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7 Common CPAP Problems

In 2004 I was working CPAP consultations at our sleep lab when a little old couple walked in for their follow up appointment. I immediately remembered them from their nights at the sleep lab because they reminded me of my grandparents and the way “Mrs. Smith” took care of “Mr. Smith”. It had been a couple of weeks since they had been here and I fully expected to see the older man more alive and energetic since he began using his CPAP machine. I was quite disappointed when I approached them sitting there in the waiting room and “Mr.Smith” was fast asleep with his head slumped down to the side.

I inquired to “Mrs. Smith” about “Mr. Smith’s” progress and whether or not he been using the CPAP machine. She assured me that he sleeps with the machine every night and in fact she puts the CPAP mask on him and gets him all situated before bed. About that time our doctor had called them into his office but it wasn’t long until they were brought back to see me. Upon looking at “Mr. Smith” I noticed he had the most blood shot eyes I had ever seen and looked like a possessed character from a horror movie.

“Mr. Smith” didn’t speak much, mostly just nods of his head to indicate yes or no and “Mrs. Smith” was the primary interpreter. I guess after 58 years of marriage you can tell just about anything from a person just by body mannerisms. “Mrs. Smith” indicated to me that no matter how tight she strapped his CPAP mask headgear she just couldn’t keep it from leaking into his eyes. This was quite confusing because as the primary sleep technician the night of his study I knew the Ultra Mirage mask we used had very minimal leak. Perplexed, I asked “Mrs. Smith” to go through the fitting routine on Mr. Smith and it became obvious very quickly what the problem was. She was putting the mask on him upside down, meaning the forehead support was resting on his chin and the wide part of the nasal cushion was up around the bridge of his forehead.

Ah, this explains the irritation to his eyes and after I informed “Mrs. Smith” what the problem was she began to cry. She blamed herself for causing this pain to her husband and told me that they were just going to give up hope of using CPAP all together. Long story short, after using the mask properly for 2 more weeks they came back in for another CPAP follow up and all was well. The positive outcomes we had told them to expect when they began using CPAP was starting to take effect and “Mr. Smith” was showing tremendous improvement. I haven’t been working for that sleep lab in quite some time now but I like to think that we made a difference in the sleep health of “Mr. and Mrs. Smith” and they have been able to enjoy many more years together.

A lot of people struggle with using CPAP and it can be frustrating as you try to get used to it, but it's key that you make every effort to adhere to treatment. CPAP therapy is essential to avoiding sleep disordered breathing events that lead to complications such as heart problems, hypertension, diabetes and daytime fatigue. Listed below are the most common CPAP problems people have during the initial use; with time and patience, CPAP can positively affect your quality of life and health.

1. CPAP Air Pressure Feels Too Much or Too Little

Many first time users complain that air pressure is the root cause of discontinuing use. There are many different solutions to help you overcome these feeling.

Pressure Too High:

You may be able to fall asleep and adjust to CPAP pressure by using a "ramp" feature on the CPAP machine. CPAP Ramp allows you to start with lower air pressure than your therapy pressure, followed by an automatic, gradual increase in the pressure to your prescribed setting as you fall asleep. Most ramp settings will allow you to start as low as 4cm/H20 (comparable to breathing room air) and allows up to 45 minutes to build up to therapy pressure. Other options are Bi-Level (BiPAP) devices that have 2 separate pressures, one for inhalation and the other for exhalation. Unlike CPAP, one constant pressure, Bi-level drops to a lower, more tolerable pressure when you exhale.Another tip or secret could be the use of a full face mask which allows you to breathe through both nose and mouth instead of one concentrated breathing cycle through your nose only. Certain manufactures include pressure relief settings of their CPAP machines such as EPR (ResMed) and CFlex/AFlex (Philips Respironics). Consider speaking with your physician about the use of an Auto adjusting CPAP machine if your pressure problems persist.

Pressure Too Low:

Feel like you’re not getting enough air from your CPAP machine? If this is on the initial use of starting CPAP therapy you may want to turn your “Ramp” feature off and start from your higher prescribed therapy pressure or consult with your physician about raising your starting ramp pressure. Be sure to check for high mask leak or to be sure air is not escaping through open oxygen ports on your mask. If this is something you are noticing after weeks or months of use please keep in mind that your body is adjust and has acclimated to starting pressure of CPAP but you are still receiving the prescribed therapy pressure.

2. The CPAP Mask You Are Using Just Isn’t For You

There is a reason there are so many different styles of CPAP masks on the market. Subtle variations in our face shape and size make it uncomfortable or impossible to wear certain masks. CPAP mask irritation is the number one reason people declare when discontinuing use of CPAP therapy. Be sure to work closely with your doctor and sleep technicians the night of your CPAP titration to make sure you have a CPAP mask that suits your needs and fits you. As always, we recommend that you use the mask fitting guides provided on our site or if you are unsure about the correct size, purchase the “fit packs”, they include all size cushions to insure proper mask fit.

Do I Have the Style of CPAP Mask that is Right for Me?
  • There are many different types and styles of CPAP masks available on the market. Mask style are available in classifications such as Full Face, Nasal, Nasal Pillow, and Oral. Full Face CPAP masks cover your mouth AND nose, allowing you to breathe through both. These may make some people feel claustrophobic, but they work well at providing a stable fit if you move around a lot in your sleep. Other masks feature nasal pillows that fit under your nose and straps that cover less of your face. These can feel less cumbersome. And they may work well if you wear glasses or read with the mask on, because some nasal pillow systems obstruct vision less than do full face masks. However, they may not work if you move around a lot in your sleep or sleep on your side.
Do I Have the Correct Size CPAP Mask for Me?
  • Many CPAP and Bi-PAP masks are available in different size options. It is imperative that the correct size be used to establish comfort and effectiveness, a mask that is incorrectly sized will most likely result in insufficient airway pressure and irritation. Also, keep in mind that if you are switching masks made from one CPAP manufacturer to another that a certain size in one mask doesn't mean you'll be the same size in the other.

3. Adjusting to the Use of a CPAP or BiPAP Machine

Listen, most of us, besides Bane from the Batman series, have lived our entire lives without sleeping with something on our face. This is a foreign feeling that will take some getting used to and adjusting during the initial days or week of using it may require practice. So how do you “practice” wearing CPAP? By wearing just the CPAP mask for short periods of time while you're awake, for example while watching television or try wearing the mask and hose with the air pressure on, still during the daytime, while you're awake. Then later on that night once you’re ready for bed this should help alleviate any type of anxious feelings that would otherwise keep you laying awake and thinking about what is on your face.

Keep in mind that inconsistent and sporadic use of CPAP therapy will delay getting used to it and the positive outcomes that come with consistent use of CPAP therapy. Simply put, if you use CPAP just here and there you are not getting the full benefit and for lack of a better term, just sleeping with a mask on your face. If you need to, slowly build up from a few hours per night to the point where you can sleep the entire night with it.

4. Dryness or Nasal Irritation

Most CPAP devices are prescribed to be used with heated humidification. This is a separate heating element that warms water contained in a chamber to create moisture in the air that is being passed through the machine and CPAP tubing. The humidity setting is adjustable and can be raised if you notice dryness or irritation. For those with more humidity needs, consider using a heated CPAP hose tubing (if your machine allows this). Speak to your physician, he or she may prescribe a nasal steroid spray if your dryness doesn't respond to heated humidity. It's also important that your mask fit well. A leaky mask can dry out your nose.

5. Claustrophobic Sensations

Wearing something on our face can make anyone claustrophobic. Practice by first just holding the CPAP mask up to your face without any of the other parts. Once comfortable with that, try wearing the CPAP mask with the headgear straps attached. Next, try holding on the mask and hose, without the straps, with the hose attached to the CPAP machine at a low pressure setting (turn the ramp feature on). And, finally, wear the mask with the straps and with the air pressure machine turned on while awake. After you're comfortable with that, try sleeping with it on. You may want to consider less invasive masks such as nasal pillows or light-weight nasal CPAP masks.

6. Mask Leaks and Facial Irritation

A leaky or improperly sized CPAP mask can mean the difference between CPAP compliance and non compliance. If you're not getting the full amount of air pressure needed to provide that splint in the airway you may still be having apneas and not aware of it. Incorrect CPAP mask size can also cause skin irritation and release air into your eyes, causing them to become dry or teary. Adjusting or over tightening the CPAP mask headgear can make it worse and prevent you from being able to fall asleep along with mask strap marks that dig into your skin. Be sure to select a mask that does not leak around the eyes and doesn’t require over tightening achieving a proper seal. You may go through four or five masks before you find the right one for you, and by right we mean comfortable with no leak issues.

Keep in mind that masks that cover more areas of the face such as full face masks are more prone to higher leaks. Nasal pillows traditionally have the lowest leak rate as well have been noted to be the most lightweight and comfortable to wear, however if you are a mouth breather or have a deviated septum a full face mask may be the only effective mask for you.

7. I Wake Up In the Middle of the Night and My CPAP Mask is off

Relax; this is quite common for new CPAP users. I’m a CPAP user myself and occasionally I will wake up to the sound of air blowing my mask around on the bedroom floor. It's normal to sometimes wake up to find you've removed the mask in your sleep. Congestion or high CPAP pressures may cause this and in cases like mine where I wear a nasal pillow mask, the lightweight mask itself makes it easier for me to “accidentally” pull it off during the night. If you toss and turn a lot in your sleep, you may find that a full face CPAP mask will stay on your face more securely.