.