Continuous Positive Airway Pressure (CPAP) is currently the most effective treatment option for certain severities of Obstructive Sleep Apnea (OSA). However, you may experience a few common CPAP side effects throughout your sleep apnea therapy journey, such as facial irritation, dry or irritated airways, or sores and swelling in and around your nasal passages.
As irritating and frustrating as it can be to deal with some of these side effects, the only way to gain the full benefits of your sleep apnea therapy is to continually use your CPAP equipment. Therefore, recognizing and solving these problems early is critical to the long-term success of treating your sleep apnea.
In this article, we aim to help you to identify and mitigate these side effects, so you can experience the full benefits of this highly effective treatment for sleep apnea and improve your overall comfort and CPAP compliance. Compliance is especially important because no matter how frustrating or annoying it can be to acclimate to CPAP, the dangers of untreated sleep apnea easily make it worth your time to push through the adversity and find the routine that makes your therapy work for you.
The good news is that many of the side effects associated with CPAP therapy can be remedied by checking your mask for leaks, ensuring you have the best size cushion or nasal pillow for your face shape, using heated humidification, more regularly or more thoroughly cleaning your equipment, or adding a CPAP mask liner to your setup. There is also a good selection of nasal sprays and sinus rinses that can help with dryness and airway irritation as well.
We’ll explore these solutions to common CPAP side effects and more, so keep reading if you struggle with dryness, irritation, headaches, or other discomforts during or after CPAP therapy.
1. CPAP and Headaches
After waking up with a pulsing throb at your temples, you may be wondering to yourself: “Can a CPAP give you a headache?”
Morning headaches from untreated sleep apnea can occur, but side effects from using a CPAP machine typically do not include headaches. Interestingly enough, CPAP therapy was even shown to reduce headaches in those that experienced chronic migraines.
If you are experiencing a headache after starting CPAP therapy, then your CPAP pressure may be too high or your equipment could be causing a sinus blockage, creating the pressure in your head that causes a CPAP sinus headache.
The best course of action is to consult your healthcare provider about lowering your pressure setting or trying an APAP machine, but it’s also possible that your mask style simply isn’t the best option for you. If you’re using a nasal or nasal pillow mask, a full face mask that allows for mouth breathing may help you find relief from too much sinus pressure.
If you’re already using a full face mask, switching to a hybrid mask like the AirFit F30i may reduce pressure around your sinuses. While they still provide air to both your nose and mouth, hybrid masks are different from full face masks because they don’t completely cover your nose. Other popular hybrid masks—like the InnoMed/RespCare Hybrid Full Face CPAP Mask With Nasal Pillows or the Mirage Liberty Full Face Mask With Nasal Pillows—rest underneath your nose like a nasal cradle or nasal pillow to supply air to your nose as well as your mouth without the unnecessary sinus pressure.
Alternatively, if you are experiencing CPAP congestion headaches, adding moisture and encouraging mucus to move and free up your airway can reduce the inflammation that may be causing the congestion. To do so, you may benefit from using a heated humidifier, which is a tried-and-true method for adding moisture to your airway and helps many people find relief from feeling stuffy and congested. Another option is to add aromatherapy into your CPAP regimen by using something like the CPAP Vapor Clear Sinus Blaster. Please note, however, that when using essential oils with CPAP, you should never add the oil directly to your humidifier. Instead, it’s best to place a couple of drops of your preferred oil on a small cotton pad and place it in front of your machine’s air intake/filter.
If you’ve tried these solutions and still don’t find any relief, you may need to contact your ENT for further evaluation.
2. CPAP Mask Skin Irritation: Break-Outs, Sores, and Red Marks
CPAP side effects may include skin irritation, particularly along your cheeks or nose. Bumps, sores, and redness are usually caused by three main reasons:
- Build-Up of Facial Oils Underneath the Mask Cushion: When experiencing skin irritation from your CPAP mask, the first thing you’ll want to do is evaluate your cleaning routine. When you don’t clear your mask of the sweat, facial oils, and saliva that commonly builds up overnight, you’re more likely to experience redness and irritation.
- Over-Tightened Headgear: If you need to over-tighten your headgear to get a good seal, it may be a sign that it’s time to replace your cushions, as aging cushions require more tension for a secure and stable seal. It may also be an indication that you need to change your cushion size.
- An Allergic Reaction to the Mask Material: While in the past, latex allergies may have played a role in CPAP skin irritation, the vast majority of modern CPAP masks are made with silicone. Silicone allergies are rare but do happen, so you may need to switch to a gel or cloth mask to find relief.
How Do I Avoid Red Marks?
Similar to nasal sores and other skin irritations, red marks can be caused by over-tightening your CPAP mask. Your mask should only be tightened enough to create a secure seal. To avoid over-tightening your mask, work clockwise to make small adjustments to the headgear until the mask is secure but not overly tight. Cleaning your mask cushion, nasal pillows, and nasal prongs daily helps you to achieve a better seal as well.
If you know your mask fits, it’s not time for any replacements, and you are routinely cleaning it, consider adding mask strap pads—a soft covering for your headgear straps—to your CPAP set-up.
Red marks from your CPAP mask can be upsetting first thing in the morning, but there are several products that are designed to target and minimize red marks and other skin irritation, including:
Why Is My Face Breaking Out Around My Nose?
You may notice acne or pimples along the area where your mask is worn—especially if your skin is prone to breakouts—due to your facial oils building up under your mask. You can minimize this reaction by washing your face each evening before applying your mask and by wiping down your mask each morning. If you are still experiencing breakouts, you may want to consider a nasal pillow mask since the design makes less direct contact with your skin. If you can’t wear a nasal pillow mask due to mouth breathing, try to add a CPAP chin strap to your CPAP setup to encourage nasal breathing.
We also recommend keeping your mask clean, which may reduce or eliminate breakouts, with the following:
- Travel Citrus II Mask Wipes
- Control III Disinfectant
- Unscented Mask Wipes
- Purdoux Travel CPAP Mask Wipes With Unscented Aloe Vera
While uncommon, a silicone allergy may be contributing to your breakouts, so it may be worth having your healthcare provider test you for a silicone allergy. A gel or cloth mask may help you reduce acne from your CPAP mask if making a change to your cleaning routine doesn’t fix things for you.
Why Am I Getting Sores Inside My Nose?
Wearing nasal pillows or nasal prong devices that are too big or the wrong shape for your nose can cause sores inside your nostrils.
Switching to a nasal mask with a cradle design—such as the AirFit N30i—may bring relief to your irritated nostrils due to its curved nasal cradle design, which hugs the base of your nose instead of going inside your nose. Additionally, sores inside the nose can be caused by the CPAP air drying out the mucous membrane. Adding moisture from a heated humidifier is your best solution, but many people with irritated nostrils find relief by treating their sores with a moisturizer or coconut oil during the daytime.
While you may be tempted to use a lubricant such as Vaseline to get relief, it’s important to know that it may begin to break down your mask cushion. This can compromise your seal and require you to replace your equipment sooner than necessary, so use it sparingly or not at all. You’ll also want to avoid oil-based moisturizers, scented products, and soaps with lanolin, as your seal will become easily compromised.
Why Is The Bridge of My Nose Sore?
Sores are usually indicative of your headgear straps being over-tightened. You may be tightening your headgear too much to reduce or eliminate an air leak, but over-tightening your headgear can cause soreness—and it usually means your mask is too large, too old, or not the best style for your needs.
If your nasal bridge soreness persists even after changing out an old cushion and you’ve already tried multiple cushion sizes, it may be worth considering a new mask style altogether. Nasal cradle options—like the DreamWear Nasal Mask—will eliminate pressure on the top of your nose. If nasal cradle masks aren’t for you, nasal pillow masks can also be an effective option in reducing soreness on the bridge of your nose. If you believe it is your cushion sizing, look for masks on CPAP.com that have a Fit Pack to try all the cushion and nasal pillow sizes to find the perfect fit.
Other comfort items that may help with nasal bridge soreness include:
3. Dry Eyes Caused by Air Leaks From Your CPAP Mask
If you’re waking up with dry eyes after using your CPAP, it’s likely that you may have a leak in your CPAP mask around the bridge of your nose. The most common reason for air leaks around the bridge of your nose is that your mask is too big or too long for your nose.
Choosing the best-fitting CPAP mask can help, and if you’re having to over-tighten your headgear just to get a good seal, you may benefit from trying another cushion size or another mask entirely. It’s also possible that oils from your face, moisturizer, or make-up are compromising your mask seal, so be sure to thoroughly clean your mask in the morning and your face before bed to help prevent mask leaks.
Adding a mask liner like the ones below can help to create a secure seal and act as a barrier between your skin and your mask. Mask liners can also prevent facial sores or breakouts caused by overly tight headgear. These mask liners are moisture-wicking and will protect your seal from sweat and facial oils, too.
These mask liners may help reduce mask leaks and prevent dry eyes when using CPAP:
- Silent Night Full Face Mask Liners
- RemZzzs Padded Full Face CPAP Mask Liners
- RemZzzs Padded Nasal CPAP Mask Liners
- RemZzzs Nasal Pillow CPAP Mask Liners
4. Dry Mouth When Using CPAP
One of the most common questions from those new to CPAP is, “How can I prevent dry mouth with CPAP?” For nasal or nasal pillow mask owners, CPAP dry mouth typically happens simply because your mouth falls open during sleep, inhibiting the effectiveness of your CPAP treatment due to your therapy air escaping and drying out your mouth at the same time.
If you’re experiencing CPAP dry mouth with a nasal or nasal pillow mask, adding a CPAP chinstrap to support your jaw and encourage nasal breathing can help mitigate the loss of pressure through your mouth, reducing mouth dryness. You can also try a mask that is specifically designed for mouth breathers to increase the effectiveness of your therapy.
For those that use or prefer a full face mask but still experience dry mouth after CPAP, breathing in dry, pressurized air is the likely culprit. Regardless of the type of mask you wear, you should see a reduction in dry mouth symptoms by adding heated humidification to your therapy air. Adding a heated humidifier can make CPAP more comfortable, allowing you to benefit even more from your therapy.
5. Nasal Dryness With CPAP (Dry Nose)
Waking up with a dry nose or congestion is a commonly experienced CPAP side effect and usually indicates a lack of humidification. You may be wondering, “Why am I congested from CPAP use?”
Breathing in the continuous flow of air from your CPAP machine can easily dry out and irritate your nostrils and can occasionally even cause a nosebleed for some individuals. As a response, your nasal passages may be trying to create a barrier of protection by producing excess mucus, which can lead to equally-irritating nasal congestion.
Whether your nose is dry or full of mucus, a heated humidifier can add the moisture your nasal passages need to reduce or eliminate the irritation. Already using a heated humidifier? Try a higher humidification setting or add an insulated cover for your hose, heated tubing, or a soothing nasal spray to your care routine. It’s important to correct this issue since dry, cracked, or bleeding nasal passages can make you susceptible to infection.
Here are a few tried and tested solutions for bringing relief to dry and irritated nasal passages:
If you’re still experiencing issues after trying these recommendations, you may need to visit your ENT (be sure to let them know you’re on CPAP therapy) for guidance.
6. CPAP and Sinus Infections
Regardless of your choice of CPAP mask, sinus congestion can occur. Using a heated humidifier, though, adds moisture back into your therapy air and helps alleviate irritation. Less irritation means less produced mucus, and less mucus means less congestion. Our online catalog features sinus relief products that are designed to relieve sinus congestion.
Frequent infections can also be an indicator that your mask and tubing need either more thorough or more regular cleaning. Be sure to rinse your hose out and hang it to dry every morning and clean it with soap and water at least once a week to avoid developing respiratory infections from CPAP. If you live near construction or in a drier, dustier climate, you may also want to replace your air filter more regularly or opt for finer hypoallergenic filter options if available.
7. Bloating and Gas From Swallowing CPAP Air
While not exclusive to CPAP, another side effect that can occur during therapy is Aerophagia, which is the discomfort, gas, or bloating that’s caused by the accidental swallowing of air. While not overly common, CPAP Aerophagia can be a very uncomfortable experience. Here are a few things that may be causing it:
- Your Pressure Needs Adjusting: CPAP Aerophagia can be caused by either therapy pressure that is too high or too low. It’s easy to accidentally ingest too much air when your pressure is too high, but if it’s too low to adequately treat your apneas, you may end up just swallowing air in gulps when trying to breathe normally.
- Mouth Breathing: If you wear a nasal or nasal pillow mask but don’t use a chinstrap, your mouth may be falling open while you sleep. This lets air pressure escape through your mouth, which can cause you to begin unconsciously gasping for air and swallowing some in the process. This can be remedied by wearing a CPAP chinstrap.
- Exhalation Pressure Is Too High: If you’re having difficulty exhaling against your therapy pressure, it may cause an anxious choking episode where you begin to hyperventilate, which is when you begin quickly swallowing air. Most machines have a feature that may be referred to as Expiratory Pressure Relief (EPR), which reduces the incoming pressure during exhalation for a more natural breathing pattern. Consult your user manual to see if this is an option for your machine.
If you frequently experience Aerophagia from CPAP, you might try experimenting with your sleeping position if the tips above don’t bring relief. Switching to a different mask style may also help, but even if that doesn’t work for you, you might need to consider switching to an APAP machine. An APAP machine will always deliver the lowest necessary therapy pressure to keep your airway open, ensuring you aren’t gasping for air in your sleep.
Tips for Preventing CPAP Side Effects
Unwanted CPAP side effects can be discouraging, but don’t give up on your sleep apnea treatment just yet. The following recommendations may reduce or eliminate some of the issues you’re experiencing:
- Ensure You Have the Proper Mask Fit
- Double-Check That Your Headgear Straps Are Secured
- Clean Your CPAP Equipment Regularly
- Avoid Using Oil-Based Cleaning Products
- Add Humidification or Mask Liners
- Consider Sinus Medication or Heated Tubing
- Use Water-Soluble Saline Gel on Nostrils
You may also find it helpful to wear your CPAP mask during the day while fully awake to get more comfortable wearing it. You should use this time to also make any adjustments to your mask fit and seal quality to reduce the overall irritation and the number of sores you may experience.
Adjust Your CPAP Pressure to Prevent CPAP Side Effects
Are you still experiencing adverse side effects after trying the applicable methods in this article? Fortunately, changes to your pressure settings can often be made to improve or eliminate these unwanted side effects.
Before requesting changes from your health care provider, double-check your pressure settings to ensure the numbers match what your sleep care physician prescribed.
If you’ve had changes in your weight, the amount of alcohol you consume, started or stopped smoking, or had alterations made to your medication or overall health (such as a diabetes diagnosis), adjustments may need to be made to your pressure settings. Your doctor can review your CPAP data to determine the pressure settings that will best benefit you.
Always consult your doctor before making any changes to your sleep therapy treatment, and consider these quick tips throughout the article to help prevent the CPAP side effects you’re experiencing.
Ultimately, adhering to your sleep apnea treatment will help you avoid complications, ranging from excessive daytime sleepiness to cardiovascular events. It can be frustrating to get used to a CPAP device, but it’s crucial to stick with it. While CPAP therapy can cause certain side effects, the benefits and advantages almost always outweigh the drawbacks.
While many people don’t have any difficulty using their CPAP equipment and report having the best sleep of their lives after the initial adjustment period, some people do still experience minor side effects like dry eyes and nasal sores from time to time.
To troubleshoot your side effects, the best place to start is by evaluating your mask fit and cleaning habits, as many CPAP side effects are a result of skin cell buildup or aged or improperly sized cushions. Heated humidification can help relieve dried airways and mask liners may be the missing piece to securing your cushion’s seal once and for all. Remember to always talk with your doctor before making any major changes to your current CPAP routine like adjusting your own pressure setting.
Our expert customer service team is also ready to help you through any issues you might encounter on your therapy journey. Our team is available from 8 a.m. to 8 p.m. (CST) Monday through Friday and 8 a.m. to 5 p.m. (CST) on Saturdays. You can also contact us by using the Live Chat feature on our website or texting us at 832-308-2219.
Eric graduated from Texas State University in 2016 with a Bachelor’s Degree in Journalism. He has worked as a freelance photographer, editor, and writer. Eric is committed to providing the most value possible to CPAP.com readers by creating a highly approachable user experience, with an emphasis on actionable information and thorough research.