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    Sleep Apnea 101: Side Effects

    CPAP Side Effects

    Side Effects

    Positive side effects include initial bursts of energy in some users ("a CPAP high"), deep and restful sleep, improved mood, ability to focus and concentrate, improved work place performance and improved relationships with friends and loved ones.

    Negative side effects of CPAP reported by new users include: nose irritation, nasal congestion, headaches, bloating and continued tiredness after starting treatment ("sleep debt"). Each of these issues can be eliminated or moderated. Read the FAQs tab below to learn more about the side effect you wish to correct.

    Side Effects FAQs

    What are the health risks of untreated Sleep Apnea?
    Untreated Sleep Apnea can lead to:
    • High Blood Pressure
    • Stroke
    • Heart Attack
    • Congestive Heart Failure
    • Cardiac Arrhythmia
    • Depression
    • Glaucoma
    • Obesity
    • Diabetes
    • Chronic Fatigue
    • Morning Headache
    What are the symptoms of Sleep Apnea?
    The following symptoms go hand and hand with Sleep Apnea:
    • Loud and frequent snoring
    • Periods of not breathing during sleep
    • Snorting, gasping or choking during sleep
    • Need to urinate during the night
    • High blood pressure
    • Morning headaches
    • Awakening tired in the morning
    • Daytime or evening lethargy
    • GERD (Gastroesophageal reflux disease)
    • Drowsy driving, limited attention, memory loss and poor judgment
    • Personality changes
    • Weight gain, severe leg swelling, body mass index of 25 or more
    • Hyperactive behavior, especially in children
    • Decreased size of airways and large neck
    What are the benefits of using CPAP therapy?
    Successful CPAP users report improvements in:
    • Quality of Sleep
    • Quality of Life
    • Energy and Motivation
    • Mood & Disposition
    • Job Performance
    • Sexual Drive and Performance
    • Alertness While Driving

    A failure to use CPAP therapy to treat Sleep Apnea may increase your risk for conditions linked to untreated OSA:

    • Hypertension (OSA increases your risk of hypertension by up to five times)
    • Stroke
    • Congestive Heart Failure (CHF)
    How do I avoid red marks?
    Most red marks on the face are caused by over tightening the CPAP mask. CPAP masks should only be tightened down enough to create a seal. To avoid over tightening your mask, you should work clockwise around the mask, making small adjustments to the headgear, until the mask is securely in place but not overly tight. You should avoid pulling too much on one side of the mask than on the other.

    By cleaning your mask cushion, nasal pillows, and nasal prongs on a daily basis, you ensure a better seal each time you put on your mask. If you know you have a mask that fits, and are cleaning it daily, and still have red marks, consider using Mask Straps Pads which are soft covering for the headgear straps.

    Swift LT Soft Wraps
    Why do I have a headache when I wake up?
    CPAP does not normally cause headaches unless there is a sinus related problem or if the pressure is too high.

    Sinus systems extend behind your ears. When a CPAP is used and part of the sinus cavities are blocked, a situation is created where there is a pressure differential between the sinus cavities affected. These pressure differences can sometimes be felt as sinus headaches or just plain headaches, even though they are caused by sinus blockages. These can be treated using over the counter medications to open the sinus. CPAP heated humidifiers can also open and maintain sinus systems. If you do not use a heated humidifier, we strongly suggest using one. If this does not correct the problem, visit your ENT.
    Why is my mouth dry in the morning?
    Dry mouth is a sign that you are opening your mouth while you sleep. If you use a nasal mask, breathing through your mouth bypasses any humidification you may be using so increasing the heat will not be effective. Breathing through your mouth while using a nasal mask reduces the benefit of CPAP therapy.

    First, be sure the mask is not leaking. If the mask is six to nine months old and leaking, try replacing it. If it is new and leaking, the fit could be incorrect. We can help you find a mask with a great fit.

    If your mask is new and NOT leaking, try a Chinstrap to keep your jaw up and mouth from dropping open during sleep. If a chinstrap doesn't solve the problem, try masks recommended for Mouth Breathers.

    If you use a full face mask and have a dry mouth, try adding a Heated Humidifier to add moisture.
    Why is my nose so dried out?
    The primary reason nasal passages can become dry from CPAP use is lack of adequate humidification.

    CPAP air is an irritant - to one degree or another - to everyone. The irritation may cause the nasal passages to dry out and bleed, or the mucous membranes may try to protect the nasal passages by producing excess mucous, resulting in congestion. The irritation can be cumulative, developing over time. Furthermore, dry, cracked or bleeding nasal passages are a breeding ground for infection.

    Using a Heated Humidifier to add moisture to the CPAP air may reduce or eliminate the irritation. An unheated, Passover Humidifier may not offer enough additional moisture. If you are already using a heated humidifier, try turning it up to a higher setting. If that produces condensation in the six foot hose, you should try an Insulating Cover for the hose. You can also try using a Nose Lubricant to reduce the dryness.
    Why am I congested from CPAP use?
    The primary reason nasal passages can dry out from CPAP use is lack of adequate humidification.

    CPAP air is an irritant - to one degree or another - to everyone. The irritation may cause the nasal passages to dry out and bleed, or the mucous membranes may try to protect the nasal passages by producing excess mucous, resulting in congestion. The irritation can be cumulative, developing over time. Furthermore, dry, cracked or bleeding nasal passages are a breeding ground for infection.

    Add a Heated Humidifier to add moisture to the CPAP air and reduce or eliminate the irritation. A passover humidifier may not offer enough moisture. If you are already using a heated humidifier, try turning it up to a higher setting. If that produces condensation in the six foot hose, you should try an Insulating Cover for the hose. You can also try using a Nose Lubricant to reduce the dryness.

    You can also try using a Sinus Rinse before going to bed and again once you wake in the morning to help clear your sinuses.

    NeilMed Sinus Rinse
    What can I do for sinus and congestion relief?
    A lot of new CPAP users report having an increase in sinus congestion after starting CPAP therapy. When treating your obstructive sleep apnea, sinus congestion presents a roadblock to healthy breathing. CPAP air is an irritant - to one degree or another - to everyone. The irritation may cause the nasal passages to dry out and bleed, or the mucous membranes may try to protect the nasal passages by producing excess mucous and so congestion results.

    The best option is to add a Heated Humidifier to add moisture to the CPAP air and reduce or eliminate the irritation. If you are already using a heated humidifier, try turning it up to a higher setting. If that produces condensation in the six foot hose, you should try an Insulating Cover for the hose. Other options are to:
    • Wait and see if humidification adjustments help decrease the congestion.
    • Visit your the ENT (ear nose and throat) doctor, and let them know you are on CPAP therapy.
    • Try using a Sinus Rinse before going to bed and again once you wake in the morning to help clear your sinuses.
    As a general rule, those with obstructive sleep apnea should avoid using sedating medicines. Sedatives relax the muscles of the air passage even more and can effect your apneas. You should consult your doctor before using these types of medicines.
    What are the benefits of using a humidifier?
    Many PAP users experience nasal congestion and dryness of the nose and throat during treatment. This can be especially problematic for new users who are adapting to treatment. Humidification adds moisture to the air helping to reduce the symptoms of dryness and congestion.

    Nasal congestion also leads to mouth breathing, which perpetuates the problem of dryness. If this is an issue for you, try a heated humidifier.
    Why is my face breaking out around my nose?
    Sores, redness and bumps around your nose can be caused by one of three main reasons: facial oils are building up under the mask material; the mask is overly tight; or the mask material is causing an allergic reaction.

    A breakout can occur from the facial oils building up under the mask at night. You can help minimize this by washing your face before putting on the mask at night and by cleaning the facial oils off the mask every morning. If you are still experiencing a breakout, you might consider Nasal Pillow Masks. The nasal pillow design has less material in direct contact with the skin.

    Sores at the bridge of the nose or below the nose are usually due to tightening the headgear straps too much. The pressure will create soreness, then a bruise, and may eventually create an open sore if left untreated. Your mask should seal when worn comfortably. If you have to over tighten your mask to get a good seal, consider switching to another mask type. To avoid over tightening your mask, you should work clockwise around the mask, making small adjustments to the headgear, until the headgear is securely in place but not overly tight. You should avoid pulling too much on one side of the mask than on the other.

    Most masks are made of silicone, which is an inert substance. But silicone is manufactured in chemicals to which some people are allergic. The chemicals normally degrade and disperse over time, but may cause a reaction when first used. The solution is to remove surface chemicals before using the mask. Washing the mask will reduce or eliminate the problem. This process can be accelerated by long soaks in warm soapy water. This method can be used with all types of masks, and should also be applied to mask replacement parts. While soaking the mask will help remove the surface chemicals, it my reduce the life of the silicone.
    Why am I getting sores inside my nose?
    Sores inside the nose may be caused by nasal pillow or nasal prong devices that are too big or the wrong shape for your nose.

    If you use nasal pillows, try the smallest size available that seals around your nares. Your nose might also be sensitive to the presence of the nasal pillows, and it might take time for your nose to "toughen up" and adjust to the nasal pillows. Try switching back and forth between the nasal pillow mask and a nasal mask. You might also try Nose Lubricants to reduce the irritation.
    Citrus Mask Wipes

    Nasal prongs must be inserted into the nostrils and seal tightly, so they may cause irritation or sores. It may be just a matter of your nose "toughening up" over time, so try switching back and forth between the nasal prong device and a nasal mask. If the sores do not heal, we suggest you discontinue using the nasal prongs.

    Sores inside the nose may also be caused by the CPAP air drying out the mucous membrane. Adding moisture with a Heated Humidifier may help alleviate the problem.
    Why do I wake up feeling bloated with air in my stomach and intestines?
    Bloating is a sign you are swallowing the CPAP air. There is no real medical solution, but we have found that your sleeping position may be a factor. First, try sleeping as flat as possible, even without a pillow. If the bloating persists, try sleeping on your side or elevated. The position must be different from your current posture.

    If changing your position doesn't resolve the problem, talk to your doctor about the possibility of lowering your pressure a bit. It may let a few apneas through, but the trade-off might be worth it.
    Aerophagia
    The word "phage" in Greek means "to eat." Aerophagia is literally to eat air. In the modern context, it means swallowing too much air, a common cause of gas in the stomach and belching.

    This is sometimes a result of CPAP Therapy. Unfortunately, the best solutions for this problem are not a catch all but instead an attempt to find the middle ground between needed CPAP pressures.

    Here's what you can do:
    1. Talk with your CPAP prescribing physician. The doctor may suggest decreasing the CPAP pressure in order to decrease the bloating. This decision would need to be made by your doctor to ensure you do not suffer from a constricted airway. Alternatively, your doctor may consider transitioning you to an auto-titrating machine. APAPs reduce the average pressure that the user receives. The pressure settings need to be set by the provider or sleep study, as the wrong pressure may make the situation much worse.
    2. As the chin of a CPAP user nears the chest, air has a greater chance of entering the digestive tract. When possible, try to lay in a position which allows the chin to remain above the torso.
    3. Change your normal pattern, and try a different sleeping position to keep air out of the stomach. Lay on the left side or rotate to the right side. Incline with pillows or lay flat.
    If these fail, It may be that you should consider a surgical alternative to CPAP. Many have tried all sorts of other solutions to this bloating problem with little success.
    What is rainout?
    Rainout is the accumulation of water in a CPAP tube due to warm moist air cooling and condensing on its way from your CPAP machine to your CPAP mask.

    The image below from Fisher & Paykel explains how rainout is formed. Warm, moist air leaves the heated humidifier and travels through the CPAP tube. As air flows through the tube, the temperature of the room causes the tube to cool. As the tube cools, the air inside releases its moisture, and creates condensation in the hose.

    Solutions to rainout include:
    • Raise the temperature of your bedroom.
    • Keep your CPAP machine at the same level as your bed.
    • Insulate your tubing with a hose cover like Snugglehose.
    • Reduce the tempurature setting on your heated humidifier.
    • Purchase a CPAP machine with a rainout reduction comfort feature.
    • Some machine systems offer a compatible heated CPAP hose which maintains the temperature from the machine all the way to the mask, reducing the occurrence of rainout. The list of available heated hoses can be found here: Hoses With Heating Coils.
    • If your machines uses a standard hose, consider the ComfortLine Heated Tubing Kit.


    Conventional Humidification
    Why is there water in the six foot CPAP hose?
    Water collects in the six foot hose when the ambient room air is much colder than the heated CPAP air, or when there is too much moisture being produced by the humidifier.

    First, be sure that no vents or fans blow directly onto the CPAP hose.

    Next, try turning down the temperature on the heated humidifier. If that alleviates the problem but causes irritation to the nasal passages, return the humidifier to the previous setting and add an Insulating Cover to the hose.

    If neither response works, try using a heated CPAP hose.
    Why would I want to insulate my CPAP hose?
    Cool air holds less moisture than warm air. If warm air from a heated humidifier cools while moving through the CPAP hose, water will condense inside the hose rather than travel to the user. The condensation that accumulates inside the CPAP hose is referred to as "rainout."

    Insulating the CPAP hose will help maintain the moisture in the airflow all the way to the mask.
    What is a hose cover?
    A hose cover is placed over the hose in order to insulate the hose and to make the hose more comfortable. The simplest and most cost effective way to insulate a CPAP hose is to wrap it in an insulating fabric. This enables the hose to remain flexible and adds little weight.

    Companies such as Snugglehose provide a cost effective tubing insulation available in several colors and styles. Not only will the covers reduce or eliminate rainout, they also provide a more personal and less institutionalized appearance. An example of a Snugglehose is shown below.

    Snugglehose
    How do I avoid getting tangled in CPAP hoses?

    There are a few ways to keep from getting tangled up in your CPAP tubing. Try running your CPAP hose behind the headboard of your bed. Also, there are several types of suspension systems we carry here at CPAP.com. You can see the different types of Hose Management Systems under our Comfort & Cleaning section. One example is the HoseBuddy Tangle Free CPAP Hose Suspension System:

    HoseBuddy

    Other examples of Hose Management Systems are:

    Why might I want to use Aromatherapy with my Machine?
    Pleasant smells induce strong feelings of calm, comfort, and relaxation. The sense of smell is part of the brain's emotional centers and cognitive distraction (the ability to exclude other distracting stimuli) is an important feature of human olfaction.

    Some people do not like the "machine" smell which can be delivered from the machine. The aromatherapy can help control the scent you smell when going to sleep.

    Some people tend to feel claustrophobic when using their CPAP. Having relaxing scents delivered through the machine can reduce the anxiety levels to reach a higher comfort level.

    CPAP Aromatherapy consists of a variety of different essential oils which are applied to the included diffuser pad and placed in front of the machine's air intake. You should not apply essential oils directly to the machine filter, because it would break down the machine filter. You should also not add the essential oil to the humidifier chamber water, because it can damage your humidifier chamber. Pur-Sleep Aromatherapy Pur-Sleep Diffuser
    How do I stop mask leaks?
    Air leaks can be caused by masks that are too big, too old, or simply the wrong style.

    Air leaking into the eyes is usually an indication that the mask is too big (long or wide) as are leaks at the base of the nose. Leaks may also occur under the nose due to facial hair.

    As the silicone in the mask cushion ages, it deteriorates and becomes too soft to hold a seal. For many masks, the cushion may be removed and replaced to extend the life of the mask. View our Replacement Part Finder to see if a replacement cushion is available for your mask.

    When a cushion has softened to the point where it will no longer hold a seal, you may be able to tighten it enough to stop the leaking when you go to sleep, but during the night the seal will loosen and leak.

    Mask leaks may also be caused by the pillow pushing against the mask and changing the position and seal of the mask. There are special CPAP Pillows which are are designed to minimize the contact of the CPAP mask with the pillow, even when you are sleeping on your side.

    Multi-Mask CPAP Pillow
    Why do I wake up to find my mask is off?
    People tend to remove their masks during sleep because they are not getting enough air.

    The CPAP pressure may be reduced if your mask is leaking. Your mask may be too big or too old. We would suggest you resize your mask to be sure you have the best fit. If your mask fits, but it is six to nine months old, it should be replaced. As the silicone in the mask cushion ages, it deteriorates and becomes too soft to hold a seal. For many masks, you can get a replacement cushion. See our Replacement Part Finder to see if your mask has a replaceable cushion.

    If the CPAP air is being delivered effectively and without leaks, it may be that the pressure is set too low. Pressure settings may require change due to weight gain or loss and aging. You should speak to your doctor if you think your pressure may need to be adjusted.
    Why is air leaking from my mouth?
    It is common for air to leak from the user's open mouth during CPAP therapy. Many factors can cause the user's mouth to fall open. For example, a common catalyst for mouth breathers' is nasal irritation from CPAP therapy.

    The correlation between a lack of humidification and mouth leaks is a topic that has been heavily researched. The hypothesis is that a significant amount of mouth leakage is caused by the following cycle:
    • CPAP therapy is used with ineffective or no humidification,
    • The nasal membranes are unable to adequately condition the increased airflow and after a few minutes the airway and nasal passages become dry.
    • To remedy the dryness and obtain moisture, the body uses the mouth to breathe.
    • CPAP air follows the path of least resistance and leaks out of the open mouth.
    • The air leaking through the mouth causes more dryness.
    • Patient wakes up feeling tired with significant dryness in mouth and dry, swollen nasal passages.

    The answer to this cycle is humidification. If the mouth continues to open during sleep, a Chinstrap may be needed to hold the jaw up so that the mouth can close. If mouth breathing continues, a full face mask, hybrid mask, or oral mask is suggested. See our recommended masks for Mouth Breathers.
    I breathe through my mouth, what are my options?
    People who have a deviated septum, small nostrils, or who suffer from seasonal allergies or chronic sinus issues, may breathe through the mouth rather than the nose. If you are a person who breathes through your mouth you may be able to wear most masks with a few adaptations. Add a Chinstrap if using nasal pillows, nasal prongs or a nasal mask.
    Sullivan Chinstrap

    A full face mask or hybrid mask can be used without a chinstrap because the seal covers both the nose and mouth. A full face mask will allow you to breathe through your mouth or through your nose.

    If you suffer from chronic sinus issues, a full face mask or an oral face mask are good options. Oral masks work best for mouth breathers with blocked nasal passages. You must use a heated humidifier with the oral mask. CPAP.com sells the Oracle HC452 Oral CPAP mask.

    If you are a mouth breather who cannot or who does not want to wear a chinstrap, please see our recommended masks for Mouth Breathers.
    Why do I wake up with dry eyes?
    Air leaking from the mask at the bridge of the nose and over the eyes during sleep will cause the eyes to dry out. The most common reason for air leaking at the nose bridge is that the mask is too big or too long for the nose.

    We would suggest you resize your mask to be sure you have the best fit. A mask that has an adjustment at the bridge may also be helpful in getting a good fit. Nasal pillow or nose cushion devices which do not rest on the nose are also an option.

    It is not advisable to tighten the headgear to eliminate the air leak. Pressure from a mask that is too tight will cause bruises and even open sores if applied long enough.
    Why is the bridge of my nose sore?
    Sores at the bridge of the nose or below the nose are usually due to tightening the headgear straps too much. The pressure will create soreness, then a bruise, and may eventually create an open sore if left untreated.

    Headgear is usually tightened too much to reduce or eliminate air leaks. A small degree of this may be necessary, but too much is an indication that the mask is too large, too old, or the wrong style.

    If your mask is six to nine months old and the silicone is becoming too soft to hold a seal, try replacing it. Find the right replacement cushion for your mask using our Replacement Part Finder.

    It is usually necessary to stop wearing a mask to allow these sores to heal. Nasal Pillows are an option in the meantime.
    If I lose weight, will I cure my OSA?
    The answer to this question depends on the person. Some people report experiencing less severe or cured sleep apnea after losing weight. Others report no change in their sleep apnea with weight lose. Most experience other benefits by losing weight healthily. Losing weight is good for your overall health when done properly.

    Did You Know, Side Effects

    • Rainout is when condensation forms in your hose. It can be minimized by using a heated hose or a tubing wrap found on our hose comfort page.
    • If you are waking up with red marks, visit our page on Skin Irritation Products to view padded mask straps and mask liners intended to prevent sores and pressure marks.

    Side Effects Articles

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    Research Articles