If you’re reading this article, you may be having trouble with your new CPAP machine. You may be asking yourself, “Why is my CPAP so hard to use?” or “Will I ever get used to CPAP?”
Perhaps your Sleep Apnea mask is leaking air, or the fit is too tight for your head and gives you a headache. Perhaps the straps are digging into your scalp or the mask is leaving marks on your skin. Either of these issues may be making it tough for you to keep your CPAP mask on all night.
Some people feel claustrophobic sleeping with a CPAP mask. Wearing something on your face can feel awkward, or breathing pressurized air makes you feel trapped.
On the other hand, maybe you sleep fine but you wake up feeling less than terrific in some way: you’re still tired, or you’re bloated, or you have a dry nose or throat.
Adjusting to a New CPAP Machine Takes Time
If you’re struggling with your new CPAP machine, you’re not alone. Lots of people with apnea have an adjustment period as they get used to treatment. If you’ve spent your entire life sleeping without the help of a medical device, adjusting to wearing a “Darth Vader” mask to bed isn’t something that you can do overnight (no pun intended).
And there certainly is a noticeable difference between breathing room air on your own and breathing forced, pressurized air that’s delivered to your nasal passages from a machine. Some people also need time to get accustomed to the light whirring sound coming from the CPAP motor.
For all of these reasons and more, very few users get totally used to CPAP or BiPAP therapy right away.
However, CPAP is the most effective therapy for managing obstructive Sleep Apnea, so it’s worth hanging in there and making the necessary modifications while you get to know the machine. Some of these modifications are tweaks and fine-tuning of your equipment, done by technologists or your doctor at a sleep center. Others are lifestyle or mindset modifications: mainly, adjusting your expectations.
Not All People See Benefits from CPAP Right Away
When you’ve been chronically exhausted and sleepy for months or years on end, it’s only natural to hope for noticeably better sleep on day one. But with Sleep Apnea, that’s not always the case.
Not all people feel the amazing benefits of refreshing sleep on night one with a CPAP machine, or even in week one. Typically, there is a relationship between the severity of your Sleep Apnea and how quickly you’ll begin to feel better.
This relationship is not what you might think. The worse your Sleep Apnea is, the quicker your response will be. If your Sleep Apnea is mild to moderate, you definitely will benefit from nightly CPAP therapy, but the changes in your sleep that you perceive when you’re awake may be more subtle. (Even if the “behind the scenes” health benefits, like reduced risk of heart disease, are already taking place.)
Also, how fragmented your sleep was before CPAP makes a difference in your perception of improvement. If you have upper airway resistance syndrome (UARS)—“breathing through a straw” rather than choking from an obstruction—your number of respiratory events may not look like severe Sleep Apnea at first glance. But your arousals from sleep could be almost as frequent as someone with severe OSA. So for patients with UARS, CPAP may dramatically improve the quality of your sleep pretty rapidly.
Even if you do feel a difference in your sleep and an improvement in your daytime sleepiness right away, you may still struggle with some common issues for which there are solutions. Keep reading to find out what those are.
Common CPAP Machine Problems and Solutions
When people call their CPAP supplier or visit their sleep center to say “I have a CPAP problem,” they’re usually dealing with one of the following issues. Don’t be afraid to share your problems with your sleep experts; they’re familiar with all these issues and know how to help you improve your experience with a few basic changes to your CPAP machine or your routine.
Swallowing air (Aerophagia)
Aerophagia occurs when a patient swallows excess air during the night and feels bloated in the morning or during the night when they awaken.
Causes. You may be experiencing aerophagia for a few different reasons: your air pressure setting may be too high; your full face mask may be causing you to gulp extra air through your mouth, or the positioning of your head while sleeping may be the reason.
Solutions. A nasal CPAP with humidification restricts air delivery to your nose only, leaving your mouth free to exhale without being covered by a mask. Or you could change to BiPAP if the CPAP pressure is too high on exhalation, where the air swallowing occurs (switching to BiPAP often eliminates this problem).
Consider an APAP machine if you only need the higher pressures during REM sleep. Or you can add a body positioning device to keep you off of your back, a sleeping posture which needs higher pressures to splint the airway open.
Almost half of all CPAP mask users say leakage was their reason for abandoning therapy. A mask leak occurs when you don’t have a firm seal keeping the air in. For example, if you wear a full face mask, maybe the edges of the mask are not fitted properly to your cheeks. If your CPAP mask is leaking pressurized air, unfortunately, you’re not getting the full benefit from the treatment.
Causes. A poorly fitting apnea mask with a weak seal is the most common cause of leaks. Your mask may be worn out, or it could need cleaning.
Solutions. The importance of a good fitting mask is paramount to success. If you have a leak in your apnea machine mask, this needs to be addressed by a different mask so you can comply with your therapy. Don’t assume that what you’re using is all that’s available; depending on your apnea severity, you may have your choice of nasal pillows, nasal masks, and full face masks. And within each of these three basic styles, enough variety exists that you can find something to fit you better. Ask your supplier or home medical equipment provider what your options are.
Also, CPAP mouth leaks can be addressed in a few ways, and in the following order: first, by adding or increasing the humidification level in the circuit (by reducing the inflammation of the nasal passages); second, by wearing a chin strap; and as a last resort, by changing to a full face mask.
Lastly, remember the importance of regular CPAP mask replacements, as the masks are delicate and need to be replaced at least every 3-6 months.
Claustrophobia is the fear of being trapped in a small space. People with this anxiety disorder can have panic attacks—rapid heart rate, sweating, hyperventilation, and a feeling of doom—brought on by this fear. If you are claustrophobic, you may have a dread of being unable to breathe (suffocation). This fear can sometimes affect people with apnea when they first attempt to use a CPAP machine.
Causes. A preexisting anxiety disorder can make you more susceptible to claustrophobic reactions when wearing your CPAP mask. You may perceive difficulty breathing against the air pressure.
Solutions. CPAP mask desensitization is the main approach to overcoming claustrophobia. Rather than slapping the mask on at bedtime, try using it in a recliner while watching TV first. Hold it on at first with your hands; then, work your way up to putting the headgear on fully while watching TV in the living room. This approach can gradually acclimate you to the feel of wearing something over your mouth and/or nose.
Tearing the CPAP mask off in the middle of the night and not remembering it
This is a very common complaint from apnea patients. They start out the evening wearing the mask and complying with their therapy, but they wake up in the middle of the night or the morning realizing they’ve removed it while asleep.
Causes. Usually, you’ll take off your apnea mask because of a mouth leak or mask leak during the night.
Solutions. Make sure you have adequate humidification for comfort; wear a chin strap if needed; and, as a last resort, try a full face mask to prevent mouth leaks.
Nasal dryness from non-humidified air can lead to a stinging sensation inside the nose, nosebleeds, nasal sores, or nasal infections.
Causes. Lack of appropriate humidification.
Solutions. Increase the humidification setting on your CPAP machine. In addition to this, or in place of it, use a nasal saline spray to moisturize your nasal passages. However, do not use the nasal spray Afrin, as it can have side effects for people with high blood pressure and diabetes (two conditions which often result from sleep apnea).
A lack of sufficient saliva in the mouth can leave your tongue and mouth feeling sticky or sandpapery. Dry mouth can also extend to “dry throat,” leading to a sore throat, sores, cough, or infections. Chronic dry mouth can also lead to dental problems like cavities and gum disease.
Causes. You may develop dry mouth from a mouth leak or as a side effect of wearing a full face mask.
Solutions. Increase your humidification setting and add a chin strap to eliminate mouth leaks.
CPAP pressure is too high
If your CPAP pressure is too high, you may feel like you’re laboring hard to exhale against the air pressure. This may lead to a feeling of claustrophobia. In some extreme cases, high pressure can lead to trouble eliminating CO2 from your system, which can cause other health problems.
Causes. If your doctor and sleep technologists determine that you require a higher inspiratory air pressure to keep your airway open, you may find it uncomfortable to exhale against this pressure.
Solutions. CPAP desensitization may help you get used to the air pressure. If you can’t adjust or your blood gas levels are not in balance, you may benefit from changing the mode to BiPAP or APAP.
David Repasky has been using CPAP treatment since 2017 and has first-hand experience with what it’s like to live with Sleep Apnea. He brings the patient’s perspective to the CPAP.com blog and has received formal training in CPAP machines, masks, and equipment.