How to deal with common problems in CPAP breathing therapy

CPAP therapy can improve breathing at night and considerably relieve symptoms of obstructive sleep apnea. CPAP stands for “continuous positive airway pressure”. In this form of treatment, people with obstructive sleep apnea wear a mask while they sleep that only covers their nose. There are also masks, however, that cover the mouth as well as the nose. A tube leading from the machine to the mask blows mildly pressurized air taken from the immediate surroundings into the airways. This incoming air stops the relaxed muscles from collapsing, which prevents breathing pauses from happening.

This treatment takes some getting used to. Many people can already handle their CPAP machine quite well after one or two nights. But some have major problems dealing with the machine and stop their therapy.

In the following paragraph we would like to give you some practical advice that might help you to deal with typical problems:

• The mask does not fit well: Masks are available in different sizes. If you have the feeling that your mask does not fit well, you can go to your supplier and try out other mask sizes. There are also different types of masks: While some cover the mouth and nose, others only cover the nose. There are also nasal pillows where two end pieces made of soft plastic are put directly into the nostrils. All masks have their advantages and disadvantages. Masks that cover the mouth and nose might make people feel closed in or frightened, especially when they first start using them. But they are more effective against breathing pauses, and are also more stable. Nose pillows on the other hand are less confining, but they do not provide such a stable fit if people move around in their sleep. It is also worth checking the mask strap, because there are different types of mask straps too.
• Getting used to the mask is hard: Even after finding the right size and type of mask it might be difficult to wear the mask on a regular basis. Wearing the mask for 10 to 30 minutes during the day, for example when watching television or reading, is one option. Getting used to it during the day might make it easier to wear it at night too. It can also help to slowly increase the length CPAP is used. It is important to seek professional advice early on if difficulties come up.
• The mask leaks: A leaking mask changes the air pressure and reduces the effectiveness of the breathing therapy. Leaking air can also dry out your eyes. Masks often leak because they do not fit well or because the mask straps have not been adjusted correctly. You can check this by changing the position and pressure of the mask. If this does not help or you are unsure whether the mask is working properly, it is a good idea to talk to the people who supplied you with the machine and its accessories and explained to you how to use them. In this case it can also be worth to try out another size or another type of mask. Another reason might be that the mask is too old and the soft silicone or gel insert has hardened. Masks have an average lifespan of one to two years.
• The mask is unconsciously removed during sleep: It is normal to unconsciously take off the mask every now and then. But if this happens a lot and frequently interrupts treatment, changing the type of mask might help.
• The noise of the machine disturbs sleep: Many of the newer CPAP machines are very quiet. Louder noise can be caused by a blocked air filter or because the machine does not work properly. Then it is a good idea to have it checked by a professional. In newer machines, bothersome noise is usually caused by the mask valve. You can try wearing earplugs to muffle the noise or switching to a mask with a quieter valve.

 

Other problems that can arise during CPAP ventilation include, for example:

• Your nose is dry and stuffy: An air humidifier can be attached to modern CPAP machines. Moist air helps prevent the mucous membranes of the nose and throat from drying out. The level of air humidity can be adjusted by changing the temperature of the water. If the humidity level is not high enough, the breathing tube leading the air to the mask can also be insulated by so-called tubing wraps or covers. Some machines even come with a heated tube. Moreover, there are over-the-counter ointments and sprays to moisturize the mucous membranes of the nose.
• Your mouth is dry: Your doctor should make sure that the pressure is neither too high nor too low. Adjusting the pressure might help keep you from breathing through your mouth at night. If you use a mask that only covers your nose, one option is switching to a mask that fits over both your mouth and nose. Using an air humidifier can also help. A so-called chin strap keeps your mouth closed while you sleep and might prevent it from getting dry.
• Falling asleep is difficult: People who find it difficult to fall asleep might benefit from general good sleep habits: These include, for example, not drinking alcohol or coffee or not eating heavy meals before going to bed, and making sure the place where you sleep is quiet and dark. It can also help to skip daytime naps if you have difficulties falling asleep at night. Getting used to the mask during the day might also make it easier to fall asleep with it on at night. You can find more information on what to do about sleeping problems here.

It may help to switch the mask or the machine

You can switch not only the mask, but the CPAP machine too. Some people switch to a machine that works in a different way, for example from CPAP to auto-CPAP: While a conventional CPAP machine delivers constant air pressure, an auto-CPAP machine adjusts the level of air pressure to the breathing. Some people prefer varying air pressure to fixed air pressure. It is also possible to switch to so-called BiPAP (biphasic positive airway pressure) breathing therapy: these machines produce less pressure when you breathe out than when you breathe in.

You can find more information on obstructive sleep apnea and its treatment in our feature.

Other options for support and help

In Germany, you can find more information on regional support and help services at the Independent Patient Counselling Germany (in German: Unabhängige Patientenberatung – UPD). Click here to read more (in German, Turkish and Russian).


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)


Next planned update: September 2014. You can find out more about how our health information is updated here.

© IQWiG (Institute for Quality and Efficiency in Health Care) Last update of this website: 05/22/2012