A CPAP machine uses a hose and mask to provide a steady stream of air at a pressure determined during a sleep study. The mask may be a nasal mask or a full-face mask that covers both the nose and the mouth.
Unfortunately, many CPAP patients fail to comply with the treatment plan prescribed by their doctors because of various problems they encounter with either the fit of the mask, an inability to fall asleep, or side effects such as nose congestion or dry mouth. Current research estimates that as many as 40% of patients stop using CPAP after only a few months.
Here are 10 of the most common CPAP problems and tips for solving them.
1. Can’t Get Used to the Mask
Understandably, it can be very difficult to fall asleep with something on your face and air blowing at you. A CPAP system can be intimidating, so it helps to take small steps when you are getting started. To get familiar with how the CPAP mask feels, put it on and wear it for short periods of time during the day while you are awake, perhaps while reading a book or watching TV.
Later, wear both the mask and hose with the device turned on while you are awake. Don’t think about CPAP, but rather concentrate on what you are reading or the show you are watching. This is important because you need to learn to turn your mind completely away from CPAP. One way to do that is to engage in a normal, routine activity that you enjoy, and focus on it.
Finally, start using the CPAP system every time you sleep, including for naps. As with building any new habit, stick with it for at least a few weeks or a month. If you only use CPAP every now and then, it won’t become an accepted part of your life. So get into the habit of using it.
If you haven’t been getting enough sleep for a long time, and you begin getting a full night’s sleep with CPAP, it won’t be long before you begin to associate it with sleep and feeling better.
2. Feel Claustrophobic
Use the mask while awake, as described above, to slowly get used to it. If that doesn’t work and you still feel claustrophobic, try each of the steps below, one at a time, until you are comfortable with it, and then proceed to the next one:
- Hold just the mask (without the straps or hose) on your face.
- Use the straps and try wearing the mask.
- Hold the mask with the attached hose (but not the straps) on your face. Turn on the CPAP machine, maybe using the ramp feature (described in the section “Can’t Tolerate Forced Air” below).
- Use the straps and put on the mask. Turn on the CPAP machine as above.
After you go through these steps, try sleeping with the mask and machine on. Consider doing relaxation exercises to help reduce your anxiety.
If you still feel claustrophobic, don’t give up. There are many different styles and sizes of masks available, so keep trying to find one that works for you. Certainly, use the smallest, simplest mask that your doctor and CPAP supplier think will do the job. Most important, think positively about the CPAP system, and remember that you are using it to improve your health and feel better.
3. Can’t Fall Asleep
Try the suggestions in the first two steps above to get used to the mask and reduce your anxiety related to CPAP use.
Stay active throughout the day to help your body follow the circadian rhythm and keep the hormonal balance so you will be tired and ready to go to bed at night. Then consider the following evening ritual and bedtime “good sleep habits” to help you fall asleep and achieve deep restorative sleep:
- Avoid caffeine consumption in the afternoon and evening.
- Avoid sugary snacks and simple carbohydrate consumption before bedtime (cookies, chips, bread, pasta).
- Consider a warm bath, herbal tea, a fun book, or a conversation with a loved one to help you relax.
- Minimize “screen time” and turn off electronics at least one hour before bedtime.
- Think about something other than CPAP; for example, concentrate on taking deep breaths that cause your belly to rise, or memorize poems or song lyrics and recite them to yourself while you are trying to fall asleep.
4. Mask Doesn’t Fit
Each one of us has a unique facial shape, so the mask style and size that fits someone else may not be right for you. Be sure to work closely with your doctor and CPAP supplier to find a CPAP mask that fits properly.
There are numerous styles and sizes of CPAP masks available. Full-face masks cover both your nose and your mouth, and they work well if you breathe through your mouth during sleep. These masks are held on your face by elastic straps that you pull across your forehead and cheeks. This type of mask is the one most likely to stay in place during the night.
If you don’t need a mask that covers both your nose and mouth, there are much smaller and less bulky masks that cover only your nose, and there are even masks that simply fit under or in your nose. The straps for these types of masks cover much less of your face. So these types of masks work well if you wear glasses and want to read with the mask on. However, if you sleep on your side or stomach or move a lot during sleep, this type of mask may be knocked out of place more easily than a full-face mask.
Different manufacturers size their masks differently, so you can be a certain size in a mask from one manufacturer and a different size in a mask from another manufacturer. But most masks are adjustable, so ask your doctor or CPAP supplier to show you how to adjust your mask to get the best fit.
For more information on mask style, size, and fit, see our article Get a Great Fit for Your CPAP Mask
5. Can’t Tolerate Forced Air
Some CPAP machines have a “ramp” feature you can use if the pressure of the air blowing at you seems overwhelming. It allows you to set a low air pressure for the first thirty minutes or so. Then the machine gradually increases the air pressure to “ramp up” to the pressure setting you need and that your doctor prescribed for you.
The ramp feature also alleviates the difficulty you may experience when you breathe out (exhale) against a fixed pressure while you are trying to fall asleep. While you are still awake, you are not in danger of experiencing an apnea event since they only occur when you are asleep; therefore, you don’t need the prescribed air pressure during that time.
If the ramp feature doesn’t help, ask your doctor if you could change to a device that constantly adjusts the pressure while you are asleep. One example is a bi-level positive airway pressure (BPAP) machine that provides exhalation relief. It delivers more pressure when you breathe in (inhale) and less when you breathe out (exhale) to make the breathing process more natural.
Another example is an automatic positive airway pressure (APAP) machine that has a low setting and a high setting that it fluctuates between throughout the night to deliver the minimal pressure required to keep your airway open. Because APAP therapy has a higher average rate of compliance than CPAP use, more and more insurance companies are likely to pay for it if it is recommended by a sleep clinic.
6. Dry Nose
Does your mask fit well? A mask that leaks air can dry out your nose. Try a different mask style or size if you have to tighten the straps often to prevent air leakage because that means the mask does not fit properly.
There are CPAP systems that feature a heated humidifier that you can attach to the machine to add moisture to the CPAP air. You can adjust the humidification to a comfortable level.
Also, try a saline nasal spray at bedtime and consider asking your doctor if using a nasal decongestant or antihistamine could help.
For more information, see our article Why You Need a Heated Humidifier
7. Air Leaks
A mask that does not fit and leaks air is not delivering the full air pressure you need. It also may irritate your skin or blow air into your eyes and cause them to become dry and irritated.
Adjust the pads and straps to get a better fit. If the mask fits over your nose, make sure it sits no higher up on your nose than necessary to cover your nostrils and that it is sealed all around. If it is too high on your nose and unsealed, a leak near the top would direct air into your eyes.
If the adjustments do not work, ask your supplier to help you find a different style or size mask, particularly if your weight has changed a lot. There are so many different styles and sizes to choose from. You may want to try a mask with nasal pillows.
In any case, if you develop skin deterioration or sores, contact your doctor right away.
8. Dry Mouth
When you begin CPAP therapy, you want to start with the smallest and lightest mask possible. So masks that deliver air only through the nose are the place to start. Now, when using a nasal delivery device, you must keep your mouth closed for the therapy to work.
If you breathe through your mouth at night (sleep with your mouth open) and cannot keep your mouth closed, the first thing to try is a chinstrap to hold your jaw up and keep your mouth closed. Another option is a full-face mask that will allow you to breathe through your nose or your mouth. With a full-face mask, you won’t need a chinstrap because the seal covers both your nose and mouth.
Finally, a heated humidifier can be attached to the CPAP machine to add moisture to the CPAP air. For more information, see our article Why You Need a Heated Humidifier
9. Removing the Mask During Sleep
You wake up and the mask is gone. It’s normal to sometimes remove the mask in your sleep. Since a full-face mask stays in place better, that may be the first thing to try. A chinstrap will also help keep the mask on your face.
If you think you may have removed the mask because your nose was congested, try adding a heated humidifier to your CPAP machine.
If removing the mask continues to be a problem, consider setting an alarm for some time during the night to check whether the mask is still on. When the alarm wakes you up, if you find that the mask is still on, you can set the alarm for a later time the next night.
10. Machine Noise Is Annoying
The new models of CPAP machines are very quiet, almost silent. If the noise level of the machine is loud enough to be annoying, first check its air filter to make sure it is clean and that there isn’t anything in its way that might be blocking it. Also, keep your mask and hose clean and well maintained to minimize noise.
If the machine is still making a noise, have your doctor or CPAP supplier check it to make sure it is working properly.
If the machine is working properly and the noise is still bothering you, consider these steps:
- Go old school and try wearing earplugs.
- Use a white noise sound machine, music, or sounds of waves to cover up the CPAP machine noise.
- Ask your doctor or CPAP supplier for extra tubing (if available and safe for your machine) and place the machine as far away from the bed as possible to help make the machine noise less noticeable.
The only thing constant in life is change. A diagnosis of sleep apnea and the need to use a CPAP device is a massive change. We hope that the above tips along with the #1 CPAP PILLOW by EnduriMed will help you endure and even thrive on this journey.
Your keys to success are time and patience. You must have patience and you must persevere because the treatment is essential to avoid complications of sleep apnea, such as heart disease, stroke, inability to concentrate, excessive daytime sleepiness, and automobile accidents.
So adjust settings, troubleshoot problems, and speak with your doctor and CPAP supplier to ensure the best mask and experience for you. It can take some time to find the correct settings and get used to the mask, but practice makes perfect.
CPAP can positively affect your quality of life and health, and our pillow can help you …
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